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Results from a Pilot Randomized Controlled Trial of a Single-Session Growth-Mindset Intervention for Internalizing Symptoms in Autistic Youth

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Title: Results from a Pilot Randomized Controlled Trial of a Single-Session Growth-Mindset Intervention for Internalizing Symptoms in Autistic Youth
Language: English
Authors: Alan H. Gerber (ORCID 0000-0002-8133-3995), Allison Nahmias, Jessica L. Schleider, Matthew D. Lerner
Source: Journal of Autism and Developmental Disorders. 2025 55(9):3050-3064.
Availability: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
Peer Reviewed: Y
Page Count: 15
Publication Date: 2025
Sponsoring Agency: National Institute of Mental Health (NIMH) (DHHS/NIH)
Office of the Director (OD) (DHHS/NIH)
National Science Foundation (NSF)
Health Resources and Services Administration (HRSA) (DHHS)
Contract Number: MH18268
DP5OD028123
Document Type: Journal Articles
Reports - Research
Descriptors: Autism Spectrum Disorders, Symptoms (Individual Disorders), Comorbidity, Adolescents, Personality, Interpersonal Competence, Intervention, Depression (Psychology), Self Control, Anxiety
DOI: 10.1007/s10803-024-06341-2
ISSN: 0162-3257
1573-3432
Abstract: Autistic youth experience elevated rates of co-occurring internalizing symptoms. Interventions to treat internalizing symptoms in autistic youth are almost uniformly costly and time-intensive, blunting dissemination of intervention and highlighting the need for scalable solutions. One promising option is a relatively new class of evidence-based treatments, single-session interventions (SSIs), however, no study has examined SSIs for depression symptoms in autistic youth. Participants included 40 autistic adolescents ranging in age from 11 to 16 (M[subscript age] = 14.22, N[subscript male] = 32). Eligible youth who agreed to participate were randomized to either the active intervention (Project Personality), or an active control designed to mimic supportive therapy. Participants and their caregiver completed questionnaires immediately before, after, and three months post intervention. All participants completed the intervention independently and largely reported enjoying it. The intervention was delivered with 100% fidelity. Findings demonstrated improvements in perceived primary control, malleability of personality, and social competence relative to the active control group immediately post-intervention. Further, results revealed improvements in self-reported depression symptoms and parent reported emotional regulation at 3-month follow up. This study was the first to assess a GM-SSI designed to treat depression symptoms in autistic adolescents. Results indicated improvements in perceived control immediately post-intervention and downstream improvements in depression. Nonetheless, we did not find improvements in symptoms of anxiety, suggesting that autistic adolescents may require modifications to the intervention to maximize benefit. Findings demonstrate the utility of GM-SSI for internalizing symptoms for autistic youth and hold considerable promise as a low-intensity and scalable intervention.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1481204
Database: ERIC
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  Value: <anid>AN0187434581;aut01sep.25;2025Aug22.05:47;v2.2.500</anid> <title id="AN0187434581-1">Results from a Pilot Randomized Controlled Trial of a Single-Session Growth-Mindset Intervention for Internalizing Symptoms in Autistic Youth </title> <p>Autistic youth experience elevated rates of co-occurring internalizing symptoms. Interventions to treat internalizing symptoms in autistic youth are almost uniformly costly and time-intensive, blunting dissemination of intervention and highlighting the need for scalable solutions. One promising option is a relatively new class of evidence-based treatments, single-session interventions (SSIs), however, no study has examined SSIs for depression symptoms in autistic youth. Participants included 40 autistic adolescents ranging in age from 11 to 16 (M<sub>age</sub> = 14.22, N<sub>male</sub> = 32). Eligible youth who agreed to participate were randomized to either the active intervention (Project Personality), or an active control designed to mimic supportive therapy. Participants and their caregiver completed questionnaires immediately before, after, and three months post intervention. All participants completed the intervention independently and largely reported enjoying it. The intervention was delivered with 100% fidelity. Findings demonstrated improvements in perceived primary control, malleability of personality, and social competence relative to the active control group immediately post-intervention. Further, results revealed improvements in self-reported depression symptoms and parent reported emotional regulation at 3-month follow up. This study was the first to assess a GM-SSI designed to treat depression symptoms in autistic adolescents. Results indicated improvements in perceived control immediately post-intervention and downstream improvements in depression. Nonetheless, we did not find improvements in symptoms of anxiety, suggesting that autistic adolescents may require modifications to the intervention to maximize benefit. Findings demonstrate the utility of GM-SSI for internalizing symptoms for autistic youth and hold considerable promise as a low-intensity and scalable intervention.</p> <p>Keywords: SSI; GM-SSI; Growth mindset; Single session intervention; Autism; Adolescents; Psychology and Cognitive Sciences Psychology Medical and Health Sciences Public Health and Health Services</p> <p>Copyright comment Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</p> <p>Autistic youth experience elevated rates of co-occurring internalizing symptoms (Simonoff et al., [<reflink idref="bib55" id="ref1">55</reflink>]). Interventions to treat internalizing symptoms in autistic youth are almost uniformly costly and time-intensive (Buescher et al., [<reflink idref="bib4" id="ref2">4</reflink>]; Perihan et al., [<reflink idref="bib44" id="ref3">44</reflink>]), blunting dissemination of intervention and highlighting the need for scalable and accessible solutions (Kazdin & Blase, [<reflink idref="bib20" id="ref4">20</reflink>]; Libsack et al., [<reflink idref="bib30" id="ref5">30</reflink>]). One promising option is a relatively new class of evidence-based treatments, single-session interventions (SSIs), which have shown remarkable efficacy in treating a range of other developmental psychopathologies (Schleider & Weisz, [<reflink idref="bib49" id="ref6">49</reflink>]). While prior work has utilized SSIs for specific phobias in autistic children (Ollendick et al., [<reflink idref="bib42" id="ref7">42</reflink>]), no study to date has examined SSIs for depression symptoms in autistic youth, which have the potential to dramatically reduce the cost and expand the public health impact of accessible intervention options for autistic youth. This study offers the first pilot randomized controlled trial (RCT) for autistic youth of a digital SSI designed for internalizing symptoms in non-autistic youth.</p> <hd id="AN0187434581-2">Internalizing Symptoms in Autistic Youth</hd> <p>Internalizing symptoms are consistently reported as among the most common co-occurring symptoms experienced by autistic youth (Fucà et al., [<reflink idref="bib9" id="ref8">9</reflink>]; Guerrera et al., [<reflink idref="bib12" id="ref9">12</reflink>]; Simonoff et al., [<reflink idref="bib55" id="ref10">55</reflink>]). Further, emotion regulation skills are often difficult for autistic youth (Mazefsky et al., [<reflink idref="bib35" id="ref11">35</reflink>]), and are associated with increased internalizing symptoms (Bos et al., [<reflink idref="bib3" id="ref12">3</reflink>]; Li et al., [<reflink idref="bib29" id="ref13">29</reflink>]; Rieffe et al., [<reflink idref="bib46" id="ref14">46</reflink>]). Studies have demonstrated varying rates of co-occurring anxiety in autistic youth (Kent & Simonoff, [<reflink idref="bib21" id="ref15">21</reflink>]), with a recent meta-analysis indicating that almost 40% experience at least one anxiety disorder (van Steensel et al., [<reflink idref="bib58" id="ref16">58</reflink>]). Similarly, rates of depression are elevated in autistic youth (Menezes et al., [<reflink idref="bib37" id="ref17">37</reflink>]), with rates as high as 20% in adolescence (Greenlee et al., [<reflink idref="bib11" id="ref18">11</reflink>]). Both have been reported as among the most impairing co-occurring conditions by parents and teachers of autistic youth (Kaat et al., [<reflink idref="bib17" id="ref19">17</reflink>]).</p> <p>Given the high rates of co-occurring internalizing symptoms, treatments for these symptoms are of the utmost importance. On average, many autistic adolescents tend to respond to traditional cognitive behavior therapy (CBT) for these symptoms, though individual response is variable (Weston et al., [<reflink idref="bib66" id="ref20">66</reflink>]). There is evidence that CBT targeting internalizing symptoms in autistic adolescents may improve social impairment, a core symptom of autism (Maddox, Miyazaki & White, [<reflink idref="bib33" id="ref21">33</reflink>].), as well as improve deficits in executive function (Kenworthy et al., [<reflink idref="bib22" id="ref22">22</reflink>]). While CBT has been shown to be effective for anxiety, it has shown less utility for depression (White et al., [<reflink idref="bib68" id="ref23">68</reflink>]). Crucially, CBT is resource-intensive and often requires adaption to meet the needs of autistic youth (Kerns et al., [<reflink idref="bib25" id="ref24">25</reflink>]; Riches et al., [<reflink idref="bib45" id="ref25">45</reflink>]; Spain & Happé, [<reflink idref="bib56" id="ref26">56</reflink>]), limiting access to high quality intervention. This highlights the need for more efficient, scalable interventions with the potential to meet the pervasive, unmet demand for treatment in this population.