Metacognitive Model to Promote Independence Among Adolescents With Autism Spectrum Disorder: Implementation of a Shopping Task in the Community

Adolescents with autism spectrum disorder (ASD) present difficulties performing daily activities essential to preparation for adulthood (American Psychiatric Association, 2013). Metacognitive functions are essential for performing everyday tasks. The literature points to metacognitive deficits in ASD, yet does not indicate how these deficits impact everyday activities in ecological contexts (Panerai et al., 2016). Our metacognitive model, based on functional cognition and evidence-based practice for individuals with ASD, provides occupational therapists with a framework for assessing metacognition and strategy-use in a natural environment. This, using of performance-based assessments and the design of metacognitive interventions for enhancing independence in adolescents with ASD. The study aims were to examine the efficacy of the metacognitive intervention model to promote independent performance of a shopping task in adolescents with ASD, and to identify which cognitive and metacognitive variables will predict improved performance following the intervention. This quasi-experimental study included 56 adolescents with high functioning ASD between 11 and 19 years recruited through the educational system. All attended classes for students with ASD at mainstream schools. Three schools were haphazardly assigned to the intervention group (n = 33; 29 boys, 4 girls; M = 14.58 years, SD = 1.77) and 3 schools to the control group (n = 23 participants; 17 boys, 6 girls; M = 14.43 years, SD = 1.56). Outcome measures for both groups pre- and post-intervention included the WebNeuro to assess cognitive and metacognitive abilities and the Test of Grocery Shopping Skills (Brown et al., 2009), an ecological performance-based tool to assess functional cognition. Both interventions were implemented by occupational therapists in the participant’s educational environment. The intervention protocol based on the model, included 8 structured sessions focused on metacognitive strategies and practicing them using the Virtual Action Planning Supermarket (Klinger et al., 2004) software that simulating a shopping task in a supermarket. The control group participants received similar setting of traditional interventions for youth with ASD targeting consumer skills. ANOVA repeated measures with interaction effect and t-tests with Bonferroni correction were conducted to analyze improvement following the intervention. Stepwise linear and logistic regressions were conducted to identify which cognitive and metacognitive variables will predict improved shopping performance following the intervention. Relative to pre-intervention performance, both groups showed significant improvement in time, redundancy, and strategies use. The intervention group improved significantly more than the control group in accuracy (F(1,54) = 14.23, p < 0.001, ηp² = 0.21) and strategies use (F(1,53) = 4.55, p < 0.05, ηp² = 0.08). Significant improvement was also obtained in attention (t = -.39, p < 0.01) and executive functions (t = -3.44, p < 0.01) among the intervention group, whereas none was noted in the control group. The WebNeuro memory domain predicted accuracy in post-intervention performance in both the intervention (29.4% of variance) and control group (24.5%); the attention domain explained 23.4% of the redundancy variance among the intervention group. Study results indicate the potential of a functional cognitive intervention to significantly improve performance of a community shopping task for adolescents with ASD. This study provides evidence for the efficacy of a functional cognition intervention in at promoting independence and community participation among adolescents with ASD, and advocates a framework for future related evidence-based practices.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed). Arlington, VA: American Psychiatric Publishing.

Brown, C., Rempfer, M., & Hamera, E. (2009). The Test of Grocery Shopping Skills. Bethesda, Md: AOTA Press.

Klinger, E., Chemin, I., Lebreton, S., & Marié, R. (2004). A virtual supermarket to assess cognitive planning. CyberPsychology & Behavior, 7, 292–293.

Panerai, S., Tasca, D., Ferri, R., Catania, V., Genitori D’Arrigo, V. G., Di Giorgio, R., & Elia, M. (2016). Metacognitive and emotional/motivational executive functions in individuals with autism spectrum disorder and attention deficit hyperactivity disorder: Preliminary results. Rivista Di Psichiatria, 51(3), 104–109. https://doi.org/10.1708/2304.24794