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Closing the Gap: A Randomized Trial Targeting Daily Living Skills in Autistic Adolescents

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Title: Closing the Gap: A Randomized Trial Targeting Daily Living Skills in Autistic Adolescents
Language: English
Authors: Amie Duncan (ORCID 0000-0002-6317-4302), Jareen Meinzen-Derr, Lisa Ruble, Carrie Fassler, Lori J. Stark
Source: Focus on Autism and Other Developmental Disabilities. 2026 41(1):3-15.
Availability: SAGE Publications and Hammill Institute on Disabilities. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
Peer Reviewed: Y
Page Count: 13
Publication Date: 2026
Sponsoring Agency: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (DHHS/NIH)
Contract Number: K23HD09485501A1
Document Type: Journal Articles
Reports - Research
Education Level: High Schools
Secondary Education
Grade 9
Junior High Schools
Middle Schools
Grade 10
Descriptors: Autism Spectrum Disorders, Adolescents, Daily Living Skills, Program Effectiveness, Intervention, High School Students, Grade 9, Grade 10, Student Characteristics, Attendance, Homework, Satisfaction
Assessment and Survey Identifiers: Vineland Adaptive Behavior Scales, Goal Attainment Scale, Autism Diagnostic Observation Schedule, Wechsler Abbreviated Scale of Intelligence
DOI: 10.1177/10883576251355188
ISSN: 1088-3576
1538-4829
Abstract: Autistic adolescents without an intellectual disability (ID) have daily living skills (DLS) that are approximately 6 years below peers. This study evaluated the efficacy of the Surviving and Thriving in the Real World (STRW) intervention, which targets DLS, compared to an active control group. Autistic adolescents were randomized to STRW or control. The primary outcome was the caregiver-reported Vineland Adaptive Behavior Scales, 3rd Edition (VABS-3) DLS domain and Personal, Domestic, and Community sub-domains. The secondary outcome was DLS Goal Attainment Scaling (DLS-GAS) caregiver interview. Compared to control (n = 22), autistic teens in STRW (n = 26) made significant improvements on the VABS-3 DLS domain (p = 0.04) and Domestic sub-domain (p = 0.01) and the DLS-GAS areas of Cooking, Laundry, and Money Management (all p's < 0.05). STRW narrowed the gap between DLS and age as autistic adolescents acquired age-appropriate domestic, personal, and community DLS compared to the control group.
Abstractor: As Provided
Entry Date: 2026
Accession Number: EJ1496471
Database: ERIC
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  Value: &lt;anid&gt;AN0191101964;fdd01mar.26;2026Jan28.00:49;v2.2.500&lt;/anid&gt; &lt;title id=&quot;AN0191101964-1&quot;&gt;Closing the Gap: A Randomized Trial Targeting Daily Living Skills in Autistic Adolescents&#160;&lt;/title&gt; &lt;p&gt;Autistic adolescents without an intellectual disability (ID) have daily living skills (DLS) that are approximately 6 years below peers. This study evaluated the efficacy of the Surviving and Thriving in the Real World (STRW) intervention, which targets DLS, compared to an active control group. Autistic adolescents were randomized to STRW or control. The primary outcome was the caregiver-reported Vineland Adaptive Behavior Scales, 3rd Edition (VABS-3) DLS domain and Personal, Domestic, and Community sub-domains. The secondary outcome was DLS Goal Attainment Scaling (DLS-GAS) caregiver interview. Compared to control (n = 22), autistic teens in STRW (n = 26) made significant improvements on the VABS-3 DLS domain (p =.04) and Domestic sub-domain (p =.01) and the DLS-GAS areas of Cooking, Laundry, and Money Management (all p &#39;s &amp;lt;.05). STRW narrowed the gap between DLS and age as autistic adolescents acquired age-appropriate domestic, personal, and community DLS compared to the control group.&lt;/p&gt; &lt;p&gt;Keywords: autism spectrum disorder; adaptive behavior; daily living skills; adolescence&lt;/p&gt; &lt;p&gt;While individuals with autism spectrum disorder (ASD) have impaired social-communication skills and restricted and repetitive behaviors and interests ([&lt;reflink idref=&quot;bib2&quot; id=&quot;ref1&quot;&gt;2&lt;/reflink&gt;]), they also often have significant challenges in acquiring age appropriate daily living skills (DLS) ([&lt;reflink idref=&quot;bib9&quot; id=&quot;ref2&quot;&gt;9&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib18&quot; id=&quot;ref3&quot;&gt;18&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib43&quot; id=&quot;ref4&quot;&gt;43&lt;/reflink&gt;]). DLS are a component of adaptive behavior and are the essential, everyday tasks that a person does to take care of themselves at home, school, work, and in the community ([&lt;reflink idref=&quot;bib35&quot; id=&quot;ref5&quot;&gt;35&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib45&quot; id=&quot;ref6&quot;&gt;45&lt;/reflink&gt;]). DLS are often categorized into the areas of personal (e.g., hygiene and self-care tasks, taking medications, managing one&#39;s health), domestic (e.g., household chores, cooking, cleaning, doing laundry), and community (e.g., purchasing items, using a checking/savings account, budgeting for expenses, navigating around the community) ([&lt;reflink idref=&quot;bib46&quot; id=&quot;ref7&quot;&gt;46&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;Deficits in DLS emerge in preschool-age autistic children and persist into childhood, adolescence, and adulthood ([&lt;reflink idref=&quot;bib3&quot; id=&quot;ref8&quot;&gt;3&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib5&quot; id=&quot;ref9&quot;&gt;5&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib9&quot; id=&quot;ref10&quot;&gt;9&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib43&quot; id=&quot;ref11&quot;&gt;43&lt;/reflink&gt;]). In autistic individuals, higher DLS have been consistently linked to increased chronological age ([&lt;reflink idref=&quot;bib9&quot; id=&quot;ref12&quot;&gt;9&lt;/reflink&gt;]), increased age at diagnosis ([&lt;reflink idref=&quot;bib1&quot; id=&quot;ref13&quot;&gt;1&lt;/reflink&gt;]), higher cognitive abilities (i.e., IQ; [&lt;reflink idref=&quot;bib5&quot; id=&quot;ref14&quot;&gt;5&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib9&quot; id=&quot;ref15&quot;&gt;9&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib17&quot; id=&quot;ref16&quot;&gt;17&lt;/reflink&gt;]), better developed language skills ([&lt;reflink idref=&quot;bib5&quot; id=&quot;ref17&quot;&gt;5&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib9&quot; id=&quot;ref18&quot;&gt;9&lt;/reflink&gt;]), and better developed social-communication skills ([&lt;reflink idref=&quot;bib5&quot; id=&quot;ref19&quot;&gt;5&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib17&quot; id=&quot;ref20&quot;&gt;17&lt;/reflink&gt;]). While individuals with ASD do develop DLS over time, acquisition of DLS is slower compared to typically developing children and children with non-spectrum diagnoses ([&lt;reflink idref=&quot;bib5&quot; id=&quot;ref21&quot;&gt;5&lt;/reflink&gt;]) and DLS may even regress in adulthood ([&lt;reflink idref=&quot;bib5&quot; id=&quot;ref22&quot;&gt;5&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib7&quot; id=&quot;ref23&quot;&gt;7&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib32&quot; id=&quot;ref24&quot;&gt;32&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib43&quot; id=&quot;ref25&quot;&gt;43&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;Over 50% of autistic individuals do not have an intellectual disability (ID; [&lt;reflink idref=&quot;bib4&quot; id=&quot;ref26&quot;&gt;4&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib30&quot; id=&quot;ref27&quot;&gt;30&lt;/reflink&gt;]), and are more likely to have a larger gap between their IQ and DLS compared to autistic individuals with a co-occurring ID ([&lt;reflink idref=&quot;bib5&quot; id=&quot;ref28&quot;&gt;5&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib7&quot; id=&quot;ref29&quot;&gt;7&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib21&quot; id=&quot;ref30&quot;&gt;21&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib43&quot; id=&quot;ref31&quot;&gt;43&lt;/reflink&gt;]). One recent study found that autistic teens without ID had DLS standard scores that were over 34 points below their full-scale IQ standard score ([&lt;reflink idref=&quot;bib17&quot; id=&quot;ref32&quot;&gt;17&lt;/reflink&gt;]). DLS are needed throughout the lifespan, but they become particularly important as autistic adolescents without ID prepare to make the transition to adulthood because of their strong link to positive outcomes in work, college, independent living, social connectedness, and quality of life ([&lt;reflink idref=&quot;bib7&quot; id=&quot;ref33&quot;&gt;7&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib14&quot; id=&quot;ref34&quot;&gt;14&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib16&quot; id=&quot;ref35&quot;&gt;16&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib19&quot; id=&quot;ref36&quot;&gt;19&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib27&quot; id=&quot;ref37&quot;&gt;27&lt;/reflink&gt;], [&lt;reflink idref=&quot;bib26&quot; id=&quot;ref38&quot;&gt;26&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib31&quot; id=&quot;ref39&quot;&gt;31&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib33&quot; id=&quot;ref40&quot;&gt;33&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib37&quot; id=&quot;ref41&quot;&gt;37&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib42&quot; id=&quot;ref42&quot;&gt;42&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib49&quot; id=&quot;ref43&quot;&gt;49&lt;/reflink&gt;]). Autistic adults who have better developed DLS are more likely to attend college, be employed, and have social relationships with same-age peers.&lt;/p&gt; &lt;p&gt;Several studies have been conducted to better understand the nature of the profile of DLS strengths and challenges in autistic individuals without ID. As assessed by the Vineland Scales of Adaptive Behavior, Third Edition (VABS-3; [&lt;reflink idref=&quot;bib46&quot; id=&quot;ref44&quot;&gt;46&lt;/reflink&gt;]), the DLS domain is often the most impaired area of adaptive behavior such that autistic adolescents have lower DLS compared to both the Social and Communication domains ([&lt;reflink idref=&quot;bib12&quot; id=&quot;ref45&quot;&gt;12&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib17&quot; id=&quot;ref46&quot;&gt;17&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib48&quot; id=&quot;ref47&quot;&gt;48&lt;/reflink&gt;]). We conducted a microanalysis of specific items on the VABS-3 DLS sub-domains of Personal, Domestic, and Community and found that autistic adolescents without ID displayed strengths that were more similar to elementary school-age children including eating and drinking, brushing teeth, getting dressed, using electronics, putting toys and belongings away, telling time, and basic money-identification skills ([&lt;reflink idref=&quot;bib17&quot; id=&quot;ref48&quot;&gt;17&lt;/reflink&gt;]). The majority of adolescents with ASD struggled to obtain age appropriate skills across as evidenced by difficulties with specific items on the VABS-3 DLS sub-domains of Personal (e.g., choosing clothing appropriate for the weather, taking medications, bathing regularly), Domestic (e.g., doing simple household chores, mopping and vacuuming, doing dishes, cooking snacks or meals, doing laundry, cleaning rooms), and Community (e.g., using a clock to keep track of time, buying groceries, purchasing items, using a checking or savings account, budgeting, working a part-time job). Thus, it is clear that autistic adolescents without ID would likely benefit from interventions that target DLS to build age appropriate skills and increase the likelihood of a successful transition from high school to the adult world.