Top

Journal of Autism and Developmental Disorders

28-04-2024 | Original Article

Randomized Feasibility Pilot of an Executive Functioning Intervention Adapted for Children’s Mental Health Settings

Auteurs: Kelsey S. Dickson, Megan Galligan, Tana Holt, Lauren Kenworthy, Laura Anthony, Scott Roesch, Lauren Brookman-Frazee

Gepubliceerd in: Journal of Autism and Developmental Disorders

Abstract

The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for autistic children. The goal of the present study was to conduct a randomized feasibility trial of Unstuck and On Target, an executive functioning intervention, adapted for delivery in children’s community mental health setting. Mental health therapists (n = 26) enrolled with participating autistic clients (n = 32) were randomized to receive training in and deliver the adapted Unstuck intervention or to deliver care as usual. We completed masked observational measures of Unstuck strategy use (fidelity) during recorded sessions of participating therapist-client dyads and collected measures of acceptability from participating clients and their caregivers. We also collected measures of pre-post changes in executive functioning and mental health symptoms. Therapists trained in Unstuck demonstrated significantly higher use of Unstuck strategies compared to usual care therapists. Caregivers and autistic clients perceive adapted Unstuck as highly acceptability and helpful. Autistic clients whose therapists were trained in adapted Unstuck demonstrated larger pre-post changes in executive functioning compared to usual care. Across all participating clients, changes in executive functioning were significantly related to changes in mental health symptoms. Finally, clients of therapists trained in adapted Unstuck demonstrated moderate improvements in overall mental health symptoms. The current study provides preliminary evidence of the feasibility and impact of Unstuck and On Target for children’s community mental health settings.

Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms & profiles: An integrated system of multi-informant assessment

Anthony, L. G., Anthony, B., & Kenworthy, L. (2020). Improving Classroom Behaviors among Students with Symptoms of Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder Patient- Centered Outcomes Research Institute (PCORI). https://doi.org/10.25302/06.2020.AD.13047379.

Bloemen, A. J. P., Oldehinkel, A. J., Laceulle, O. M., Ormel, J., Rommelse, N. N. J., & Hartman, C. A. (2018). The association between executive functioning and psychopathology: General or specific? Psychological Medicine, 48(11), 1787–1794. https://doi.org/10.1017/S0033291717003269.CrossRefPubMed

Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., Bakken, S., Kaplan, C. P., Squiers, L., Fabrizio, C., & Fernandez, M. (2009). How we Design Feasibility studies. American Journal of Preventive Medicine, 36(5), 452–457. https://doi.org/10.1016/j.amepre.2009.02.002.CrossRefPubMedPubMedCentral

Brookman-Frazee, L., Drahota, A., Stadnick, N., & Palinkas, L. A. (2012). Therapist perspectives on community mental health services for children with Autism Spectrum disorders. Adm Policy Mental Health, 39(5), 365–373. https://doi.org/10.1037/t38826-000.CrossRef

Brookman-Frazee, L., Drahota, A., & Chlebowski, C. (2016). An individualized mental health intervention for children with autism spectrum disorders (AIM HI): A model to address challenging behaviors in children with ASD—a therapist manual. University of California, San Diego

Brookman-Frazee, L., Stadnick, N., Chlebowski, C., Baker-Ericzén, M. J., & Ganger, W. (2017). Characterizing psychiatric comorbidity in children with autism spectrum disorder receiving publicly funded mental health services. Autism, 22(8), 938–952. https://doi.org/10.1177/1362361317712650.CrossRefPubMedPubMedCentral

Brookman-Frazee, L., Roesch, S., Chlebowski, C., Baker-Ericzén, M. J., & Ganger, W. (2019). Effectiveness of training therapists to deliver an Individualized Mental Health Intervention for Children with ASD in Publicly Funded Mental Health Services. JAMA Psychiatry, 0812, 1–10. https://doi.org/10.1001/jamapsychiatry.2019.0011.CrossRef

Brookman-Frazee, L., Chlebowski, C., Villodas, M., Roesch, S., & Martinez, K. (2021). Training community therapists to deliver an individualized Mental Health intervention for Autism Spectrum Disorder: Changes in caregiver outcomes and mediating role on child outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 60(3), 355–366. https://doi.org/10.1016/j.jaac.2020.07.896.CrossRef

