Behavioral and Neural Outcomes of a New Executive Function Treatment for Transition-Age Youth with ASD

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PROJECT SUMMARY Autism Spectrum Disorders (ASD) affect 1 in 88 children in the United States. Individuals without intellectual disabilities comprise the fastest-growing subgroup of ASD and account for two-thirds of the total population. Impaired executive functions (EF) occur as a result of abnormal prefrontal cortex function and are related to poor adult outcome. EF problems are pivotal targets for intervention because they are common, linked to independence, and responsive to treatment. The proposed study will test the effectiveness of a school-based cognitive behavioral EF intervention, called Flexible Futures (FF), for college-bound youth with ASD and evaluate the neural correlates of treatment outcome. FF is a targeted, phenotype-specific intervention focused on the domains of EF that are most impaired in ASD – flexibility and planning skills. This K23 Mentored Patient-Oriented Career Development Award application is to request support for the candidate's development as an independent investigator specializing in the development and implementation of innovative interventions personalized for specific cognitive profiles that are transportable for mass usage in school-settings. This K23 Mentored Patient-Oriented Career Development Award will provide focused research experience and theoretical training in the development of evidence-based treatments that support transition to adulthood in ASD. The award will also provide training and experience in the investigation of neural predictors and correlates of treatment outcome using neuroimaging methods. In accordance with these goals, the training aims of this proposal are to: 1) develop an understanding of causal models of developmental disabilities and expertise in measurement of key outcomes at the behavioral, cognitive, and neural levels; 2) acquire expertise in the development of treatments for transition-age youth within the school setting; and 3) gain competencies in the methodology, design, and implementation science of pragmatic community-partnered effectiveness trials. The proposed research aims for this project are to: 1) refine the treatment manual for Flexible Futures and test its acceptability, feasibility, and effectiveness in a school setting, 2) identify neural correlates of treatment change using fMRI, and 3) identify biomarkers of EF outcomes at the behavioral, cognitive, and neural level. The treatment manual will be iteratively refined with input from experts in the field of ASD research and tested for effectiveness against a social skills intervention within an educational setting. Flexible Futures is anticipated to result in changes at the behavioral, cognitive, and neural level. Specifically, it is hypothesized that participants in Flexible Futures will demonstrate greater gains in flexibility and planning compared to those in social skills treatment. Significant changes in behavior and brain activity as a result of Flexible Futures could have profound implications for the development and refinement of psychological treatments for ASD.