The development and evaluation of the Cognitive Behavioural Social Competence Therapeutic Intervention for Adults with Autism Spectrum Disorder without an Intellectual Disability (CBSCTI-ASD)

Many young people with autism spectrum disorder (ASD) can have an average or above average IQ yet still struggle with the social competencies needed to successfully navigate into adulthood. Despite many individuals with ASD experiencing significant challenges during their transition into adulthood, evidence-based social skills interventions to support individuals with ASD during this transition are rather limited. There is growing evidence to suggest that social competencies in adults with ASD without an intellectual disability (ID) can be enhanced through both individual Cognitive Behavioural Therapy (CBT) and group CBT. However, little is known about the benefit of combining these modalities for individuals with ASD transitioning into adulthood. Moreover, there are no studies which have investigated the neural plasticity of a multimodal CBT intervention for adults with ASD without ID. The first stage of this PhD project involved developing and writing the Cognitive Behavioural Social Competence Therapeutic Intervention (CBSCTI-ASD) manual for Adults with ASD without ID. This PhD project includes a total of three studies: Study 1 Evaluation of CBSCTI-ASD; Study 2 Neuroplasticity of the Social Brain Following CBSCTI-ASD and Study 3 Exploring the Experiences of Parents' with an Adult Child with Autism Spectrum Disorder. For Study 1, CBSCTI-ASD was developed and delivered to five young adults with ASD without ID. The aims of the first study were to evaluate intervention feasibility and efficacy by triangulating data findings. Feasibility was supported and CBSCTI-ASD received high user satisfaction ratings. Adherence to the intervention were high, recorded at ~90% and fidelity to treatment were also high ranging from ~86% to ~100%. Quantitative findings from study 1 indicates that over an eight-week time period the intervention group experienced significant improvements with regard to their social motivation, non-verbal conversation, emotional empathy, assertiveness, interpersonal relationships and self-control. Qualitative findings provide further anecdotal support towards intervention feasibility and efficacy. After the completion of CBSCTI-ASD, four participants who received CBSCTI-ASD and two of their parents completed semi-structured interviews. Thematic Analysis (TA) revealed four main themes: satisfaction with CBSCTI-ASD, important components of CBSCTI-ASD, challenges and critiques and recommendations. Two qualified cognitive behavioural therapists helped with the delivery of CBSCTI-ASD. Their opinions and experiences of CBSCTI-ASD delivery were explored during a focus group. Findings from TA revealed three themes: training and delivery, successes and challenges, and therapist recommendations. The qualitative findings from study 1 also highlight factors which those involved in delivering and receiving CBSCTI-ASD believed could be effective in guiding the further development of the intervention. Study 2 involved applying functional near infrared spectroscopy (fNIRS) to explore neurological function and changes in neural activity in cortical regions of the Prefrontal Cortex (PFC), an area associated with the social brain. The aim of study 2 was to assess functional regions of the social brain and evaluate the possible neurological effects of CBSCTI-ASD. While applying fNIRS to measure neural functioning, the five participants from the CBSCTI-ASD intervention group from study 1 and a closely matched typically developed control group completed a pre/post-test conversation task. Findings from study 2 show that both the intervention group and the typically developed control group significantly increased neural activity in the Medial PFC (MPFC) during the conversation task, thus confirming a target region of interest for measuring change in neural function. However, no significant differences in brain activity over time between the intervention group and the typically developed control group were identified. Post hoc analysis did shows that the intervention group significantly increased neural activation in the left MPFC from pre-test to post-test. Finally, study 3 aimed to explore the experiences of seven parents with an adult child with ASD without ID. TA was conducted on semi-structured interviews and six main themes emerged: receiving a diagnosis, challenges, parents coping strategies, support and treatment, recommendations for intervention and positive parenting. The findings from study 3 highlight important and complex issues which should be considered when providing support to adults with ASD and their families. The findings from study 1 and 2 indicate that CBSCTI-ASD appears to be a feasible intervention and efficacy is supported at improving social competencies in young adults with ASD without ID. Qualitative findings from study 3 elucidates the intricacies of living with ASD and provides a promising starting point to further the development of CBSCTI-ASD. While these initial findings are promising, additional research is needed to further develop CBSCTI-ASD and provide an assessment of the efficacy of the intervention using larger randomised controlled trials.