PROJECT SUMMARY/ABSTRACT
Autistic people are vulnerable to traumatic social experiences such as relational bullying and sexual violence
by peers. Social anxiety and unhappiness with the quality of peer relationships are impairing problems for
many. There are too few social skills interventions for autistic adults that have been tested through randomized
controlled trials (RCTs). This project will test mechanism engagement and feasibility of Healthy Relationships
on the Autism Spectrum (HEARTS). The HEARTS intervention was developed through a NIMH K18 (2020-
2022) and feasibility tested with a sample of N=55 autistic adults ages 18-40 years old from across the US.
HEARTS is a six-session class delivered in real time online. HEARTS is novel because it was developed
through a community-based participatory process with autistic adults, the class sessions are co-delivered by
one autistic and one non-autistic facilitator who work as a team, and the curriculum uses a neurodiversity-
embracing stance instead of a deficit model approach. Specifically, HEARTS does not teach social skills such
as small talk, making eye contact, practice at conversational turn-taking, or other skills that may contribute to
autistic “masking” or camouflaging. Instead, HEARTS draws on evidence-based violence prevention
programming and teaches autistic participants to recognize the differences between healthy and unhealthy
relationships, how to meet people and start new friendships or romantic relationships, how to negotiate sexual
consent, recognize boundaries, and end friendships or dating relationships when needed—while respecting,
rather than seeking to minimize or eliminate, autistic differences. The goal of the proposed clinical trial is to
demonstrate that the target mechanism can be engaged and to pilot all methods (e.g., randomization, facilitator
training) in preparation for a fully powered trial to test HEARTS’ effectiveness. HEARTS is highly scalable in
that it was intentionally created for online delivery. In the HEARTS K18 non-experimental feasibility test,
participation was associated with positive changes in outcomes including social motivation. In the proposed
RCT we will test HEARTS acceptability and participant engagement; fidelity of the facilitators to the original
manual; and provider satisfaction with HEARTS (N=160). We will also test mechanism engagement. We
hypothesize that HEARTS participants will demonstrate significant decreases in hostile automatic thoughts,
decreased rejection sensitivity, and increased social motivation, relative to participating completing the active
control condition (ACC). We will also test clinical impact. We hypothesize that participants who complete
HEARTS will demonstrate statistically significant improvement in satisfaction with quality of peer relationships
(clinical outcome), relative to ACC participants. We will recruit 160 research participants in partnership with the
Asperger/Autism Network (AANE) organization, and benefit from a 5-person autistic Advisory Board.
Consistent with stated priorities in the IACC Strategic Plan for autism research, the proposed research
constitutes a new and innovative approach to promoting wellness and health for autistic adults.