Neural and Behavioral Outcomes of Social Skills Groups in Children with ASD

描述（由申请人提供）：严重的社会交往障碍是自闭症谱系障碍（ASD）的标志。虽然社会功能的改善被广泛认为是干预的一个重要目标，学龄儿童的社会技能治疗一直是少数控制调查的主题。现有文献表明，认知行为（CBT）技术是常用的，可以在短期内改善ASD患者的目标社交技能。然而，由于现有研究的方法限制（例如，缺乏随机分组，样本量小，缺乏基于手册的课程，对推广或维持的评估很少）。几项神经影像学研究发现，ASD患者参与社会认知的关键大脑区域激活不足。然而，也有证据表明，通过向高功能ASD儿童提供明确的指示来注意重要的社交线索，如说话者的面部表情和语调，可以显着增加规范神经网络的活动。这表明，认知行为方法的社会技能治疗可能会增加社会反应在行为和神经水平。本研究的目的是探讨基于CBT的社交技能治疗对社会认知和支持它的神经结构的急性和持续影响。高功能ASD儿童（8-11岁）将被随机分配到12周的认知行为社交技能组或社交游戏对照组，以控制非特异性治疗效果。将在基线、治疗后即刻和3个月随访时进行功能性MRI扫描以及社会认知、适应功能和症状严重程度的行为评估。我们假设，与社交游戏对照组的儿童相比，CBT组的儿童在治疗后和随访时的社会功能和关键大脑区域的激活都会有更大的改善。本研究旨在解决一些早期的方法学限制，以提供有关CBT方法对社会技能治疗的短期疗效和持久性的急需信息，以及伴随和/或预测治疗反应的神经事件。 公共卫生相关性：认知行为疗法（CBT）社交技能小组通常用于患有ASD的高功能儿童;然而，这些治疗的有效性和持久性尚不清楚。仅在美国，ASD的经济负担估计在每年300亿美元的范围内，针对社交技能核心缺陷的有效治疗评估势在必行。为此，拟议的研究是一项随机对照调查，旨在评估短期影响和维护的技能教基于CBT的社会技能组，在行为和神经水平。

DESCRIPTION (provided by applicant): Profound impairment in social interaction is a hallmark of autism spectrum disorders (ASD). Although improvement in social functioning is widely considered to be a crucial target for intervention, social skills treatments for school-age children have been the subject of few controlled investigations. The available literature suggests that cognitive behavioral (CBT) techniques are commonly used and may improve targeted social skills in the short term in individuals with ASD. However, drawing firm conclusions about the efficacy of CBT social skills training remains difficult, particularly with respect to maintenance of skills and generalization to natural settings, owing to methodological limitations of extant studies (e.g., lack of random assignment to groups, small sample size, lack of manual-based curricula, minimal assessment of generalization or maintenance). Several neuroimaging studies have found that individuals with ASD underactivate key brain regions involved in social cognition. However, there is also evidence to suggest that activity in normative neural networks can be increased significantly by providing high-functioning children with ASD with explicit instructions to pay attention to important social cues, such as a speaker's facial expression and tone of voice. This suggests that a cognitive behavioral approach to social skills treatment may increase social responsiveness at both the behavioral and neural levels. The purpose of this investigation is to examine the acute and sustained effects of a CBT-based social skills treatment on social cognition and the neural architecture that supports it. High-functioning children with ASD (8-11 years old) will be randomly assigned to a 12-week cognitive behavioral social skills group or a social play comparison group to control for non-specific therapeutic effects. Functional MRI scans as well as behavioral assessments of social cognition, adaptive functioning, and symptom severity will be acquired at baseline, immediately following treatment, and at a 3- month follow-up. We hypothesize that children in the CBT group will show greater improvement in social functioning and increased activation of key brain regions, relative to children in the social play comparison group, both post-treatment and at follow-up. This study aims to address some of the earlier methodological limitations to provide much needed information about the short-term efficacy and durability of a CBT approach to social skills treatment, as well as the neural events that accompany and/or predict response to treatment. PUBLIC HEALTH RELEVANCE: Cognitive behavioral therapy (CBT) social skills groups are commonly used with high functioning children with ASDs; however, the efficacy and durability of these treatments are unknown. With the economic burden of ASD estimated in the range of $30 billion annually in the U.S alone, evaluation of efficacious treatments targeting core deficits in social skills is imperative. Toward this effort, the proposed study is a randomized controlled investigation designed to evaluate short-term effects and maintenance of skills taught in CBT-based social skills groups, at both the behavioral and neural levels.