&lt;/p&gt; &lt;p&gt;Our team has been iteratively developing, refining, and evaluating Surviving and Thriving in the Real World (STRW; [&lt;reflink idref=&quot;bib10&quot; id=&quot;ref49&quot;&gt;10&lt;/reflink&gt;]), which is an intervention package that targets the acquisition of age appropriate DLS for autistic adolescents without ID using evidence-based strategies (e.g., video modeling, technology, task analysis, reinforcement, etc.) that have been successfully employed to improve skill acquisition and functioning in DLS and other areas ([&lt;reflink idref=&quot;bib20&quot; id=&quot;ref50&quot;&gt;20&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib34&quot; id=&quot;ref51&quot;&gt;34&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib47&quot; id=&quot;ref52&quot;&gt;47&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib50&quot; id=&quot;ref53&quot;&gt;50&lt;/reflink&gt;]). STRW consists of 14 weekly sessions with content that targets critical DLS for autistic adolescents in the areas of personal (i.e., developing a morning and/or nighttime hygiene and personal care routine), domestic (i.e., doing laundry, cleaning the kitchen, cooking in the microwave, stove, and oven), and community (i.e., grocery shopping, purchasing items, using a checking or savings account, saving for purchases, budgeting for expenses). Each STRW session consists of a concurrent caregiver group session and an adolescent group session (see [&lt;reflink idref=&quot;bib10&quot; id=&quot;ref54&quot;&gt;10&lt;/reflink&gt;] for additional information). The STRW intervention was iteratively developed following the sequential steps of the ORBIT model of intervention development ([&lt;reflink idref=&quot;bib8&quot; id=&quot;ref55&quot;&gt;8&lt;/reflink&gt;]) and also guided by our team&#39;s research on the profile of DLS strengths and challenges in autistic teens without ID ([&lt;reflink idref=&quot;bib12&quot; id=&quot;ref56&quot;&gt;12&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib17&quot; id=&quot;ref57&quot;&gt;17&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib48&quot; id=&quot;ref58&quot;&gt;48&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;As part of our early work, our team facilitated several focus groups with autistic teens and their caregivers to identify specific age appropriate DLS to target. We also conducted a series of case studies with autistic adolescents and their caregivers in both the clinic and school settings to identify what specific DLS to target, evaluate the use of various evidence-based strategies, and determine the ideal structure, format, and duration of the DLS intervention ([&lt;reflink idref=&quot;bib10&quot; id=&quot;ref59&quot;&gt;10&lt;/reflink&gt;]). In a proof-of-concept pre-post trial of the STRW intervention ([&lt;reflink idref=&quot;bib13&quot; id=&quot;ref60&quot;&gt;13&lt;/reflink&gt;]), seven autistic adolescents made gains on the caregiver-reported Vineland Adaptive Behavior Scales, Second Edition (Vineland-II; [&lt;reflink idref=&quot;bib45&quot; id=&quot;ref61&quot;&gt;45&lt;/reflink&gt;]) DLS domain and also progressed on individualized goals in the areas of morning hygiene routine, cooking, laundry, and money management as assessed by Goal Attainment Scaling (GAS; [&lt;reflink idref=&quot;bib25&quot; id=&quot;ref62&quot;&gt;25&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib40&quot; id=&quot;ref63&quot;&gt;40&lt;/reflink&gt;]). We then conducted a feasibility randomized clinical trial (RCT) of STRW compared to a waitlist control group ([&lt;reflink idref=&quot;bib11&quot; id=&quot;ref64&quot;&gt;11&lt;/reflink&gt;]). Caregivers reported that adolescents with ASD who received STRW (&lt;emph&gt;n&lt;/emph&gt; = 6) made gains in their overall DLS as measured by VABS-3 ([&lt;reflink idref=&quot;bib46&quot; id=&quot;ref65&quot;&gt;46&lt;/reflink&gt;]) and their personal skills (i.e., VABS-3 DLS Personal sub-domain and GAS Morning Routine) compared to the waitlist control group (&lt;emph&gt;n&lt;/emph&gt; = 6). When the waitlist control group crossed over and completed the STRW intervention, the total combined sample of autistic adolescents who completed STRW (&lt;emph&gt;n&lt;/emph&gt; = 10) made caregiver-reported gains in the VABS-3 DLS domain and three sub-domains and all five areas on the GAS. These findings are clinically meaningful because from baseline to 6-month follow-up, autistic adolescents in STRW gained approximately 5.5 years in the VABS-3 DLS Personal sub-domain, 7.3 years in the Domestic sub-domain, and 4.3 years in the Community sub-domain. While promising, these pilot studies had small sample sizes, lacked a control group, and included adolescents of all ages enrolled in high school (i.e., 14–21 years of age).&lt;/p&gt; &lt;p&gt;In the current study, we sought to continue the iterative development and evaluation of STRW by examining whether adolescents just starting high school (i.e., in the 9th or 10th grades and between the ages of 14–16 years) would demonstrate improved DLS after completing the STRW intervention. This developmental time period may be optimal because younger adolescents will have more time to practice DLS prior to graduating from high school. Furthermore, younger adolescents may have fewer competing priorities (e.g., applying to college, working a part-time job, extracurricular activities) than older adolescents. Thus, the primary objective of the current study was to further evaluate the STRW intervention&#39;s efficacy by conducting a pilot RCT comparing STRW to an active control group (i.e., social skills intervention) to ensure that improvements in DLS by participants can be attributed to receiving the STRW intervention ([&lt;reflink idref=&quot;bib44&quot; id=&quot;ref66&quot;&gt;44&lt;/reflink&gt;]). Our primary DLS outcome was caregiver report on the VABS-3 DLS domain and three sub-domains raw scores. Our secondary DLS outcome was the DLS-GAS, which assesses individualized progress in the areas of hygiene, laundry, cooking, and money management as reported by the caregiver. We also sought to further examine attendance, attrition, fidelity, satisfaction from caregivers and teens, and homework completion rates.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-2&quot;&gt;Method&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;hd id=&quot;AN0191101964-3&quot;&gt;Participants&lt;/hd&gt; &lt;p&gt;Inclusion criteria for the current study included (a) being enrolled in 9th or 10th grade in high school; (b) an ASD diagnosis; (c) full-scale IQ &amp;gt; 70; and (d) a VABS-3 DLS domain or sub-domain score at least 15 points below full scale IQ (i.e., a DLS deficit). All participants were recruited using various methods including opt-out emails and letters sent to families of adolescents who met inclusion criteria at an autism outpatient clinic, direct referrals from clinicians and school personnel, and fliers distributed to community organizations and schools. The study protocol was approved by the IRB and was registered at ClinicalTrials.gov (NCT03984513). Adolescents completed an assent and caregivers completed an informed consent prior to participating.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-4&quot;&gt;Procedures&lt;/hd&gt; &lt;p&gt;All caregiver participants completed a phone screening to assess inclusion criteria. If inclusion criteria appeared to be met, both teen and caregiver participants were scheduled for an in-person baseline eligibility assessment. All adolescents participated in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2; [&lt;reflink idref=&quot;bib28&quot; id=&quot;ref67&quot;&gt;28&lt;/reflink&gt;]) to confirm a diagnosis of ASD. Adolescents (&lt;emph&gt;n&lt;/emph&gt; = 62) were also administered the Stanford-Binet Intelligence Scales, Fifth Edition (SB-5; [&lt;reflink idref=&quot;bib36&quot; id=&quot;ref68&quot;&gt;36&lt;/reflink&gt;]) abbreviated battery to assess IQ. Five adolescent participants completed other cognitive assessments (e.g., Wechsler Abbreviated Scale of Intelligence, Second Edition; [&lt;reflink idref=&quot;bib29&quot; id=&quot;ref69&quot;&gt;29&lt;/reflink&gt;]) as part of other research studies and these were used in the current study to decrease participant burden. Caregiver participants completed the VABS-3 caregiver interview to determine whether the adolescent had a DLS deficit (i.e., VABS-3 DLS domain or sub-domain score at least 15 points below their IQ). If adolescents met inclusion criteria, they were enrolled in the study. Randomization occurred once an eligible cohort of 10–16 adolescents were enrolled and was stratified by IQ (&amp;gt;85 and &amp;lt;85) using a computer list generated by an individual independent of the current study. After participants were randomized to STRW or the social skills control group, they began the intervention within 2 weeks.