Parent implemented treatment for repetitive behaviors in children with ASD: Using a novel telehealth approach to increase service access

项目总结 在新冠肺炎疫情期间，家庭面临着重大挑战，特别是那些照顾患有艾滋病的孩子的家庭 自闭症谱系障碍(ASD)。最近的一项火花调查1(N=8000)发现，大约95%的父母 报告称，他们的孩子因服用新冠肺炎而出现的挑战性行为增加，以及受限、重复的 儿童的行为和兴趣(RRBI)很可能属于这一类。因为只有35%的父母接受了 星火调查显示，他们的孩子正在远程接受治疗服务，新冠肺炎大流行很可能 加重ASD的这一核心症状。RRBI通常是临床治疗的目标，因为它们可以显著地 干扰学习，并与长期的功能障碍和精神共病有关 (例如，焦虑)。鉴于患有自闭症的儿童目前不同寻常，正经历着严重的 在治疗和教育服务方面，儿童的RRBI和合并症很可能在这个时候被放大。 然而，没有有效的疗法来治疗ASD中发现的各种重复的、僵化的行为，以及 还没有专门针对这一核心制定的行为干预的大规模研究 症状域。这导致了有效行为患者数量之间的显著治疗差距 用于针对自闭症非典型社交行为的治疗与设计的治疗相比 来治疗重复的行为。因此，我们的团队开发并试行了家庭实施的治疗方法 行为不灵活(FITBI)，源于奖赏和学习的神经行为模型。的总目标是 FITBI是教父母如何在环境中识别可能引发RRBI症状的高概率线索 并教他们的孩子抑制重复的行为，取而代之的是更灵活、更实用的行为 行为。自我们最初的试点研究以来，对以技术为基础的干预措施的需求肯定有所增加。 虽然远程健康干预对患有自闭症儿童的有效性正在显现，但早期研究表明 通过远程保健为ASD儿童提供的干预可能与面对面干预一样有效。 然而，我们目前还不了解远程提供的RRBI干预措施的有效性。 因此，本项目的总体目标是进行平行组随机对照试验(RCT)。 比较远程交付FITBI(为期12周的干预+6个月内的3次强化课程)与远程交付 在最终样本量为100名(3-9岁)患有自闭症的儿童中，对仅限父母教育(PE)的控制条件进行了调查 仪式性重复行为的比率很高。我们将使用Torsh，这是一个全面的安全在线平台 通过远程医疗增强治疗师与家长之间的辅导。此外，这项提案的一个重要目标是审查 与治疗反应和摄取相关的儿童和父母因素，以促进翻译 关于个性化干预方法的研究和知识。

PROJECT SUMMARY Families are facing significant challenges during the COVID-19 pandemic, especially those caring for a child with autism spectrum disorder (ASD). A recent SPARK survey1 (N = 8,000) found that approximately 95% of parents reported increases in their child’s challenging behaviors as a result of COVID-19, and the restricted, repetitive behaviors and interests (RRBI) of children likely fall within this category. Since only 35% of parents who took the SPARK survey indicated their child is receiving therapy services remotely, the COVID-19 pandemic will likely exacerbate this core symptom of ASD. RRBIs are often the target for clinical treatment, as they can significantly interfere with learning, and are associated with long-term functional impairment, and psychiatric comorbidities (e.g., anxiety). Given children with ASD are currently out of routine and experiencing a severe reduction in therapeutic and educational services, the RRBIs and comorbidities of children are likely magnified at this time. Yet, there are no effective therapies to treat the full range of repetitive, inflexible behaviors found in ASD, and there have been no large-scale studies of behavioral interventions specifically developed to target this core symptom domain. This has resulted in a significant treatment gap between the number of effective behavioral therapies used to target atypical social-communication behaviors in autism when compared to those designed to treat repetitive behaviors. Thus, our team developed and pilot-tested the Family-Implemented Treatment for Behavioral Inflexibility (FITBI), derived from neurobehavioral models of reward and learning. The overall goal of FITBI is to teach parents how to identify high probability cues in the environment that can elicit RRBI symptoms and teach their child to inhibit repetitive behaviors and instead replace them with flexible and more functional behaviors. Since our initial pilot studies, the need for technology-based interventions has certainly increased. While the effectiveness of telehealth interventions for children with ASD is emerging, early research suggests interventions delivered via telehealth for children with ASD may be just as effective as in-person interventions. Yet, we currently have no understanding of the effectiveness of RRBI interventions delivered remotely. Therefore, the overall goal of this project is to conduct a parallel group randomized controlled trial (RCT) comparing remote delivery of FITBI (12-week intervention + 3 booster sessions over 6 months) to remote delivery of a parent education only (PE) control condition in a final sample size of 100 (3-9 years) children with ASD and high rates of ritualistic repetitive behaviors. We will use TORSH, a comprehensive secure online platform that enhances therapist-parent coaching via telehealth. Further, an important objective of this proposal is to examine child and parent factors associated with treatment response and uptake in order to advance translational research and knowledge on personalized intervention approaches.