Parent implemented treatment for repetitive behaviors in children with ASD: Using a novel telehealth approach to increase service access

家长对自闭症谱系障碍儿童的重复行为进行治疗：使用新颖的远程医疗方法来增加服务的可及性

• 批准号: 10194031
• 负责人: Brian Antonio Boyd
• 金额: $ 52.67万
• 依托单位: UNIVERSITY OF KANSAS LAWRENCE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-10 至 2026-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10194031
• 关键词: Acute; Aftercare; Anxiety; Behavior; Behavior Therapy; Behavioral; COVID-19; COVID-19 pandemic; Caregivers; Caring; Categories; Cellular Phone; Child; Child Behavior; Clinical Treatment; Cues; Distal; Education; Effectiveness; Environment; Ethnic Origin; Family; Feeling; Goals; Intervention; Intervention Studies; Knowledge; Learning; Link; Low income; Marital Status; Mediating; Modeling; Outcome; Parents; Persons; Pilot Projects; Play; Probability; Race; Randomized Controlled Trials; Reporting; Research; Rewards; Role; Sample Size; Secure; Services; Stress; Surveys; Symptoms; Technology; Testing; Therapeutic; Time; Translational Research; Videoconferencing; anxiety symptoms; autism spectrum disorder; autistic children; base; behavioral study; communication behavior; comorbidity; comparison group; design; effective therapy; experience; falls; fascinate; flexibility; follow-up; functional disability; implementation intervention; improved; interest; neglect; neurobehavioral; novel; pandemic disease; personalized intervention; reduce symptoms; remote delivery; remote intervention; repetitive behavior; skills; social communication; telehealth; treatment effect; treatment research; treatment response; trial comparing; uptake

PROJECT SUMMARY Families are facing significant challenges during the COVID-19 pandemic, especially those caring for a child with autism spectrum disorder (ASD). A recent SPARK survey1 (N = 8,000) found that approximately 95% of parents reported increases in their child’s challenging behaviors as a result of COVID-19, and the restricted, repetitive behaviors and interests (RRBI) of children likely fall within this category. Since only 35% of parents who took the SPARK survey indicated their child is receiving therapy services remotely, the COVID-19 pandemic will likely exacerbate this core symptom of ASD. RRBIs are often the target for clinical treatment, as they can significantly interfere with learning, and are associated with long-term functional impairment, and psychiatric comorbidities (e.g., anxiety). Given children with ASD are currently out of routine and experiencing a severe reduction in therapeutic and educational services, the RRBIs and comorbidities of children are likely magnified at this time. Yet, there are no effective therapies to treat the full range of repetitive, inflexible behaviors found in ASD, and there have been no large-scale studies of behavioral interventions specifically developed to target this core symptom domain. This has resulted in a significant treatment gap between the number of effective behavioral therapies used to target atypical social-communication behaviors in autism when compared to those designed to treat repetitive behaviors. Thus, our team developed and pilot-tested the Family-Implemented Treatment for Behavioral Inflexibility (FITBI), derived from neurobehavioral models of reward and learning. The overall goal of FITBI is to teach parents how to identify high probability cues in the environment that can elicit RRBI symptoms and teach their child to inhibit repetitive behaviors and instead replace them with flexible and more functional behaviors. Since our initial pilot studies, the need for technology-based interventions has certainly increased. While the effectiveness of telehealth interventions for children with ASD is emerging, early research suggests interventions delivered via telehealth for children with ASD may be just as effective as in-person interventions. Yet, we currently have no understanding of the effectiveness of RRBI interventions delivered remotely. Therefore, the overall goal of this project is to conduct a parallel group randomized controlled trial (RCT) comparing remote delivery of FITBI (12-week intervention + 3 booster sessions over 6 months) to remote delivery of a parent education only (PE) control condition in a final sample size of 100 (3-9 years) children with ASD and high rates of ritualistic repetitive behaviors. We will use TORSH, a comprehensive secure online platform that enhances therapist-parent coaching via telehealth. Further, an important objective of this proposal is to examine child and parent factors associated with treatment response and uptake in order to advance translational research and knowledge on personalized intervention approaches.

项目摘要 在COVID-19大流行期间，家庭面临着重大挑战，尤其是那些照顾患有此病的孩子的家庭 自闭症谱系障碍（ASD）。最近的一项SPARK调查1（N = 8，000）发现，大约95%的父母 报告说，由于COVID-19，他们的孩子的挑战性行为增加， 儿童的行为和兴趣（RRBI）可能属于这一类。因为只有35%的父母参加了 SPARK调查显示，他们的孩子正在接受远程治疗服务，COVID-19大流行可能会 加剧了ASD的核心症状RRBI通常是临床治疗的目标，因为它们可以显著地 干扰学习，并与长期功能障碍和精神病合并症有关 (e.g.,焦虑）。考虑到ASD儿童目前脱离常规， 治疗和教育服务，RRBI和儿童合并症可能在此时被放大。 然而，没有有效的疗法来治疗ASD中发现的所有重复性，不灵活的行为， 目前还没有专门针对这一核心的行为干预的大规模研究 症状域这导致了有效的行为治疗数量之间的显着差距， 与那些设计的治疗相比， 来治疗重复性行为因此，我们的团队开发并试点测试了家庭实施的治疗方法， 行为不灵活性（FITBI），源于奖励和学习的神经行为模型。的总目标 FITBI是教父母如何识别环境中可能引起RRBI症状的高概率线索 并教他们的孩子抑制重复的行为，取而代之的是灵活的，更实用的 行为。自我们进行初步试点研究以来，对基于技术的干预措施的需求肯定有所增加。 虽然远程医疗干预对ASD儿童的有效性正在显现，但早期研究表明， 通过远程保健为ASD儿童提供的干预措施可能与亲自干预措施一样有效。 然而，我们目前还不了解远程提供的RRBI干预措施的有效性。 因此，本项目的总体目标是进行平行组随机对照试验（RCT） 比较FITBI的远程分娩（12周干预+6个月内的3次强化治疗）与远程分娩 在100名（3-9岁）ASD儿童的最终样本量中， 仪式性重复行为的发生率很高我们将使用TORSH，一个全面的安全在线平台， 通过远程保健加强治疗师-家长指导。此外，这项建议的一个重要目标是审查 与治疗反应和吸收相关的儿童和父母因素， 个性化干预方法的研究和知识。