</p> <hd id="AN0187434581-3">Single Session Interventions for Internalizing Symptoms</hd> <p>Research indicates that psychotherapy leads to improvements in childhood internalizing symptoms, notably for symptoms of anxiety (Weisz et al., [<reflink idref="bib65" id="ref27">65</reflink>]). Nonetheless, almost half of youth participating in psychotherapy attend just one session (Edbrooke-Childs et al., [<reflink idref="bib8" id="ref28">8</reflink>]), limiting the effectiveness of treatment. Single-session interventions (SSI) are a novel and highly promising treatment modality designed to address this need (Hoyt & Talmon, [<reflink idref="bib16" id="ref29">16</reflink>]). A review of the literature indicated that SSIs for anxiety were more effective than no treatment and as effective as multiple sessions in some cases (Bertuzzi et al., [<reflink idref="bib2" id="ref30">2</reflink>]). Further, a meta-analysis across 50 randomized trials demonstrated that SSIs produced significant reductions in a wide range of psychopathology for youth as young as 4 years of age. Effect sizes ranged by type of problem, with improvements in anxiety representing the largest effect (<emph>g</emph> = 0.58), while the overall effect for depression was (<emph>g</emph> = 0.21). Further, no differences emerged in the effectiveness of online (self-guided) SSIs relative to SSIs delivered by a clinician, suggesting that more scalable, digitally-delivered options might still yield clinical benefits (Schleider & Weisz, [<reflink idref="bib49" id="ref31">49</reflink>]).</p> <p>Digital SSIs represent a promising future direction in the field and hold great promise as a therapeutic tool for providing low-cost, accessible treatments (Schleider et al., [<reflink idref="bib52" id="ref32">52</reflink>]). They can be delivered in just one sitting and without therapist involvement. Prior research indicates that youth completing web-based SSIs report high rates of perceived acceptability (Schleider, Dobias, Sung, Mumper et al., [<reflink idref="bib53" id="ref33">53</reflink>]). Further, a large online randomized trial found that SSIs led to reductions in depression and hopelessness in adolescents with elevated symptoms of depression (Schleider et al., [<reflink idref="bib54" id="ref34">54</reflink>]), with an effect size of <emph>d</emph> = 0.18 for improvements in depression. Low-cost web-based SSIs have recently shown promise in reducing internalizing symptoms for youth in under-resourced countries (Osborn et al., [<reflink idref="bib43" id="ref35">43</reflink>]; Venturo-Conerly et al., [<reflink idref="bib59" id="ref36">59</reflink>]), demonstrating the potential impact of effective SSIs.</p> <p>One particularly promising SSI that can be delivered in-person or in a digital format is the growth mindset single session intervention (GM-SSI). The goal of this intervention is to target adolescent depression and anxiety by facilitating a growth mindset (i.e., the ability to recognize that personal traits are malleable, and thus amenable to change; Schleider & Weisz, [<reflink idref="bib48" id="ref37">48</reflink>]). Indeed, the mechanism of action for GM-SSIs appears to be improvements in primary control, which lead to greater declines in depressive symptoms (Schleider et al., [<reflink idref="bib51" id="ref38">51</reflink>]). GM-SSIs convey the message that people, along with their symptoms, can change, a core principle of CBT. In large scale clinical trials of non-autistic youth, GM-SSIs have shown reliable and robust effects on depression and anxiety symptoms, even 3 to 9 months post-treatment, compared to active control conditions designed to mimic nondirective, supportive therapy. (Schleider et al., [<reflink idref="bib54" id="ref39">54</reflink>]; Schleider & Weisz, [<reflink idref="bib50" id="ref40">50</reflink>]).</p> <hd id="AN0187434581-4">Single Session Interventions for Neurodiverse Youth</hd> <p>There is a paucity of research on SSIs for neurodiverse youth. Mulligan et al. ([<reflink idref="bib39" id="ref41">39</reflink>]) implemented an SSI for children with neurological conditions that targeted internalizing symptoms, finding improvements in self-efficacy and anxiety. Another study found that youth with intellectual disability were more likely to endorse a fixed mindset mentality, and that a greater endorsement of a fixed mindset approach was associated with greater mental health issues (Verberg et al., [<reflink idref="bib60" id="ref42">60</reflink>]). Further, a six-session growth mindset intervention specifically designed for adolescents with intellectual disability demonstrated effects on mental health problems at three month follow up (Verberg et al., [<reflink idref="bib61" id="ref43">61</reflink>]). Previous work has successfully adapted a one-session treatment for specific phobias in autistic children (Ollendick et al., [<reflink idref="bib42" id="ref44">42</reflink>]). However, despite considerable promise for low-intensity and single-session interventions for neurodiverse youth (Libsack et al., [<reflink idref="bib30" id="ref45">30</reflink>]), there have been no studies of SSIs designed to target depression symptoms in autistic youth.</p> <p>Given that CBT-based interventions for depression and anxiety consistently reduce symptomatology in autistic and non-autistic youth, GM-SSIs may represent a plausible, scalable intervention for autistic youth experiencing these common and impairing co-occurring psychiatric symptoms (Libsack et al., [<reflink idref="bib30" id="ref46">30</reflink>]). Indeed, such an intervention would represent a leap forward for the field, which almost exclusively relies upon empirically supported but highly intensive interventions (Weston et al., [<reflink idref="bib66" id="ref47">66</reflink>]). Nonetheless, the potential of GM-SSIs to reduce internalizing problems and improve psychosocial functioning in autistic youth has yet to be explored.</p> <hd id="AN0187434581-5">Current Study</hd> <p>To our knowledge, this was the first pilot randomized controlled trial (RCT) of a GM-SSI targeting internalizing symptoms in autistic adolescents. The overall aims of this study were to assess feasibility and fidelity of intervention delivery and to compare effect sizes in autistic youth to previously demonstrated effects in non-autistic youth. We hypothesized that participants in the GM-SSI would show greater improvements in putative treatment mechanisms of GM-SSIs, as well as several pre-registered primary and secondary outcomes, compared to autistic adolescents who received an active control program designed to mimic nondirective supportive therapy. Specifically, we hypothesized that autistic youth receiving the GM-SSI would show greater increases in primary (1a) and secondary (2a) perceived control immediately post-intervention. We also hypothesized that autistic youth receiving the GM-SSI would show greater improvements in growth personality mindset (2a) and self-perception (2b) immediately post-intervention. Lastly, we hypothesized that autistic youth receiving the GM-SSI would show significant reductions in depression (3a) and anxiety (3b) symptoms, as well as improvements in emotional regulation (3c) at 3-month follow-up.</p> <hd id="AN0187434581-6">Method</hd> <p></p> <hd id="AN0187434581-7">Participants</hd> <p>Participants included 40 autistic adolescents ranging in age from 11 to 16 (see Table 1). Eligibility requirements included being between the ages of 11–16, an intelligence quotient (IQ) greater than or equal to 70, and a total of 11 or greater on the Social Communication Questionnaire (SCQ; see measures). As this was a pilot RCT, there were no specific inclusion criteria for internalizing symptoms. Participants were also assessed for autism with the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2; see measures) or the Brief Observation of Symptoms of Autism (BOSA; see measures). Exclusion criteria were limited to the presence of a significant medical disability that would interfere with study participation. There were no differences across demographic and screening measures between intervention groups (see Table 1).