Autism Spectrum Disorder
Conditions
Brief summary
The unemployment rate is quite high among adults with an autism spectrum disorder (ASD). Inadequate transition planning during high school and gaps between vocational needs and availability of evidence-based services help explain the struggles of transition-age youth at obtaining employment. There is a paucity of research on developing and evaluating services to support the transition to the work force after graduating from high school. The lack of available resources to support transition-age youth with an ASD speaks to the need to develop interventions that ameliorate obstacles to employment and help support the transition to the work force. Due to the social deficits characterizing ASD innovative interventions could target preparing job interview skills for students facing the transition to employment as the job interview is a critical gateway to securing a job offer. Thus, the overarching goal of this study is to modify an existing virtual reality job interview skills training program for use in high school students with ASD and to test the feasibility and effectiveness of conducting this intervention in a high school setting via a small controlled trial. Thus, study's first aim is to modify the existing 'Virtual Reality Job Interview Training' program to meet the specific needs of high school seniors with ASD. This will accomplish this by conducting in depth interviews with high school students with ASD and their vocational counselors to solicit feedback to modify the current training's learning goals, content, usability, and simulated interview scripts to meet the specific needs of transition age youth. An expert panel will determine the final modifications to the training program based on the results of the qualitative data analysis and their own views of the program. Second aim of the study is to conduct a pilot trial to evaluate the feasibility, acceptability, portability, fidelity and preliminary effectiveness of the modified intervention in a randomized controlled trial. This study will also explore potential mechanisms for effectiveness and collect pilot implementation data.
Interventions
BEHAVIORALVirtual Reality Job Interview Training
Students will engage in didactic training related to strategies to perform well during a job interview as well as repeated practice with a virtual hiring manager. Throughout and after completion of the virtual interviews, participants will receive feedback on their performance.
BEHAVIORALServices as Usual
Study participants will be receiving their community-based or school-based services as usual that may include but is not limited to vocational skill training, daily living skill training, and social skill training.
Sponsors
University of Wisconsin, Madison
SIMmersion, LLC
National Institute of Mental Health (NIMH)
University of Michigan
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
16 Years to 21 Years
Healthy volunteers
No
Inclusion criteria
1. 16-26 years old and enrolled in high school or post-high school transition programming; 2. Educational Diagnosis of autism spectrum disorder using the Social Responsivity Scale 2nd Edition28, or a diagnosis of cognitive impairment, emotional disability, educational impairment or other health impairment according to the students Individualized Education Plan (IEP). They may have diagnosis of autism spectrum disorder as indicated in their IEP/school plan, or as indicated by a parent; 3. Fluency in English with at least a 3rd grade reading level (confirmed with the Wide Range Achievement Test); 4. Currently receiving transitional services as specified in IEP or other; 5. Willing to be video-recorded; and 6. Willing and able to provide informed consent.
Exclusion criteria
1. Has an uncorrected hearing or visual problem that prevents him or her from using the training. 2. Has a medical illness that compromises their cognition (for example, moderate to severe traumatic brain injury) Inclusion and
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Job Interview Skills | Collected at Pre-Test and Post-Test visits (within approximately 1 month of active treatment) | Interviewing skills will be measured using a role-play measure in which subjects act out one job interview scenario with trained actors. Interviews will be video recorded and scored. There is one mock interview and pre-test and one mock interview at post-test. The method of assessment is the job interview skills rating scale as measured by the Mock Interview Rating Scale, which has 14 items with each item ranging from 1 (Unlikely) to 7 (Very Likely). Possible scores range from 14 to 98, with higher scores indicating better interview skills. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Job Interview Self-Efficacy | Collected at Pre-Test and Post-Test visits (within approximately 1 month of active treatment) | 9 item self-report consisting of 11 items on a 5-point Likert-type scale, with 1 indicating Not at all and 5 indicating Very True. The range of scores is from 11 to 55, with higher scores indicating more self-efficacy/motivation to complete job interviews, which is a better outcome. |
| Change in Job Interview Anxiety | Collected at Pre-Test and Post-Test visits (within approximately 1 month of active treatment) | 15 item self-report using a modified version of the brief Personal Report of Public Speaking Apprehension (PRSPA; McCroskey, 1970). After reviewing the brief PRSPA, we selected and reframed 10 items using a three point Likert-type scale (0 = not at all, 1 = sometimes, and 2 = often). Higher scores indicated higher anxiety, and scores could range from 0 to 26. |
| Competitive Employment | Collected at pre-test and at 6 months after completing Post-Test Visit | Obtained a part-time or full-time community-based job as completed via a self-report measure yes/no question. This survey could have been completed by either participants themselves, parents, or teachers. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in Depressive Symptoms | Collected at Pre-Test and Post-Test visits (within approximately 1 month of active treatment). | Participants self-reported level of depressive symptoms at pre-test and post-test using the brief version of the Mood and Feelings Questionnaire (b-MFQ; Angold et al., 1995). The measure include 13 items on a scale of 0 to 2, with a total range of 0 to 26. Scores of 12 or greater suggest clinical depression, so higher scores indicate higher depressive symptoms, which is a negative outcome. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Services as Usual Study participants will be receiving their community-based or school-based services as usual that may include but is not limited to vocational skill training, daily living skill training, and social skill training.
