Surviving and Thriving in the Real World: A Daily Living Skills Intervention for Adolescents with Autism Spectrum Disorder

项目总结/摘要 患有自闭症谱系障碍（ASD）的人，即使是那些被定义为高功能（IQ >70）的人， 严重的日常生活技能（DLS）缺陷与独立生活的不良成年结果有关， 高等教育、就业和与他人交往。然而，目前没有 针对收购DLS的干预方案。重新提交这份指导性的以患者为导向的 研究职业发展奖（K23）支持候选人的长期目标， 评估针对ASD青少年DLS的有效干预措施，以促进成功过渡到 成年和生活质量的提高。候选人将通过获得 指导和培训（1）开发和利用严格的方法来客观地衡量DLS 结果;（2）进行随机临床试验（RCT），（3）实施先进的统计分析， 随机对照试验，（4）利用目标实现量表来衡量个人水平的进展，以及（5）加强 手稿和赠款写作技巧。该奖项将设在辛辛那提儿童医院医疗中心 在洛里斯塔克博士的指导下， 瑞文（科罗拉多大学）和丽莎卢布（肯塔基州大学）。拟议的研究将发展， 开展并评估一项团体干预的可行性RCT，即在真实的世界中生存和发展 （STRW），以增加DLS（例如，卫生，烹饪，洗衣和金钱管理）在青少年高 功能性ASD K23中提出的STRW干预措施的关键组成部分是一个迭代过程 (e.g.,有针对性的具体技能、基于证据的策略的使用、家长的参与等）。在进行 RCT，探索性DLS结果测量（即，电脑化的每日电话日记，行为观察 将开发和试点直接评估DLS的目标DLS）。STRW的可行性RCT将是 对56名年龄在14-21岁之间的ASD青少年及其父母进行了研究。参与者将被 随机分配到STRW或对照组（即，社会技能组）。主要DLS结局（即，Vineland 适应性行为量表，第3版），次要DLS结局（即，目标实现比例），以及 探索性DLS结果（即，每日电话日记、直接行为观察、DLS自我报告） 评估。将在治疗后比较STRW与对照组的初步疗效（目标1） 并将在6个月随访时测量治疗增益的维持（目标2）。执行功能， 社会技能，精神病理学，和父母的因素将被探讨，以检查他们对目标DLS的影响 (Aim 3）。DLS干预有可能直接影响目前的功能和未来的成人结局， 高功能ASD青少年通过提高成功所需技能的能力， 独立生活和就业。这项研究将为更严格的疗效试验提供基础。 DLS干预将在本K奖结束前在R 01赠款申请中提出。

PROJECT SUMMARY/ABSTRACT Individuals with autism spectrum disorder (ASD), even those defined as high functioning (IQ >70), have significant daily living skills (DLS) deficits that have been linked to poor adult outcome in independent living, post-secondary education, employment, and socializing with others. However, there are currently no intervention packages that target the acquisition of DLS. The resubmission of this Mentored Patient-Oriented Research Career Development Award (K23) supports the candidate's long-term goals of implementing and evaluating effective interventions that target DLS in adolescents with ASD to facilitate a successful transition to adulthood and an increased quality of life. The candidate will pursue her short-term goals by receiving mentorship and training in (1) developing and utilizing rigorous methodology to objectively measure DLS outcomes; (2) conducting randomized clinical trials (RCTs), (3) implementing advanced statistical analyses of RCTs, (4) utilizing goal attainment scaling to measure progress at the individual level, and (5) enhancing manuscript and grant writing skills. The award will be based at Cincinnati Children's Hospital Medical Center under the mentorship of Dr. Lori Stark and co-mentorship of Drs. Avani Modi, Jareen Meinzen-Derr, Judy Reaven (University of Colorado), and Lisa Ruble (University of Kentucky). The proposed research will develop, conduct, and evaluate a feasibility RCT of a group intervention, Surviving and Thriving in the Real World (STRW), to increase DLS (e.g., hygiene, cooking, laundry, and money management) in adolescents with high functioning ASD. An iterative process informed key components of the STRW intervention proposed in the K23 (e.g., specific skills targeted, use of evidence-based strategies, parental involvement, etc.). Prior to conducting the RCT, exploratory DLS outcome measures (i.e., computerized daily phone diaries, behavioral observations of targeted DLS) that directly assess DLS will be developed and piloted. A feasibility RCT of STRW will then be conducted with 56 adolescents with ASD between the ages of 14-21 and their parents. Participants will be randomized to either a STRW or control group (i.e., social skills group). Primary DLS outcomes (i.e., Vineland Adaptive Behavior Scales, 3rd Edition), secondary DLS outcomes (i.e., goal attainment scaling), and exploratory DLS outcomes (i.e., daily phone diaries, direct behavioral observations, self-report of DLS) will be assessed. The preliminary effectiveness of STRW will be compared to the control at post-treatment (Aim 1) and maintenance of treatment gains will be measured at 6-month follow-up (Aim 2). Executive functioning, social skills, psychopathology, and parenting factors will be explored to examine their effect on targeted DLS (Aim 3). A DLS intervention has the potential to directly affect current functioning and future adult outcomes in adolescents with high functioning ASD by increasing capabilities for skills that are needed to be successful in independent living and employment. This research will provide the basis for a more rigorous efficacy trial of the DLS intervention to be proposed in an R01 grant application prior to the end of this K award.