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-5&quot;&gt;Intervention Groups&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;hd id=&quot;AN0191101964-6&quot;&gt;Surviving and Thriving in the Real World&lt;/hd&gt; &lt;p&gt;STRW is a 14-week intervention (see Table 1) for both autistic adolescents and their caregivers that targets critical age appropriate DLS in the areas of personal (e.g., hygiene, self-care), domestic (e.g., cleaning, cooking, laundry, grocery shopping), and community (e.g., making purchases, using a checking account, creating long-term savings goals). Evidence-based strategies such as task analysis (e.g., breaking down the steps of a morning hygiene routine), video modeling (e.g., learning how to make a grilled cheese on the stovetop using video modeling), and technology (e.g., reminder to switch laundry from the washing machine to the dryer using a phone app) are used to learn, observe, and independently practice targeted DLS. Concurrent caregiver and adolescent group sessions are held weekly. Caregivers discuss how their adolescent is progressing with their DLS goals and receive instruction and guidance on how to teach a new DLS goal over the coming week. Adolescents discuss how they are progressing with their goals and receive instruction, modeling, and hands-on practice with specific DLS. An essential treatment ingredient of STRW is the DLS contract, which defines the specific DLS goals, expectations, and rewards that adolescents are working on with support from their caregiver each week. See [&lt;reflink idref=&quot;bib10&quot; id=&quot;ref70&quot;&gt;10&lt;/reflink&gt;] for an in-depth overview of STRW&#39;s content, format, use of evidence-based strategies, and essential treatment ingredients. In March 2020, STRW was converted from in-person to telehealth delivery due to the COVID-19 restrictions on in-person clinical care. While in-person STRW consisted of weekly concurrent adolescent and caregiver sessions (90 minutes) in a clinic setting, STRW-telehealth (STRW-T) was adapted to consist of weekly caregiver group sessions (90 minutes) and caregiver/teen dyad sessions (60 minutes) held separately via HIPAA compliant Zoom. Treatment content was identical for both in-person and telehealth versions of STRW, but small modifications were made based on whether STRW was delivered in the clinic setting (e.g., made a grilled cheese on the clinic&#39;s stovetop, behavioral rehearsal of the steps of doing one&#39;s laundry) or home setting (e.g., made a grilled cheese on their own stovetop, practiced doing laundry using their own washing machine and dryer). See [&lt;reflink idref=&quot;bib10&quot; id=&quot;ref71&quot;&gt;10&lt;/reflink&gt;] for an in-depth description of the treatment protocol including descriptions of in-person STRW and the transition to STRW-T (e.g., use of HIPAA compliant Zoom, PowerPoint slides, use of videos for cooking and laundry demonstrations). See also Supplemental Figure 1 for details on the content, the use of evidence-based strategies, structure, and essential treatment components of STRW-T.&lt;/p&gt; &lt;p&gt;Table 1. Content of Surviving and Thriving in the Real World (STRW) Sessions.&lt;/p&gt; &lt;p&gt;Graph&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;colgroup&amp;gt;&amp;lt;col align=&quot;left&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;/colgroup&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Session&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Overview of session content&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; 1&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Overview of STRW: importance of targeting DLS to meet goals in adulthood&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; 2&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Morning Routine: hygiene and self-care tasks; breaking down morning routine steps&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; 3&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Morning Routine: develop a contract with morning routine as the first targeted goal&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; 4&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Laundry: sort clothes and do laundry using a washing machine&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; 5&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Laundry: do laundry using a dryer; develop a system to fold and put clothes away&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; 6&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Kitchen/Cooking: safe kitchen practices; no-cook recipes; cook a microwave recipe&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; 7&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Kitchen/Cooking: mix and measure ingredients; cook a recipe in the oven&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; 8&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Kitchen/Cooking: clean the kitchen using a checklist; cook a recipe on the stove&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; 9&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Grocery Shopping: find and purchase items at the grocery store; put groceries away&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;10&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Money Management: increase understanding of spending money; use a money diary&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;11&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Money Management: use a checking and savings account; develop a savings contract&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;12&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Money Management: save up for items; create and stick to a weekly/monthly budget&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;13&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Money Management: plan an event with a predefined budget&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;14&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Party/Graduation: review progress made during STRW and set future DLS goals&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;1 &lt;emph&gt;Note.&lt;/emph&gt; DLS = daily living skills.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-7&quot;&gt;Control Group—Program for the Evaluation and Enrichment of Relational Skills (PEERS)&lt;/hd&gt; &lt;p&gt;PEERS is a 14-week social skills intervention for autistic adolescents and their caregivers that targets age-appropriate social skills including having back and forth conversations with others, identifying sources of friends, hosting get-togethers, and handling disagreements ([&lt;reflink idref=&quot;bib24&quot; id=&quot;ref72&quot;&gt;24&lt;/reflink&gt;], [&lt;reflink idref=&quot;bib23&quot; id=&quot;ref73&quot;&gt;23&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib22&quot; id=&quot;ref74&quot;&gt;22&lt;/reflink&gt;]). PEERS was chosen as the active control group intervention because it is similar to STRW in terms of length (90-minute sessions), number (14 weekly sessions), overall structure of sessions (caregiver and teen sessions), and addresses a clinically meaningful set of skills for autistic teens and their families. The PEERS intervention does not directly target the acquisition of age appropriate DLS and has been shown to increase social skills, but not DLS ([&lt;reflink idref=&quot;bib6&quot; id=&quot;ref75&quot;&gt;6&lt;/reflink&gt;]). PEERS was also converted from in-person to telehealth delivery in March 2020 due to the COVID-19 pandemic using their telehealth materials (e.g., use of HIPAA compliant Zoom, PowerPoint slides, pre-recorded videos for role play activities) ([&lt;reflink idref=&quot;bib15&quot; id=&quot;ref76&quot;&gt;15&lt;/reflink&gt;]). In-person PEERS consisted of concurrent weekly teen and caregiver sessions (90 minutes) in the clinic setting, while PEERS-telehealth (PEERS-T) consisted of currently weekly teen and caregiver sessions (90 minutes) held via Zoom. Treatment content was identical for both in-person and telehealth versions of PEERS.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-8&quot;&gt;Primary DLS Outcome&lt;/hd&gt; &lt;p&gt;The VABS-3 is a commonly used assessment of adaptive behavior that includes the Social, Communication, and DLS domains. The items on the VABS-3 DLS domain do not directly map on to the STRW intervention content, such that the VABS-3 contains items not addressed in the STRW intervention. The STRW intervention also targets many skills that are not included on the VABS-3. The change in raw score on the VABS-3 DLS domain and three DLS sub-domains (i.e., Personal, Domestic, and Community) from baseline to post-treatment was the primary outcome measure. Raw scores on the VABS-3 are more sensitive to individual changes than standard scores and are commonly used in studies assessing change in DLS over time in autistic individuals ([&lt;reflink idref=&quot;bib5&quot; id=&quot;ref77&quot;&gt;5&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib7&quot; id=&quot;ref78&quot;&gt;7&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib13&quot; id=&quot;ref79&quot;&gt;13&lt;/reflink&gt;], [&lt;reflink idref=&quot;bib11&quot; id=&quot;ref80&quot;&gt;11&lt;/reflink&gt;]). While we were not powered to conduct additional analyses, we examined changes in the three DLS sub-domain age equivalent scores, which are calculated from raw scores, and also examined changes in the DLS Domain standard score from baseline to post-treatment to assess clinical meaningfulness. A member of the study team who was masked to participants&#39; treatment group assignment completed all VABS-3 caregiver interviews at baseline and post-treatment.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-9&quot;&gt;Secondary DLS Outcome&lt;/hd&gt; &lt;p&gt;The DLS-Goal Attainment Scaling (DLS-GAS), which was developed by our team for use with the STRW intervention, was used to create and assess progress in individualized goals in the 4 areas of Morning Routine, Laundry, Cooking, and Money Management, which were combined for a Total score (see [&lt;reflink idref=&quot;bib10&quot; id=&quot;ref81&quot;&gt;10&lt;/reflink&gt;] for an in-depth description of the development and use of DLS-GAS protocol in our previous efficacy studies on the STRW intervention). GAS ([&lt;reflink idref=&quot;bib25&quot; id=&quot;ref82&quot;&gt;25&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib39&quot; id=&quot;ref83&quot;&gt;39&lt;/reflink&gt;]) uses structured guidelines to create and evaluate DLS goals on a 5-point scale (−2 to +2). All caregiver participants chose a goal that they wanted to work on in the 4 areas, and goals were not required to align with content in the STRW intervention. At baseline, all participants receive a score of −2 for each goal, which indicates that this is their current level of functioning (e.g., &quot;Casper completes 4 out of 8 morning routine steps with 2 prompts.&quot;). At post-treatment, caregivers report any progress on the 4 DLS goals that were developed at baseline and receive a score reflecting any change (e.g., acquisition or mastery of skill, decreased prompts from the caregiver, etc.). At post-treatment, a score of −1 is indicative of 50% progress, a score of 0 is indicative of 100% progress, a score of +1 is indicative of 150% progress, and a score of +2 is indicative of 200% progress. The goal is to progress to a score of 0 (e.g., &quot;Casper completes 8 out of 8 morning routine steps with 1 prompt.&quot;), and progress beyond a score of 0 may indicate generalization to other environments or complete independence/mastery of a skill. The median change in DLS-GAS scores from baseline to post-treatment across the 4 DLS goals was the secondary outcome measure. The GAS total score was calculated as an average of the 4 DLS-GAS scores and the median baseline to post-treatment changes for this variable were also evaluated. In addition, GAS-specific criterion ratings of measurability, equivalence, and level of difficulty were used to ensure that goals were comparable at baseline between intervention groups ([&lt;reflink idref=&quot;bib39&quot; id=&quot;ref84&quot;&gt;39&lt;/reflink&gt;]; [&lt;reflink idref=&quot;bib38&quot; id=&quot;ref85&quot;&gt;38&lt;/reflink&gt;]). A masked member of the study team completed the DLS-GAS interview with caregiver participants at baseline and post-treatment.