Telehealth Parent-Only Treatment for Youth with Autism Spectrum Disorder and Overweight/Obesity

摘要 在美国，大约每54名儿童中就有一名被诊断出患有自闭症谱系障碍(ASD)。其中 患有自闭症的儿童，估计超重和肥胖(OW/OB)的范围从19%到高达55% 大多数研究报告的OW/OB比率等于或高于通常发育中的儿童。OW/OB In 童年一直持续到成年，并与负面的健康和心理社会后果有关。 到目前为止，对于患有OW/OB的典型儿童，最成功的治疗方法是基于家庭的行为疗法 治疗(FBT)，每周分别为父母和孩子提供以小组为基础的治疗，超过6- 一个月的期间。然而，患有自闭症的儿童通常被排除在这些试验之外，并给予他们独特的 介绍，需要一个量身定做的治疗方案。针对没有子女的父母的FBT计划(以父母为基础 治疗[PBT])更适合有ASD和OW/OB儿童的家庭，因为功能和 儿童的语言水平会影响他们直接参与集约化小组活动的能力 程序。研究表明，PBT在儿童减肥方面不逊于FBT，而且实施成本更低。 我们小组已经为患有ASD和OW/OB的儿童开发并试点测试了PBT组(称为PBT-ASD)。 我们的试验数据表明，PBT-ASD计划是可行的，可以接受的，并对儿童显示出初步效果 减肥。这个项目是这个研究计划的下一步，我们将招募150名有OW/OB的青年 和ASD及其父母，并随机让他们接受为期6个月的远程健康PBT-ASD或积极的健康教育 比较程序(HE)。我们将在五个时间点评估儿童和家长的主要结果；基线、中期 治疗(3个月)、治疗后(6个月)、6个月随访(12个月)和12个月随访(1个月 18)。这项研究的主要目的是比较PBT-ASD和HE对目标儿童体重的影响 (BMIz/%BMIp95)。次要目标是确定在多大程度上 PBT-ASD和HE影响父母BMI、父母和孩子的体力活动和饮食摄入量、孩子的进餐时间 行为、父母教养方式和自我效能感。作为一个探索性目标，我们将评估主持人(例如家长和 儿童性别、父母和子女年龄、父母教育程度、父母基线BMI、儿童基线BMIz/%BMI 父母执行功能、父母教养、儿童症状严重程度、儿童适应行为技能)和 PBT-ASD的中介因素(如父母教养方式、儿童症状严重程度)和HE治疗对儿童BMIz/%BMI的影响 随着时间的推移，P95。这项研究计划可以提高ASD儿童的实践标准，并 可以为患有自闭症和OW/OB的儿童提供量身定制的干预。我们相信，通过与 父母使用远程医疗模式，我们有可能提供有效和持久的治疗，这可以 很容易传播给患有自闭症和OW/OB儿童的父母。

ABSTRACT Approximately 1 in 54 children in the United States is diagnosed with autism spectrum disorder (ASD). Among children with ASD, estimates of overweight and obesity (OW/OB) range from 19% to as high as 55% with the majority of studies reporting OW/OB rates equal to or greater than typically developing children. OW/OB in childhood tracks well into adulthood and is associated with negative health and psychosocial consequences. To date, the most successful treatment for typically developing children with OW/OB is family-based behavioral treatment (FBT), which delivers weekly group-based treatment to the parent and child separately over a 6- month period. However, children with ASD are typically excluded from these trials and given their unique presentation, require a tailored treatment program. FBT programs for parents without their child (Parent-based treatment [PBT]) are more appropriate for families with a child with ASD and OW/OB, as the functioning and language levels of the children can impact their ability to directly participate in an intensive group-based program. Research shows that PBT is noninferior to FBT on child weight loss and is less costly to implement. Our group has developed and pilot tested a PBT group for children with ASD and OW/OB (called PBT-ASD). Our pilot data showed that the PBT-ASD program was feasible, acceptable and showed initial efficacy on child weight loss. This project is the next step in this program of research, and we will recruit 150 youth with OW/OB and ASD and their parent and randomize them to a 6-month telehealth PBT-ASD or active health education comparator (HE). We will assess main outcomes in children and parents at five time points; baseline, mid- treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12) and 12-month follow-up (month 18). The primary aim of this study is to compare the effect of PBT-ASD and HE on the target child’s weight (BMIz/%BMIp95) over the 18 months of the study. The secondary aim is to determine the extent to which the PBT-ASD and HE affect parent BMI, parent and child physical activity and dietary intake, child mealtime behavior, parenting style and self-efficacy. As an exploratory aim, we will evaluate moderators (e.g. parent and child gender, parent and child age, parent educational level, parent baseline BMI, child baseline BMIz/%BMI p95, parent executive functioning, parenting, child symptom severity, child adaptive behavior skills) and mediators (e.g. parenting, child symptom severity) of the PBT-ASD and the HE treatment on child BMIz/%BMI p95 over time. This program of research could advance the standard of practice for children with ASD, and could result in a tailored intervention for children with both ASD and OW/OB. We believe that by working with parents using a telehealth model, we can potentially provide an effective and durable treatment, which can easily be disseminated to parents with children with both ASD and OW/OB.