PONE-D-21-38878Transition approaches for autistic young adults: a case series studyPLOS ONE

Dear Dr. Pillay,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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I would suggest that in revising your manuscript you pay particular attention to reviewer 3's suggestions regarding the methodology and results section. I do not think you need to add much to the introduction, but you might consider including a bit more reference to the research on experiences of transition.  Please ensure that your decision is justified on PLOS ONE’s publication criteria and not, for example, on novelty or perceived impact.

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Amanda A. Webster

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This paper describes an interesting study conducted ethically and with methodological rigour. It provides qualitative data that describe the impact of transition on young adults on the autism spectrum with reference to 9 specific cases.

The only area where I think you could improve is in the conclusions you draw from some of the evidence you provide. For example, in the case of Mr. Reggie you conclude that his lack of employment and social connection could have led to his mental health challenges. You do not consider whether his mental health issues could be the reason for his difficulties with socialising and finding employment. You may well have additional data that has led you to some of your conclusions but these are not always evident in the material provided in the paper.

On the whole this paper is well-written and clearly presented. Well done.

Reviewer #2: Overall this is an excellent article that has touched on a very important issue that confronts many autistics and their families, namely the transition to adult stages.

However, to improve this manuscript I advise the following four minor modifications:

1. For the reader it would be good to have a section about what ASD diagnosis each participant received (i.e., Asperger syndrome under the DSM-IV-TR) and (if the data was captured) how many years has the participant had their diagnosis.

2. A copy of the About You survey as an attachment. This will assist others to conduct a replication or repeat of the study.

3. In Table 1 “Living circumstances” and “Program” do not add up to 9 participants. Please explain or correct this numerical discrepancy.

4. In the Strengths and Limitations section please write a small paragraph stating that one limitation of the study was that it was restricted to only participants who had access to a computer. Only having access to a computer is an example of selectin bias. Also it would be appropriate to highlight that multiple approaches to data collection would have potentially increased the sample size. For example, in conjunction to using an online survey, distributing and collecting hard copies of surveys from participants who attended an event at an autism association might have yielded more responses.

Reviewer #3: Review for PLOS-One

Transition approaches for autistic young adults: a case series study

Introduction

The introduction needs to be rewritten to emphasise the importance of transition for young adults with Autism . T here is very limited reference to the transition literature in general and transition literature and for young adults with Autism . The same comment could be made about Quality of Life. The richness of the quality of life literature is missing and is needed as QoL is a key outcome variable and a proxy variable for transition.

Study Aims and Design

The study aims are clearly stated and are appropriate to longitudinal design. However, I would question whether a case series design will as the authors claim, _allow for empirical inquiry and contextual analysis of unique features, events, and their relationships.’”

I think that the authors need to rewrite this section so there is greater acknowledgement of strengths and weaknesses of Case Series studies. For instance, I question whether they provide empirical data because of the lack of a comparison group. The strengths of some of the features of this case series design such as that it is a prospectïve design and data was collected over a 12 month time period are acknowledged. However, I think the authors should acknowledge that only descriptive data and statistics should be used. Case series design studies are a good way to generate new hypotheses but, in my opinion, do not deliver high levels of empirical evidence.

Results

The demographic results are clearly presented but there is no discussion of them in the text. For example, is there any reason for the overwhelming number of participants being female?

I am confused by Page 8 line 156 which says all of the data relates to Quality of Life. Line 163 then states that there were significant increases in QOL.

The word significant needs to be replaced in this sentence as the design does not allow for statements such as this to be made.

This next paragraph then goes on to describe other measures that in line 173 they state as being indicators of successful and unsuccessful transitions.

I think these claims need to be tempered given the limitations of the design, the quality of the measures and the lack of representative sample that is being presented and the lack of inclusion of the transition literature previously mentioned under the Introduction section.

I also have to question whether two open-ended questions added to the About Me Survey can really assess changes in quality of life.

Results

There are some issues with the decisions made in this section as well which reflect lack of knowledge of quality of life measurement. The authors have defined high quality of life as above 80 and low quality of life as 79 and below.

In previous research 75 has been categorised as average quality of life across populations. I would suggest that the authors need to provide support for this decision.

The second issue is that all authors in this field recognise that Quality of Life is a multifaceted construct, yet the authors have used the total scores for analysis of statistical change.

I would suggest that the authors reanalyse this section using the subscale scores. Using the total scores could lead to poor conclusions and masking of important interactions.

Given the extensive reanalysis and rewriting that I have recommended I do not think it is necessary to comment on the final sections of the paper.

These may need to be extensively rewritten in light of the reanalysis of the Quality of Life subscales

This is an interesting topic but I feel that this paper needs major revisions and reanalysis of some data before it could be accepted for publication.

Thank you for the opportunity to review this paper

Best Wishes

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Reviewer #1: Yes: Dr Debra Costley

Reviewer #2: No

Reviewer #3: No

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Transition approaches for autistic young adults: a case series study

PONE-D-21-38878R1

Dear Dr. Pillay,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Amanda A. Webster

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for your careful consideration and response to comments.

This is a very interesting and important paper that highlights an area which is under researched but which can make a significant difference to the lives of autistic individuals.

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No