Brookman-Frazee, L., Chlebowski, C., Villodas, M., Garland, A., McPherson, J., Koenig, Y., & Roesch, S. (2022). The effectiveness of training community mental health therapists in an evidence-based intervention for ASD: Findings from a hybrid effectiveness-implementation trial in outpatient and school-based mental health services. Autism. https://doi.org/10.1177/13623613211067844.CrossRefPubMedPubMedCentral

Cannon, L., Kenworthy, L., Alexander, K. C., Werner, M. A., & Anthony, L. G. (2018). Unstuck and on target! An executive function curriculum to improve flexibility, planning, and Organization. Brookes Publishing.

Cohen, J. (2013). Statistical power analysis for the behavioral sciences. Routledge

Constantino, J. N., & Gruber, C. P. (2012). Social Responsiveness Scale Second Edition (SRS-2): Manual. Western Psychological Services.

Demetriou, E. A., Lampit, A., Quintana, D. S., Naismith, S. L., Song, Y. J. C., Pye, J. E., Hickie, I., & Guastella, A. J. (2018). Autism spectrum disorders: A meta-analysis of executive function. Molecular Psychiatry, 23(5), 1198–1204. https://doi.org/10.1038/mp.2017.75.CrossRefPubMed

Dickson, K. S., Aarons, G. A., Anthony, L. G., Kenworthy, L., Crandal, B. R., Williams, K., & Brookman-Frazee, L. (2020). Adaption and pilot implementation of an autism executive functioning intervention in children’s mental health services: A mixed-methods study protocol. Pilot and Feasibility Studies, 6(1), 1–13. https://doi.org/10.1186/s40814-020-00593-2CrossRef

Dickson, K. S., Galligan, M. L., & Lok, H. (2021a). Short report: A quantitative methodological review of participant characteristics in the literature testing mental health interventions for youth with autism spectrum disorder. Autism. https://doi.org/10.1177/13623613211056408CrossRefPubMedPubMedCentral

Dickson, K. S., Kenworthy, L., Anthony, L., & Brookman-Frazee, L. (2021b). Mental Health Therapist perspectives on the role of executive functioning in children’s Mental Health services. Evidence-Based Practice in Child and Adolescent Mental Health, 00(00), 1–16. https://doi.org/10.1080/23794925.2021.2013142.CrossRef

Dickson, K. S., Lind, T., Jobin, A. B., Kinnear, M., Lok, H., & Brookman-Frazee, L. (2021c). A Systematic Review of Mental Health Interventions for ASD: Characterizing Interventions, Intervention Adaptations, and Implementation Outcomes. Administration and Policy in Mental Health.

Dickson, K. S., Galligan, M., Holt, T., Anthony, L., Kenworthy, L., & Brookman-Frazee, L. (2024). Incorporating community perspectives to inform the scaling-out of an evidence-based executive functioning intervention from schools to Community Mental Health settings. Evidence-Based Practice in Child and Adolescent Mental Health, 9(1), 60–77. https://doi.org/10.1080/23794925.2023.2191353CrossRef

Elias, R., Murphy, H. G., Turner, K. A., & White, S. W. (2019). Feasibility and preliminary efficacy of an adapted Transdiagnostic treatment for children with executive function deficits. Journal of Cognitive Psychotherapy, 33(4), 343–356. https://doi.org/10.1891/0889-8391.33.4.343.CrossRefPubMed

Eyeberg, S. M., & Pincus, D. (1999). Eyberg child behavior inventory and sutter-eyberg student behavior inventory - revised: Professional manual. Psychological Assessment Resources.

Factor, R. S., Ryan, S. M., Farley, J. P., Ollendick, T. H., & Scarpa, A. (2017). Does the Presence of anxiety and ADHD symptoms add to Social Impairment in Children with Autism Spectrum Disorder? Journal of Autism and Developmental Disorders, 47(4), 1122–1134. https://doi.org/10.1007/s10803-016-3025-9.CrossRefPubMed

Frank, H. E., Becker-Haimes, E. M., & Kendall, P. C. (2020). Therapist training in evidence-based interventions for mental health: A systematic review of training approaches and outcomes. Clinical Psychology: Science and Practice, 27(3), 1–30. https://doi.org/10.1111/cpsp.12330.CrossRef

Frazier, T. W., Dawson, G., Murray, D., Shih, A., Snyder, J., & Angela, S. (2018). Brief report: A Survey of Autism Research priorities across a Diverse Community of stakeholders. Journal of Autism and Developmental Disorders, 48(11), 3965–3971. https://doi.org/10.1007/s10803-018-3642-6.CrossRefPubMed

Gioia, G. A., Isquith, P. K., Guy, S. C., & Kenworthy, L. (2015). Behavior rating inventory of executive function: Second- Edition (BRIEF-2). Psychological Assessment Resources.

