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199日大流行期间，家庭面临着巨大的挑战，尤其是那些为儿童带来的挑战 自闭症谱系障碍（ASD）。最近的Spark Survey1（n = 8,000）发现，约有95％的父母 据报道，由于COVID-19的结果，孩子的挑战行为增加了，重复性，重复性 儿童的行为和利益（RRBI）可能属于这一类别。由于只有35％的父母 Spark调查表明，他们的孩子正在远程接受治疗服务，Covid-19可能会大流行 加剧ASD的核心症状。 RRBI通常是临床治疗的目标，因为它们可以显着 干扰学习，并与长期功能障碍和精神病合并症有关 （例如，动画）。鉴于ASD患有ASD的儿童目前不合时宜，并且严重减少 治疗和教育服务，儿童的RRBI和合并症目前可能会放大。 然而，没有有效的疗法来治疗ASD中发现的全部重复性，僵化的行为，并且 没有针对该核心的专门针对行为干预措施进行的大规模研究 症状领域。这导致了有效行为的数量之间的显着治疗差距 与设计的疗法相比 治疗重复行为。这是我们的团队开发并进行了试点测试的家庭实施治疗 行为僵化（FITBI），源自奖励和学习的神经行为模型。总体目标 FITBI将教父母如何识别可能引起RRBI症状的环境中的高概率提示 并教他们的孩子抑制重复行为，而用灵活，更有用的替代它们 行为。自我们最初的试点研究以来，对基于技术的干预措施的需求肯定增加了。 虽然远程医疗对ASD儿童的有效性正在出现，但早期研究表明 通过远程医疗为患有ASD的儿童提供的干预措施可能与面对面的干预措施一样有效。 但是，我们目前尚不了解远程提供的RRBI干预措施的有效性。 因此，该项目的总体目标是进行平行组随机对照试验（RCT） 比较FITBI的远程交付（12周干预 + 3个助推器会议）与远程交付 在最终的100（3-9岁）ASD和ASD儿童的最终样本大小和父母教育的控制状态（PE）控制状态 仪式性重复行为的高率。我们将使用Torsh，这是一个全面的安全在线平台 通过远程医疗增强治疗师父母的教练。此外，该提议的一个重要目标是检查 与治疗反应和摄取相关的子女因素和父母因素，以推动翻译 关于个性化干预方法的研究和知识。