Skilltalk: A Community-Engaged Participatory Project to Develop a Video-Modeling Library for Healthy Relationships Among Autistic Adults

Background and Purpose: Autistic young adults (AYA) often struggle with creating and maintaining relationships with friends and family, work colleagues, or even service and healthcare providers. Video modeling is effective in teaching AYA vocational skills, yet there is limited use of video-modeling to help AYA develop and improve their communication and relationship skills, which are critical for quality of life. We developed the SkillTalk video library to include over 150 videos to teach AYA communication and relationship skills.

The purpose of the study was to determine whether the SkillTalk video library was effective in teaching AYA relationship skills. We used a randomized controlled trial (N=115) with attention control condition (ACC; website with resources).

Methods: The study was conducted nationwide in the United States. Participants completed virtual pre-test surveys assessing their self-perception of their confidence, perceived skills, and knowledge around key relationship skills. Then, they participated in a video-recorded simulated conversation (role-play) with trained staff. They were randomly assigned to SkillTalk vs. ACC. They repeated the self-assessment surveys and role-plays after 1- and 3-months exposure to their assigned resource. The final survey also provided the opportunity for participants to give free-response feedback on the resource. Survey data were analyzed with ANCOVA comparing groups, and video recordings of the simulated conversations were coded and analyzed for participants’ use of skills.

To ensure the resource was reflective of AYA’s real experiences, autistic collaborators were incorporated at all levels of the resource design and evaluation including: an autistic project director, focus group participants who informed skill selection, script writers, actors, and video coders.

Results: The SkillTalk group increased in their confidence using skills significantly more than the control, specifically in their confidence to effectively: give constructive feedback (p=.004), compromise with others (p=.003), tell others wants or needs (p<.001), resolve conflicts (p=0.42), advocate for themselves at home (p=.001), and advocate for themselves at school or work (p<.001). Further, the treatment group showed improvement on two mental health-related with a significant decrease in their social isolation scores (p= .018) and an increase in life satisfaction scores (p<.001). Coding of the conversations also found significant improvement of multiple skills by the treatment group including conflict resolution (p=.002), feedback (p=.02), and overall relationship skills (p<.001).

Participants were satisfied with the resources. One participant noted, “I appreciate that these videos are more ‘modern’... They are actually relatable, and it makes me feel seen.” Another noted, “I appreciated the skills pertaining to self-advocacy...it was empowering to see other autistic adults advocate for themselves and not be penalized., and watching them do it gave me a script.”

Conclusions and Implications: The SkillTalk resource was effective for teaching AYA several relationship and communication skills that can be used to increase their independent and interdependent living quality of life. Representation of AYA throughout the development and evaluation of SkillTalk enhanced the social validity of the resource. Objective measures of skill development are feasible and critical for intervention evaluation.