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-10&quot;&gt;Attendance, Fidelity, Homework Completion, and Satisfaction&lt;/hd&gt; &lt;p&gt;Therapists recorded attendance at every STRW session. Each adolescent, caregiver, and dyad STRW session was video recorded, and fidelity ratings were completed for 20% of adolescent and caregiver group sessions and 10% of dyad sessions. All fidelity coding was completed by trained coders who were not involved in treatment delivery. In Sessions 4–14, STRW therapists completed a homework check-in to determine whether adolescents and caregivers were utilizing a DLS contract to target goals in the areas of morning routine, laundry, cooking, grocery shopping, and money management after they had been introduced in adolescent or dyad sessions. At all STRW sessions, participants completed satisfaction ratings on a 5-point scale (i.e., 1 being &quot;not helpful&quot; and 5 being &quot;very helpful&quot;) and were able to provide open-ended feedback about specific sessions.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-11&quot;&gt;Analysis Plan&lt;/hd&gt; &lt;p&gt;A priori power analysis indicated that a total sample size of 56 (28 per group) was needed to detect a medium effect size between the STRW and control intervention groups. An intention-to-treat approach was used to assess the change in primary and secondary DLS outcomes over time as a function of participants who completed the intervention groups (STRW vs. PEERS). Descriptive statistics were calculated for demographics, attendance, attrition, fidelity, homework completion, and satisfaction ratings. General linear models (GLMs) were constructed to evaluate mean change in VABS-3 DLS domain and sub-domain outcomes within intervention groups. The models included the VABS-3 baseline values to control for potential baseline differences in these outcomes. Sex at birth and IQ remained in all models as covariates because the distribution of variables was not balanced between intervention groups. To account for potential clustering effect of cohort, we included a variable for cohort in the repeated statement. Results were reported as adjusted Least Square means (LSmeans) with standard errors. Effect sizes were also reported with Cohen&#39;s d. Baseline and post-treatment VABS-3 raw scores were reported as LSmeans adjusted for the same covariates included in the outcome models. A Wilcoxon Rank Sum test was chosen to assess the median change in DLS-GAS scores between the STRW and PEERS groups because this data was not normally distributed. Because the delivery of intervention shifted from in-person to telehealth, we conducted a sensitivity analysis to evaluate whether telehealth vs. in-person impacted outcomes. Statistical significance was set at &lt;emph&gt;p&lt;/emph&gt; &amp;lt;.05. All analyses were conducted using SAS version 9.4 ([&lt;reflink idref=&quot;bib41&quot; id=&quot;ref86&quot;&gt;41&lt;/reflink&gt;]).&lt;/p&gt; &lt;hd id=&quot;AN0191101964-12&quot;&gt;Results&lt;/hd&gt; &lt;p&gt;A total of 67 participants (see Figure 1) completed a baseline assessment and 9 were excluded due to not having a DLS deficit (&lt;emph&gt;n&lt;/emph&gt; = 6) or having an IQ &amp;lt; 70 (&lt;emph&gt;n&lt;/emph&gt; = 3). Across 5 cohorts, 58 eligible participants were randomized to STRW or PEERS (see Table 2). One cohort was enrolled in the in-person STRW or PEERS intervention groups (&lt;emph&gt;n&lt;/emph&gt; = 13). One in-person cohort (&lt;emph&gt;n&lt;/emph&gt; = 10) was suspended in March 2020 due to in-person care restrictions at the start of the COVID-19 pandemic and was then restarted in June 2020. Three cohorts (&lt;emph&gt;n&lt;/emph&gt; = 35) were enrolled in STRW telehealth (STRW-T) and PEERS telehealth (PEERS-T). Approximately 10 participants were lost to follow-up due to scheduling conflicts (&lt;emph&gt;n&lt;/emph&gt; = 2), COVID-19-related difficulties (&lt;emph&gt;n&lt;/emph&gt; = 7), or because they did not like the group they were allocated to (&lt;emph&gt;n&lt;/emph&gt; = 1). Thus, a total of 48 participants completed STRW (&lt;emph&gt;n&lt;/emph&gt; = 26) or PEERS (&lt;emph&gt;n&lt;/emph&gt; = 22).&lt;/p&gt; &lt;p&gt;DIAGRAM: Figure 1. CONSORT Flow Diagram of Participants for Surviving and Thriving in the Real World (STRW) Intervention and Program for the Evaluation and Enrichment of Relational Skills (PEERS). Note. DLS = daily living skills.&lt;/p&gt; &lt;p&gt;Table 2. Demographic Characteristics of Participants for Surviving and Thriving in the Real World (STRW) or PEERS Interventions.&lt;/p&gt; &lt;p&gt;Graph&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;colgroup&amp;gt;&amp;lt;col align=&quot;left&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;/colgroup&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Characteristic&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;STRW (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt; = 29)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;PEERS (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt; = 29)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt;&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Age at study entry, &amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt; (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;15.4 (0.8)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;15.2 (0.8)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.39&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Sex at birth, &amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt; (%)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;0.01&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Male&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;26 (89.7)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;17 (58.6)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Female&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;3 (10.3)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;12 (41.4)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;IQ, &amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt; (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;100.4 (9.3)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;102.8 (10.7)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.03&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td colspan=&quot;4&quot;&amp;gt;VABS-3 Standard Scores, &amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt; (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Communication Domain&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;68.0 (13.6)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;68.5 (15.9)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.90&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; DLS Domain&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;64.0 (13.6)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;54.8 (22.5)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.08&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Socialization Domain&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;64.8 (16.9)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;63.1 (10.9)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.59&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Adaptive Behavior Composite&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;65.4 (10.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;62.1 (12.6)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.27&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td colspan=&quot;4&quot;&amp;gt;VABS-3 DLS Raw Scores, &amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt; (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Personal Sub-domain&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;89.8 (10.0)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;86.7 (11.1)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.27&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Domestic Sub-domain&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;27.1 (15.5)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;23.1 (15.0)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.31&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Community Sub-domain&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;71.2 (11.3)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;64.1 (13.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.03&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; DLS Domain&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;188.1 (26.9)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;173.8 (33.0)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.08&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;ADOS-2 Comparison Score, &amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt; (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7.5 (1.6)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7.2 (1.7)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.57&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Race, &amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt; (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;0.03&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; White&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;26 (89.7)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;22 (75.9)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Black&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;5 (17.2)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Asian&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2 (10.3)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1 (3.5)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Other/Unknown&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1 (3.5)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Ethnicity, &amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt; (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;0.74&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Hispanic&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2 (6.9)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Non-Hispanic&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;28 (96.6)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;26 (89.7)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Not reported&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1 (3.5)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1 (3.5)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Household income, &amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt; (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;0.13&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; &amp;amp;#60;$20,000&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1 (3.5)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7 (24.1)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; $20K&amp;amp;#8211;49.9K&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7 (24.1)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;6 (20.7)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; $50K&amp;amp;#8211;99.9K&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7 (24.1)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7 (24.1)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; &amp;amp;#62;$100K&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;13 (44.8)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;8 (27.6)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Not reported&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1 (3.5)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1 (3.5)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Primary Caregiver Education, &amp;lt;italic&amp;gt;M&amp;lt;/italic&amp;gt; (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;0.65&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; High school degree/GED&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1 (3.5)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Some college&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7 (24.1)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;9 (31.0)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; College or graduate degree&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;22 (75.9)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;19 (65.5)&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Lost to follow-up/dropout&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;3 (10.3)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7 (24.1)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.16&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;2 &lt;emph&gt;Note.&lt;/emph&gt; PEERS = Program for the Evaluation and Enrichment of Relational Skills ([&lt;reflink idref=&quot;bib22&quot; id=&quot;ref87&quot;&gt;22&lt;/reflink&gt;]); VABS-3 = Vineland Adaptive Behavior Scales, Third Edition ([&lt;reflink idref=&quot;bib46&quot; id=&quot;ref88&quot;&gt;46&lt;/reflink&gt;]); DLS = daily living skills; ADOS = Autism Diagnostic Observation Schedule, Second Edition ([&lt;reflink idref=&quot;bib28&quot; id=&quot;ref89&quot;&gt;28&lt;/reflink&gt;]); GED = General Educational Development certificate.&lt;/p&gt; &lt;p&gt;See Table 2 for participant characteristics at baseline. The intervention groups were significantly different from one another on IQ, sex at birth, race, VABS-3 DLS domain, and VABS-3 Community sub-domain. PEERS participants (&lt;emph&gt;M&lt;/emph&gt; = 102.8) had higher IQs than STRW participants (&lt;emph&gt;M&lt;/emph&gt; = 100.4), but the mean IQ scores were both in the average range. There were fewer females in STRW (&lt;emph&gt;n&lt;/emph&gt; = 3) compared to PEERS (&lt;emph&gt;n&lt;/emph&gt; = 12). The PEERS group also had more racially diverse adolescents than the STRW group. Adolescents in STRW (&lt;emph&gt;M&lt;/emph&gt; = 64.0) had higher VABS-3 DLS domain standard scores than adolescents in PEERS (&lt;emph&gt;M&lt;/emph&gt; = 54.8). On the VABS-3 Community sub-domain, STRW participants (&lt;emph&gt;M&lt;/emph&gt; = 71.2) had significantly higher raw scores than PEERS participants (&lt;emph&gt;M&lt;/emph&gt; = 64.1).&lt;/p&gt; &lt;hd id=&quot;AN0191101964-13&quot;&gt;Attendance and Attrition&lt;/hd&gt; &lt;p&gt;The current pilot RCT was completed by 48 of 58 participants (82.8%); 26 of 29 in STRW (89.7%) and 22 of 29 in PEERS (75.9%). There was no between group differences for participants lost to follow-up (&lt;emph&gt;p&lt;/emph&gt; =.16). Mean attendance rates were high for both in-person and telehealth STRW and PEERS groups (&amp;gt;85%). Attendance at STRW-T teen dyad sessions was not significantly higher (&lt;emph&gt;p&lt;/emph&gt; =.06) than that at STRW in-person teen sessions. There were no significant differences in attendance for telehealth vs. in-person for PEERS. Fidelity rates for in-person STRW were 92.7% (caregiver) and 93.7% (teen) and fidelity rates for STRW-T were 100.0% (caregiver) and 93.6% (dyad).&lt;/p&gt; &lt;hd id=&quot;AN0191101964-14&quot;&gt;Primary DLS Outcome&lt;/hd&gt; &lt;p&gt; &lt;emph&gt;VABS-3.&lt;/emph&gt; See Table 3 for the adjusted means and standard deviations of the raw scores on the VABS-3 DLS domain and sub-domains at baseline and post-treatment. Results of the GLMs indicated that adolescents in STRW made significantly more gains on the DLS domain (&lt;emph&gt;p&lt;/emph&gt; =.04) and the Domestic sub-domain (&lt;emph&gt;p&lt;/emph&gt; =.01) compared to PEERS. STRW participants did not make statistically significant improvements on the Community sub-domain (&lt;emph&gt;p&lt;/emph&gt; =.06) compared to PEERS participants. From baseline to post-treatment, teens in STRW improved their VABS-3 DLS domain raw score by 37.6 points compared to the 22.0-point improvement demonstrated by teens in PEERS. There was a medium effect size for the change score difference between the STRW and PEERS groups on the DLS domain (d =.50) and Domestic sub-domain (d =.64). No significant group differences were found on the VABS-3 Personal sub-domain raw score (&lt;emph&gt;p&lt;/emph&gt; =.34). On the VABS-3 DLS domain standard score, adolescents in STRW gained 18.3 points, going from 64.9 (16.7) at baseline to 83.1 (14.9) at post-treatment, while adolescents in PEERS gained 13.6 points, going from 57.8 (23.0) at baseline to 71.4 (21.4) at post-treatment.&lt;/p&gt; &lt;p&gt;Table 3. Adjusted Mean VABS-3 DLS Domain and Sub-domain Raw Scores From Baseline to Post-Treatment.&lt;/p&gt; &lt;p&gt;Graph&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;colgroup&amp;gt;&amp;lt;col align=&quot;left&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;/colgroup&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;left&quot; rowspan=&quot;2&quot;&amp;gt;Sub-domain/domain&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot; colspan=&quot;4&quot;&amp;gt;STRW (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt; = 26)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot; colspan=&quot;4&quot;&amp;gt;PEERS (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt; = 22)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot; rowspan=&quot;2&quot;&amp;gt;&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt;&amp;lt;xref ref-type=&quot;table-fn&quot; rid=&quot;tfn5&quot;&amp;gt;b&amp;lt;/xref&amp;gt;&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot; rowspan=&quot;2&quot;&amp;gt;Cohen&#39;s d&amp;lt;xref ref-type=&quot;table-fn&quot; rid=&quot;tfn6&quot;&amp;gt;c&amp;lt;/xref&amp;gt;&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Baseline&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Post&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Change score&amp;lt;xref ref-type=&quot;table-fn&quot; rid=&quot;tfn4&quot;&amp;gt;a&amp;lt;/xref&amp;gt;&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Cohen&#39;s d&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Baseline&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Post&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Change score&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Cohen&#39;s d&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Personal&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;94.1 (2.2)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;100.0 (1.9)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;8.8 (2.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.08&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;87.8 (2.0)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;95.6 (1.7)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;6.9 (1.6)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.91&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.34&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.25&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Domestic&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;31.8 (3.3)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;45.2 (3.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;17.2 (2.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.08&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;25.1 (2.9)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;33.3 (3.1)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7.6 (2.5)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.61&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.01&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.64&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Community&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;73.1 (2.7)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;83.5 (2.7)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;12.6 (2.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.05&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;64.9 (2.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;74.4 (2.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7.3 (1.3)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.83&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.06&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.48&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Total DLS&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;199.0 (6.1)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;228.8 (7.1)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;37.6 (6.6)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.35&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;177.9 (5.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;203.3 (6.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;22.0 (4.4)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.88&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.04&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.50&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;ulist&gt; &lt;item&gt;3 &lt;emph&gt;Note.&lt;/emph&gt; VABS-3 = Vineland Adaptive Behavior Scales, Third Edition ([&lt;reflink idref=&quot;bib46&quot; id=&quot;ref90&quot;&gt;46&lt;/reflink&gt;]); DLS = daily living skills; STRW = Surviving and Thriving in the Real World intervention; PEERS = Program for the Evaluation and Enrichment of Relational Skills ([&lt;reflink idref=&quot;bib22&quot; id=&quot;ref91&quot;&gt;22&lt;/reflink&gt;]).&lt;/item&gt; &lt;item&gt;4 Change score results reported as LSMeans with standard errors from GLM after controlling for gender and IQ.&lt;/item&gt; &lt;item&gt;5 &lt;emph&gt;p&lt;/emph&gt;-value based on general linear models testing the difference in change pre- to post-scores between intervention groups.&lt;/item&gt; &lt;item&gt;6 Cohen&#39;s d of the adjusted mean change score difference between the two groups.