Risk and Resiliency for Youth With Autism During the Transition to Adulthood

自闭症青少年在向成年过渡期间的风险和恢复能力

• 批准号: 8189725
• 负责人: Julie Lounds Taylor
• 金额: $ 14.22万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-16 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8189725
• 关键词: Acute; Address; Adult; Applications Grants; Area; Autistic Disorder; Award; Behavioral; Biological; Biological Factors; Biological Markers; Child; Clinical; Clinical Research; Collection; Complex; Data; Data Collection; Daughter; Development; Development Plans; Diagnosis; Employment; Environment; Environmental Risk Factor; Family; Functional disorder; Goals; Hydrocortisone; Individual; Intervention; Intervention Studies; Language; Lead; Link; Longitudinal Studies; Measures; Mental Health; Mental disorders; Mentored Research Scientist Development Award; Mentors; Mentorship; Modeling; Mothers; National Institute of Mental Health; Outcome; Pattern; Plague; Policies; Problem behavior; Psyche structure; Psychologist; Public Health; Recruitment Activity; Reporting; Research; Resources; Risk; Risk Factors; Role; Schools; Scientist; Secondary Schools; Services; Son; Special Education; Stress; Structure; Symptoms; System; Testing; Time; Training; Translational Research; Waiting Lists; Youth; autism spectrum disorder; base; biological adaptation to stress; career development; cost; disability; experience; high school; hypothalamic-pituitary-adrenal axis; malleable risk; meetings; peer; programs; resilience; skills; social; stressor; success; young adult

DESCRIPTION (provided by applicant): This application for an NIMH Mentored Research Scientist Career Development (K01) award seeks support to develop a program of research focused on the roles of biological stress response, behavioral functioning, and environmental resources in promoting a successful transition to adulthood for youth with autism spectrum disorders (ASD). Exiting high school is a challenging time for these youth, given the loss of services through the school system. Because the hypothalamic-pituitary-adrenal (HPA) axis modulates an individual's ability to react emotionally and physiologically to challenging environments, its dysfunction is a promising biological factor that might exacerbate poor outcomes for these young adults. Thus, a central component of the training plan is mentorship in HPA axis functioning and stress response as it relates to ASD. The second key component of the training plan is mentoring in clinical research skills. The candidate is a developmental psychologist with no clinical training, and thus she has relied on clinicians to recognize autism symptoms and diagnose ASD in her research. Furthermore, comorbid psychiatric disorders are extremely common in youth with ASD but can be difficult to recognize because their symptoms often overlap with symptoms of ASD. Because the absence of comorbid psychiatric disorders is an important component of positive adult outcomes, it is important to recognize their occurrence. The candidate will also pursue training in: 1) Measuring the quality and availability of disability-related services in the school and adult-service systems; 2) Conducting longitudinal research among families of youth with ASD; 3) Developing additional methodological and statistical expertise to analyze complex diurnal cortisol and longitudinal data; and 4) Behavioral intervention research. Together, this training will allow for the identification of risk factors for poor transition that are malleable (such as stress response or family environment). As part of the candidate's career development plan, she proposes a longitudinal study of youth with ASD who are preparing to exit high school. This project aims to: 1) Investigate the changes in and inter-relations among stress response profiles, behavioral profiles, and environmental resources as youth with ASD transition to adulthood; and 2) Investigate how adult outcomes are predicted by baseline measures (collected while in high school) and changes in stress response profiles, behavioral profiles, and environmental resources. Youth will be recruited during their final year of high school, with data collection at approximately 6 months before they exit school as well as 6 and 18 months after exit. At each time point, semi-structured observations will be used to examine autism symptoms and diagnosis, and diurnal cortisol will be collected. Mothers will report on their son or daughter's autism symptoms, behavior problems, daily activities, disability-related services, family warmth and criticism, and their own mental health. At the second time point (6 months after exit), a social stressor paradigm will be used (along with cortisol collection) to measure acute biological stress response among these youth. As a result of this research, the candidate will be able to identify malleable risk factors, that when aided could promote positive adult outcomes and better transitions to adulthood. So far, poor outcomes for adults with ASD have been linked only to static, unchanging risk factors such as low IQ and poor early language. Yet due to the surge of children with ASD exiting school systems and the high public costs of ASD, it is critical to examine risk factors that are amenable to intervention. The candidate plans to use the expertise gained through this award to develop an R01 grant proposal investigating long-term patterns of biological, behavioral, and family risk and resiliency following high school exit for youth with ASD compared to peers without ASD, with the long-term goal of developing and studying interventions to promote transition success. PUBLIC HEALTH RELEVANCE: Using longitudinal data collected at 3 time points over a 2-year time span, this project will examine how biological stress response combines with behavioral functioning and environmental resources to influence the transition to adulthood and positive outcomes for young adults with autism spectrum disorders (ASD). So far, poor outcomes for these adults have been linked only to static, unchanging risk factors such as low IQ and poor early language. Yet due to the surge of children with ASD exiting school systems and the high public costs of ASD, there is an urgent public health and scientific need to understand the range of malleable factors that influence the adaptation of young adults with ASD during the "transition years" and beyond.

