A School-Based Approach to Building Resilience and Mental Health Among Adolescents on the Autism Spectrum: A Longitudinal Mixed Methods Study

Abstract

Tackling mental health difficulties in adolescents on the autism spectrum requires a comprehensive prevention approach. A 3-year multisite proof-of-concept longitudinal study implemented an evidence-based multilevel resilience intervention in schools to promote protective factors at the adolescent, parent, and school level. The intervention, consisting of the adolescent, parent and teacher components of the Resourceful Adolescent Program–Autism Spectrum Disorder (RAP-ASD) augmented with the Index for Inclusion, was implemented in 6 secondary schools with 30 adolescents with an autism diagnosis in Grades 7 and 8, 31 parents of 23 of the adolescents, and school staff. The intervention was implemented with good validity and acceptability. Quantitative data from adolescents and parents were analysed using the Reliable Change Index, and qualitative data were analysed using Consensual Qualitative Research. Triangulated quantitative and qualitative outcomes from the majority of adolescents and their parents showed some evidence for promoting resilience for adolescents with a diagnosis or traits of autism, as reflected in reliable improvements in coping self-efficacy and school connectedness, and a reduction in anxiety symptoms and emotional and behavioural difficulties. A reliable improvement in depressive symptoms was more modest and was only achieved by a small minority of adolescents. This multilevel, strength-focused, resilience-building approach represents a promising and sustainable school-based primary prevention program to improve the quality of life for adolescents on the spectrum by promoting their mental health and providing their families with much needed support.

Coping‐resilience profiles and experiences of stress in autistic adults

“…Although some of these may already incorporate elements of coping and resilience among their areas of focus (McGillivray & Evert, 2014 ; Oswald et al, 2018 ), interventions with an explicit focus on stress reduction and management in autistic adults are relatively limited. Further, while there are promising programs referred to as resilience interventions with autistic youth (e.g., Resourceful Adolescent Program–Autism Spectrum Disorder, RAP‐ASD; Shochet et al, 2022 or Resilience Builder Therapy Program, RBP; Habayeb et al, 2017 ), these interventions do not incorporate resilience as a primary target or outcome measure. As far as we know, stress interventions are yet to be designed and conducted in autistic adults, which specifically target and measure coping strategy use and resilience.…”

Creating Inclusive Schools for Autistic Students: A Scoping Review on Elements Contributing to Strengths-Based Approaches

“…Common limitations in the quantitative studies include inappropriate sample size and lack of detailed report on analytic methods. Only two out of the seven intervention studies reported on statistical significance [47,49]. Common limitations in the qualitative studies include limited description of data analysis, limited verification procedure to establish credibility and no reflexivity of the account.…”

“…Participants in the seven intervention studies included autistic students (n = 102, male n = 82, female n = 20) ranging from 8 years old to 17 years old (mean = 13.34), and one study did not report age ranges, only grade levels (grades six to eight) [41]. Three studies included only male students [42,44,46], and four studies contained both male and female students [41,45,47,49]. Among the six studies investigating the different perspectives and experiences, three studies examined the views of autistic students and youth (n = 72) [10,48,51], with one study including the views of parents (n = 18) on the types of strengths autistic students have [51], and three studies investigated the experiences and perspectives of school staff (n = 123), including teachers, principals, education support officers and administrative assistants [40,43,50].…”

“…Koegel et al [44] and Koegel et al [45] reported improved frequency in initiating and maintaining conversations and increased feelings of happiness and enjoyment in autistic students following implementing lunchtime activities and clubs incorporating their interests in high school settings. Shochet et al [49] implemented a strengths-focused multilevel intervention at school that was found to improve students' social, emotional resilience and mental health. Ten studies utilised students' strengths and interests to improve academic outcomes, from improved academic skills in one specific area, such as writing skills [39] to academic outcomes in Science, Technology, Engineering and Mathematics (STEM) areas [38,40,41,47] and overall academic performance [36,43,48,50,51].…”

“…All articles except two [10,49] identified at least one specific strength or interest of autistic students (Table 3). The strengths relating to students' learning and school experiences include cognitive abilities, knowledge in specific subjects linked to their SIAs, visual and sensory processing abilities, music, art, sports and motor skills and personality and attitude.…”