权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Flexible scheduling to prevent the development of disabling resistance to change

灵活的调度，以防止发展阻碍变革的阻力

基本信息

批准号：
MR/R000883/1
负责人：
Kate Woodcock
金额：
$ 18.84万
依托单位：
University of Birmingham
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2018
资助国家：
英国
起止时间：
2018 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FR000883%2F1
关键词：
Flexible scheduling prevent development disabling

项目摘要

Several neurodevelopmental disorders, including autism spectrum disorder, fragile X and Prader-Willi syndrome are associated with strong difficulties in dealing with changes to routines or expectations ("resistance to change" henceforth). Such resistance to change represents a highly disabling aspect of these disorders because it commonly precipitates behaviour problems that have a major negative impact on the lives of individuals with the disorders and their families.Evidence from experimental studies shows that this resistance to change is associated with limitations in cognitive flexibility (task switching), which is the ability to think about situations differently depending on changing demands. Furthermore, work on the typical development of cognitive flexibility suggests that - from both theoretical and empirical perspectives - this may be facilitated by exposure to environments with specific characteristics, namely those comprising flexiblility. Finally, our own work with individuals with PWS suggests that exposure to more rigid routines can be detrimental to an individual's subsequent ability to deal with changes, perhaps particularly when this exposure occurs during early school years.Taken together, this evidence suggests that an intervention strategy which increases flexibility in the environments that children are exposed to during early school years (when cognitive flexibility is developing rapidly), may be effective in preventing the development of disability linked to resistance to change. The present project aims to develop such an intervention strategy capitalising on current best practice, which advocates use of visual schedules to structure environments (to avoid changes that may precipitate contemporary behaviour problems). Thus, the inherent limitations of best practice implied by the evidence outlined above, will also be addressed.Critically, the present project aims to develop the intervention strategy and an associated implementation monitoring tool, collaboratively with stakeholders to maximise acceptability. Furthermore, the feasibility of implementing the intervention and monitoring; the capacity of the intervention to increase flexibility in children's routines; and the feasibility of the measures needed to evaluate the intervention in future pilot work will be assessed.The present work represents an essential step in the creation of a new intervention strategy that can prevent the development of disability linked to resistance to change, which is relevant for individuals with several neurodevelopmental disorders. Importantly, resistance to change is associated with particularly high negative impact (most disabling) for many families but is not well addressed in existing prevention approaches. Thus, the present strategy would be the first to systematically target prevention of resistance to change.The work will enable a future pilot randomised controlled study. The future planned pilot study will evaluate how far exposure to increased flexibility in routines during early childhood - mediated by the presently developed flexible visual scheduling caregiver led intervention - can prevent the development of disability linked to resistance to change, via increases in cognitive flexibility. Since in the present project, the intervention will be developed collaboratively to maximise acceptability; if the outcome of the pilot study suggests its efficacy, this can be immediately followed by a large evaluation, designed to enable the intervention to be used to decrease disability on a wide scale.

一些神经发育障碍，包括自闭症谱系障碍、脆性X染色体和普拉德-威利综合征，都与应对常规或期望变化的强烈困难有关（下文称为“抗拒变化”）。这种对改变的抵制代表了这些障碍的一个高度残疾的方面，因为它通常会导致行为问题，对障碍患者及其家庭的生活产生重大负面影响，实验研究的证据表明，这种对改变的抵制与认知灵活性（任务转换）的限制有关，认知灵活性是根据不断变化的需求以不同的方式思考情况的能力。此外，关于认知灵活性的典型发展的工作表明，从理论和经验的角度来看，这可能是通过暴露于具有特定特征的环境，即那些包括flexiblility。最后，我们自己对PWS患者的研究表明，暴露于更严格的日常生活可能不利于个人随后应对变化的能力，尤其是当这种暴露发生在上学早期时。这一证据表明，一种干预策略，增加灵活性的环境中，儿童暴露在早期学年（当认知灵活性迅速发展时），可能有效地防止与抵制变化有关的残疾的发展。本项目旨在开发这样一种干预策略，利用当前的最佳实践，提倡使用视觉时间表来构建环境（以避免可能引发当代行为问题的变化）。因此，上述证据所暗示的最佳实践的固有局限性，也将被address.Critically，本项目的目的是制定干预战略和相关的实施监测工具，与利益相关者合作，以最大限度地提高可接受性。此外，实施干预和监测的可行性;干预增加儿童日常生活灵活性的能力;目前的工作是制定一项新的干预战略的重要步骤，该战略可以防止与抵制变革有关的残疾的发展，这与患有几种神经发育障碍的个体有关。重要的是，对改变的抵制与对许多家庭的特别高的负面影响（大多数是致残性的）有关，但现有的预防方法没有很好地解决这一问题。因此，目前的战略将是第一个系统地针对预防变化的阻力。这项工作将使未来的试点随机对照研究。未来计划的试点研究将评估在多大程度上暴露于增加灵活性的日常生活在幼儿期-介导的目前开发的灵活的视觉调度护理人员领导的干预-可以防止残疾的发展与阻力的变化，通过增加认知的灵活性。由于在本项目中，将合作开发干预措施，以最大限度地提高可接受性;如果试点研究的结果表明其有效性，则可以立即进行大型评估，旨在使干预措施能够用于大规模减少残疾。