&lt;/item&gt; &lt;/ulist&gt; &lt;p&gt;Results of the sensitivity analysis testing whether intervention delivery (telehealth vs. in-person) impacted outcomes were consistent with the primary analysis. For all models, the inclusion of intervention delivery type did not change the results with respect to differences between groups regarding any of the DLS outcomes. Intervention delivery type was not a significant variable in the models for change in the Domestic (&lt;emph&gt;p&lt;/emph&gt; =.71) and Community (&lt;emph&gt;p&lt;/emph&gt; =.44) sub-domain raw scores and the Total DLS score (&lt;emph&gt;p&lt;/emph&gt; =.52). For the Personal sub-domain, individuals who received the interventions via telehealth had a slightly higher raw score (β=4.1 (&lt;emph&gt;SE&lt;/emph&gt; 1.9), &lt;emph&gt;p&lt;/emph&gt; =.04) compared to receiving the interventions in-person. However, the difference in the adjusted mean change scores of the Personal sub-domain was consistent with the original analysis (STRW 7.8 vs. PEERS 5.8, &lt;emph&gt;p&lt;/emph&gt; =.32).&lt;/p&gt; &lt;hd id=&quot;AN0191101964-15&quot;&gt;Secondary DLS Outcome&lt;/hd&gt; &lt;p&gt; &lt;emph&gt;DLS-GAS.&lt;/emph&gt; Medians for the 5 DLS-GAS area scores and the change scores from baseline to post-treatment are shown in Table 4. There were no differences on the three criterion measures (i.e., equivalence, difficulty, and measurability) between STRW and PEERS (&lt;emph&gt;p&lt;/emph&gt;&#39;s ranged from.17 to.86), indicating that the GAS goals are psychometrically equivalent between groups at baseline. A Wilcoxon Rank Sums test revealed that the STRW group had significantly higher median change scores in Cooking, Laundry, and Money Management (all &lt;emph&gt;p&lt;/emph&gt;&#39;s &amp;lt;.001) as compared to PEERS. There was not a significant difference between the STRW and PEERS groups in the Morning Routine area (&lt;emph&gt;p&lt;/emph&gt; =.06) or Total (&lt;emph&gt;p&lt;/emph&gt; =.10).&lt;/p&gt; &lt;p&gt;Table 4. Median Item Scores and Change Scores With Interquartile Range in Brackets on the DLS-GAS for STRW and PEERS.&lt;/p&gt; &lt;p&gt;Graph&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;colgroup&amp;gt;&amp;lt;col align=&quot;left&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;/colgroup&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Item&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;STRW median (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;PEERS median (&amp;lt;italic&amp;gt;SD&amp;lt;/italic&amp;gt;)&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt;&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Baseline&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8722;2.0 (0.0)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8722;2.0 (0.0)&amp;lt;/td&amp;gt;&amp;lt;td align=&quot;center&quot;&amp;gt;&amp;amp;#8212;&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td colspan=&quot;4&quot;&amp;gt;Morning Routine&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Post-Treatment&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.0 [&amp;amp;#8722;1.0, 2.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8722;0.5 [&amp;amp;#8722;2.0, 0.0]&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Change Score&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2.0 [1.0, 4.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.5 [0.0, 2.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.06&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td colspan=&quot;4&quot;&amp;gt;Kitchen/Cooking&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Post-Treatment&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.0 [&amp;amp;#8722;1.0, 1.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8722;2.0 [&amp;amp;#8722;2.0, &amp;amp;#8722;1.0]&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Change Score&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2.0 [1.0, 3.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.0 [0.0, 1.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.0001&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td colspan=&quot;4&quot;&amp;gt;Laundry&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Post-Treatment&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.0 [&amp;amp;#8722;1.0, 1.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8722;1.5 [&amp;amp;#8722;2.0, &amp;amp;#8722;1.0]&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Change Score&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2.0 [1.0, 3.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.5 [0.0, 1.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.0001&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td colspan=&quot;4&quot;&amp;gt;Money Management&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Post-Treatment&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.0 [&amp;amp;#8722;1.0, 0.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8722;1.5 [&amp;amp;#8722;2.0, 0.0]&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Change Score&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2.0 [1.0, 2.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.5 [0.0, 2.0]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.03&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td colspan=&quot;4&quot;&amp;gt;Total DLS-GAS&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Post-Treatment&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8722;0.3 [&amp;amp;#8722;0.8, 0.1]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8722;0.8 [&amp;amp;#8722;1.5, 0.6]&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt; Change Score&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.8 [1.3, 2.1]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.2 [0.5, 2.6]&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.10&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;7 &lt;emph&gt;Note.&lt;/emph&gt; STRW = Surviving and Thriving in the Real World intervention; PEERS = Program for the Evaluation and Enrichment of Relational Skills ([&lt;reflink idref=&quot;bib22&quot; id=&quot;ref92&quot;&gt;22&lt;/reflink&gt;]); GAS = Goal Attainment Scaling (author created).&lt;/p&gt; &lt;hd id=&quot;AN0191101964-16&quot;&gt;STRW Satisfaction and Homework Completion Rates&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;hd id=&quot;AN0191101964-17&quot;&gt;Satisfaction&lt;/hd&gt; &lt;p&gt;Satisfaction rates were high for teens (all means &amp;gt; 3.2) and caregivers (all means &amp;gt; 4.3). No significant differences were found between mean satisfaction ratings for STRW in-person vs. STRW-T (all &lt;emph&gt;p&lt;/emph&gt;&#39;s &amp;gt;.25).&lt;/p&gt; &lt;hd id=&quot;AN0191101964-18&quot;&gt;Homework Completion&lt;/hd&gt; &lt;p&gt;See Table 5 for homework completion rates for STRW caregiver, teen, and dyad sessions. For in-person STRW, Morning Routine homework was reported as being completed at the highest frequency by teens and caregivers and Cooking (caregiver) and Grocery Shopping (teen) was completed at the lowest frequency. For STRW telehealth, Morning Routine homework was completed at the highest frequency and Grocery Shopping was completed at the lowest frequency. Caregivers in the STRW-T dyad sessions reported using the DLS contract more than the in-person caregivers (&lt;emph&gt;p&lt;/emph&gt; =.05).&lt;/p&gt; &lt;p&gt;Table 5. Average Homework Completion Rates for STRW In-Person and Telehealth Sessions.&lt;/p&gt; &lt;p&gt;Graph&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;colgroup&amp;gt;&amp;lt;col align=&quot;left&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;col align=&quot;char&quot; char=&quot;.&quot; /&amp;gt;&amp;lt;/colgroup&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Homework&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;In-person caregiver&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;In-person teen&amp;lt;/th&amp;gt;&amp;lt;th align=&quot;center&quot;&amp;gt;Telehealth dyad&amp;lt;/th&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Contract&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;84.5&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;95.0&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;97.5&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Morning Routine&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;93.9&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;97.0&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;99.2&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Laundry&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;73.5&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;84.8&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;86.9&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Cooking&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;54.5&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;80.6&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;68.9&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Grocery Shopping&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;72.0&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;67.0&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;57.2&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Money Management&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;66.5&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;68.3&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;64.2&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;8 &lt;emph&gt;Note.&lt;/emph&gt; STRW = Surviving and Thriving in the Real World intervention.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-19&quot;&gt;Discussion&lt;/hd&gt; &lt;p&gt;Autistic adolescents in their first two years of high school who received the STRW intervention made significantly greater gains in domestic, community, and overall DLS on the VABS-3 (DLS domain and Domestic sub-domain) and DLS-GAS (Cooking, Laundry, and Money Management areas) compared to an active control group (i.e., the PEERS social skills intervention). Specifically, adolescents with ASD in STRW gained 37.6 points on their VABS-3 DLS domain raw score from baseline to post-treatment compared to a gain of 22.0 points in the PEERS group. The clinical meaningfulness of this change in DLS is illustrated by an 18-point gain on the VABS-3 DLS domain standard score as it improved from 64.9 at baseline to 83.1 at post-treatment for teens in STRW, which signifies a narrowing of the gap between DLS and chronological age as this score approaches being in the &quot;average range&quot; (i.e., 85–115). The VABS-3 DLS domain standard score for teens in PEERS only increased by 13 points, going from 57.8 at baseline to 71.4 at post-treatment.