描述（由申请人提供）：本申请为NIMH指导研究科学家职业发展（K01）奖寻求支持，以开发一个研究项目，重点研究生物应激反应，行为功能和环境资源在促进自闭症谱系障碍（ASD）青年成功过渡到成年中的作用。高中毕业对这些年轻人来说是一个具有挑战性的时期，因为他们失去了通过学校系统提供的服务。由于下丘脑-垂体-肾上腺（HPA）轴调节个体对挑战性环境的情感和生理反应能力，其功能障碍是一个有希望的生物学因素，可能会加剧这些年轻人的不良后果。因此，培训计划的核心组成部分是指导与ASD相关的下丘脑轴功能和应激反应。培训计划的第二个关键部分是临床研究技能方面的指导。候选人是一名没有接受过临床训练的发展心理学家，因此她在研究中依赖临床医生来识别自闭症症状并诊断ASD。此外，共病性精神障碍在患有ASD的青少年中极为常见，但由于其症状通常与ASD的症状重叠，因此很难识别。因为没有精神疾病共病是积极的成人结局的一个重要组成部分，所以认识到它们的发生是很重要的。候选人还将接受以下方面的培训：1)衡量学校和成人服务系统中残疾相关服务的质量和可用性；2)对青少年ASD家庭进行纵向研究；3)发展更多的方法和统计专业知识，以分析复杂的皮质醇日变化和纵向数据；4)行为干预研究。总之，这一培训将有助于确定易受影响的不良过渡的风险因素（例如压力反应或家庭环境）。作为候选人职业发展计划的一部分，她建议对准备高中毕业的自闭症青少年进行纵向研究。本项目旨在：1)探讨青少年ASD向成年过渡过程中应激反应谱、行为谱和环境资源的变化及其相互关系；2)研究如何通过基线测量（在高中时收集）和压力反应谱、行为谱和环境资源的变化来预测成人的结果。青年将在他们高中的最后一年被招募，在他们离开学校前大约6个月以及离开学校后6个月和18个月收集数据。在每个时间点，将使用半结构化观察来检查自闭症症状和诊断，并收集日皮质醇。母亲们会报告他们儿子或女儿的自闭症症状，行为问题，日常活动，残疾相关服务，家庭温暖和批评，以及他们自己的心理健康。在第二个时间点（退出后6个月），将使用社会压力源范式（以及皮质醇收集）来测量这些年轻人的急性生物应激反应。作为这项研究的结果，候选人将能够识别可塑的风险因素，当帮助可以促进积极的成年结果和更好地过渡到成年。到目前为止，患有自闭症的成年人的不良结果只与静态的、不变的风险因素有关，比如低智商和早期语言能力差。然而，由于退出学校系统的自闭症儿童人数激增，以及自闭症的公共成本高昂，检查可进行干预的风险因素至关重要。候选人计划利用通过该奖项获得的专业知识来制定R01拨款提案，调查患有ASD的青少年与没有ASD的同龄人在高中毕业后的生物，行为和家庭风险和弹性的长期模式，以制定和研究促进过渡成功的干预措施。