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: 9251023
• 负责人: Julie Lounds Taylor
• 金额: $ 5.09万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 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 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9251023
• 关键词: Risk; Resiliency; Youth; Autism; During

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.

描述(由申请者提供)：NIMH导师研究科学家职业发展(K01)奖的申请寻求支持，以制定一个研究计划，重点关注生物应激反应、行为功能和环境资源在促进患有自闭症谱系障碍(ASD)的青年成功过渡到成年过程中的作用。考虑到通过学校系统失去服务，高中毕业对这些年轻人来说是一个具有挑战性的时期。由于下丘脑-垂体-肾上腺(HPA)轴调节个体对具有挑战性的环境做出情感和生理反应的能力，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结局。因此，培训计划的核心部分是指导HPA轴的功能和压力反应，因为它与ASD有关。培训计划的第二个关键组成部分是临床研究技能的指导。候选人是一位没有接受过临床培训的发展心理学家，因此她在研究中依赖临床医生来识别自闭症症状和诊断自闭症。此外，合并精神障碍在患有自闭症的年轻人中非常常见，但可能很难识别，因为他们的症状往往与自闭症的症状重叠。因为没有合并精神障碍是积极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。候选人还将在以下方面进行培训：1)衡量学校和成人服务系统中与残疾有关的服务的质量和可获得性；2)在患有自闭症的青年家庭中进行纵向研究；3)开发更多的方法和统计专业知识，以分析复杂的昼夜皮质醇和纵向数据；以及4)行为干预研究。综合起来，这项培训将有助于确定过渡不良的可延展性风险因素(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，她提议对准备高中毕业的患有自闭症的年轻人进行纵向研究。本项目的目标是：1)调查青少年自闭症患者进入成年期后应激反应谱、行为谱和环境资源的变化及其相互关系；2)调查基线测量(在高中时收集的)以及应激反应谱、行为谱和环境资源的变化如何预测成人的结果。青年将在高中最后一年被招募，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，并收集白天的皮质醇。母亲将报告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，以及自己的心理健康。在第二个时间点(退出6个月后)，将使用社会应激源范式(连同皮质醇收集)来测量这些青年中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延展性的风险因素，这些因素在得到帮助时可以促进积极的成人结果和更好地过渡到成年。到目前为止，成人自闭症患者的不良结局只与静态的、不变的风险因素有关，如低智商和糟糕的早期语言。然而，由于患有自闭症的儿童大量离开学校系统，以及自闭症的高昂公共成本，研究适合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的青年高中毕业后与没有ASD的同龄人相比的生物、行为和家庭风险和弹性的长期模式，长期目标是开发和研究促进过渡成功的干预措施。

项目成果

A systematic review of vocational interventions for young adults with autism spectrum disorders.

对患有自闭症谱系障碍的年轻人的职业干预的系统评价。

• DOI: 10.1542/peds.2012-0682
• 发表时间: 2012
• 期刊: Pediatrics
• 影响因子: 8
• 作者: Taylor,JulieLounds;McPheeters,MelissaL;Sathe,NilaA;Dove,Dwayne;Veenstra-Vanderweele,Jeremy;Warren,Zachary
• 通讯作者: Warren,Zachary