Motivation for Daily Living Skills

Many autistic teens and young adults often have a hard time doing the everyday skills they need to live on their own. These daily living skills (DLS) include things like taking care of themselves (like showering and getting dressed), doing chores at home (like cooking and cleaning), and handling things in the community (like saving money). Even if someone is able to do these skills, they might still struggle to do them. This shows that being able and knowing how to do these skills isn't the only important part-other things can make it hard to do daily tasks, like motivation.

Early research shows that some autistic young adults may not feel very motivated to do these daily tasks. There are different types of motivation. The researchers made three programs that focus on these different types.

One program focuses on intrinsic (internal) motivation and uses Motivational Interviewing strategies. Motivational Interviewing is a type of therapy that helps people find their personal reasons for making changes in their lives. This program will explore what is important to the participant and connect that value back to their daily living skill goal.

The researchers also made an extrinsic (external) motivation program. This program uses different behavioral strategies and will focus on a person finding outside sources of motivation. Some examples of these strategies are tracking how many times the participant completes their daily living skill in a week and giving themself a reward (like 'skin' in a video game or a t-shirt of their favorite band) if they reach their goal.

The third program is a combined program. This program includes activities from both the extrinsic motivation and intrinsic motivation programs explained above.

This study will compare these three programs in a preliminary efficacy trial. Preliminary efficacy means that this is the first trial where the researchers will look if there any benefits the participants may get from the treatments. The goal of this trial is to see which program helps autistic teens and young adults (ages 16-25) feel more motivated to do daily living skills. The results will help researchers plan a bigger study to find out whether intrinsic motivation, extrinsic motivation, or the combination of the two together work best.

The main questions the researchers of this trial want to answer are:

• Can the trial improve motivation to complete daily living skills for skills that people know how to do but struggle to do them consistently?
• Can the trial improve completion of the daily living skill that the participant identifies they want to do more often?
• Do people report feeling more empowered to complete the daily living skill they want to do more often?
• Are there any characteristics of a person that make them more or less likely to benefit from the treatment?

Another part of this treatment program is looking at social support. All teens/young adults enrolled in this study will be asked to choose someone in their life to be involved in the study with them. This person is called an 'Important Person' (IP) and can be anyone close to them, like a family member, friend, roommate, partner, etc. The IP will be expected to support the teen/young adult throughout this treatment.

All three programs have 5 therapy sessions and the follow-up session two weeks later. Sessions 1 through 5 includes answering some questionnaires and doing a 60-minute or 90-minute therapy session with a trained clinician. The IPs will join the last 15 minutes of each session and answer some questionnaires. These sessions will be in-person at the Children's Hospital of Philadelphia at their Philadelphia campus. The follow-up session includes both the teen/young adult participants and their IPs. This session can be done online and only involves answering some questionnaires. The goal of this session is to see if people stay motivated after the programs end.

Participation in this trial should not take more than 9 weeks and has three phases: a Screening and Consent Phase, Intervention Phase, and Follow-Up Phase.

In the Screening and Consent Phase, people who are interested will fill out a short form online to see if they are eligible to join this study. Then, they will have a follow-up call on Microsoft Teams with someone from the research team to confirm they are eligible and to collect their consent to join the study if they want to. After that, they get their study schedule and move into the Intervention Phase. The Intervention Phase includes the 5 therapy sessions that are part of the treatment programs and answering questionnaires. The trial ends with the Follow-Up phase where the participant and IP will receive a link to their final questionnaires two weeks after their last therapy session.

A possible benefit from participating in this study is that the treatments might help the teens/young adults feel more motivated to do daily living skills they want to do more often. They and their IP will also receive payment for completing the questionnaires.

Inclusion criteria

for Autistic Teens and Young Adults:

• Age 16-25 years
• Participants reporting an autism diagnosis from a qualified provider (Psychiatrist, Psychologist, Developmental Pediatrician, Neurologist). When possible, diagnosis will be confirmed through the Children's Hospital of Philadelphia (CHOP) Electronic Health Record (EHR).
• Must identify an important person who is able to communicate by understanding and speaking full sentences in English
• Ability to communicate by understanding and using full sentences in English
• Informed Consent
• Be willing to have sessions audio- and video-recorded

Exclusion criteria

for Autistic Teens and Young Adults:

• Diagnosis of Intellectual Disability
• Participant is currently considered a suicide risk in the opinion of the Investigator or is currently demonstrating active suicidal or homicidal ideation or self-injurious behavior.
• Current, comorbid psychiatric disorder with sufficiently intense symptoms in the opinion of the Investigator that these symptoms may confound treatment.
• Changes to mental health treatment plan (ex. starting or ending therapy or psychotropic medications over the course of this intervention).
• Participation in a prior trial of our intrinsic motivation condition

Inclusion criteria

for Important Person:

• Age 18 years or older
• Must attend at least 15 minutes of each treatment session
• Ability to communicate by understanding and using full sentences in English
• Informed consent
• Be willing to have sessions audio- and video-recorded

Exclusion criteria

for Important Person:

• Is not willing to support the autistic teen/young adult with their daily living skill goal