</p> <p>Table 1 Demographics and clinical characteristics of the sample pre-intervention (<emph>N</emph> = 40)</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Variable</p></th><th align="left"><p>Overall, N = 40</p></th><th align="left"><p>Control, N = 20</p></th><th align="left"><p>Project personality, N = 20</p></th><th align="left"><p>Statistic</p></th></tr></thead><tbody><tr><td align="left"><p>Age, mean (SD)</p></td><td align="left"><p>14.22 (1.57)</p></td><td align="left"><p>14.17 (1.41)</p></td><td align="left"><p>14.27 (1.76)</p></td><td align="left"><p>0.20</p></td></tr><tr><td align="left"><p>Sex, n (%)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>Female</p></td><td align="left"><p>8 (20%)</p></td><td align="left"><p>4 (20%)</p></td><td align="left"><p>4 (20%)</p></td><td align="left"><p>-</p></td></tr><tr><td align="left"><p>Male</p></td><td align="left"><p>32 (80%)</p></td><td align="left"><p>16 (80%)</p></td><td align="left"><p>16 (80%)</p></td><td align="left" /></tr><tr><td align="left"><p>Race, n (%)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>2.67</p></td></tr><tr><td align="left"><p>White</p></td><td align="left"><p>30 (75%)</p></td><td align="left"><p>16 (80%)</p></td><td align="left"><p>14 (70%)</p></td><td align="left" /></tr><tr><td align="left"><p>Black</p></td><td align="left"><p>5 (12%)</p></td><td align="left"><p>2 (10%)</p></td><td align="left"><p>3 (15%)</p></td><td align="left" /></tr><tr><td align="left"><p>Asian</p></td><td align="left"><p>2 (5.0%)</p></td><td align="left"><p>0 (0%)</p></td><td align="left"><p>2 (10%)</p></td><td align="left" /></tr><tr><td align="left"><p>More than one</p></td><td align="left"><p>3 (7.5%)</p></td><td align="left"><p>2 (10%)</p></td><td align="left"><p>1 (5.0%)</p></td><td align="left" /></tr><tr><td align="left"><p>Ethnicity, n (%)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>0.28</p></td></tr><tr><td align="left"><p>Not Hispanic</p></td><td align="left"><p>36 (90%)</p></td><td align="left"><p>17 (85%)</p></td><td align="left"><p>19 (95%)</p></td><td align="left" /></tr><tr><td align="left"><p>Hispanic</p></td><td align="left"><p>4 (10%)</p></td><td align="left"><p>3 (15%)</p></td><td align="left"><p>1 (5.0%)</p></td><td align="left" /></tr><tr><td align="left"><p>Family income, n (%)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left"><p>2.18</p></td></tr><tr><td align="left"><p>$75,000-$120,000</p></td><td align="left"><p>7 (18%)</p></td><td align="left"><p>2 (11%)</p></td><td align="left"><p>5 (26%)</p></td><td align="left" /></tr><tr><td align="left"><p><$75,000</p></td><td align="left"><p>11 (29%)</p></td><td align="left"><p>6 (32%)</p></td><td align="left"><p>5 (26%)</p></td><td align="left" /></tr><tr><td align="left"><p>>$120,000</p></td><td align="left"><p>15 (39%)</p></td><td align="left"><p>9 (47%)</p></td><td align="left"><p>6 (32%)</p></td><td align="left" /></tr><tr><td align="left"><p>Decline to answer</p></td><td align="left"><p>5 (13%)</p></td><td align="left"><p>2 (11%)</p></td><td align="left"><p>3 (16%)</p></td><td align="left" /></tr><tr><td align="left"><p>SCQ total score, mean (SD)</p></td><td align="left"><p>19.20 (5.38)</p></td><td align="left"><p>20.20 (5.51)</p></td><td align="left"><p>18.20 (5.19)</p></td><td align="left"><p>1.18</p></td></tr><tr><td align="left"><p>IQ composite standard score, mean (SD)</p></td><td align="left"><p>105.47 (15.63)</p></td><td align="left"><p>107.47 (14.40)</p></td><td align="left"><p>103.47 (16.93)</p></td><td align="left"><p>0.78</p></td></tr><tr><td align="left"><p>ADOS-2 calibrated severity score, mean (SD)</p></td><td align="left"><p>6.63 (2.25)</p></td><td align="left"><p>6.80 (2.18)</p></td><td align="left"><p>6.47 (2.39)</p></td><td align="left"><p>0.40</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph> A T-test or Chi-square test was used for group comparisons SCQ = Social Communication Questionnaire; ADOS-2 = Autism Diagnostic Observation Schedule, Second Edition. <sups>*</sups><emph>p</emph> <.05. <sups>**</sups><emph>p</emph> <.01. <sups>***</sups><emph>p</emph> <.001</p> <hd id="AN0187434581-8">Procedures</hd> <p>Participants were initially drawn from youth who had recently completed cognitive and diagnostic testing during an in-person visit to the senior author's laboratory and had already met eligibility criteria for this study (see Screening Tools). These cognitive and diagnostic screening assessments were typically completed within a few months of the intervention, however, a few participants had received testing more than 6 months before completing the intervention. During the COVID-19 pandemic, the study was opened to adolescents who had not previously completed all screening measures. The BOSA (see measures) was used to confirm autism diagnostic status for these participants. All other study measures (e.g., baseline, outcome) were completed concurrently and on the same timeline for all participants (as described below).</p> <p>Eligible youth who agreed to participate were randomized to either the active or control intervention conditions (see intervention conditions for details). Participants and their caregivers were not aware of their assigned treatment group. Group assignment was also kept masked from study personnel who interacted with participants. Before beginning the intervention, adolescents and their caregiver completed baseline questionnaires regarding key study outcomes. Immediately after the intervention, adolescents completed a brief post-intervention questionnaire battery. Finally, adolescents and their caregiver were asked to complete online follow-up questionnaires three-months post-intervention (see Fig. 1 for details). Study details were pre-registered on the Open Science Foundation page at: https://osf.io/pa5jy.</p> <p>Graph: Fig. 1 Recruitment flow diagram</p> <p>Youth initially completed the intervention and baseline questionnaires during an in-person visit, however, the COVID-19 pandemic interrupted in-person data collection. Before the study shifted entirely online, 12 participants (30%) completed the intervention and baseline questionnaires in-person. The rest of the participants (28; 70%) completed the study in an entirely virtual (i.e., delivered online) format. For those participants, a research assistant scheduled a virtual (i.e., over Zoom) session instead of an in-person baseline visit. However, the procedure during this session was virtually identical to the in-person visits.</p> <hd id="AN0187434581-9">Intervention Conditions</hd> <p>Growth Mindset Single Session Intervention (GM-SSI; Schleider & Weisz, [<reflink idref="bib48" id="ref48">48</reflink>], [<reflink idref="bib50" id="ref49">50</reflink>]). The content of the intervention, called Project Personality, is designed for youth experiencing symptoms of depression, specifically sadness and hopelessness. The contents of the intervention consist of five key components: (<reflink idref="bib1" id="ref50">1</reflink>) An introduction to the brain and neuroplasticity; (<reflink idref="bib2" id="ref51">2</reflink>) Written testimonials from older youth regarding the malleability of personality traits; (<reflink idref="bib3" id="ref52">3</reflink>) Vignettes from older youth describing their use of growth mindsets to deal with emotional setbacks; (<reflink idref="bib4" id="ref53">4</reflink>) Selected scientific content supporting that personality can change in positive ways; (<reflink idref="bib5" id="ref54">5</reflink>) A self-persuasion writing exercise where participants are asked to detail how they would respond to a hypothetical peer rejection scenario (e.g., Aronson, [<reflink idref="bib1" id="ref55">1</reflink>]). All intervention activities are self-administered by participating youth and delivered in a web-based format on a computer, including illustrations and audio-recordings of text. It is entirely delivered via Qualtrics and takes approximately 30 min to complete. Project Personality can be delivered flexibility, for example, at the participants home or during an in-person lab visit.</p> <p>Control Intervention (Schleider & Weisz, [<reflink idref="bib48" id="ref56">48</reflink>], [<reflink idref="bib50" id="ref57">50</reflink>]). The control intervention for this study was a supportive therapy, called the Sharing Feelings Intervention. It is structurally similar to the growth mindset intervention, but it is intended to mimic supportive therapy. The aim of the control intervention is to encourage youth to identify and express their emotions to close others, however, no specific skills or beliefs are emphasized. The intervention is designed to control for nonspecific aspects of treatment, such as engagement in a computer-based treatment program. It includes a similar number of activities as the growth mindset intervention. Key components include: (<reflink idref="bib1" id="ref58">1</reflink>) An introduction to human emotion; (<reflink idref="bib2" id="ref59">2</reflink>) Written testimonials from older youth regarding times when they benefited from sharing their feelings with friends or family; (<reflink idref="bib3" id="ref60">3</reflink>) A worksheet regarding challenges in sharing emotions; (<reflink idref="bib4" id="ref61">4</reflink>) A writing exercise where participants are asked to detail how they would feel after hypothetical positive and negative scenarios. It is also entirely self-administered via Qualtrics and takes approximately 30 min to complete.</p> <hd id="AN0187434581-10">Measures</hd> <p></p> <hd id="AN0187434581-11">Screening Tools</hd> <p>The Kaufman Brief Intelligence Scale- Second Edition (KBIT-2) is a clinician-administered cognitive assessment that can be administered across the lifespan and scored following age-specific norms (Kaufman & Kaufman, [<reflink idref="bib19" id="ref62">19</reflink>]).</p> <p>The Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) is a relatively brief clinician-administered cognitive assessment (Wechsler, [<reflink idref="bib62" id="ref63">62</reflink>]). It is intended for use across the lifespan and produces an age-normed full-scale IQ estimate. Three participants completed a WASI-II.</p> <p>The Autism Diagnostic Observation Schedule-2 (ADOS-2) is a semi-structured assessment tool that aims to elicit social interactions through a series of prompts (Lord et al., [<reflink idref="bib32" id="ref64">32</reflink>]). It was administered by research-reliable examiners as part of the diagnostic confirmation procedure. Participants completed either a module 3 or 4 for individuals with fluent speech.</p> <p>The Brief Observation of Symptoms of Autism (BOSA) is an adaption of the ADOS-2 intended to provide a similarly structured social interaction via telehealth (Dow et al., [<reflink idref="bib7" id="ref65">7</reflink>]). It was administered and scored by examiners who had already achieved research reliability on the ADOS-2. Participants completed the F2 module for youth with fluent speech. There were six participants who completed a BOSA.</p> <p>The Social Communication Questionnaire (SCQ) is a parent-report measure designed to be a screening tool for autism (Rutter et al., [<reflink idref="bib47" id="ref66">47</reflink>]). Raw total scores range from 0 to 39, with higher scores reflecting greater autism-consistent symptoms. A cutoff score of 11 was used to maximize sensitivity (Norris & Lecavalier, [<reflink idref="bib40" id="ref67">40</reflink>]).