Development of a Social Communication Intervention Mobile App for Adolescents With Autism Spectrum Disorder and Social Communication Disorder: Protocol for a Pilot Randomized Clinical Trial.

Researchers tested a mobile app called NDTx-01 designed to help teenagers with autism and social communication challenges. The app uses games and stories based on proven therapy methods. 39 teens used the app for 10 minutes a day, 5 days a week, alongside their regular treatments. The study was completed successfully and showed promise, leading to a larger study across 5 hospitals in South Korea.

This protocol describes a pilot randomized controlled trial evaluating NDTx-01, a digital therapeutic mobile app for adolescents aged 10-18 with autism spectrum disorder (ASD) or social communication disorder (SCD). The app integrates cognitive behavioral therapy principles, story-based interventions, and gamification elements for 10 minutes daily, 5 days weekly. Conducted across 3 major hospitals, 39 participants were enrolled and randomly assigned to intervention (NDTx-01 plus treatment as usual) or control groups (treatment as usual only). Outcomes were measured using standardized assessments including adaptive behavior scales, social responsiveness measures, and clinical global impressions.

The study was completed successfully with results published in April 2025, leading to a larger confirmatory trial at 5 hospitals.

The study demonstrates feasibility of digital therapeutic interventions for adolescents with ASD/SCD, addressing geographical and accessibility barriers. However, the lack of clear between-group differences suggests need for larger studies to establish specific efficacy beyond standard care.

This is a pilot study protocol with limited sample size (39 participants). Results show improvements in both groups, making it unclear what specific benefits the app provided beyond standard care. No adverse events or safety data are reported in this protocol paper.

Autism spectrum disorder (ASD) and social communication disorder (SCD) are neurodevelopmental disorders characterized by deficits in social communication that hinder social adaptation, with limited pharmacological options for therapy owing to the absence of identified biomarkers. Individuals with ASD or SCD require lifelong interventions tailored to their development stages. However, most existing interventions primarily focus on early childhood, leaving adolescents relatively underserved. Moreover, timely access to interventions is often limited by geographic and economic barriers as specialized clinics and therapists tend to be concentrated in major urban areas.

This pilot randomized clinical trial aimed to evaluate the initial safety and efficacy of NDTx-01, a digital therapeutic (DTx) for adolescents with ASD or SCD. NDTx-01 was designed to overcome the accessibility limitations by integrating cognitive behavioral therapy principles, story-based interventions, and gamification elements. We introduce a protocol for a multicenter, prospective, assessor-blinded pilot randomized clinical trial involving children and adolescents aged 10 to 18 years diagnosed with ASD or SCD. Participant enrollment was conducted at 3 major medical hospitals.

Enrolled participants were randomly assigned to either the intervention group (NDTx-01 and treatment as usual [TAU]) or the control group (TAU only). TAU included medications and therapeutic services. Participants were instructed to use the app approximately 10 minutes per day, 5 days a week. To evaluate the efficacy of NDTx-01, standardized tools were administered, including the Korean version of the Vineland Adaptive Behavior Scales, Second Edition (K-VABS-II); the Social Responsiveness Scale, Second Edition; Clinical Global Impressions-Severity (CGI-S); Clinical Global Impressions-Improvement (CGI-I); the Social Communication Questionnaire; and the Korean version of the Stress Index for Parents of Adolescents.

Assessments were conducted in weeks 0, 1, 2, 4, and 6, except for K-VABS-II, CGI-S, and CGI-I, which were administered only in weeks 0, 4, and 6. Statistical analyses were conducted using the SAS software. Between-group differences were assessed using independent 2-tailed 2-sample t tests or Wilcoxon rank sum tests. Within-group changes were evaluated using paired t tests or Wilcoxon signed rank tests.

From August 2024 to December 2024, a total of 42 individuals were screened, 39 (93%) participants who met the inclusion criteria were enrolled, and 1 participant withdrew consent; the remaining participants completed the study. The pilot randomized clinical trial was successfully completed, and the results were published in April 2025. As of 2025, we are conducting a confirmatory clinical trial at 5 major hospitals across South Korea. The results of this pilot clinical trial provided important insights into the initial safety and efficacy of DTx as interventions for adolescents with ASD and SCD.

Both groups demonstrated statistically significant improvements in adaptive skills and socialization. Clinical Research Information Service KCT0009140; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26713. DERR1-10.2196/66419.