Project Summary/Abstract: Daily living skills (DLS), which are the tasks (e.g., hygiene, cooking, laundry, managing money) that individuals do to take care of themselves at home, school, work, and in the community, are impaired in autistic adolescents without an intellectual disability (ID) such that their skills are 6-8 years behind same-aged peers. Age appropriate DLS have been linked to achieving better adult outcomes in employment, college, independent living, and overall quality of life. In the recent Lancet Commission on the future of care and clinical treatment in ASD there was a call to action to address DLS in adolescence as a potential intervention target to increase the likelihood of attaining positive adult outcomes. However, until our team began developing and evaluating the Surviving and Thriving in the Real World (STRW) intervention, there were no known comprehensive, evidence-based DLS interventions for autistic adolescents at this critical developmental period. In two recent pilot randomized clinical trials (RCTs), STRW demonstrated statistically significant and clinically meaningful gains in DLS (i.e., gains of 2-4 years of DLS over the course of a 14-week intervention) compared to a control condition (i.e., PEERS social skills intervention). In our two pilot RCTs, STRW was converted to telehealth due to COVID-19. There were equal DLS gains between in-person STRW and STRW-telehealth (STRW-T) and there were numerous benefits to telehealth delivery. The next step in this line of work is to assess the efficacy of STRW-T in a fully powered Phase 3 RCT compared to an attention control condition (PEERS-telehealth; PEERS-T) and examine the impact of improved DLS on early adult outcomes by following adolescents 6-months after high school graduation. We will enroll 192 autistic teens without ID in the 11th/12th grades and randomize them to receive STRW-T (n = 96) or PEERS-T (n = 96). Caregivers and adolescent participants will complete a comprehensive multi-method DLS battery (i.e., interview, survey, daily phone diaries, goal attainment scaling) at baseline, post-treatment, and 6-month follow- up. Young adult outcomes in work, college, and quality of life will be assessed 6-months post-high school graduation for all participants. The current proposal has the following aims: (1) examine the efficacy of STRW- T on DLS compared to PEERS-T; (2) evaluate whether the improvement in DLS outcomes by STRW-T are sustained at 6-month follow-up; (3) examine the effects of STRW-T intervention on outcomes in college, work, and QoL after high school graduation compared to PEERS. We will also explore the mediating role of improved DLS on young adult outcomes. If the aims of the proposed study are achieved, STRW-T would fill the gap in the current evidence base for treating DLS in autistic adolescents and would be the first study to examine whether a DLS intervention impacts work, college, and QoL outcomes after graduation from high school. Our long term goal is to narrow the gap between age and DLS, and also fill the existing treatment gap by disseminating and implementing this intervention into routine clinical practice for autistic teens.

PROJECT NARRATIVE Autistic adolescents have deficits in age-appropriate daily living skills (e.g., hygiene, laundry, cooking, cleaning, managing money) that impact their ability to successfully transition from high school to the adult world and achieve positive outcomes in employment, college, independent living, and quality of life. Our team iteratively developed the first evidence based DLS intervention for autistic adolescents without ID, Surviving and Thriving in the Real World (STRW), which recently demonstrated statistically significant and clinically meaningful gains in daily living skills for adolescents with autism compared to a social skills control group. The current proposal seeks to conduct a fully powered, multi-site randomized clinical trial to assess the efficacy of the STRW-telehealth (STRW-T) intervention to increase the acquisition of age-appropriate daily living skills and examine the impact of improved daily living skills on early adult outcomes after high school graduation.