Symposia
Autism Spectrum and Developmental Disorders
Grace Lee Simmons, M.A.
The University of Alabama
Tuscaloosa, Alabama
Susan White, Ph.d., ABPP
Doddridge Saxon Chair in Clinical Psychology
University of Alabama
Tuscaloosa, Alabama
Introduction
Autism Spectrum Disorder (ASD) is characterized by impaired social reciprocity, which is understood to derive, in part, from a demonstrable lack of interest in engaging with peers and forging appropriate and healthy friendships (i.e., impaired social motivation). Yet there is a notable paucity of intervention work targeting social motivation in ASD. We developed and implemented an innovative, internet-based program for youth with ASD targeting social motivation – the Social Motivation Intervention Leveraging E-learning (SMILE).
Methods
In Phase 1 we sought end-user input from a panel of 9 expert advisors to assist in the development of the SMILE program. Expert advisors included three parents of children with ASD, two educators, two clinicians, and two clinical researchers. Advisors completed an online survey and one-hour structured interview.
In Phase 2 we are piloting SMILE via a small randomized control design (RCT) using a waitlist-control, with 32 – 36 autistic children (ages 8 – 12). SMILE is led by a graduate-level clinician to groups of 6 – 8 children over ZOOM. SMILE includes six group sessions scheduled biweekly (3 weeks, total) and two sessions with caregivers.
Results
Integrating feedback from expert advisors, adjustments were made to the SMILE Program addressing four themes of session structure (e.g., managing parent involvement; clear break schedule); session content (e.g., providing didactic psychoeducation to parents about ASD); reinforcement (e.g., praise time during session wrap-up); and sensory concerns (e.g., mailed handouts; integration of activities involving physical movement).
The SMILE pilot trial is ongoing and final results will be included in the November Symposium. Of the 24 children enrolled, the majority are male (79%) and White (50%), with comorbid ADHD (75%). Primary aims of fidelity (i.e., treatment objectives delivered as intended) and acceptability (i.e., < 15% attrition, average attendance >80%, caregiver-reported Program Satisfaction) will speak to viability of SMILE. Video-coded Therapeutic Alliance will reflect dyadic engagement in SMILE using the Therapy Process Observational Coding System-Alliance Scale (TPOCS-A).
Discussion
Findings speak to the utility of telehealth delivery of clinical interventions to improve targeted deficits (i.e., impaired social motivation) in children with ASD. Future research might integrate SMILE into existing social intervention protocols, allowing clinicians to best meet their client’s needs and potentially augment treatment effects.