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

描述（由申请人提供）：社交互动的严重缺陷是自闭症谱系障碍（ASD）的标志。虽然社会功能的改善被广泛认为是干预的关键目标，但对学龄儿童的社会技能治疗一直是少数对照调查的主题。现有的文献表明，认知行为（CBT）技术是常用的，可以在短期内提高自闭症患者的目标社交技能。然而，由于现有研究方法的局限性（例如，缺乏随机分组、小样本量、缺乏基于手册的课程、对泛化或维持的评估很少），对CBT社会技能训练的有效性得出确切的结论仍然很困难，特别是在技能的维持和自然环境的推广方面。几项神经影像学研究发现，自闭症患者大脑中与社会认知有关的关键区域活动不足。然而，也有证据表明，通过向高功能自闭症儿童提供明确的指示，让他们注意重要的社会线索，如说话人的面部表情和语调，可以显著增加规范神经网络的活动。这表明，认知行为方法治疗社交技能可能会在行为和神经水平上提高社会反应性。本研究的目的是检查基于cbt的社会技能治疗对社会认知的急性和持续影响以及支持它的神经结构。高功能自闭症儿童（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，以控制非特异性治疗效果。功能MRI扫描以及社会认知、适应性功能和症状严重程度的行为评估将在基线、治疗后立即和3个月随访时获得。我们假设，在治疗后和随访中，与社会游戏对照组的儿童相比，CBT组的儿童在社会功能和关键大脑区域的激活方面表现出更大的改善。本研究旨在解决一些早期方法上的局限性，以提供有关CBT治疗社交技能的短期疗效和持久性的急需信息，以及伴随治疗和/或预测治疗反应的神经事件。

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.