Background: There are a few ecologically valid measurements of Daily Living Skills (DLS)-a critical component of adaptive functioning (AF)-for autistic adolescents and young adults. This is particularly important given that DLS predict outcomes as autistic adolescents transition to adulthood.
Methods: We pilot-tested the assessment section of two modules of the Computerized Functional Skills Assessment and Training program (CFSAT) in 25 autistic (n = 4 female) and 25 non-autistic (n = 6 female) adolescents and young adults to evaluate preliminary feasibility in an autistic sample. Tasks involved using an ATM and ticket-buying machine. We also assessed AF and DLS with a well-validated self-report questionnaire. We examined group differences in performance and relationships between performance on CFSAT and an existing measure of AF and DLS. We also conducted regression analyses to investigate the associations between age, IQ, executive functioning (EF), and CFSAT task performance.
Results: All but one autistic participant were able to complete the CFSAT tasks. Autistic participants made more errors, but did not take longer to complete the task, than non-autistic participants. Performance correlated strongly with self-reported AF generally and DLS specifically. The regression analyses revealed that task performance was associated with EF in the autistic group, but not the non-autistic group.
Conclusions: These results provide preliminary support for the use of a new performance-based ecologically valid assessment of DLS in an autistic population. Two CFSAT modules were well-tolerated and detected differences in DLS ability. Strong correlations with an existing measure of AF suggest evidence of construct validity. The EF was associated with CFSAT task performance in autistic individuals. Such a tool could help identify individuals who would benefit from a DLS intervention.
Keywords: adaptive functioning; cognition; computerized cognitive training; daily living skills.
Why is this an important issue?: For autistic adolescents and young adults, one of the most important predictors of success after high school are daily living skills (DLS), which are a component of adaptive functioning (AF), or the ability to operate independently when engaged in day-to-day tasks. However, most of the measures used to assess these abilities are parent- or child-report questionnaires, which may lack objectivity.
What was the purpose of this study?: The Computerized Functional Skills Assessment and Training program (CFSAT) is an innovative software program that was designed to teach people how to perform daily tasks that require the use of technology. This study piloted two CFSAT modules in a sample of autistic adolescents and young adults. The researchers wanted to see whether the program could be completed by the autistic participants and whether their performance related to an existing measure of DLS and other cognitive measures known to be related to AF.
What did the researchers do?: This study piloted the assessment portion of two CFSAT modules in 25 autistic and 25 non-autistic adolescents and young adults to investigate whether it might be a useful measure of DLS skills in autistic individuals. The assessment portion of the program gives participants tasks to complete on a virtual ATM and Metro Ticket Kiosk and records time to completion and accuracy. Participants also used a questionnaire to self-report DLS and general AF and performed cognitive tasks.
What were the results of the study?: All but one autistic participant were able to complete both tasks. The autistic group made more errors but did not take more time to complete the tasks compared with the non-autistic group. Performance on the CFSAT was related to self-reported DLS scores on a questionnaire and to scores on cognitive tasks.
What do these findings add to what was already known?: Previous work recommended computer-based DLS programs for autistic individuals. Since our results suggest the CFSAT is a viable computer-based program of DLS for autistic adults, CFSAT could help fill a need for DLS tools that are more applicable to real life than currently available questionnaires. Findings provide preliminary support that the CFSAT assessment measures DLS and could be a promising program to further study.
What are potential weaknesses in the study?: Weaknesses of our work include that the measures used in this study only assessed two specific tasks encountered in daily living. Data on participants' real-life experience were not fully collected, so the association between the amount of real-life experience on these tasks and computer task performance will require further study. No data asking whether the tasks studied are useful for autistic adolescents and adults were collected. The study was small and consisted of relatively fewer women, which means that results will need to be replicated in a larger sample.
How will these findings help autistic adults now or in the future?: This work could eventually pave the way for interventions that improve DLS (including the training version of the CFSAT) that may be helpful for teaching autistic individuals technology-related functional skills.
Copyright 2023, Mary Ann Liebert, Inc., publishers.