Interagency Autism Coordinating Committee (IACC) (2017). 2016–2017 Interagency Autism Coordinating Committee Strategic Plan For Autism Spectrum Disorder.

Jones, D. R., Dallman, A., Harrop, C., Whitten, A., Pritchett, J., Lecavalier, L., Bodfish, J. W., & Boyd, B. A. (2021). Evaluating the feasibility of the NIH Toolbox Cognition Battery for Autistic Children and adolescents. Journal of Autism and Developmental Disorders, 52(2), 689–699. https://doi.org/10.1007/s10803-021-04965-2.CrossRefPubMedPubMedCentral

Keefer, A., White, S. W., Vasa, R. A., & Reaven, J. (2018). Psychosocial interventions for internalizing disorders in youth and adults with ASD. International Review of Psychiatry, 30(1), 62–77. https://doi.org/10.1080/09540261.2018.1432575.CrossRefPubMed

Kenworthy, L., Anthony, L. G., Naiman, D. Q., Cannon, L., Wills, M. C., Luong-Tran, C., Werner, M. A., Alexander, K. C., Strang, J., Bal, E., Sokoloff, J. L., & Wallace, G. L. (2014). Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. Journal of Child Psychology and Psychiatry and Allied Disciplines, 55(4), 374–383. https://doi.org/10.1111/jcpp.12161.CrossRefPubMed

Kenworthy, L., Freeman, A., Ratto, A., Dudley, K., Powell, K. K., Pugliese, C. E., Strang, J. F., Verbalis, A., & Anthony, L. G. (2020). Preliminary psychometrics for the executive function challenge task: A novel, hot flexibility, and planning task for youth. Journal of the International Neuropsychological Society, 26(7), 725–732. https://doi.org/10.1017/S135561772000017X.CrossRefPubMedPubMedCentral

Lai, M. C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. The Lancet Psychiatry, 6(10), 819–829. https://doi.org/10.1016/s2215-0366(19)30289-5.CrossRefPubMed

Lau, A. S., Gonzalez, J. C., Barnett, M. L., Kim, J. J., Brookman-Frazee, L., Saifan, D., & Brookman-Frazee, L. (2018). Community Therapist reports of Client Engagement challenges during the implementation of multiple EBPs in children’s Mental Health. Evidence-Based Practice in Child and Adolescent Mental Health, 3(3), 197–212. https://doi.org/10.1080/23794925.2018.1455545.CrossRefPubMedPubMedCentral

Lawson, R. A., Papadakis, A. A., Higginson, C. I., Barnett, J. E., Wills, M. C., Strang, J. F., Wallace, G. L., & Kenworthy, L. (2015). Everyday executive function impairments predict Comorbid Psychopathology in Autism Spectrum and attention deficit hyperactivity disorders. Neuropsychology, 29(3), 445–453. https://doi.org/10.1037/neu0000145.CrossRefPubMed

Lawson, L. P., Richdale, A. L., Haschek, A., Flower, R. L., Vartuli, J., Arnold, S. R. C., & Trollor, J. N. (2020). Cross-sectional and longitudinal predictors of quality of life in autistic individuals from adolescence to adulthood: The role of mental health and sleep quality. Autism, 24(4), 954–967. https://doi.org/10.1177/1362361320908107.CrossRefPubMed

Leon, A. C., Davis, L. L., & Kraemer, H. C. (2012). Role and interpretation of Pilot studies in Clinical Research. Journal of Psychiatric Research, 45(5), 626–629. https://doi.org/10.1016/j.jpsychires.2010.10.008.The.CrossRef

