A longitudinal study identifying psychological and service delivery targets to improve daily living skills and quality of life outcomes among transition-age autistic youth

项目摘要 在接下来的十年里，大约有100万自闭症患者将年满18岁，其中许多人没有达到目标所需的技能 他们和他们家人所渴望的生活质量。没有有效的支持，自闭症青年每天都在与 生活技能，无论他们的智力如何。日常生活技能是独立的基础，有偿的 就业，以及自闭症成年人更好的生活质量。针对这一年龄段的现有日常生活技能干预 只有适度的效果，或者对真实世界的设置表现出较差的概括性。目前的治疗方法依赖于显式 具体的日常生活技能的指导(例如，洗澡的步骤)，它们缺乏可变的 支持日常生活技能发展和概括的心理因素。治疗是进一步的 由于对健康的社会决定因素(例如，家庭收入、社区)了解不足 资源)有助于日常生活技能。识别易变的心理因素和社会决定因素 健康推动过渡期自闭症青年日常生活技能的变化是改善公共健康的关键 和社会正义。这些知识将确定关键的干预措施和服务交付目标，以改善日常工作 生存技能。更好的执行功能和自我决定能力与更高级的日常生活相关 技能，这两个因素都随着自闭症的治疗而改善。我们的中心科学前提是，对 日常生活技能和促进这些技能的服务提供系统将随着更多的知识而得到提高 直接影响这些技能的心理和系统因素。此外，日常生活技能的提高将 导致下游生活质量和生产力的提高。该项目将解决我们在以下方面的差距 具有前瞻性纵向研究的知识，评估推动日常变化的心理因素 自闭症青少年高中毕业期间的生活技能(目标1)以及日常生活技能的影响 关于生活质量(目标2)。我们还将探索个人-(例如，家庭收入)和 邻里层面(童年机会指数)因素对日常生活技能的影响(目标3)。最后，还有一位将军 需要较大的代表性样本(即智商范围、会说/不会说、出生时性别分配、性别、 种族、民族)。拟议的纵向研究将包括3次访问(T1：基线，T2：+1年，T3：+2年；最终 N=170)。我们的招聘策略将确保所有参与者在高中前和高中后至少有一个时间点 出口。我们预测：目标1，H1)执行功能和自我决定将解释在 协变量以上的日常生活技能；目标1，h2a，b)执行功能和自我决定力 基线将预测T3时的日常生活技能以及上述协变量上的日常生活技能随时间的变化； H3a，b)日常生活技能的较大增长将预示着更好的客观和主观生活质量以及更好的 随着时间的推移，生活质量会发生变化。在目标3中，我们探讨了以下社会决定因素的直接和间接影响 健康。该项目将产生关键知识，以加强日常生活技能干预和交付 将改善自闭症成人的长期结果并增加公平获得服务机会的系统。

PROJECT ABSTRACT Approximately 1 million autistics will turn 18 in the next decade, many without the skills they need to achieve the quality-of-life that they and their families’ desire. Without effective supports, autistic youth struggle with daily living skills, regardless of their intellectual abilities. Daily living skills are fundamental to independence, paid employment, and better quality-of-life for autistic adults. Existing daily living skill interventions for this age group have only modest effects or show poor generalization to real world settings. Current treatments rely on explicit instruction of specific daily living skills (e.g., the steps for taking a shower), and they lack inclusion of mutable psychological factors that support the development and generalization of daily living skills. Treatments are further limited by inadequate knowledge of how social determinants of health (e.g., family income, community resources) contribute to daily living skills. Identification of mutable psychological factors and social determinants of health driving change in daily living skills for transition-age autistic youth is a vital to improving public health and social justice. This knowledge will identify pivotal intervention and service delivery targets for improving daily living skills. Better executive function and self-determination skills are associated with more advanced daily living skills, and both factors improve with treatment in autism. Our central scientific premise is that interventions for daily living skills, and the service delivery systems that promote them, will be enhanced with greater knowledge of psychological and systemic factors that directly impact these skills. Further, enhanced daily living skills will result in downstream improvements in quality-of-life and productivity. This project will address gaps in our knowledge with a prospective longitudinal study that evaluates psychological factors that drive change in daily living skills during the time when autistic youth exit high school (AIM 1), as well as the impact of daily living skills on quality-of-life (AIM 2). We will also explore the influence of both individual- (e.g., family income) and neighborhood-level (childhood opportunity index) factors on daily living skills (AIM 3). Finally, there is a general need for large representative samples (i.e., IQ range, speaking/nonspeaking, sex-assigned-at-birth, gender, race, ethnicity). The proposed longitudinal study will contain 3 visits (T1: baseline, T2: +1 yr., T3: +2 yrs.; final N=170). Our recruitment strategy will ensure all participants have at least one timepoint pre- and post-high school exit. We predict: AIM 1, H1) executive function and self-determination will explain significant variance in concurrent daily living skills above covariates; AIM 1, H2a,b) executive functioning and self-determination at baseline will predict daily living skills at T3 and change in daily living skills over time above covariates; AIM 2, H3a,b) larger increases in daily living skills will predict better objective and subjective quality-of-life and better change in quality-of-life over time. In AIM 3, we explore both direct and indirect effects of social determinants of health. This project will generate critical knowledge for enhancing daily living skills interventions and delivery systems that will improve long-term outcomes for autistic adults and increase equitable access to services.