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: 10388241
• 负责人: Brian Antonio Boyd
• 金额: $ 51.4万
• 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/10388241
• 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; 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; pilot test; psychiatric comorbidity; 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.

项目概要 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儿童的家庭 自闭症谱系障碍（ASD）。最近的 SPARK 调查1（N = 8,000）发现，大约 95% 的家长 报告称，由于 COVID-19，他们的孩子的挑战性行为有所增加，并且限制性、重复性的行为 儿童的行为和兴趣（RRBI）可能属于这一类。因为只有 35% 的家长参加了 SPARK 调查显示，他们的孩子正在远程接受治疗服务，COVID-19 大流行可能会 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合并症有关 （例如，焦虑）。鉴于目前患有自闭症谱系障碍 (ASD) 的儿童已经脱离了正常生活，并且其学习能力严重下降。 治疗和教育服务、RRBI 和儿童合并症此时可能会被放大。 然而，目前还没有有效的疗法来治疗自闭症谱系障碍中发现的各种重复性、僵化行为，并且 目前还没有专门针对这一核心的行为干预措施的大规模研究 症状域。这导致了有效行为治疗数量之间存在显着的治疗差距。 与设计的疗法相比，用于针对自闭症非典型社交沟通行为的疗法 来治疗重复行为。因此，我们的团队开发并试点了家庭实施的治疗方法 行为不灵活（FITBI），源自奖励和学习的神经行为模型。总体目标为 FITBI 旨在教家长如何识别环境中可能引发 RRBI 症状的高概率线索 并教导孩子抑制重复行为，并用灵活且更实用的行为取而代之 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无疑有所增加。 虽然远程医疗干预对自闭症儿童的有效性正在显现，但早期研究表明 通过远程医疗为患有自闭症谱系障碍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。 然而，我们目前还不了解远程实施的 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） 将 FITBI 远程交付（12 周干预 + 6 个月内 3 次加强课程）与远程交付进行比较 最终样本量为 100 名（3-9 岁）自闭症谱系障碍儿童，仅进行家长教育 (PE) 控制条件 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， 通过远程医疗加强治疗师与家长的指导。此外，该提案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，以促进转化 有关个性化干预方法的研究和知识。