&lt;/p&gt; &lt;p&gt;Adolescents in STRW also made particularly large gains (17.2 point improvement) on the DLS Domestic sub-domain raw score compared to adolescents in PEERS (7.6 point improvement) from baseline to post-treatment. These gains in domestic skills significantly narrowed the gap between DLS and chronological age in teens who received the STRW intervention. Practically, this corresponds to gaining 3.1 years (i.e., age equivalence score) of domestic DLS for the STRW group and 1.8 years for the PEERS group. The content of STRW is highly focused on increasing domestic skills such as doing one&#39;s laundry, folding and putting clothing away, cleaning up the kitchen (e.g., wiping up spills, taking out the trash), and cooking snacks and meals in the oven or on the stovetop. Adolescents also set specific goals to practice these domestic skills on their DLS contract between sessions. The gains on the VABS-3 DLS Community sub-domain raw score were approaching significance (&lt;emph&gt;p&lt;/emph&gt; =.06) such that teens in the STRW intervention demonstrated improvement in skill acquisition (12.6-point gain) compared to the PEERS intervention (7.3-point gain). This increase translates to adolescents in STRW making gains of 2.0 years of community DLS compared to 1.5 years for adolescents in PEERS. The 2-year gain in the Community sub-domain is meaningful because these complex set of skills are not targeted until the final four sessions of STRW, which allows for less time to practice and master these DLS. This finding also provides preliminary support for the refinements that were made to STRW based on our earlier iterations to target money management skills throughout the 14-week intervention through both in-session activities (e.g., guessing the price of grocery items) and homework assignments (e.g., using a money tracker to monitor saving and spending, increasing awareness of monthly bills). Future work will need to determine whether these community skills maintain and continue to grow over time as teens who completed STRW are able to practice these skills in the real world (e.g., depositing their money from a paycheck into a savings account, saving up for a laptop for college, etc.).&lt;/p&gt; &lt;p&gt;There were no significant differences in the VABS-3 Personal sub-domain between intervention groups. One possible reason for this finding is that many of the self-care and hygiene items on the VABS-3 DLS Personal sub-domain are somewhat broad (e.g., bathing/showering regularly) and do not include specific items that were often addressed as part of the Morning Routine goal on the DLS contract for STRW participants (e.g., wearing deodorant, washing face, cleaning nails, fully rinsing shampoo out of hair). Lack of progress on the VABS-3 Personal sub-domain may also be due to the number of items and how they are scored. Specifically, there may be a ceiling effect on the Personal sub-domain because there are only 55 items (highest possible score is 110) and the baseline scores of adolescents in STRW (94.1) and PEERS (87.8) were already close to this score. In addition, many of the items on the Personal sub-domain are not age appropriate and would not be expected of younger adolescents (e.g., making doctor appointments, refilling medications). Furthermore, incremental progress on individual VABS-3 Personal sub-domain items is not always captured on the VABS-3 score (e.g., going from taking a shower once a week to three times per week would still be a score of &quot;1&quot; if the caregiver is providing a verbal reminder). Regardless, the lack of gains in personal DLS are somewhat surprising because both adolescents and caregivers in STRW reported completing their Morning Routine goal at very high rates (&amp;gt;93.9%). Refinements are currently being made to the STRW intervention to address goal setting for specific hygiene and personal care skills and to ensure that the intervention content facilitates the acquisition of specific personal DLS.&lt;/p&gt; &lt;p&gt;On the DLS-GAS, which is a more idiographic assessment of progress on specific DLS goals, adolescents in STRW made significantly larger gains in domestic DLS and community DLS, but not in the area of personal DLS compared to adolescents in PEERS. These results suggest that STRW may truly be impacting the majority of DLS that it targets as part of the intervention curriculum. Furthermore, the DLS-GAS may be a more sensitive assessment of detecting progress in age appropriate DLS, including acquisition of specific skills, increased autonomy, and decreased dependence on caregivers to complete tasks. Similar to the results on the VABS-3, it is promising to see improvements in money management skills on the DLS-GAS since this is a critical life skill that is essential to successfully working and living independently in adulthood.&lt;/p&gt; &lt;p&gt;Attendance rates were high across both in-person and telehealth versions of STRW. Similarly, satisfaction ratings indicated that caregivers and teens perceived STRW sessions as highly beneficial. Homework completion rates demonstrated STRW caregiver and adolescent participants were motivated to work on specific DLS goals between sessions and the DLS contract was used at very high rates (&amp;gt;84.5%) to target goals in the DLS areas of personal, domestic, and community. The utilization and buy-in of adolescents and their caregivers to use the DLS contract to target goals in STRW suggests that the beginning of high school (i.e., 9th/10th grades) may be a particularly ideal time to intervene and target the development of age appropriate DLS. While these adolescents have competing demands (e.g., academic workload, extracurricular activities, etc.), they likely have less demands than older adolescents who are also preparing for high school graduation (e.g., applying to college, working a part-time job, applying to part-time or full-time jobs, etc.). Furthermore, by targeting DLS earlier in adolescence, this allows for more time to be devoted by both the teen and their caregiver to becoming increasingly independent with age-appropriate DLS (e.g., waking up and getting ready for school, preparing one&#39;s own breakfast and lunch, cleaning one&#39;s room) and practicing additional DLS that may be needed as they transition to adulthood (e.g., planning meals for the week, making a grocery list for needed items, paying bills, making dentist or doctor appointments, refilling medications). Teens may also be more successful with acquiring additional age-appropriate DLS if they use the same evidence-based strategies (e.g., DLS contract, task analysis, technology) that led to the acquisition of DLS in the STRW intervention.&lt;/p&gt; &lt;p&gt;While only a small proportion of the participants in the current study completed in-person STRW (22.9%) vs. STRW-telehealth (77.1%), there do appear to be advantages to telehealth delivery. Attendance at telehealth sessions was higher than that at in-person teen sessions, although it was not significantly higher (&lt;emph&gt;p&lt;/emph&gt; =.06). Caregivers in STRW-telehealth also reported utilizing the DLS contract more than caregivers in in-person STRW, which may be due to the individualized nature in which a therapist creates and modifies the DLS contract in collaboration with the caregiver and teen in the dyad sessions. Furthermore, compared to in-person delivery, STRW-T has decreased participant burden such that participants do not have to travel to group sessions and have flexibility with rescheduling the dyad sessions. The therapist burden of STWR-T is also less such that fewer materials are required (e.g., ingredients for cooking sessions, access to a kitchen and laundry area) and fewer therapists are needed to conduct the caregiver group sessions and caregiver/teen dyad sessions. For example, in-person STRW requires at least 3 therapists (i.e., 1 for the caregiver group, 2–3 for the teen group), while STRW-T can be facilitated by 1 therapist (i.e., 1 therapist runs the caregiver group and all dyad sessions). Lastly, while STRW-T is manualized and covers the same content as the in-person version, it allows for the therapist to problem solve issues within the dyad&#39;s unique home environment (e.g., helping teen to better organize their room so that he is able to independently put clothing away, identifying where to post the morning routine task analysis checklist to increase success). The content of STRW can also be individualized more in the telehealth version because the intervention is delivered in the home rather than the clinic setting (e.g., cooking preferred recipes on their own kitchen equipment, using their own washer and dryer to do their own laundry).&lt;/p&gt; &lt;p&gt;The adolescents who received the PEERS intervention did make more gains in their DLS than we had anticipated, but there may be several possible explanations. First, participants in PEERS were encouraged to become more involved in socializing with peers (e.g., inviting friends over, getting involved in clubs and activities), which have led to increases in DLS (e.g., personal hygiene skills, cleaning room before a friend comes over). However, this finding has not been shown in other studies ([&lt;reflink idref=&quot;bib6&quot; id=&quot;ref93&quot;&gt;6&lt;/reflink&gt;]). Another possible explanation is that recruitment materials for the current study advertised a DLS intervention, so caregiver and adolescent participants may have been particularly motivated to work on these skills. Lastly, the DLS assessments that were administered at baseline may have spurred caregivers and teens to work on specific DLS. In particular, the goal setting that occurred while completing the DLS-GAS may have led to caregivers to target specific DLS. For example, one caregiver who was randomized to the PEERS intervention indicated that she was working on building her teen&#39;s cooking skills after setting the DLS-GAS goals at the baseline assessment.&lt;/p&gt; &lt;p&gt;The current pilot RCT also had several limitations. The sample size, while larger than our previous iterations, was still relatively small, which limits the analyses and conclusions that can be drawn from the data (e.g., identifying treatment responders). The current sample was 84.2% White. Future studies evaluating the efficacy of STRW need to have a more diverse sample in terms of race, ethnicity, and socioeconomic status. While 25.9% of the sample was female, the majority of the females were randomized to the PEERS group. Our study stratified randomization to intervention group by IQ, but several other variables were significantly different or trending toward being significantly different between the groups (e.g., sex at birth, VABS-3 DLS domain score, race, and income). Future studies should consider stratifying randomization based on sex, race/ethnicity, and socioeconomic status. The current study did not collect satisfaction ratings from participants in the control group, so it was not possible to examine differences in satisfaction between the intervention groups. Lastly, caregivers were the sole reporters of DLS and future studies would benefit from conducting multi-modal (e.g., direct observation, daily diary, interview, survey) and multi-informant (e.g., caregiver, adolescent) DLS assessments&lt;/p&gt; &lt;p&gt;Autistic adolescents without an ID who completed the STRW intervention showed marked improvements toward age appropriate DLS, especially in the acquisition of essential domestic and community DLS. On the VABS-3, adolescents in STRW not only gained 2.0 to 3.1 years of DLS over the course of the 14-week intervention but also moved their DLS closer to the average range such that their skills are more commensurate with same-age peers. The current results suggest that a larger RCT is needed to evaluate the efficacy of STRW-T in a larger sample of adolescents with ASD compared to an active control group. Future research needs to also examine whether gains in DLS that occur as a result of the STRW intervention impact longer-term adult outcomes in employment, post-secondary education, independent living, social connectedness, and quality of life.