Exploring Mechanisms of Change in a Pilot Trial of the RUBI Program in Educational Settings

摘要 大约50%患有自闭症谱系障碍(ASD)的儿童表现出破坏性行为，如 发脾气、攻击性和不合规，这些都会显著影响对学术任务的有效投入 以及与同伴的关系，以及导致在更严格的课堂环境中安置。当前校本 行为管理方法虽然有效，但既耗时又耗费资源。有一个 需要高效、务实的干预模式，与直接护理提供者建立能力，简化 干预过程，减少对密集行为支持的需求，并增加 患有自闭症的儿童可以得到服务。RUBI计划是一种基于证据的父母调解干预 这改善了患有自闭症儿童的破坏性行为。认为学校是主要的干预手段 为患有自闭症的儿童设置的环境，而半教育者经常努力解决 课堂上，有机会通过将RUBI从诊所的分娩转移到 在学校和从家长到副教育者。目前的研究是最近完成的NIMH- 资助以人为本的设计研究，目标是修改RUBI，以确保其适用于 教育环境。拟议的为期三年的试点随机试验旨在测试新的- 重新设计的助教人员提供的RUBI在教育环境(RUIPS)干预中使用的比较 减少80名自闭症小学生破坏性行为的日常护理训练。鉴于危急关头 不仅需要了解干预是否起作用，而且需要了解干预是如何起作用的，这项研究还将检查 红宝石干预的副教育者和儿童层面的机械路径。圆满完成 拟议的研究将允许在公立学校进行大规模的红宝石有效性试验，以减少破坏性 这有可能改善全国自闭症儿童的生活质量。

ABSTRACT Approximately 50% of children with autism spectrum disorder (ASD) exhibit disruptive behaviors such as tantrums, aggression, and noncompliance that significantly impact meaningful engagement in academic tasks and with peers as well as result in placement in more restrictive classroom settings. Current school-based behavioral management approaches, while effective, are time-consuming and resource-intensive. There is a need for efficient and pragmatic intervention models that build capacity with direct care providers, streamline the intervention process, reduce the need for intensive behavioral supports, and increase the number of children with ASD who can be served. The RUBI program is an evidence-based parent-mediated intervention that improves disruptive behavior in children with ASD. Considering schools serve as the primary intervention setting for children with ASD, and paraeducators often struggle to address challenging behavior in the classroom, there is an opportunity to meaningfully improve care by moving RUBI from delivery in clinic to school and from parent to paraeducator. The current study is an extension of a recently completed NIMH- funded human-centered design study targeting modification of RUBI to ensure its appropriateness for use in educational settings. The proposed three-year pilot randomized trial aims to test the effectiveness of the newly- redesigned paraeducator-delivered RUBI for use in Educational Settings (RUBIES) intervention compared to usual care training in reducing disruptive behavior in 80 elementary-school children with ASD. Given the critical need to understand not just whether, but also how interventions work, this study also will examine paraeducator- and child-level mechanistic pathways of the RUBIES intervention. Successful completion of the proposed study will allow for a large-scale effectiveness trial of RUBIES in public schools to reduce disruptive behavior, which has the potential to improve the quality of life for children with ASD across the country.