Risk and Resiliency for Youth With Autism During the Transition to Adulthood

描述（由申请人提供）：NIMH指导研究科学家职业发展（K 01）奖的申请寻求支持，以开发一项研究计划，重点关注生物应激反应，行为功能和环境资源在促进自闭症谱系障碍（ASD）青年成功过渡到成年的作用。由于学校系统失去了服务，对这些年轻人来说，离开高中是一个具有挑战性的时期。由于下丘脑-垂体-肾上腺（HPA）轴调节个体对挑战性环境的情感和生理反应能力，因此其功能障碍是一个有希望的生物学因素，可能会加剧这些年轻人的不良结局。因此，培训计划的一个核心组成部分是HPA轴功能和压力反应方面的指导，因为它与ASD有关。培训计划的第二个关键组成部分是指导临床研究技能。这位候选人是一位没有接受过临床训练的发展心理学家，因此她在研究中依靠临床医生来识别自闭症症状并诊断ASD。此外，共病精神障碍在患有ASD的青少年中非常常见，但很难识别，因为它们的症状经常与ASD的症状重叠。因为没有共病精神障碍是积极的成人结局的重要组成部分，所以认识到它们的发生是很重要的。候选人还将继续培训：1）衡量学校和成人服务系统中与残疾相关的服务的质量和可用性; 2）在ASD青少年家庭中进行纵向研究; 3）开发额外的方法和统计专业知识，以分析复杂的昼夜皮质醇和纵向数据;和4）行为干预研究。总之，这种培训将允许识别具有可塑性的不良过渡的风险因素（如压力反应或家庭环境）。作为候选人职业发展计划的一部分，她建议对准备离开高中的ASD青年进行纵向研究。该项目旨在：1）调查压力反应曲线，行为曲线和环境资源之间的变化和相互关系，作为ASD向成年过渡的青年; 2）调查成人结果如何通过基线测量（在高中时收集）和压力反应曲线，行为曲线和环境资源的变化来预测。将在高中最后一年招募青年，在他们离校前约6个月以及离校后6个月和18个月收集数据。在每个时间点，将使用半结构化观察来检查自闭症症状和诊断，并收集昼夜皮质醇。母亲们将报告儿子或女儿的自闭症症状、行为问题、日常活动、残疾相关服务、家庭温暖和批评以及自己的心理健康状况。在第二个时间点（退出后6个月），将使用社会应激源范例（沿着皮质醇收集）来测量这些青年中的急性生物应激反应。作为这项研究的结果，候选人将能够确定可塑性的风险因素，当辅助可以促进积极的成年结果和更好地过渡到成年。到目前为止，ASD成年人的不良结局仅与静态，不变的风险因素有关，如低智商和早期语言不良。然而，由于ASD儿童退出学校系统的激增以及ASD的高昂公共成本，审查易于干预的风险因素至关重要。候选人计划利用通过该奖项获得的专业知识来开发R 01赠款提案，调查ASD青年高中毕业后与没有ASD的同龄人相比的生物，行为和家庭风险和弹性的长期模式，长期目标是开发和研究干预措施，以促进过渡成功。

DESCRIPTION (provided by applicant): This application for an NIMH Mentored Research Scientist Career Development (K01) award seeks support to develop a program of research focused on the roles of biological stress response, behavioral functioning, and environmental resources in promoting a successful transition to adulthood for youth with autism spectrum disorders (ASD). Exiting high school is a challenging time for these youth, given the loss of services through the school system. Because the hypothalamic-pituitary-adrenal (HPA) axis modulates an individual's ability to react emotionally and physiologically to challenging environments, its dysfunction is a promising biological factor that might exacerbate poor outcomes for these young adults. Thus, a central component of the training plan is mentorship in HPA axis functioning and stress response as it relates to ASD. The second key component of the training plan is mentoring in clinical research skills. The candidate is a developmental psychologist with no clinical training, and thus she has relied on clinicians to recognize autism symptoms and diagnose ASD in her research. Furthermore, comorbid psychiatric disorders are extremely common in youth with ASD but can be difficult to recognize because their symptoms often overlap with symptoms of ASD. Because the absence of comorbid psychiatric disorders is an important component of positive adult outcomes, it is important to recognize their occurrence. The candidate will also pursue training in: 1) Measuring the quality and availability of disability-related services in the school and adult-service systems; 2) Conducting longitudinal research among families of youth with ASD; 3) Developing additional methodological and statistical expertise to analyze complex diurnal cortisol and longitudinal data; and 4) Behavioral intervention research. Together, this training will allow for the identification of risk factors for poor transition that are malleable (such as stress response or family environment). As part of the candidate's career development plan, she proposes a longitudinal study of youth with ASD who are preparing to exit high school. This project aims to: 1) Investigate the changes in and inter-relations among stress response profiles, behavioral profiles, and environmental resources as youth with ASD transition to adulthood; and 2) Investigate how adult outcomes are predicted by baseline measures (collected while in high school) and changes in stress response profiles, behavioral profiles, and environmental resources. Youth will be recruited during their final year of high school, with data collection at approximately 6 months before they exit school as well as 6 and 18 months after exit. At each time point, semi-structured observations will be used to examine autism symptoms and diagnosis, and diurnal cortisol will be collected. Mothers will report on their son or daughter's autism symptoms, behavior problems, daily activities, disability-related services, family warmth and criticism, and their own mental health. At the second time point (6 months after exit), a social stressor paradigm will be used (along with cortisol collection) to measure acute biological stress response among these youth. As a result of this research, the candidate will be able to identify malleable risk factors, that when aided could promote positive adult outcomes and better transitions to adulthood. So far, poor outcomes for adults with ASD have been linked only to static, unchanging risk factors such as low IQ and poor early language. Yet due to the surge of children with ASD exiting school systems and the high public costs of ASD, it is critical to examine risk factors that are amenable to intervention. The candidate plans to use the expertise gained through this award to develop an R01 grant proposal investigating long-term patterns of biological, behavioral, and family risk and resiliency following high school exit for youth with ASD compared to peers without ASD, with the long-term goal of developing and studying interventions to promote transition success.