A hybrid effectiveness-implementation trial of a school based executive function treatment for transition age youth with autism

对患有自闭症的过渡年龄青少年进行基于学校的执行功能治疗的混合有效性实施试验

• 批准号: 10331309
• 负责人: Cara Pugliese
• 金额: $ 66.04万
• 依托单位: CHILDREN'S RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-02-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10331309
• 关键词: Adaptive Behaviors; Adherence; Adolescence; Adoption; Adult; Advocacy; Advocate; Aftercare; Age; Area; Behavior; Behavioral; Caring; Cognitive; Communities; Community Trial; Data; Development; Effectiveness; Emotions; Evaluation; Evidence based intervention; Evidence based practice; Executive Dysfunction; Failure; Family; Funding; Future; Goals; Human Resources; Impairment; Individual; Intellectual functioning disability; Intervention; K-Series Research Career Programs; Knowledge; Link; Mental Health Services; Methods; Mission; Modeling; Monitor; National Institute of Mental Health; Neuronal Plasticity; Outcome; Penetration; Persons; Population; Prefrontal Cortex; Prevalence; Problem Solving; Public Health; Randomized; Randomized Controlled Trials; Reach Effectiveness Adoption Implementation and Maintenance; Research; Research Personnel; Risk; Schools; Secondary Schools; Services; Social support; Societies; Stress; Students; Subgroup; System; Techniques; Teenagers; Therapeutic; Thinking; Time; Time Management; Youth; adolescent with autism spectrum disorder; autism spectrum disorder; base; college; design; dosage; effective intervention; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; effectiveness testing; effectiveness trial; evidence base; executive function; falls; flexibility; follow-up; functional independence; future implementation; high school; implementation determinants; implementation evaluation; implementation facilitators; implementation strategy; implementation trial; improved; improved outcome; individuals with autism spectrum disorder; neural network; novel; physical conditioning; primary outcome; process evaluation; psychiatric symptom; response; secondary outcome; skills; social skills; success; therapy design

PROJECT SUMMARY The proposed study is highly relevant to the 2017 Interagency Autism Coordinating Committee priorities to improve transition to adulthood in autism spectrum disorders (ASD). It also advances NIMH’s mission to develop interventions that: 1) assess the mechanisms through which an intervention produces therapeutic change (Strategy 3.1); and 2) have been tested for effectiveness through pragmatic community-based trials that examine implementation factors to improve the fit of the intervention (Strategy 3.3). Caring for transition- age youth with ASD is a significant public health concern and the exit from high school is a period of amplified risk. Individuals without intellectual disabilities (ID) comprise the fastest-growing subgroup of ASD and account for two-thirds of the total population. Due to rising prevalence, there will be a 123% increase in the number of youth with ASD exiting secondary school in the next decade. The educational system is increasingly the primary service access point for youth with ASD, with as many of 90% served in public school settings. As such, the transition from high school is often characterized as “falling over a cliff,” as youth with ASD lose these educational and social supports. As few as 9% of autistic individuals without ID reach full functional independence as adults, resulting in a loss to society, as well as to the youth and their families. Impaired executive functions (EF) in ASD occur as a result of abnormalities in neural networks involving prefrontal cortex, and are related to poor adult outcome. EF problems are pivotal targets for intervention because they are common, linked to independence, and responsive to treatment. The proposed study will test the effectiveness of a school-based cognitive behavioral EF intervention, Flexible Futures (FF), for transition- age youth with ASD (AIM 1) and evaluate mechanisms of treatment change (AIM 2). FF targets flexibility and planning skills and focuses on key functions needed for adult success: understanding one’s own thinking style and advocating for accommodations; flexible problem-solving; time management; goal setting; developing plans; monitoring progress. FF was designed from inception to be embedded in high schools and delivered by school staff to improve generalization of skills, increase access to mental health care, and fill a gap in a lack of evidence-based approaches to support postsecondary transition. A small, pilot randomized controlled trial found students receiving FF made greater gains in planning, flexibility, adaptive, and classroom behavior when compared to students receiving the usual ASD supports at school. This project capitalizes on the opportunity to utilize pragmatic community trials to probe mechanisms of treatment change and explore barriers and facilitators to implementation (AIM 3) to improve sustainable adoption and implementation of effective, generalizable, evidence-based interventions. If successful, the proposed project will demonstrate the widespread effectiveness and feasibility of an accessible intervention to improve transition outcomes for youth with ASD that can be rapidly disseminated and implemented by schools across the nation.

项目摘要 这项拟议的研究与2017年机构间自闭症协调委员会的优先事项高度相关， 改善自闭症谱系障碍（ASD）向成年过渡。它还推进了NIMH的使命， 制定干预措施：1）评估干预措施产生治疗效果的机制 变革（战略3.1）; 2）通过务实的社区试验检验了有效性 检查实施因素，以提高干预措施的适用性（策略3.3）。关注转型- 患有ASD的青少年是一个重要的公共卫生问题，高中毕业是一个放大的时期， 风险没有智力残疾的人（ID）构成了ASD和帐户增长最快的亚组。 占总人口的三分之二由于患病率上升， 在未来十年内，患有自闭症的青少年将离开中学。教育系统越来越 ASD青少年的主要服务接入点，其中90%在公立学校环境中提供服务。作为 因此，从高中的过渡通常被描述为“从悬崖上摔下来”，因为患有ASD的年轻人失去了这些 教育和社会支持。只有9%的没有ID的自闭症患者达到完全功能 这是一个很大的问题，因为它使青年人失去了作为成年人的独立性，从而给社会以及青年及其家庭带来了损失。 ASD中的执行功能（EF）受损是神经网络异常的结果， 前额叶皮层，并与不良的成年结果有关。EF问题是干预的关键目标 因为它们很常见，与独立性有关，并且对治疗有反应。这项研究将测试 以学校为基础的认知行为EF干预的有效性，灵活的未来（FF），过渡- 年龄青年ASD（AIM 1）和评估治疗变化的机制（AIM 2）。FF以灵活性为目标， 计划技能，并侧重于成人成功所需的关键功能：了解自己的思维方式 提倡住宿;灵活解决问题;时间管理;目标设定;发展 计划;监测进展。FF从一开始就被设计成嵌入高中，并由 学校工作人员提高技能的普及，增加获得精神卫生保健的机会，并填补缺乏 支持中学后过渡的循证方法。一项小型、初步随机对照试验 发现接受FF的学生在计划，灵活性，适应性和课堂行为方面有更大的收获， 与在学校接受ASD支持的学生相比。该项目利用机会， 利用务实的社区试验，探索治疗变化的机制，探索障碍， 促进实施（目标3），以改善可持续的采用和实施有效的， 可推广的循证干预措施。如果成功，拟议项目将展示 为改善青年的过渡成果而采取的可获得干预措施的广泛有效性和可行性 ASD可以在全国各地的学校迅速传播和实施。