Services as Usual: Study participants will be receiving their community-based or school-based services as usual that may include but is not limited to vocational skill training, daily living skill training, and social skill training. | 23 |
| Services as Usual + Virtual Reality Job Interview Training In addition to the services as usual comparator, participants will participate in Virtual Reality Job Interview Training.
Virtual Reality Job Interview Training: Students will engage in didactic training related to strategies to perform well during a job interview as well as repeated practice with a virtual hiring manager. Throughout and after completion of the virtual interviews, participants will receive feedback on their performance.
Services as Usual: Study participants will be receiving their community-based or school-based services as usual that may include but is not limited to vocational skill training, daily living skill training, and social skill training. | 48 |
| Total | 71 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 0 | 1 |
Baseline characteristics
| Characteristic | Total | Services as Usual + Virtual Reality Job Interview Training | Services as Usual |
|---|---|---|---|
| Adult and Child Behavior Checklist Externalizing Behaviors | 51.9 T-Score STANDARD_DEVIATION 10.5 | 52.0 T-Score STANDARD_DEVIATION 10.3 | 51.6 T-Score STANDARD_DEVIATION 11.1 |
| Adult and Child Behavior Checklist Internalizing Behaviors | 58.0 T-Score STANDARD_DEVIATION 10.3 | 59.5 T-Score STANDARD_DEVIATION 10.3 | 54.9 T-Score STANDARD_DEVIATION 10.1 |
| Age, Continuous | 19.7 years STANDARD_DEVIATION 2.8 | 19.8 years STANDARD_DEVIATION 3 | 19.4 years STANDARD_DEVIATION 2.6 |
| Cognitive ability Crystalized Cognition Composite | 41.9 T-Score STANDARD_DEVIATION 12.1 | 42.7 T-Score STANDARD_DEVIATION 12.4 | 40.1 T-Score STANDARD_DEVIATION 11.5 |
| Cognitive ability Fluid Cognition Composite | 30.8 T-Score STANDARD_DEVIATION 11.7 | 29.6 T-Score STANDARD_DEVIATION 10.9 | 33.3 T-Score STANDARD_DEVIATION 13.1 |
| Co-occuring IDEA categorizations Cognitive impairment | 11 Participants | 9 Participants | 2 Participants |
| Co-occuring IDEA categorizations Emotional disturbance | 8 Participants | 5 Participants | 3 Participants |
| Co-occuring IDEA categorizations Other health impairment | 15 Participants | 10 Participants | 5 Participants |
| Co-occuring IDEA categorizations Specific learning disability | 8 Participants | 5 Participants | 3 Participants |
| Current grade Junior | 9 Participants | 6 Participants | 3 Participants |
| Current grade Senior | 20 Participants | 14 Participants | 6 Participants |
| Current grade Sophomore | 5 Participants | 3 Participants | 2 Participants |
| Current grade Transitional year | 37 Participants | 25 Participants | 12 Participants |
| Mood and Feelings Questionnaire | 5.4 units on a scale STANDARD_DEVIATION 4.1 | 5.7 units on a scale STANDARD_DEVIATION 4.1 | 4.7 units on a scale STANDARD_DEVIATION 4.1 |
| Race/Ethnicity, Customized Asian American | 2 Participants | 2 Participants | 0 Participants |
| Race/Ethnicity, Customized Black/African American | 19 Participants | 11 Participants | 8 Participants |
| Race/Ethnicity, Customized Caucasian | 39 Participants | 26 Participants | 13 Participants |
| Race/Ethnicity, Customized Latinx | 6 Participants | 6 Participants | 0 Participants |
| Race/Ethnicity, Customized More than one race | 4 Participants | 2 Participants | 2 Participants |
| Race/Ethnicity, Customized Native American | 1 Participants | 1 Participants | 0 Participants |
| Region of Enrollment United States | 71 participants | 48 participants | 23 participants |
| Sex: Female, Male Female | 13 Participants | 10 Participants | 3 Participants |
| Sex: Female, Male Male | 58 Participants | 38 Participants | 20 Participants |
| Social Responsiveness Scale (Second Edition) | 65.2 T-Score STANDARD_DEVIATION 13.4 | 65.7 T-Score STANDARD_DEVIATION 13.2 | 63.9 T-Score STANDARD_DEVIATION 14.1 |
| Vocational history Currently employed at competitive, integrated job | 6 Participants | 5 Participants | 1 Participants |
| Vocational history Ever employed at competitive, integrated job | 21 Participants | 16 Participants | 5 Participants |
| Vocational history Ever had a job interview | 22 Participants | 14 Participants | 8 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 23 | 0 / 48 |
| other Total, other adverse events | 0 / 23 | 0 / 48 |
| serious Total, serious adverse events | 0 / 23 | 0 / 48 |
Outcome results
Primary
Change in Job Interview Skills
Interviewing skills will be measured using a role-play measure in which subjects act out one job interview scenario with trained actors. Interviews will be video recorded and scored. There is one mock interview and pre-test and one mock interview at post-test. The method of assessment is the job interview skills rating scale as measured by the Mock Interview Rating Scale, which has 14 items with each item ranging from 1 (Unlikely) to 7 (Very Likely). Possible scores range from 14 to 98, with higher scores indicating better interview skills.
