A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).

Autism Spectrum Disorder (ASD) is a developmental disability that affects how people communicate and process information. People with ASD may have difficulty with aspects of social communication like starting and maintaining conversations, taking turns in conversation, asking questions, or interpreting humor and sarcasm. Due to these challenges, young adults with ASD may have difficulty making friends or getting involved in peer groups. Young women with ASD, in particular, may face additional challenges with socialization and self-image. Past research has found that girls with ASD tend to be diagnosed at a later age than boys with ASD, and young women with ASD face especially high risk for psychological challenges like anxiety or depression.

Various coaching programs have been developed to teach conversational skills to people with ASD. These programs often rely on having a coach shadowing an individual with ASD to provide prompting, reminders, and feedback. “Bug-in-ear” technology, also known as Covert Audio Coaching (CAC), may provide similar feedback while being much less obtrusive in real-world social situations. Using headphones or an earpiece, a coach can communicate with a client to provide discreet feedback on their actions or behaviors in real time. In a recent NIDILRR-funded study, researchers tested a CAC program with four female college students with ASD. They wanted to find out if the CAC would assist the students with ASD to ask more questions in conversations with their peers. They also wanted to find out if providing feedback on the number of questions asked would lead to more independent question-asking.

As part of the project I-CONNECT PLUS: Enhancing Community Participation for Adolescents and Adults with ASD Using Online Instruction, Coaching, and Accessible Self-Management Technologies, researchers enrolled four female college students with ASD in a CAC study. The students attended a local community college, were between the ages of 18 and 23, and had been receiving autism-related special education services in school before going to college. All four students reported that they had difficulty making friends and often sat by themselves during lunch on campus. In addition, eight women without ASD were recruited to be conversation partners.

The study consisted of three phases in the following order: a baseline phase, a CAC phase, and a CAC plus feedback phase. During each phase of the study, each student was observed while having a conversation with two of the conversation partners during lunch in the campus dining hall, and researchers recorded the number of questions that the student with ASD asked during the conversation. Each conversation session lasted about 10 minutes. A laptop computer with videoconferencing software running was on the table so researchers could observe from a distance and collect data on the number of questions the student asked during all three phases.

During the baseline phase, each student was observed without any coaching for five or more 10-minute sessions. After the baseline phase concluded and before the CAC phase began, each student was asked to view a 30-minute online instructional module on “maintaining a conversation.” The instructional module included scenarios and video examples to demonstrate conversational skills such as appropriately asking questions.

During the CAC phase, the student incorporated the use of their cellphone and ear-bud style headphones to receive coaching. The peer coach called the student at the start of the session and reminded her to ask questions during the conversation. Wearing one earbud, the student could listen to the coach throughout the session while engaging with her conversation partners. If there was a break in the conversation, the coach prompted the student to “ask a question” or suggested a specific question to ask. The coach also reminded her to stay engaged in the conversation and show she was listening. Each student participated in 10 or more CAC sessions.

During the CAC plus feedback phase, the coach provided pre-session instructions that included feedback on the number of questions the student asked in previous sessions. As with the CAC sessions, the student incorporated the use of her phone and wore an earbud to listen to the coach’s prompts and comments throughout the session. Students participated in three to five CAC plus feedback sessions.

From baseline phase to the end of the study, each student participated in 30 - 40 sessions in all phases combined, with the number of sessions in each phase determined individually. The researchers looked at the average number of questions each student asked during each phase of the study. In addition, three of the students completed a questionnaire where they reported how they felt about the CAC program.

The researchers found that all four of the students asked more questions during peer conversations during the CAC phase than they did during the baseline phase. The students’ question-asking increased by an average of 6.16 questions per session. During the “CAC plus feedback” phase of the study, two of the students further increased the average number of questions they asked, by an average of 2.3 questions per session over the CAC-only phase.

The researchers also found that the students gave positive feedback about the online instructional module and the coaching they received during conversations. The students reported that they liked the video examples included in the module. They wrote that the coaching helped them improve their conversational skills, and that using the discrete “bug-in-ear” technology was preferable to having someone sit next to them and prompt them during conversations.

The authors noted that mobile devices may offer a promising way for adolescents and young adults with ASD to practice social skills in real-world settings like a college cafeteria. Mobile devices are mainstream and can offer opportunities for users to receive feedback and reminders discreetly, without feeling stigmatized by having someone shadow them during their social interactions. In this study, CAC assisted the students with ASD in maintaining conversations with their peers, which could help them to build friendships over time. Future research may be useful to determine whether the benefits of CAC might last after remote coaching is completed.

To Learn More

The Virginia Commonwealth University Autism Center for Excellence offers training and education resources for professionals who support children and adults with ASD, including how-to videos on creating social communication opportunities and verbal prompting, among other topics.

The Autistic Self-Advocacy Network offers articles, books, and videos for young people with ASD transitioning to college and adulthood.

To Learn More About this Study

Mason, R.A., Gregori, E., Wills, H.P., Kamps, D., and Huffman, J. (2019) Covert audio coaching to increase questions asking by female college students with autism: Proof of concept. Journal of Developmental and Physical Disabilities, 2019. This article is available from the NARIC collection under Accession Number J77550.