Improving Social Interaction for Adolescents With Autism During the Transition to Adulthood
Phase: NA
Conditions: Autism Spectrum Disorder, Typical Development
Sponsor: The University of Texas at Dallas

Cover Page 
 
 
 
 
 
Title: Improving Social Interaction for Adolescents with Autism During the Transition to 
Adulthood 
 
NCT Number: NCT03785327 
 
Document Date: 7/2018 
 
 

 
Methodology 
Participants 
In total, we are aiming for 154 participants ages 18 to 21 to be tested interacting in pairs of one 
autistic and one non-autistic participant. Participants are assigned to one of three conditions: 
 
1. The “neurostimulation” group with 22 autistic and 44 non-autistic adolescents. The 
autistic participants complete two sessions with different non-autistic participants at least 
one week apart, once with active neurostimulation preceding the social interaction, and 
once with sham neurostimulation in order to rule out placebo effects. This group allows 
for evaluation of Goal 2. 
 
2. The “inclusion training” group with 22 autistic and 22 TD adolescents. Each non-autistic 
participant receives inclusion training prior to the interaction. Comparing outcomes with 
the “no intervention” group allows for evaluation of Goal 3.  
 
3. The “no intervention” group consists of 22 autistic and 22 non-autistic adolescents. This 
group allows for evaluation of Goal 1 and also serves as a baseline for comparison with 
the intervention groups. 
 
All participants will be male and between 18 and 21 years old. There is a disproportionate male 
to female ratio in autism of 4:1 (Fombonne, 2009), and the recruitment source used for this study 
is over 80% male. Thus, we would not have enough female participants to assess gender effects 
and because social interaction likely differs between mixed-sex interactions relative to same-sex 
ones, including a handful of females would confound reported findings. All included autistic 
participants will have a composite score above the clinical threshold for ASD on the Autism 
Diagnostic Observation Schedule (ADOS-II; Lord et al., 2012). Non-autistic participants will 
have no history of psychiatric illness or developmental disabilities and no current ASD diagnosis 
or a first degree relative with an ASD diagnosis. Interaction partners within and across the three 
groups will be matched on age and race, and comparable on IQ. To control for effects of 
intellectual ability, and to ensure results are most relevant to autistic older adolescents without 
intellectual disability, all participants will have measured full-scale IQs over 80 to ensure they 
are in the average to above average range.   
 
Autistic participants will be recruited from the Autism Research Collaborative at UT Dallas, a 
database established by Dr. Sasson of over 150 local autistic adolescents and young adults who 
have consented to participate in research studies at UTD. Individuals in this database have been 
clinically evaluated previously and satisfy the eligibility requirements for participation in this 
study. Non-autistic adults will primarily be students at UT Dallas participating to receive course 
credit, as well as a database of students who have consented to be contacted to participate in paid 
research. Data collection will occur in Dr. Sasson’s laboratory at UT Dallas, or at the nonPareil 
Institute, a non-profit organization for autistic adults in Plano, Texas that has partnered with Dr. 
Sasson for research studies and provides his lab group with space for testing.  
 
Procedures 

Participants are screened prior to data collection to rule out exclusion criteria, answer 
demographic questions, determine scheduling availability, and ensure unfamiliarity with their 
potential interaction partner. Testing rooms will have two chairs positioned opposite each other 
for the social interaction, and a video camera will be set up to capture both participants’ full 
bodies in the frame. Chairs will be angled in such a way that faces are clearly visible to the video 
camera. After the informed consent process, participants will complete a videotaped unstructured 
measure of dyadic interaction, first developed for interactions between non-autistic individuals 
(Berry & Hansen, 1996) but recently used in autism (Usher et al., 2018). Participants will be 
seated opposite from each other in front of a video camera and instructed that they will have five 
minutes to get to know each other. The research assistant then will turn on the camera and set a 
timer for five minutes. Although the researcher will be present during the conversation to ensure 
participants complete the interaction, he or she will be separated from the participants using a 
partition.  
 
Measures 
Following the interaction, participants will complete measures at separate computer stations 
partitioned from each other using Qualtrics Survey software. These measures include: 
1. The Social Interaction Evaluation Measure (Berry & Hansen, 1996): assesses each 
partners’ evaluation of interaction quality (e.g., enjoyment of the interaction), disclosure 
(e.g., how much did your partner disclose in the conversation), engagement (e.g., how 
much did your partner influence the conversation), and intimacy (e.g., to what extent was 
the interaction intimate). 
2. First Impression Scale (Sasson et al., 2017): participants rate their partner on different 
traits (e.g., likeability and intelligence) and their intent to engage in future interactions. 
3. The Subjective Closeness Index (Berscheid et al., 1989) and the Inclusion of the Other in 
the Self (Aron et al., 1997): participants rate feelings of “closeness” to their partner, 
which is predictive of friendship formation of two unfamiliar partners and can be reliably 
detected even in brief interactions (Aron et al., 1997).  
 