Time frame: Collected at Pre-Test and Post-Test visits (within approximately 1 month of active treatment)
Population: Performance on 2 Mock Job Interviews collected at pre-test and post-test
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Services as Usual | Change in Job Interview Skills | Pre-test | 45.9 score on a scale | Standard Error 1.9 |
| Services as Usual | Change in Job Interview Skills | Post-test | 43.6 score on a scale | Standard Error 1.9 |
| Services as Usual + Virtual Reality Job Interview Training | Change in Job Interview Skills | Pre-test | 46.8 score on a scale | Standard Error 1.3 |
| Services as Usual + Virtual Reality Job Interview Training | Change in Job Interview Skills | Post-test | 49.6 score on a scale | Standard Error 1.3 |
p-value: <0.001ANCOVA
Secondary
Change in Job Interview Anxiety
15 item self-report using a modified version of the brief Personal Report of Public Speaking Apprehension (PRSPA; McCroskey, 1970). After reviewing the brief PRSPA, we selected and reframed 10 items using a three point Likert-type scale (0 = not at all, 1 = sometimes, and 2 = often). Higher scores indicated higher anxiety, and scores could range from 0 to 26.
Time frame: Collected at Pre-Test and Post-Test visits (within approximately 1 month of active treatment)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Services as Usual | Change in Job Interview Anxiety | Pre-test | 5.0 score on a scale | Standard Error 4.7 |
| Services as Usual | Change in Job Interview Anxiety | Post-test | 4.4 score on a scale | Standard Error 4.4 |
| Services as Usual + Virtual Reality Job Interview Training | Change in Job Interview Anxiety | Pre-test | 7.0 score on a scale | Standard Error 4.1 |
| Services as Usual + Virtual Reality Job Interview Training | Change in Job Interview Anxiety | Post-test | 5.7 score on a scale | Standard Error 3.8 |
p-value: 0.029ANCOVA
Secondary
Competitive Employment
Obtained a part-time or full-time community-based job as completed via a self-report measure yes/no question. This survey could have been completed by either participants themselves, parents, or teachers.
Time frame: Collected at pre-test and at 6 months after completing Post-Test Visit
Population: Competitive Employment
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Services as Usual | Competitive Employment | 0 Participants |
| Services as Usual + Virtual Reality Job Interview Training | Competitive Employment | 12 Participants |
p-value: <0.01Chi-squared
p-value: <0.05Regression, Logistic
Secondary
Job Interview Self-Efficacy
9 item self-report consisting of 11 items on a 5-point Likert-type scale, with 1 indicating Not at all and 5 indicating Very True. The range of scores is from 11 to 55, with higher scores indicating more self-efficacy/motivation to complete job interviews, which is a better outcome.
Time frame: Collected at Pre-Test and Post-Test visits (within approximately 1 month of active treatment)
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Services as Usual | Job Interview Self-Efficacy | Pre-test | 45.9 score on a scale | Standard Error 3.4 |
| Services as Usual | Job Interview Self-Efficacy | Post-test | 44.3 score on a scale | Standard Error 3.1 |
| Services as Usual + Virtual Reality Job Interview Training | Job Interview Self-Efficacy | Pre-test | 47.2 score on a scale | Standard Error 2.6 |
| Services as Usual + Virtual Reality Job Interview Training | Job Interview Self-Efficacy | Post-test | 43.5 score on a scale | Standard Error 2.4 |
p-value: 0.358ANCOVA
Other Pre-specified
Change in Depressive Symptoms
Participants self-reported level of depressive symptoms at pre-test and post-test using the brief version of the Mood and Feelings Questionnaire (b-MFQ; Angold et al., 1995). The measure include 13 items on a scale of 0 to 2, with a total range of 0 to 26. Scores of 12 or greater suggest clinical depression, so higher scores indicate higher depressive symptoms, which is a negative outcome.
Time frame: Collected at Pre-Test and Post-Test visits (within approximately 1 month of active treatment).
Population: N = number of students who completed the survey. We are missing 1 survey from an intervention participant at post-test.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Services as Usual | Change in Depressive Symptoms | Pre-test | 4.7 score on a scale | Standard Deviation 4.1 |
| Services as Usual | Change in Depressive Symptoms | Post-test | 4.0 score on a scale | Standard Deviation 3 |
| Services as Usual + Virtual Reality Job Interview Training | Change in Depressive Symptoms | Pre-test | 5.7 score on a scale | Standard Deviation 4.1 |
| Services as Usual + Virtual Reality Job Interview Training | Change in Depressive Symptoms | Post-test | 5.3 score on a scale | Standard Deviation 4 |
p-value: 0.7ANOVA