</p> <hd id="AN0187434581-12">Feasibility and Fidelity</hd> <p>Feasibility was assessed through a brief questionnaire administered after completion of the intervention. Participants were asked to rate their enjoyment of the computer-based activity on a scale of 1–10. There were also asked to report which aspects they enjoyed the most and if there was anything they would change about the activity. Fidelity was monitored based on the completion of each activity and section of the intervention.</p> <hd id="AN0187434581-13">Perceived Control</hd> <p>The Primary Control Scale for Children (PCSC) measures self-reported perceived ability to influence events or conditions through personal effort. (Weisz et al., [<reflink idref="bib63" id="ref68">63</reflink>]). It is a 24-item scale in which youth rate their agreement with statements about their ability to exert primary control (e.g., "I can do well on tests if I study hard"; "I can get other kids to like me if I try"). Higher scores reflect greater perceived primary control. Cronbach's α for the PCSC was 0.92 and 0.90 at baseline and follow-up respectively.</p> <p>The Secondary Control Scale for Children (SCSC) is a self-report scale for youth that assesses their perceived ability to shape the impact of events or conditions by adjusting to fit those conditions (Weisz et al., [<reflink idref="bib64" id="ref69">64</reflink>]). It is a 20-item scale in which youth rate their agreement with items reflecting their perception of secondary control, such as adjusting cognition ("When something bad happens, I can find a way to think about it that makes me feel better"). Higher scores indicate greater perceived secondary control. Cronbach's α for the SCSC was 0.91 and 0.90 at baseline and follow-up respectively.</p> <hd id="AN0187434581-14">Self-Perception</hd> <p>The Self Perception Profile for Children/Adolescents (SPPC/A) is a self-report questionnaire that measures youth self-esteem (Harter, [<reflink idref="bib13" id="ref70">13</reflink>], [<reflink idref="bib14" id="ref71">14</reflink>]). It is a 10-item scale in which youth rate their agreement with statements regarding their perceived social competence. Higher scores reflect greater self-esteem. This study utilized the Close Friendship and Social Competence subscales, however, the Close Friendship subscale is only available for youth ages 13 and older. Cronbach's α for the SPP-A was 0.87 and 0.86 at baseline and follow-up respectively. There was not enough data to run reliability for the SPP-C alone.</p> <p>The Implicit Personality Theory Questionnaire (ITPQ) asks youth to rate the extent of their agreement with three statements linked to the malleability of personality (e.g. "Your personality is something about you that you can't change very much"; Yeager et al., [<reflink idref="bib69" id="ref72">69</reflink>]). Items are rated using a 1-to-6 Likert scale from "Really Disagree" to "Really Agree". Lower summed scores reflect a stronger growth personality mindset. Cronbach's α for the ITPQ was 0.86 and 0.90 at baseline and follow-up respectively.</p> <hd id="AN0187434581-15">Internalizing Symptoms</hd> <p>The Children's Depression Inventory-2 (CDI-2) was used to assess depressive symptom severity, with higher T scores reflecting greater symptomatology (Kovacs, [<reflink idref="bib27" id="ref73">27</reflink>]). Both adolescents and caregivers completed this questionnaire. Higher T scores reflect greater depressive symptoms. Cronbach's α for parent-report was 0.83 at baseline and at follow-up. Cronbach's α for child-report was 0.88 and 0.90 at baseline and follow-up respectively.</p> <p>The Multidimensional Anxiety Scale for Children – Second Edition (MASC-2) is parent- and child-report questionnaire that assesses anxiety symptoms in youth (March, [<reflink idref="bib34" id="ref74">34</reflink>]). Higher T scores indicate greater anxiety symptoms. Cronbach's α for parent-report was 0.94 at baseline and at follow-up. Cronbach's α for child-report was 0.94 and 0.93 at baseline and follow-up respectively.</p> <hd id="AN0187434581-16">Executive Control</hd> <p>The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) measures executive functioning skills in both home and school environments (Gioia et al., [<reflink idref="bib10" id="ref75">10</reflink>]). Both adolescents and caregivers completed this measure. Changes in the Emotion Regulation Index (ERI) subscale were examined. Lower T scores reflect greater emotional regulation skills. Cronbach's α for parent-report ERI was 0.89 at baseline and 0.91 at follow-up. Cronbach's α for child-report ERI was 0.88 and 0.85 at baseline and follow-up respectively.</p> <hd id="AN0187434581-17">Data Analytic Plan</hd> <p>Differences across treatment groups in key clinical outcome measures at baseline were examined with t-tests to ensure successful randomization. Feasibility and total time spent on the intervention in comparison to prior studies in non-autistic samples were also assessed.</p> <p>To test Hypotheses 1–3, that Project Personality led to improvements in several key clinical variables controlling for baseline values, ANCOVA of change models utilizing linear regression were run using R version 4.21. Prior work indicates that this is one of several methods that produce an unbiased estimate of treatment effects (O'Connell et al., [<reflink idref="bib41" id="ref76">41</reflink>]). Missing data was handled using case-wise deletion and with an intent-to-treat approach. For each hypothesis, models were constructed with each of the key clinical variables at either post-intervention or 3-month follow up as the dependent variable. At step 1 of the linear regression, the same key clinical variable at baseline was entered to control for pre-intervention levels. Next, treatment group was entered at step 2 of the linear regression to assess treatment effects. A significant effect of group indicated a treatment effect on that clinical variable.</p> <p>When significant treatment effects were present, within-group effect sizes were calculated for each treatment group independently. Cohen's <emph>d</emph><subs><emph>z</emph></subs> was calculated for each treatment group following guidelines by Lakens ([<reflink idref="bib28" id="ref77">28</reflink>]). Interpretation of effect sizes were facilitated through the use of Common Language Effect Sizes (McGraw & Wong, [<reflink idref="bib36" id="ref78">36</reflink>]), which provide an estimate of likelihood of change from baseline.</p> <hd id="AN0187434581-18">Results</hd> <p></p> <hd id="AN0187434581-19">Descriptives</hd> <p>There were no significant differences at baseline across clinical outcome measures between groups (<emph>p</emph>s > 0.10), suggesting successful randomization. Table 2 displays the means and standard deviations for key variables across the study.</p> <p>Table 2 Means and standard deviations for study outcomes across all three timepoints</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left" /><th align="left" colspan="3"><p>Control</p></th><th align="left" colspan="3"><p>Project personality</p></th></tr><tr><th align="left"><p><italic>Variable</italic></p></th><th align="left"><p><italic>Pre-test</italic></p></th><th align="left"><p><italic>Post-test</italic></p></th><th align="left"><p><italic>3 month follow-up</italic></p></th><th align="left"><p><italic>Pre-test</italic></p></th><th align="left"><p><italic>Post-test</italic></p></th><th align="left"><p><italic>3 month follow-up</italic></p></th></tr></thead><tbody><tr><td align="left"><p><italic>Child-report</italic></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>PCSC</p></td><td align="left"><p>53.90 (11.94)</p></td><td align="left"><p>51.50 (13.60)</p></td><td align="left"><p>53.84 (11.71)</p></td><td align="left"><p>54.45 (12.13)</p></td><td align="left"><p>57.05 (12.96)</p></td><td align="left"><p>55.18 (9.24)</p></td></tr><tr><td align="left"><p>SCSC</p></td><td align="left"><p>32.90 (12.18)</p></td><td align="left"><p>34.35 (12.51)</p></td><td align="left"><p>32.95 (12.51)</p></td><td align="left"><p>36.15 (10.86)</p></td><td align="left"><p>38.75 (13.39)</p></td><td align="left"><p>36.59 (7.64)</p></td></tr><tr><td align="left"><p>SPP social competence</p></td><td align="left"><p>2.44 (0.73)</p></td><td align="left"><p>2.36 (0.74)</p></td><td align="left"><p>2.37 (0.74)</p></td><td align="left"><p>2.20 (0.68)</p></td><td align="left"><p>2.33 (0.74)</p></td><td align="left"><p>2.38 (0.33)</p></td></tr><tr><td align="left"><p>SPP close friendship</p></td><td align="left"><p>2.25 (0.81)</p></td><td align="left"><p>2.20 (0.83)</p></td><td align="left"><p>2.31 (0.70)</p></td><td align="left"><p>2.47 (0.58)</p></td><td align="left"><p>2.64 (0.64)</p></td><td align="left"><p>2.55 (0.77)</p></td></tr><tr><td align="left"><p>ITPQ</p></td><td align="left"><p>3.11 (1.13)</p></td><td align="left"><p>2.95 (1.24)</p></td><td align="left"><p>3.05 (1.17)</p></td><td align="left"><p>3.56 (1.00)</p></td><td align="left"><p>3.01 (1.33)</p></td><td align="left"><p>3.18 (1.11)</p></td></tr><tr><td align="left"><p>CDI-2</p></td><td align="left"><p>59.25 (11.37)</p></td><td align="left"><p>-</p></td><td align="left"><p>60.68 (13.20)</p></td><td align="left"><p>55.65 (11.98)</p></td><td align="left"><p>-</p></td><td align="left"><p>54.35 (11.27)</p></td></tr><tr><td align="left"><p>MASC-2</p></td><td align="left"><p>64.25 (13.30)</p></td><td align="left"><p>-</p></td><td align="left"><p>64.95 (14.02)</p></td><td align="left"><p>60.20 (11.93)</p></td><td align="left"><p>-</p></td><td align="left"><p>61.53 (10.44)</p></td></tr><tr><td align="left"><p>BRIEF-2 ERI</p></td><td align="left"><p>61.79 (11.94)</p></td><td