For items 1 and 2 above, participants will also report how they expect they will be rated on these 
items by their partner. We have shown that young autistic adults are often less accurate at 
determining how they are viewed by others (Sasson et al., 2018), an important skill for managing 
social relationships. We predict here that older autistic adolescents will not only be rated more 
poorly by their non-autistic partner than vice versa, but that they also will be poor at detecting 
they are being evaluated in this way. The neurostimulation intervention that targets areas of the 
brain involved in perspective-taking is predicted to improve this ability in our autistic 
participants. In contrast, the inclusion training is predicted to improve non-autistic impressions of 
autistic participants, but not affect autistic behavior or responses.  
 
Participants also complete measures assessing their social cognitive and social motivation 
abilities, as these affect social behavior and often differ in autism: 
1. Penn Emotion Recognition Task (Kohler et al., 2000): assesses the ability to recognize 
five basic emotions (i.e., happiness, sadness, fear, anger, and no emotion) from facial 
expressions. 
2. Benton Facial Recognition Task (Benton et al., 1983): measures the ability to process 
facial identity. 

3. The Awareness of Social Inference Task (TASIT; MacDonald et al., 2003): participants 
will view 16 videotaped vignettes of social interactions involving white lies or sarcasm 
and are asked to answer questions about what the characters’ intentions and motivations. 
4. Friendship Motivation Scale (Richard & Schneider. 2005): a 12-item questionnaire that 
assesses the participant’s desire to seek out and form social relationships.  
 
Analytic Plan 
Sample sizes were selected in consultation with Statistician Dr. Robert Ackerman to ensure 
successful detection of the anticipated medium effect sizes with 80% power. The research team 
consists of established researchers who are well experienced in data analysis and interpretation. 
For this project, we have selected an analytic approach designed to evaluate our three primary 
research goals. First, all self-report questionnaires will be evaluated for internal consistency 
using Cronbach’s alpha, and the Conversation Probe social behaviors will be evaluated with 
Intraclass Correlation Coefficients (ICC) for agreement between coders. In addition to reliability, 
descriptive statistics will be run for all measures, examining group means, standard deviations, 
and normality of all measures.  
 
Next, all primary goals will be assessed using an “Actor Partner Interdependence Model” 
(APIM; Kenny, Kashy, and Cook, 2006). Because data will be collected on two interacting 
individuals, the primary outcomes for both partners will be related (i.e., interaction evaluations, 
closeness, and impressions are dependent on the interaction with the partner). Thus, outcomes 
will be non-independent, and traditional analytic techniques using the general linear model 
cannot be used. Additionally, hypotheses examining how the partners influence each other 
cannot be examined with these traditional techniques and instead must be modeled with analyses 
like the APIM that take non-independence into account. APIM can estimate three types of 
effects. First, APIM can specify actor effects, or the effect of the individual’s own behavior (e.g., 
overall social skills or social cognitive ability) on the individual’s own outcome (e.g., interaction 
quality). Second, these models can specify partner effects, or the effect of the partner’s behaviors 
or abilities on the individual’s outcome. Finally, this model can specify interaction effects, 
allowing for examination of how an individual’s behaviors and traits are related to his own 
outcomes depending on his partner’s behaviors and traits.  
 
To examine effects of autism acceptance training on non-autistic participants interaction with 
autistic partners, zero-order correlations between participants’ interaction ratings were evaluated 
to assess the relationship between indicators, as well as the consistency of ratings between 
partners. Two factor mixed-model ANOVAs were run using a Geisser-Greenhouse correction to 
assess the effects of diagnosis (autistic vs. non-autistic) and training condition (Autism 
Acceptance Training vs. control) on how participants evaluated their conversation partner and 
the overall interaction. Specifically, training condition was treated as a between-subjects variable 
and autistic and NA interaction ratings (interaction quality, first impressions, closeness, warmth 
and dominance) were treated as a within-subjects factor, with separate analyses run for each 
outcome measure. As IQ differed significantly between autistic and NA individuals within 
dyads, WRAT-3 scores were included as a covariate in each ANOVA. All analyses were 
completed using SPSS 27 (IBM SPSS Inc., 2015). 
 

All analyses addressing each of the three goals will be conducted separately for each social 
interaction outcome: social interaction evaluation, closeness, and first impressions formed (i.e., 
traits and behavioral intentions). Analyses for goal 3 (the “no intervention” condition) will serve 
as a baseline to compare effectiveness of the neurostimulation intervention (goal 1) and the 
inclusion training (goal 2). Compared to baseline, it is anticipated that neurostimulation of 
autistic participants will lead to increased evaluation of their social skill, better performance on 
social cognitive tasks, and higher ratings by their non-autistic partners on closeness and first 
impressions. Both partners in the neurostimulation condition are predicted to rate the quality of 
the social interaction higher than in the baseline condition. Goal 2 (inclusion training for the non-
autistic participant) is predicted to lead to higher ratings of closeness and first impressions made 
by non-autistic participants of their autistic partners, with both partners evaluating the social 
interaction more positively compared to the “no intervention” condition. Because inclusion 
training only targets the non-autistic individual, social skill and social cognitive performance of 
autistic participants is not expected to differ here compared to baseline. Finally, we will be able 
to compare effects between Goal 1 and Goal 2 to determine which intervention, neurostimulation 
or inclusion training, produces better social outcomes for autistic adolescents. Due to the number 
of tests that will be performed, all significance tests will be evaluated at an adjusted alpha 
threshold of .01.