&lt;/p&gt; &lt;hd id=&quot;AN0191101964-20&quot;&gt;Supplemental Material&lt;/hd&gt; &lt;p&gt;Graph: Supplemental material, sj-docx-1-foa-10.1177_10883576251355188 for Closing the Gap: A Randomized Trial Targeting Daily Living Skills in Autistic Adolescents by Amie Duncan, Jareen Meinzen-Derr, Lisa Ruble, Carrie Fassler and Lori J. Stark in Focus on Autism and Other Developmental Disabilities&lt;/p&gt; &lt;ref id=&quot;AN0191101964-21&quot;&gt; &lt;title&gt; Footnotes &lt;/title&gt; &lt;blist&gt; &lt;bibl id=&quot;bib1&quot; idref=&quot;ref13&quot; type=&quot;bt&quot;&gt;1&lt;/bibl&gt; &lt;bibtext&gt; The data from this study have been shared on the National Database for Autism Research (NDAR) in accordance with National Institutes of Health (NIH) guidelines.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib2&quot; idref=&quot;ref1&quot; type=&quot;bt&quot;&gt;2&lt;/bibl&gt; &lt;bibtext&gt; The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib3&quot; idref=&quot;ref8&quot; type=&quot;bt&quot;&gt;3&lt;/bibl&gt; &lt;bibtext&gt; All phases of this study were supported by the National Institute of Child Health and Human Development (NICHD grant #K23HD094855-01A1). The NIH had no role in the design and conduct of the study.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib4&quot; idref=&quot;ref26&quot; type=&quot;bt&quot;&gt;4&lt;/bibl&gt; &lt;bibtext&gt; Amie Duncan&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibtext&gt;Graph https://orcid.org/0000-0002-6317-4302&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib5&quot; idref=&quot;ref9&quot; type=&quot;bt&quot;&gt;5&lt;/bibl&gt; &lt;bibtext&gt; Supplemental material for this article is available at https://doi.org/10.1177/10883576251355188.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib6&quot; idref=&quot;ref75&quot; type=&quot;bt&quot;&gt;6&lt;/bibl&gt; &lt;bibtext&gt; Current Affiliation: Amie Duncan, Jareen Meinzen-Derr and Lori J. 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  Data: Closing the Gap: A Randomized Trial Targeting Daily Living Skills in Autistic Adolescents
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  Label: Language
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  Data: English
– Name: Author
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  Group: Au
  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Amie+Duncan%22&quot;&gt;Amie Duncan&lt;/searchLink&gt; (ORCID &lt;externalLink term=&quot;https://orcid.org/0000-0002-6317-4302&quot;&gt;0000-0002-6317-4302&lt;/externalLink&gt;)&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Jareen+Meinzen-Derr%22&quot;&gt;Jareen Meinzen-Derr&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Lisa+Ruble%22&quot;&gt;Lisa Ruble&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Carrie+Fassler%22&quot;&gt;Carrie Fassler&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Lori+J%2E+Stark%22&quot;&gt;Lori J. Stark&lt;/searchLink&gt;
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  Data: &lt;searchLink fieldCode=&quot;SO&quot; term=&quot;%22Focus+on+Autism+and+Other+Developmental+Disabilities%22&quot;&gt;&lt;i&gt;Focus on Autism and Other Developmental Disabilities&lt;/i&gt;&lt;/searchLink&gt;. 2026 41(1):3-15.
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  Data: SAGE Publications and Hammill Institute on Disabilities. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: https://sagepub.com
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  Data: Y
– Name: Pages
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  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2026
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  Label: Sponsoring Agency
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  Data: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (DHHS/NIH)
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  Data: K23HD09485501A1
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  Data: Journal Articles&lt;br /&gt;Reports - Research
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  Data: &lt;searchLink fieldCode=&quot;EL&quot; term=&quot;%22High+Schools%22&quot;&gt;High Schools&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;EL&quot; term=&quot;%22Secondary+Education%22&quot;&gt;Secondary Education&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;EL&quot; term=&quot;%22Grade+9%22&quot;&gt;Grade 9&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;EL&quot; term=&quot;%22Junior+High+Schools%22&quot;&gt;Junior High Schools&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;EL&quot; term=&quot;%22Middle+Schools%22&quot;&gt;Middle Schools&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;EL&quot; term=&quot;%22Grade+10%22&quot;&gt;Grade 10&lt;/searchLink&gt;
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Autism+Spectrum+Disorders%22&quot;&gt;Autism Spectrum Disorders&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Adolescents%22&quot;&gt;Adolescents&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Daily+Living+Skills%22&quot;&gt;Daily Living Skills&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Program+Effectiveness%22&quot;&gt;Program Effectiveness&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Intervention%22&quot;&gt;Intervention&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22High+School+Students%22&quot;&gt;High School Students&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Grade+9%22&quot;&gt;Grade 9&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Grade+10%22&quot;&gt;Grade 10&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Student+Characteristics%22&quot;&gt;Student Characteristics&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Attendance%22&quot;&gt;Attendance&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Homework%22&quot;&gt;Homework&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Satisfaction%22&quot;&gt;Satisfaction&lt;/searchLink&gt;
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  Data: &lt;searchLink fieldCode=&quot;SU&quot; term=&quot;%22Vineland+Adaptive+Behavior+Scales%22&quot;&gt;Vineland Adaptive Behavior Scales&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;SU&quot; term=&quot;%22Goal+Attainment+Scale%22&quot;&gt;Goal Attainment Scale&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;SU&quot; term=&quot;%22Autism+Diagnostic+Observation+Schedule%22&quot;&gt;Autism Diagnostic Observation Schedule&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;SU&quot; term=&quot;%22Wechsler+Abbreviated+Scale+of+Intelligence%22&quot;&gt;Wechsler Abbreviated Scale of Intelligence&lt;/searchLink&gt;
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/10883576251355188
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1088-3576&lt;br /&gt;1538-4829
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Autistic adolescents without an intellectual disability (ID) have daily living skills (DLS) that are approximately 6 years below peers. This study evaluated the efficacy of the Surviving and Thriving in the Real World (STRW) intervention, which targets DLS, compared to an active control group. Autistic adolescents were randomized to STRW or control. The primary outcome was the caregiver-reported Vineland Adaptive Behavior Scales, 3rd Edition (VABS-3) DLS domain and Personal, Domestic, and Community sub-domains. The secondary outcome was DLS Goal Attainment Scaling (DLS-GAS) caregiver interview. Compared to control (n = 22), autistic teens in STRW (n = 26) made significant improvements on the VABS-3 DLS domain (p = 0.04) and Domestic sub-domain (p = 0.01) and the DLS-GAS areas of Cooking, Laundry, and Money Management (all p&#39;s &lt; 0.05). STRW narrowed the gap between DLS and age as autistic adolescents acquired age-appropriate domestic, personal, and community DLS compared to the control group.
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  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2026
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  Label: Accession Number
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  Data: EJ1496471
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1496471
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    Identifiers:
      – Type: doi
        Value: 10.1177/10883576251355188
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 3
    Subjects:
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Adolescents
        Type: general
      – SubjectFull: Daily Living Skills
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: High School Students
        Type: general
      – SubjectFull: Grade 9
        Type: general
      – SubjectFull: Grade 10
        Type: general
      – SubjectFull: Student Characteristics
        Type: general
      – SubjectFull: Attendance
        Type: general
      – SubjectFull: Homework
        Type: general
      – SubjectFull: Satisfaction
        Type: general
      – SubjectFull: Vineland Adaptive Behavior Scales
        Type: general
      – SubjectFull: Goal Attainment Scale
        Type: general
      – SubjectFull: Autism Diagnostic Observation Schedule
        Type: general
      – SubjectFull: Wechsler Abbreviated Scale of Intelligence
        Type: general
    Titles:
      – TitleFull: Closing the Gap: A Randomized Trial Targeting Daily Living Skills in Autistic Adolescents
        Type: main
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            NameFull: Amie Duncan
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            NameFull: Jareen Meinzen-Derr
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            NameFull: Lisa Ruble
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            NameFull: Carrie Fassler
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            NameFull: Lori J. Stark
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            – D: 01
              M: 03
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-print
              Value: 1088-3576
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            – TitleFull: Focus on Autism and Other Developmental Disabilities
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