align="left"><p>-</p></td><td align="left"><p>63.84 (12.18)</p></td><td align="left"><p>59.80 (10.81)</p></td><td align="left"><p>-</p></td><td align="left"><p>61.47 (9.33)</p></td></tr><tr><td align="left"><p><italic>Parent-report</italic></p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left"><p>CDI-2</p></td><td align="left"><p>61.50 (12.22)</p></td><td align="left"><p>-</p></td><td align="left"><p>62.16 (11.99)</p></td><td align="left"><p>61.50 (9.48)</p></td><td align="left"><p>-</p></td><td align="left"><p>60.76 (9.63)</p></td></tr><tr><td align="left"><p>MASC-2</p></td><td align="left"><p>61.95 (15.49)</p></td><td align="left" /><td align="left"><p>63.58 (15.03)</p></td><td align="left"><p>68.75 (17.35)</p></td><td align="left"><p>-</p></td><td align="left"><p>67.53 (15.38)</p></td></tr><tr><td align="left"><p>BRIEF-2 ERI</p></td><td align="left"><p>63.15 (16.10)</p></td><td align="left"><p>-</p></td><td align="left"><p>70.42 (12.01)</p></td><td align="left"><p>65.75 (12.73)</p></td><td align="left"><p>-</p></td><td align="left"><p>65.41 (9.27)</p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph> PCSC = Primary Control Scale for Children; SCSC = Secondary Control Scale for Children; SPP = The Self Perception Profile; ITPQ = Implicit Personality Theory Questionnaire; CDI-2 = Children's Depression Inventory-2; MASC-2 = Multidimensional Anxiety Scale for Children-2; BRIEF-2 = Behavior Rating Inventory of Executive Function-2; ERI = Emotional Regulation Index</p> <hd id="AN0187434581-20">Feasibility and Fidelity</hd> <p>Of the 109 adolescents recruited for participation, 40 (37%) were randomized while 26 (24%) declined to participate (see Fig. 1). All participants completed the intervention independently, and without support from research staff (though research staff were available via Zoom throughout intervention administration), through the web-based format. Only one participant requested a break during the session. All adolescents reported that they were able to comprehend the intervention; they largely reported enjoying the intervention (M = 7.83, SD = 1.14). The most common aspects that participants reported enjoying were the stories and learning about the brain. No participants suggested improvements or modifications to the intervention. Completion time for the intervention ranged from 8 to 67 min. On average, participants completed the intervention in 28 min. This is consistent with prior work in non-autistic adolescents (Schleider & Weisz, [<reflink idref="bib48" id="ref79">48</reflink>], [<reflink idref="bib50" id="ref80">50</reflink>]). The intervention was delivered with 100% fidelity. All participants completed the entirety of the digital content and there were no technical errors that prevented participants from accessing any of the content. Overall, all participants completed pre- and post-test assessments, while 37 (92.5%) completed 3-month follow up.</p> <hd id="AN0187434581-21">Perceived Control</hd> <p>Youth receiving Project Personality reported significantly greater increases in perceived primary control at post-test than did youth in the active control condition (see Table 3). For youth in the Project Personality group, increases in perceived primary control reflected a 73.28% chance of being higher at post- versus pre-intervention (<emph>d</emph><subs><emph>z</emph></subs> = 0.62). For youth in the active control group, decreases in perceived primary control reflected a 68.09% chance of being lower at post- versus pre-intervention (<emph>d</emph><subs><emph>z</emph></subs> = 0.47). There were no group differences regarding changes in perceived secondary control or primary control at 3-month follow up (see Table 3).</p> <p>Table 3 Hierarchical regression modeling of child-reported intervention outcomes</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Outcome</p></th><th align="left"><p>Predictor</p></th><th align="left"><p>B (SE)</p></th><th align="left"><p>95% CI</p></th><th align="left"><p>t</p></th><th align="left"><p>p</p></th></tr></thead><tbody><tr><td align="left"><p>PCSC (post-test)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>-4.23 (3.58)</p></td><td align="left"><p>-11.49–3.03</p></td><td align="left"><p>-1.18</p></td><td align="left"><p>0.245</p></td></tr><tr><td align="left" /><td align="left"><p>PCSC (pre-test)</p></td><td align="left"><p>1.03 (0.06)</p></td><td align="left"><p>0.91–1.16</p></td><td align="left"><p>16.28</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>4.98 (1.49)</p></td><td align="left"><p>1.96–8.00</p></td><td align="left"><p>3.34</p></td><td align="left"><p><bold>0.002</bold></p></td></tr><tr><td align="left"><p>PCSC (follow up)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>12.11 (5.51)</p></td><td align="left"><p>0.90–23.31</p></td><td align="left"><p>2.20</p></td><td align="left"><p>0.035</p></td></tr><tr><td align="left" /><td align="left"><p>PCSC (pre-test)</p></td><td align="left"><p>0.76 (0.10)</p></td><td align="left"><p>0.56–0.95</p></td><td align="left"><p>7.86</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>2.95 (2.13)</p></td><td align="left"><p>-1.39–7.30</p></td><td align="left"><p>1.38</p></td><td align="left"><p>0.175</p></td></tr><tr><td align="left"><p>SCSC (post-test)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>0.05 (2.50)</p></td><td align="left"><p>-5.02–5.12</p></td><td align="left"><p>0.02</p></td><td align="left"><p>0.984</p></td></tr><tr><td align="left" /><td align="left"><p>SCSC (pre-test)</p></td><td align="left"><p>1.04 (0.07)</p></td><td align="left"><p>0.90–1.18</p></td><td align="left"><p>15.22</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>1.01 (1.56)</p></td><td align="left"><p>-2.14–4.17</p></td><td align="left"><p>0.65</p></td><td align="left"><p>0.520</p></td></tr><tr><td align="left"><p>SCSC (follow up)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>9.98 (3.91)</p></td><td align="left"><p>2.02–17.94</p></td><td align="left"><p>2.55</p></td><td align="left"><p>0.016</p></td></tr><tr><td align="left" /><td align="left"><p>SCSC (pre-test)</p></td><td align="left"><p>0.68 (0.11)</p></td><td align="left"><p>0.46–0.89</p></td><td align="left"><p>6.45</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>2.74 (2.37)</p></td><td align="left"><p>-2.09–7.56</p></td><td align="left"><p>1.15</p></td><td align="left"><p>0.257</p></td></tr><tr><td align="left"><p>SPP social competence (post-test)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>0.00 (0.17)</p></td><td align="left"><p>-0.35–0.35</p></td><td align="left"><p>0.01</p></td><td align="left"><p>0.990</p></td></tr><tr><td align="left" /><td align="left"><p>SPP social competence (pre-test)</p></td><td align="left"><p>0.97 (0.07)</p></td><td align="left"><p>0.84–1.10</p></td><td align="left"><p>14.78</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>0.19 (0.09)</p></td><td align="left"><p>0.01–0.38</p></td><td align="left"><p>2.13</p></td><td align="left"><p><bold>0.040</bold></p></td></tr><tr><td align="left"><p>SPP social competence (follow up)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>0.90 (0.26)</p></td><td align="left"><p>0.37–1.43</p></td><td align="left"><p>3.45</p></td><td align="left"><p>0.002</p></td></tr><tr><td align="left" /><td align="left"><p>SPP social competence (pre-test)</p></td><td align="left"><p>0.59 (0.10)</p></td><td align="left"><p>0.39–0.79</p></td><td align="left"><p>6.06</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>0.21 (0.14)</p></td><td align="left"><p>-0.08–0.49</p></td><td align="left"><p>1.48</p></td><td align="left"><p>0.148</p></td></tr><tr><td align="left"><p>SPP close friendship (post-test)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>0.21 (0.28)</p></td><td align="left"><p>-0.36–0.78</p></td><td align="left"><p>0.75</p></td><td align="left"><p>0.460</p></td></tr><tr><td align="left" /><td align="left"><p>SPP close friendship (pre-test)</p></td><td align="left"><p>0.88 (0.11)</p></td><td align="left"><p>0.65–1.12</p></td><td align="left"><p>7.73</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>0.25 (0.16)</p></td><td align="left"><p>-0.07–0.57</p></td><td align="left"><p>1.59</p></td><td align="left"><p>0.125</p></td></tr><tr><td align="left"><p>SPP close friendship (follow up)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>0.98 (0.45)</p></td><td align="left"><p>0.06–1.91</p></td><td align="left"><p>2.21</p></td><td align="left"><p>0.038</p></td></tr><tr><td align="left" /><td align="left"><p>SPP close friendship (pre-test)</p></td><td align="left"><p>0.56 (0.18)</p></td><td align="left"><p>0.19–0.93</p></td><td align="left"><p>3.12</p></td><td align="left"><p>0.005</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>0.20 (0.26)</p></td><td align="left"><p>-0.33–0.73</p></td><td align="left"><p>0.77</p></td><td align="left"><p>0.447</p></td></tr><tr><td align="left"><p>ITPQ (post-test)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>-0.32 (0.32)</p></td><td align="left"><p>-0.98–0.33</p></td><td align="left"><p>-1.00</p></td><td align="left"><p>0.325</p></td></tr><tr><td align="left" /><td align="left"><p>ITPQ (pre-test)</p></td><td align="left"><p>1.05 (0.09)</p></td><td align="left"><p>0.86–1.24</p></td><td align="left"><p>11.15</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>-0.42 (0.20)</p></td><td align="left"><p>-0.82 – -0.01</p></td><td align="left"><p>-2.06</p></td><td align="left"><p><bold>0.046</bold></p></td></tr><tr><td align="left"><p>ITPQ (follow up)</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>0.84 (0.50)</p></td><td align="left"><p>-0.18–1.86</p></td><td align="left"><p>1.68</p></td><td align="left"><p>0.102</p></td></tr><tr><td align="left" /><td align="left"><p>ITPQ (pre-test)</p></td><td align="left"><p>0.72 (0.15)</p></td><td align="left"><p>0.42–1.02</p></td><td