Abstract
Paper 1: Internalizing conditions, such as anxiety and depression, and difficulties with developing and maintaining friendships are common among autistic children and adolescents. Participation in extracurricular activities may buffer against these challenges as they provide naturalistic opportunities to bring peers with shared interests and skills together. As such, the purpose of the current study was to examine associations between sport and club participation and (1) friendship success and (2) co-occurring anxiety and depression in a large sample of autistic youth. Secondary analysis was performed using data from the 2018-2019 National Survey of Children’s Health. Participants were 562 autistic children (ages 6-11 years) and 818 autistic adolescents (ages 12-17 years). Within each age group, a series of binary logistic regression analyses were conducted. Club participation was not associated with friendship or internalizing conditions. However, participation in sports was positively associated with friendship success among both children (OR = 2.07, p = .006) and adolescents (OR = 2.35, p = .001). Results also found that adolescents who participated in sports were 34% less likely to have diagnosis of depression (p = .048). Findings suggest that participation in sports may play a meaningful role in protecting against depression during adolescence and serve as a context for friendship development across childhood and adolescence. Future research should address barriers to extracurricular activity participation and identify the specific components of sports that are most beneficial to autistic youth to inform activity offerings and the development of interventions targeting friendship formation and mental health outcomes.
Paper 2: Friendships are valuable for autistic adolescents, yet differences in social communication and interaction skills may impede the development of meaningful connections. Accessible and motivating interventions are needed to support adolescents in building skills for social success. This mixed methods pilot study examined the preliminary outcomes, feasibility, and acceptability of Guild Chronicles (GC), a novel roleplaying game-based social skills intervention, on improving social skills and self-esteem and decreasing loneliness. Nine autistic adolescents (Mage=14.26) participated in the 8-week group intervention that was delivered via Discord, an online communication system. GC invites participants into a fantasy world in which they imagine themselves as heroes and collaboratively engage in adventurous quests, while receiving social coaching. Adolescents and caregivers completed measures at baseline, post-intervention, and three-month follow-up. Adolescents also participated in semi-structured interviews, which were coded via inductive thematic analysis. Findings revealed significant improvements in overall social skills from baseline to follow-up. Loneliness significantly decreased from baseline to post-intervention and gains were maintained at follow-up. Improvements in self-esteem were not significant. Session attendance and facilitator fidelity were high, indicating feasibility. Quantitative and qualitative acceptability results were positive, including high ratings of enjoyability and feelings of group acceptance. Qualitatively, autistic adolescents reported a generally positive impact on skills and self-esteem, satisfaction with the intervention experience, recommendations for future iterations, and highlighted intervention elements perceived to be especially helpful. The study provides preliminary support for GC in improving social skills and reducing loneliness among autistic adolescents. Given the small sample size, large-scale randomized controlled studies are warranted.
Paper 3: This systematic review provides an update on studies from 2016 to 2025 of group-based social skills interventions (GSSIs) for autistic youth aged 6 to 17 years old. In addition to examining intervention characteristics, efficacy, and effectiveness, further focus is on reporting factors that may relate to service uptake (i.e., intervention delivery format, feasibility, and acceptability). Specifically, the degree to which autistic input was gathered and utilized during intervention design and delivery is examined, as is feasibility through retention, attendance, and homework completion. Thirty studies were identified that met the inclusion criteria. Eight studies were delivered via telehealth as opposed to in-person. Most studies reported retention rates (which ranged from 55.9% to 100%), while only 12 studies reported attendance rates. Less than half of the reviewed studies sought input from autistic individuals in the design of the intervention or through post-intervention feedback. Four of these studies gathered input prior to study implementation through consultation or pilot studies. While emerging research on GSSIs continues to provide evidence of their general effectiveness in enhancing social skills among autistic youth, crucial gaps remain in improving the methodical rigor of studies examining interventions, as well as understanding how to individualize such interventions, optimize delivery formats for different subgroups, and integrate and center autistic voices.
