Exploring Mechanisms of Change in a Pilot Trial of the RUBI Program in Educational Settings

摘要 大约50%的自闭症谱系障碍（ASD）儿童表现出破坏性行为，如 发脾气，侵略性和不遵守，严重影响学术任务的有意义的参与 和同龄人，以及导致在更严格的课堂设置安置。目前学校 行为管理方法虽然有效，但耗时耗力。有一个 需要建立有效和务实的干预模式，与直接护理提供者建立能力， 干预过程，减少对强化行为支持的需求，并增加 ASD儿童可以得到服务。RUBI计划是一个以证据为基础的父母中介干预 改善自闭症儿童的破坏性行为。考虑到学校是主要的干预措施， ASD儿童的环境，而准教育工作者往往难以解决具有挑战性的行为， 在课堂上，有机会通过将RUBI从诊所交付到 从学校到家长再到准教育者。目前的研究是最近完成的NIMH的延伸- 资助以人为本的设计研究，目标是修改瑞比，以确保其适用于 教育环境。这项为期三年的试验性随机试验旨在测试新的 重新设计的paraeducator提供的RUBI用于教育环境（RUBIES）干预相比， 常规护理训练减少80名小学ASD儿童的破坏性行为。鉴于关键的 不仅需要了解干预措施是否有效，而且需要了解干预措施如何起作用，这项研究还将研究 辅助教育者和儿童层面的RUBIES干预机制路径。成功完成 拟议的研究将允许在公立学校进行大规模的RUBIES有效性试验，以减少干扰 行为，这有可能提高全国ASD儿童的生活质量。

ABSTRACT Approximately 50% of children with autism spectrum disorder (ASD) exhibit disruptive behaviors such as tantrums, aggression, and noncompliance that significantly impact meaningful engagement in academic tasks and with peers as well as result in placement in more restrictive classroom settings. Current school-based behavioral management approaches, while effective, are time-consuming and resource-intensive. There is a need for efficient and pragmatic intervention models that build capacity with direct care providers, streamline the intervention process, reduce the need for intensive behavioral supports, and increase the number of children with ASD who can be served. The RUBI program is an evidence-based parent-mediated intervention that improves disruptive behavior in children with ASD. Considering schools serve as the primary intervention setting for children with ASD, and paraeducators often struggle to address challenging behavior in the classroom, there is an opportunity to meaningfully improve care by moving RUBI from delivery in clinic to school and from parent to paraeducator. The current study is an extension of a recently completed NIMH- funded human-centered design study targeting modification of RUBI to ensure its appropriateness for use in educational settings. The proposed three-year pilot randomized trial aims to test the effectiveness of the newly- redesigned paraeducator-delivered RUBI for use in Educational Settings (RUBIES) intervention compared to usual care training in reducing disruptive behavior in 80 elementary-school children with ASD. Given the critical need to understand not just whether, but also how interventions work, this study also will examine paraeducator- and child-level mechanistic pathways of the RUBIES intervention. Successful completion of the proposed study will allow for a large-scale effectiveness trial of RUBIES in public schools to reduce disruptive behavior, which has the potential to improve the quality of life for children with ASD across the country.