align="left"><p>4.84</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>-0.36 (0.31)</p></td><td align="left"><p>-0.99–0.28</p></td><td align="left"><p>-1.14</p></td><td align="left"><p>0.263</p></td></tr><tr><td align="left"><p>CDI-2</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>8.59 (5.90)</p></td><td align="left"><p>-3.42–20.61</p></td><td align="left"><p>1.46</p></td><td align="left"><p>0.155</p></td></tr><tr><td align="left" /><td align="left"><p>CDI-2 (pre-test)</p></td><td align="left"><p>0.89 (0.10)</p></td><td align="left"><p>0.69–1.08</p></td><td align="left"><p>9.13</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>-4.80 (2.23)</p></td><td align="left"><p>-9.34 – -0.26</p></td><td align="left"><p>-2.15</p></td><td align="left"><p><bold>0.039</bold></p></td></tr><tr><td align="left"><p>MASC-2</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>9.96 (5.40)</p></td><td align="left"><p>-1.02–20.93</p></td><td align="left"><p>1.84</p></td><td align="left"><p>0.074</p></td></tr><tr><td align="left" /><td align="left"><p>MASC-2 (pre-test)</p></td><td align="left"><p>0.85 (0.08)</p></td><td align="left"><p>0.69–1.02</p></td><td align="left"><p>10.55</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>-1.12 (2.03)</p></td><td align="left"><p>-5.26–3.01</p></td><td align="left"><p>-0.55</p></td><td align="left"><p>0.585</p></td></tr><tr><td align="left"><p>BRIEF-2 ERI</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>8.48 (5.67)</p></td><td align="left"><p>-3.08–20.04</p></td><td align="left"><p>1.49</p></td><td align="left"><p>0.145</p></td></tr><tr><td align="left" /><td align="left"><p>BRIEF-2 ERI (pre-test)</p></td><td align="left"><p>0.90 (0.09)</p></td><td align="left"><p>0.72–1.08</p></td><td align="left"><p>10.01</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>-3.33 (1.88)</p></td><td align="left"><p>-7.15–0.50</p></td><td align="left"><p>-1.77</p></td><td align="left"><p><bold>0.086</bold></p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph> PCSC = Primary Control Scale for Children; SCSC = Secondary Control Scale for Children; SPP = The Self Perception Profile; ITPQ = Implicit Personality Theory Questionnaire; CDI-2 = Children's Depression Inventory-2; MASC-2 = Multidimensional Anxiety Scale for Children-2; BRIEF-2 = Behavior Rating Inventory of Executive Function-2; BRI = Behavior Regulation Index; ERI = Emotional Regulation Index; GEC = Global Executive Composite. B = Unstandardized beta; SE = Standard error; 95% CI = 95% Confidence interval of the standardized coefficients</p> <hd id="AN0187434581-22">Self-Perception</hd> <p>Youth receiving Project Personality reported significantly greater increases in perceived social competence at post-test than did youth in the active control condition (see Table 3). For youth in the Project Personality group, increases in perceived social competence reflected a 63.74% chance of being higher at post- versus pre-intervention (<emph>d</emph><subs><emph>z</emph></subs> = 0.35). For youth in the active control group, decreases in perceived social competence reflected a 66.99% chance of being lower at post- versus pre-intervention (<emph>d</emph><subs><emph>z</emph></subs> = 0.44). There were no group differences in perceived close friendship or perceived social competence at 3-month follow up (see Table 3).</p> <p>Youth receiving Project Personality reported significantly greater increases in perceived malleability of personality at post-test than did youth in the active control condition (see Table 3). For youth in the Project Personality group, increases in perceived malleability of personality reflected a 76.39% chance of being higher at post- versus pre-intervention (<emph>d</emph><subs><emph>z</emph></subs> = 0.72). For youth in the active control group, decreases in perceived malleability of personality reflected a 64.67% chance of being lower at post- versus pre-intervention (<emph>d</emph><subs><emph>z</emph></subs> = 0.38). There were no group differences in perceived malleability of personality at 3-month follow up according to either child- or parent-report (see Tables 3 and 4).</p> <p>Table 4 Hierarchical regression modeling of parent-reported intervention outcomes at follow up</p> <p> <ephtml> <table frame="hsides" rules="groups"><thead><tr><th align="left"><p>Outcome</p></th><th align="left"><p>Predictor</p></th><th align="left"><p>B (SE)</p></th><th align="left"><p>95% CI</p></th><th align="left"><p>t</p></th><th align="left"><p>p</p></th></tr></thead><tbody><tr><td align="left"><p>CDI-2</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>11.75 (6.03)</p></td><td align="left"><p>-0.52–24.03</p></td><td align="left"><p>1.95</p></td><td align="left"><p>0.060</p></td></tr><tr><td align="left" /><td align="left"><p>CDI-2 (pre-test)</p></td><td align="left"><p>0.83 (0.10)</p></td><td align="left"><p>0.64–1.03</p></td><td align="left"><p>8.59</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>-2.02 (2.06)</p></td><td align="left"><p>-6.21–2.18</p></td><td align="left"><p>-0.98</p></td><td align="left"><p>0.335</p></td></tr><tr><td align="left"><p>MASC-2</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>13.53 (5.13)</p></td><td align="left"><p>3.08–23.97</p></td><td align="left"><p>2.63</p></td><td align="left"><p>0.013</p></td></tr><tr><td align="left" /><td align="left"><p>MASC-2 (pre-test)</p></td><td align="left"><p>0.80 (0.08)</p></td><td align="left"><p>0.64–0.96</p></td><td align="left"><p>10.35</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>-2.27 (2.57)</p></td><td align="left"><p>-7.50–2.96</p></td><td align="left"><p>-0.88</p></td><td align="left"><p>0.384</p></td></tr><tr><td align="left"><p>BRIEF-2 ERI</p></td><td align="left" /><td align="left" /><td align="left" /><td align="left" /><td align="left" /></tr><tr><td align="left" /><td align="left"><p>Intercept</p></td><td align="left"><p>31.82 (5.57)</p></td><td align="left"><p>20.49–43.15</p></td><td align="left"><p>5.71</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>BRIEF-2 ERI (pre-test)</p></td><td align="left"><p>0.61 (0.08)</p></td><td align="left"><p>0.44–0.78</p></td><td align="left"><p>7.22</p></td><td align="left"><p>< 0.001</p></td></tr><tr><td align="left" /><td align="left"><p>Project personality</p></td><td align="left"><p>-7.90 (2.31)</p></td><td align="left"><p>-12.61 – -3.20</p></td><td align="left"><p>-3.42</p></td><td align="left"><p><bold>0.002</bold></p></td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph> ITPQ = Implicit Personality Theory Questionnaire; CDI-2 = Children's Depression Inventory-2; MASC-2 = Multidimensional Anxiety Scale for Children-2; BRIEF-2 = Behavior Rating Inventory of Executive Function-2; BRI = Behavior Regulation Index; ERI = Emotional Regulation Index; GEC = Global Executive Composite. B = Unstandardized beta; SE = Standard error; 95% CI = 95% Confidence interval of the standardized coefficients</p> <hd id="AN0187434581-23">Internalizing Symptoms</hd> <p>Youth receiving Project Personality self-reported significantly greater reductions in depression symptoms at 3-month follow-up than did youth in the active control condition (see Table 3; Fig. 2a). For youth in the Project Personality group, depression symptoms showed a 69.13% chance of decreasing from pre-intervention to 3-month follow-up (<emph>d</emph><subs><emph>z</emph></subs> = 0.50). For youth in the active control group, an opposite trajectory emerged: depression symptoms showed a 59.76% chance of worsening from pre-intervention to 3-month follow-up (<emph>d</emph><subs><emph>z</emph></subs> = 0.25). There were no group differences in parent-reported depression symptoms or child and parent-reported symptoms of anxiety (see Tables 3 and 4).</p> <p>Graph: Fig. 2 Difference scores calculated as the change between pre-test and three-month follow up on the (a) child-report version of the Children's Depression Index-2 (CDI-2) and the (b) parent-report version of the Behavior Rating Inventory of Executive Function-2 (BRIEF-2) Emotional Regulation Index (ERI) stratified by intervention group</p> <hd id="AN0187434581-24">Emotional Regulation</hd> <p>Youth receiving Project Personality self-reported marginally greater improvements in emotional regulation at 3-month follow-up than did youth in the active control condition (see Table 3). For youth in the Project Personality group, emotional regulation challenges showed a 56.99% chance of <emph>decreasing</emph> from pre-intervention to 3-month follow-up (<emph>d</emph><subs><emph>z</emph></subs> = 0.18). For youth in the active control group, emotional regulation challenges showed a 68.02% chance of <emph>worsening</emph> from pre-intervention to 3-month follow-up (<emph>d</emph><subs><emph>z</emph></subs> = 0.47).</p> <p>Parents of youth receiving Project Personality reported significantly greater improvements in emotional regulation at 3-month follow-up than did parents of youth in the active control condition (see Table 4; Fig. 2b). For youth in the Project Personality group, emotional regulation challenges reflected a 65.63% chance of decreasing from pre-intervention to 3-month follow-up (<emph>d</emph><subs><emph>z</emph></subs> = 0.40). For youth in the active control group, emotion regulation challenges showed a 75.88% chance of increasing from pre-intervention to 3-month follow-up (<emph>d</emph><subs><emph>z</emph></subs> = 0.70).