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

描述(由申请人提供)：严重的社交障碍是自闭症谱系障碍(ASD)的标志。尽管社会功能的改善被广泛认为是干预的关键目标，但学龄儿童的社交技能治疗很少受到控制调查。现有文献表明，认知行为(CBT)技术被普遍使用，并可能在短期内改善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，缺乏对小组的随机分配、样本量小、缺乏以手动为基础的课程、对推广或维护的最低评估)，就CBT社交技能培训的有效性得出确切结论仍然困难，特别是在技能保持和推广到自然环境方面。几项神经成像研究发现，自闭症患者大脑中涉及社会认知的关键区域活动不足。然而，也有证据表明，通过向患有自闭症的高功能儿童提供明确的指示，注意重要的社交线索，如说话者的面部表情和语调，标准神经网络中的活动可以显著增加。这表明，社交技能治疗的认知行为方法可能会在行为和神经层面上提高社会反应性。这项调查的目的是检验基于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。患有自闭症的高功能儿童(8-11岁)将被随机分配到为期12周的认知行为社交技能组或社交游戏对照组，以控制非特定治疗效果。在基线、治疗后立即和3个月的随访中，将获得功能磁共振扫描以及对社会认知、适应功能和症状严重性的行为评估。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中都会表现出更大的社会功能改善和关键大脑区域的激活。这项研究旨在解决一些早期的方法学局限性，以提供关于CBT方法对社交技能治疗的短期有效性和持久性以及伴随和/或预测治疗反应的神经事件的迫切需要的信息。 公共卫生相关性：认知行为疗法(CBT)社交技能小组通常用于高功能自闭症儿童；然而，这些治疗的有效性和持久性尚不清楚。据估计，仅在美国，自闭症每年的经济负担就在300亿美元左右，因此针对社会技能核心缺陷进行有效治疗的评估势在必行。为了达到这一目的，这项拟议的研究是一项随机对照调查，旨在评估基于CBT的社交技能小组在行为和神经层面上教授的技能的短期效果和保持情况。

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.