Feasibility, Acceptability, and Efficacy of an Ecological Momentary Intervention for Autistic Adults

Purpose Many autistic adults experience limited access to scalable social-emotional supports, underscoring the need for low-intensity interventions that can be integrated into daily life. This study evaluated the feasibility, acceptability, and preliminary efficacy of a one-week ecological momentary intervention (EMI) designed to enhance social attention and social-emotional functioning through in vivo real-time reporting of social interactions. Methods Thirty-one autistic adults were randomized to one of three conditions (facial expression, hair color, or passive control) and completed an EMI protocol and pre- and post-intervention measures. Results Feasibility outcomes were mixed: retention was high, but self-reported adherence fell below the a priori 80% benchmark, and utilization varied considerably. Equivalence tests indicated no condition differences in utilization, adherence, or acceptability. Net acceptability did not meet the a priori threshold of more than 50% of participants reporting neutral or positive net acceptability. Regression analyses revealed no condition-related effects on behavioral, self-report, or neural outcomes. Conclusion Overall, results suggested that the EMI achieved high retention, but did not meet the a priori thresholds of adequacy for adherence and acceptability, and did not produce detectable changes in social-emotional functioning. Refinements to EMI design and dose may be necessary to improve the potential impact of brief EMIs for autistic adults.