</p> <hd id="AN0187434581-25">Discussion</hd> <p>This was the first pilot RCT of a GM-SSI intended to address internalizing symptoms in autistic youth. Consistent with our hypotheses, we found improvements in perceived primary control, malleability of personality, and social competence relative to the active control group immediately post-intervention. Further, our results revealed improvements in self-reported depression symptoms and parent reported emotional regulation at 3-month follow up. However, we did not find any treatment effects on symptoms of anxiety. These results suggest that a GM-SSI designed for non-autistic youth demonstrates considerable promise in alleviating some key co-occurring symptoms in autistic adolescents. Nonetheless, our findings also suggest the need to adapt treatment specifically to the needs of autistic youth to maximize benefits.</p> <hd id="AN0187434581-26">Feasibility and Fidelity</hd> <p>Project Personality demonstrated strong feasibility for use with autistic youth. Participants in the study were all able to complete the intervention independently and in a comparable amount of time to non-autistic youth. Further, participants generally reported enjoying the intervention. In addition, a strength of this intervention that it can be easily delivered with 100% fidelity. Thus, it has strong potential as a scalable and low-intensity intervention for autistic youth.</p> <hd id="AN0187434581-27">Proximal Outcomes</hd> <p>We found improvements immediately post-intervention in several key outcomes including perceived primary control, malleability of personality, and perceived social competence. Prior research has identified these as proximal intervention targets that demonstrated a relationship with greater improvements in internalizing symptoms in non-autistic adolescents (Schleider et al., [<reflink idref="bib51" id="ref81">51</reflink>]). Thus, it appears that a GM-SSI designed for non-autistic youth produces similarly positive effects at post-intervention compared to non-autistic youth, at least in the short term. In contrast to non-autistic youth, who demonstrated changes in perceived primary control up to nine months post-intervention (Schleider & Weisz, [<reflink idref="bib50" id="ref82">50</reflink>]), we found no intervention effects in key proximal targets at 3-month follow up. This indicates that although autistic youth were able to grasp the key concepts of the intervention, they had difficulty explicitly maintaining this mindset three months later. This suggests that autistic youth may require an additional session or reminders (e.g., supportive text messages), which have bolstered the benefits of growth mindset interventions in other contexts (e.g., Hecht et al., [<reflink idref="bib15" id="ref83">15</reflink>]), to facilitate maintenance of treatment gains. Alternatively, the initial SSI may require adaptation to better fit the learning and processing needs and preferences of autistic adolescents.</p> <hd id="AN0187434581-28">Internalizing Symptoms and Emotional Regulation</hd> <p>Our results also demonstrated greater improvements at 3-month follow up in several clinical outcomes, such as symptoms of depression and emotion regulation skills, in the Project Personality group relative to the active control group. This is consistent with previous research in non-autistic adolescents (Schleider et al., [<reflink idref="bib54" id="ref84">54</reflink>]; Schleider & Weisz, [<reflink idref="bib48" id="ref85">48</reflink>], [<reflink idref="bib49" id="ref86">49</reflink>], [<reflink idref="bib50" id="ref87">50</reflink>]) and suggests that the current intervention shows considerable promise for use with autistic adolescents. Further, effect sizes seen in the pilot RCT are comparable or larger than what has been shown previously for non-autistic youth. Importantly, adolescents reported improvement in depression symptoms while their caregivers reported improvements in emotional regulation. This highlights the need to be sensitive to issues of informant discrepancy in interpreting results in the context of clinical trials (e.g., De Los Reyes, [<reflink idref="bib5" id="ref88">5</reflink>]; De Los Reyes et al., [<reflink idref="bib6" id="ref89">6</reflink>]). Nonetheless, there is relatively little extant research on treatment of depression in autistic youth (Kim & Lecavalier, [<reflink idref="bib26" id="ref90">26</reflink>]) despite the considerable impact of depression on autistic adolescents (Greenlee et al., [<reflink idref="bib11" id="ref91">11</reflink>]; Kaat et al., [<reflink idref="bib17" id="ref92">17</reflink>]). Therefore, a cost-effective and scalable treatment has the potential for substantial impact, especially for youth who have limited access to mental health services or who prefer to engage with online, self-guided mental health supports.</p> <p>Despite improvements in proximal targets, such as perceived primary control, we did not find parent- or child-reported improvements in anxiety symptoms relative to the active control group at 3-month follow up. This suggests that Project Personality alone may not produce downstream improvements in anxiety in the same way that it does for non-autistic youth (Schleider & Weisz, [<reflink idref="bib50" id="ref93">50</reflink>]). However, autistic youth often exhibit atypical patterns of anxiety (Kerns & Kendall, [<reflink idref="bib23" id="ref94">23</reflink>]; Kerns et al., [<reflink idref="bib24" id="ref95">24</reflink>]), and tend to under-report their anxiety (Kalvin et al., [<reflink idref="bib18" id="ref96">18</reflink>]; White et al., [<reflink idref="bib67" id="ref97">67</reflink>]). Thus, it is possible that by utilizing a questionnaire not designed for autistic youth, we may not be picking up changes in participants' anxiety (Moskowitz & Braconnier, [<reflink idref="bib38" id="ref98">38</reflink>]). Alternatively, improvements in anxiety often require behavior change (e.g., decreased avoidance of anxiety-provoking situations), which is not explicitly promoted in Project Personality. It may be the case that autistic youth have difficulty making the connection between improved perceived control and making behavioral changes to reduce their anxiety in the same way as their non-autistic peers. Thus, Project Personality may be more effective for anxiety in autistic youth if supplemented with a parent component (e.g., Sung et al., [<reflink idref="bib57" id="ref99">57</reflink>]) or with modifications that make these connections to behavior change more explicitly (e.g., Schleider, Dobias, Sung, Mumper et al., [<reflink idref="bib53" id="ref100">53</reflink>]; Schleider et al., [<reflink idref="bib54" id="ref101">54</reflink>]). These results highlight how an intervention developed for non-autistic youth may not be as effective for autistic youth and require targeted modification specific to the needs of autistic youth.</p> <hd id="AN0187434581-29">Clinical Implications</hd> <p>Rates of co-occurring internalizing symptoms in autistic youth are staggering (Simonoff et al., [<reflink idref="bib55" id="ref102">55</reflink>]) and interventions to address them are often costly and time intensive (Buescher et al., [<reflink idref="bib4" id="ref103">4</reflink>]; Perihan et al., [<reflink idref="bib44" id="ref104">44</reflink>]). Further, autistic youth from certain racial and ethnic groups, as well as geographic areas, experience restricted availability of resources (Liu et al., [<reflink idref="bib31" id="ref105">31</reflink>]). This highlights the considerable need for scalable and lower-intensity treatment options for autistic youth (Libsack et al., [<reflink idref="bib30" id="ref106">30</reflink>]). Project Personality is a GM-SSI that shows promise for improving depression symptoms and emotion regulation skills in autistic adolescents. It can be delivered entirely online and without therapist guidance. Although effect sizes in this sample were small effects, they may still be clinically meaningful at an individual level. This is particularly true if the treatment has a preventive effect against worsening of symptoms or prompts youth to seek additional therapeutic treatment. Further, even small effects can have a clinically meaningful public health impact. Thus, Project Personality holds great potential both as a frontline intervention for under-resourced youth, as well as a supplemental intervention that is highly scalable and low intensity.</p> <hd id="AN0187434581-30">Limitations</hd> <p>Results must be interpreted in the context of several limitations. First, this was a relatively small pilot study, and some effect sizes may have been too small to detect in this sample. In addition, there were no specific requirement for internalizing symptoms and thus depression and anxiety symptoms in this sample are in the average and slightly elevated ranges respectively. Further, our recruitment process was driven by parents, rather than adolescents, which may have biased the sample towards teens with less treatment motivation. Therefore, these findings need to be replicated in larger samples and targeted to youth with high levels of internalizing symptoms. In addition, due to the impact of COVID-19, initial participants completed the intervention in-person, while the rest of the sample completed it entirely online. Our sample size was too small to examine differences, but future research should consider whether effect sizes differ when completed entirely online. Given that this intervention is entirely verbally mediated, future research should also consider the impact of age and verbal ability on outcomes. Finally, while the cognitive and diagnostic assessments were typically completed within a few months of the intervention, this was not always the case.</p> <hd id="AN0187434581-31">Future Directions</hd> <p>Project Personality demonstrated potential to improve symptoms of depression and emotional regulation for autistic adolescents. Future research should replicate this work in larger and more diverse samples, which will also allow for an examination of treatment moderators. In addition, researchers should consider how this intervention may be modified for autistic youth. This could include modifying the content or adding additional sessions to improve results for autistic youth. Further, it will be important to examine the maintenance of proximal effects to determine optimal timing for a potential supplemental intervention session. Lastly, given the impact on perceived control and other proximal outcomes at post-intervention, future work should consider the use of Project Personality or other GM-SSIs as a precursor or primer for additional intervention that builds on improvements in these areas.