Currently submitted to: Journal of Medical Internet Research
Date Submitted: Jan 29, 2026
Open Peer Review Period: Jan 30, 2026 - Mar 27, 2026
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
“It Helps Him Understand Emotions”: A Mixed Methods Randomized Controlled Pilot Trial of the Autism Emotion Cognition Training System
ABSTRACT
Background:
Emotional cognition deficits are a core feature of autism spectrum disorder (ASD) and contribute significantly to social difficulties in affected children. Digital, app-based training may offer scalable, structured practice, but evidence from randomized pilot trials remains limited.
Objective:
To evaluate the feasibility, acceptability, and preliminary efficacy of the Autism Emotion Cognition Training System (AECTS), a tablet-based, parent-mediated program designed to support emotional cognition in young children with ASD.
Methods:
We conducted a single-center, two-arm, parallel-group randomized controlled pilot trial between April and October 2025. Children aged 4–8 years with ASD were assigned to AECTS plus treatment as usual (TAU) or TAU alone for 8 weeks. Feasibility and acceptability were assessed in the intervention group using a study-specific mixed-methods questionnaire (25 Likert items and 5 open-ended questions). Preliminary efficacy was explored using the Social Responsiveness Scale (SRS) and the Clinical Global Impression (CGI), with ANCOVA adjusting for baseline SRS scores.
Results:
Of 20 randomized participants, 19 completed the trial (10 in the intervention group and 9 in the control group). Caregiver-rated feasibility was high across domains (mean scores 3.92–4.70 out of 5), with the highest ratings for overall acceptability and technical feasibility. Usability showed the lowest score and greatest variability. Qualitative analysis identified four themes: (1) strong but module-specific engagement, (2) smooth operation with unclear system status, (3) variable generalization to daily life, and (4) requests for smarter personalization and realistic scenarios. On secondary outcomes, SRS scores favored the intervention group but were not statistically significant. CGI outcomes were comparable between groups.
Conclusions:
This pilot trial demonstrated that AECTS is a feasible and acceptable digital intervention for children with autism, with positive caregiver feedback and preliminary signals of benefit. Although clinical efficacy was not statistically significant, favorable trends in social responsiveness suggest potential value. Future large-scale trials with enhanced usability, adaptive personalization, real-life social scenarios, and caregiver support are warranted to establish the intervention’s effectiveness and scalability.
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