Nearly 50,000 youth with autism spectrum disorder (ASD) transition from high school to
adult life each year with only 25% of these transition-age youth with ASD (TAY-ASD)
getting jobs within 2 years of graduation. TAY-ASD's ability to sustain employment is
even more challenging due in part to their social cognitive deficits (e.g., poorly
reading social cues) that disrupt communicating with customers, coworkers, and
supervisors. Research shows nearly 90% of job dismissals among TAY-ASD are attributed to
poor work-based social functioning (e.g., poorly communicating with upset customers). The
subsequent unemployment has damaging effects on their mental, physical, and economic
health. A critical gap in federally-mandated services to support youth with ASD as they
transition from school-to-adult life is the lack of evidence-based practice to enhance
work-based social functioning. Given that TAY-ASD report computerized training tools
(developed by the investigators and others) are highly acceptable and improve their
real-world outcomes, the investigators propose to address this critical barrier to
sustained employment by developing and evaluating a novel and scalable computerized
training tool to enhance participant conversations with customers, coworkers and
supervisors at work.
The investigators propose to develop and test the effectiveness of Social Cognitive and
Affective Learning for Work (Work Chat: An Interactive Virtual Workday), a computerized
training tool. Work Chat will have three tiers of instruction designed to help TAY-ASD
prepare for effective workplace communication. Tier 1 will adapt existing evidence-based
practices to design an e-learning curriculum that trains social cognitive strategies to
help guide work-related conversations (e.g., reading social cues or regulating emotions
during supervisor feedback). In Tier 2, SIMmersion's PeopleSim® technology will enable
TAY-ASD to apply social cognitive strategies learned in Tier 1 to repetitively practice
simulated conversations with a fictional customer, coworker, or supervisor. In Tier 3,
SIMmersion will innovate PeopleSim to exist in an interactive 3-D environment to create a
virtual workday with interconnected activities were the actions made early in the day
influence conversations later in the day (e.g., a poor customer interaction may result in
constructive feedback from a supervisor).
Phase I (Feasibility) was completed with application HUM00177878.
Phase II (Efficacy) Aims:
Aim 1) Complete Work Chat development using an iterative process that includes initial
and ongoing individual-level feedback from Phase I participants and the community and
scientific advisory boards to complete the product that will be evaluated in Aims 2-3.
Aim 2) Conduct a Randomized Controlled Effectiveness-Implementation hybrid trial in a
school setting to evaluate Work Chat. The investigators will recruit and randomly assign
n=338 TAY-ASD (90% of sample frame) enrolled in school-based standard transition services
(STS) to the Work Chat group (STS+SW) or a STS group (STS). The hypothesis is that
STS+SW, compared to STS, will show greater gains in: (H1) social cognition and (H2)
work-based social functioning; as well as (H3) reduced anxiety about work-based social
encounters, and (H4) greater sustained employment by 9-month follow-up. The investigators
will test mechanistic hypotheses (H5a-b) that social cognitive ability (H5a) and
work-based social functioning (H5b) mediate the effect of treatment (STS+SW vs. STS) on
sustained employment. For the implementation evaluation, the investigators will conduct a
multilevel, mixed-method process evaluation of Work Chat's acceptability,
appropriateness, and feasibility.
Aim 3) Use community participatory research methods to prepare for commercialization. The
investigators will conduct a parallel multilevel, mixed method implementation evaluation
that focuses on the Work Chat delivery system regarding its feasibility, sustainability,
scalability, and generalizability by conduct focus groups with delivery staff and
administrators. These groups will discuss potential facilitators and barriers to Work
Chat implementation, adoption, and sustainability.