</p> <hd id="AN0187434581-32">Summary</hd> <p>In conclusion, this study was the first to assess the impact of a GM-SSI designed to treat internalizing symptoms in non-autistic youth on autistic adolescents. Results are consistent with findings in non-autistic adolescents, indicating post-intervention improvements in perceived control and downstream improvements in depression. Nonetheless, we did not find improvements in symptoms of anxiety, suggesting that autistic adolescents may require modifications to the intervention to maximize their benefit in this area. This intervention can easily be delivered at scale, and at low cost, making even small effects meaningful from a public health perspective. Ultimately, our findings demonstrate the utility of GM-SSI for internalizing symptoms for autistic youth and hold considerable promise as a low-intensity and scalable intervention for autistic adolescents.</p> <p> <bold>Acknowledgements</bold>.</p> <hd id="AN0187434581-33">Funding</hd> <p>This research was supported by grants from the Autism Research Institute and Society for Clinical Child & Adolescent Psychology to MDL as well as a grant from Autism Science Foundation to AN. In addition, effort by AG was supported by an NIMH T32 Fellowship (MH18268). JLS has received funding from the National Institute of Health Office of the Director (DP5OD028123), National Institute of Mental Health (R43MH128075), the Upswing Fund for Adolescent Mental Health, the National Science Foundation (2141710), Health Research and Services Association (U3NHP45406-01-00), the Society for Clinical Child and Adolescent Psychology, HopeLab, Kooth, Child Mind Institute, TRAILS to Wellness, and the Klingenstein Third Generation Foundation. Preparation of this article was supported in part by the Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from the National Institute of Mental Health (R25MH080916; JLS is an IRI Fellow). MDL was supported by the National Institute of Mental Health (R01MH110585 [PI: Lerner]) in the course of preparing this manuscript. The authors wish to thank all the participating families and staff for their time and effort.</p> <hd id="AN0187434581-34">Declarations</hd> <p></p> <hd id="AN0187434581-35">Ethical Approval</hd> <p>All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.</p> <hd id="AN0187434581-36">Informed Consent</hd> <p>Informed consent was obtained from all individual participants included in the study.</p> <hd id="AN0187434581-37">Conflict of Interest</hd> <p>MDL is an associate editor for JADD, but was not involved in the editorial process. JLS serves on the Scientific Advisory Board for Walden Wise and the Clinical Advisory Board for Koko; has provided consultation services to Kooth, Optum/UnitedHealth, and Woebot Health, LLC; is Co-Founder and Co-Director of Single Session Support Solutions; and receives book royalties from New Harbinger, Oxford University Press, and Little Brown Book Group. All other authors have declared that they have no competing or potential conflicts of interest.</p> <hd id="AN0187434581-38">Publisher's Note</hd> <p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p> <ref id="AN0187434581-39"> <title> References </title> <blist> <bibl id="bib1" idref="ref50" type="bt">1</bibl> <bibtext> Aronson E. The power of self-persuasion. 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  Data: <searchLink fieldCode="AR" term="%22Alan+H%2E+Gerber%22">Alan H. Gerber</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-8133-3995">0000-0002-8133-3995</externalLink>)<br /><searchLink fieldCode="AR" term="%22Allison+Nahmias%22">Allison Nahmias</searchLink><br /><searchLink fieldCode="AR" term="%22Jessica+L%2E+Schleider%22">Jessica L. Schleider</searchLink><br /><searchLink fieldCode="AR" term="%22Matthew+D%2E+Lerner%22">Matthew D. Lerner</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Autism+and+Developmental+Disorders%22"><i>Journal of Autism and Developmental Disorders</i></searchLink>. 2025 55(9):3050-3064.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Springer. Available from: Springer Nature. One New York Plaza, Suite 4600, New York, NY 10004. Tel: 800-777-4643; Tel: 212-460-1500; Fax: 212-460-1700; e-mail: customerservice@springernature.com; Web site: https://link.springer.com/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: SourceSuprt
  Label: Sponsoring Agency
  Group: SrcSuprt
  Data: National Institute of Mental Health (NIMH) (DHHS/NIH)<br />Office of the Director (OD) (DHHS/NIH)<br />National Science Foundation (NSF)<br />Health Resources and Services Administration (HRSA) (DHHS)
– Name: NumberContract
  Label: Contract Number
  Group: NumCntrct
  Data: MH18268<br />DP5OD028123
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Symptoms+%28Individual+Disorders%29%22">Symptoms (Individual Disorders)</searchLink><br /><searchLink fieldCode="DE" term="%22Comorbidity%22">Comorbidity</searchLink><br /><searchLink fieldCode="DE" term="%22Adolescents%22">Adolescents</searchLink><br /><searchLink fieldCode="DE" term="%22Personality%22">Personality</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Competence%22">Interpersonal Competence</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Depression+%28Psychology%29%22">Depression (Psychology)</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Control%22">Self Control</searchLink><br /><searchLink fieldCode="DE" term="%22Anxiety%22">Anxiety</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1007/s10803-024-06341-2
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0162-3257<br />1573-3432
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Autistic youth experience elevated rates of co-occurring internalizing symptoms. Interventions to treat internalizing symptoms in autistic youth are almost uniformly costly and time-intensive, blunting dissemination of intervention and highlighting the need for scalable solutions. One promising option is a relatively new class of evidence-based treatments, single-session interventions (SSIs), however, no study has examined SSIs for depression symptoms in autistic youth. Participants included 40 autistic adolescents ranging in age from 11 to 16 (M[subscript age] = 14.22, N[subscript male] = 32). Eligible youth who agreed to participate were randomized to either the active intervention (Project Personality), or an active control designed to mimic supportive therapy. Participants and their caregiver completed questionnaires immediately before, after, and three months post intervention. All participants completed the intervention independently and largely reported enjoying it. The intervention was delivered with 100% fidelity. Findings demonstrated improvements in perceived primary control, malleability of personality, and social competence relative to the active control group immediately post-intervention. Further, results revealed improvements in self-reported depression symptoms and parent reported emotional regulation at 3-month follow up. This study was the first to assess a GM-SSI designed to treat depression symptoms in autistic adolescents. Results indicated improvements in perceived control immediately post-intervention and downstream improvements in depression. Nonetheless, we did not find improvements in symptoms of anxiety, suggesting that autistic adolescents may require modifications to the intervention to maximize benefit. Findings demonstrate the utility of GM-SSI for internalizing symptoms for autistic youth and hold considerable promise as a low-intensity and scalable intervention.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1481204
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1481204
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  BibEntity:
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      – Type: doi
        Value: 10.1007/s10803-024-06341-2
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 3050
    Subjects:
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Symptoms (Individual Disorders)
        Type: general
      – SubjectFull: Comorbidity
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Personality
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      – SubjectFull: Interpersonal Competence
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      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Depression (Psychology)
        Type: general
      – SubjectFull: Self Control
        Type: general
      – SubjectFull: Anxiety
        Type: general
    Titles:
      – TitleFull: Results from a Pilot Randomized Controlled Trial of a Single-Session Growth-Mindset Intervention for Internalizing Symptoms in Autistic Youth
        Type: main
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            NameFull: Allison Nahmias
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            – D: 01
              M: 09
              Type: published
              Y: 2025
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            – Type: issn-print
              Value: 0162-3257
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              Value: 55
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              Value: 9
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            – TitleFull: Journal of Autism and Developmental Disorders
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