Telehealth Parent-Only Treatment for Youth with Autism Spectrum Disorder and Overweight/Obesity

摘要 在美国，大约每54名儿童中就有1名被诊断患有自闭症谱系障碍（ASD）。之间 患有ASD的儿童，超重和肥胖（OW/OB）的估计值范围从19%到高达55%， 大多数研究报告OW/OB率等于或大于正常发育儿童。OW/OB in 童年一直延续到成年，并与负面的健康和心理社会后果有关。 到目前为止，对典型发育中的OW/OB儿童最成功的治疗是以家庭为基础的行为干预。 治疗（FBT），每周为父母和孩子分别提供一次基于小组的治疗，为期6- 月期间。然而，ASD儿童通常被排除在这些试验之外， 介绍，需要量身定制的治疗方案。为没有孩子的父母提供的FBT计划（基于父母的 治疗[PBT]）更适合有ASD和OW/OB儿童的家庭，因为功能和 儿童的语言水平会影响他们直接参与密集的小组活动的能力。 程序.研究表明，PBT在儿童减肥方面并不比FBT差，而且实施成本更低。 我们的小组已经开发并试点测试了一种用于ASD和OW/OB儿童的PBT组（称为PBT-ASD）。 我们的试点数据表明，PBT-ASD方案是可行的，可接受的，并显示出初步的儿童疗效 减肥.该项目是该研究计划的下一步，我们将招募150名具有OW/OB的年轻人 和ASD及其父母，并将他们随机分配到6个月的远程健康PBT-ASD或积极的健康教育 比较器（HE）。我们将在五个时间点评估儿童和父母的主要结果：基线，中期， 治疗（3个月）、治疗后（6个月）、6个月随访（12个月）和12个月随访（月 18）。本研究的主要目的是比较PBT-ASD和HE对目标儿童体重的影响 (BMIz/%BMIp95）。第二个目的是确定 PBT-ASD和HE影响父母BMI、父母和孩子的体力活动和饮食摄入、孩子进餐时间 行为、父母教养方式和自我效能感。作为一个探索性的目标，我们将评估主持人（如父母和 儿童性别、父母和儿童年龄、父母教育水平、父母基线BMI、儿童基线BMIz/%BMI p95，父母执行功能，养育，儿童症状严重程度，儿童适应行为技能）和 PBT-ASD和HE治疗对儿童BMIz/%BMI的介导因素（例如，父母养育、儿童症状严重程度） p95时间这项研究计划可以提高ASD儿童的实践标准， 可以为ASD和OW/OB儿童提供量身定制的干预措施。我们相信，通过与 父母使用远程医疗模式，我们可以提供有效和持久的治疗， 容易传播给患有ASD和OW/OB的儿童的父母。

ABSTRACT Approximately 1 in 54 children in the United States is diagnosed with autism spectrum disorder (ASD). Among children with ASD, estimates of overweight and obesity (OW/OB) range from 19% to as high as 55% with the majority of studies reporting OW/OB rates equal to or greater than typically developing children. OW/OB in childhood tracks well into adulthood and is associated with negative health and psychosocial consequences. To date, the most successful treatment for typically developing children with OW/OB is family-based behavioral treatment (FBT), which delivers weekly group-based treatment to the parent and child separately over a 6- month period. However, children with ASD are typically excluded from these trials and given their unique presentation, require a tailored treatment program. FBT programs for parents without their child (Parent-based treatment [PBT]) are more appropriate for families with a child with ASD and OW/OB, as the functioning and language levels of the children can impact their ability to directly participate in an intensive group-based program. Research shows that PBT is noninferior to FBT on child weight loss and is less costly to implement. Our group has developed and pilot tested a PBT group for children with ASD and OW/OB (called PBT-ASD). Our pilot data showed that the PBT-ASD program was feasible, acceptable and showed initial efficacy on child weight loss. This project is the next step in this program of research, and we will recruit 150 youth with OW/OB and ASD and their parent and randomize them to a 6-month telehealth PBT-ASD or active health education comparator (HE). We will assess main outcomes in children and parents at five time points; baseline, mid- treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12) and 12-month follow-up (month 18). The primary aim of this study is to compare the effect of PBT-ASD and HE on the target child’s weight (BMIz/%BMIp95) over the 18 months of the study. The secondary aim is to determine the extent to which the PBT-ASD and HE affect parent BMI, parent and child physical activity and dietary intake, child mealtime behavior, parenting style and self-efficacy. As an exploratory aim, we will evaluate moderators (e.g. parent and child gender, parent and child age, parent educational level, parent baseline BMI, child baseline BMIz/%BMI p95, parent executive functioning, parenting, child symptom severity, child adaptive behavior skills) and mediators (e.g. parenting, child symptom severity) of the PBT-ASD and the HE treatment on child BMIz/%BMI p95 over time. This program of research could advance the standard of practice for children with ASD, and could result in a tailored intervention for children with both ASD and OW/OB. We believe that by working with parents using a telehealth model, we can potentially provide an effective and durable treatment, which can easily be disseminated to parents with children with both ASD and OW/OB.