Maddox, B. B., Crabbe, S. R., Fishman, J. M., Beidas, R. S., Brookman-Frazee, L., Miller, J. S., Nicolaidis, C., & Mandell, D. S. (2019). Factors influencing the use of cognitive–behavioral therapy with autistic adults: A Survey of Community Mental Health clinicians. Journal of Autism and Developmental Disorders, 49(11), 4421–4428. https://doi.org/10.1007/s10803-019-04156-0.CrossRefPubMedPubMedCentral

Maddox, B. B., Crabbe, S., Beidas, R. S., Brookman-Frazee, L., Cannuscio, C. C., Miller, J. S., Nicolaidis, C., & Mandell, D. S. (2020). I wouldn’t know where to start: Perspectives from clinicians, agency leaders, and autistic adults on improving community mental health services for autistic adults. Autism, 24(4), 919–930. https://doi.org/10.1177/1362361319882227.CrossRefPubMed

Maddox, B. B., Dickson, K. S., Stadnick, N. A., Mandell, D. S., & Brookman-Frazee, L. (2021). Mental Health Services for Autistic Individuals across the Lifespan: Recent advances and current gaps. Current Psychiatry Reports, 23(10). https://doi.org/10.1007/s11920-021-01278-0.

Maenner, M. J., Shaw, K. A., Bakian, A. V., Bilder, D. A., Durkin, M. S., Esler, A., Furnier, S. M., & Cogswell, M. E. (2021). Prevalence and characteristics of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2018. MMWR Surveillance Summaries, 70(11).

Pandolfi, V., Magyar, C., & Norris, M. (2014). Validity study of the CBCL 6–18 for the Assessment of emotional problems in Youth with ASD. Journal of Mental Health Research in Intellectual Disabilities, 7(4), 306–322. https://doi.org/10.1080/19315864.2014.930547.CrossRefPubMedPubMedCentral

Pearson, N., Naylor, P. J., Ashe, M. C., Fernandez, M., Yoong, S. L., & Wolfenden, L. (2020). Guidance for conducting feasibility and pilot studies for implementation trials. Pilot and Feasibility Studies, 6(1), 1–12. https://doi.org/10.1186/s40814-020-00634-w.CrossRef

Pellecchia, M., Dickson, K. S., Vejnoska, S. F., & Stahmer, A. C. (2020). The autism spectrum: Diagnosis and epidemiology. In L. M. Glidden & L. Addebuto (Eds.), APA Handbook of Intellectual and Developmental Disabilities, (1st ed.).

Pellicano, E., Dinsmore, A., & Charman, T. (2014). What should autism research focus upon? Community views and priorities from the United Kingdom. Autism, 18(7), 756–770. https://doi.org/10.1177/1362361314529627.CrossRefPubMedPubMedCentral

Pickard, K., Reyes, N., & Reaven, J. (2019). Examining the inclusion of diverse participants in cognitive behavior therapy research for youth with autism spectrum disorder and anxiety. Autism, 23(4), 1057–1064. https://doi.org/10.1177/1362361318795678.CrossRefPubMed

Pugliese, C., Werner, M., Skapek, M., Saldana, L., Kenworthy, L., & Anthony, L. G. (2020). Acceptability, and Preliminary Effectiveness of Flexible Futures: A School-Based Executive Function Treatment for Transition-age Youth with ASD. Collaborating with CommunityPartners to Deliver Evidence-Based Practice and Increase Access to Care for Individuals with ASD Across the Life Span. Atlanta, GA: Panel Presentation at: Annual Convention of the Association for Behavioral and Cognitive Therap.

Pugliese, C. E., Werner, M. A., Alexander, K. C., Cannon, L., Strang, J. F., Caplan, R., Klinger, L., Mandell, D., Dieckhaus, M., Handsman, R., Kenworthy, L., & Anthony, L. G. (2024). Development of a high school-based executive function intervention for transition-age autistic youth: Leveraging multi-level community partnerships. In School Mental Health. Advanced Online Publication. https://doi.org/10.1007/s12310-024-09661-x

Romer, A. L., & Pizzagalli, D. A. (2021). Is executive dysfunction a risk marker or consequence of psychopathology? A test of executive function as a prospective predictor and outcome of general psychopathology in the adolescent brain cognitive development study®. Developmental Cognitive Neuroscience, 51, 100994. https://doi.org/10.1016/j.dcn.2021.100994.CrossRefPubMedPubMedCentral

Rosenthal, M., Wallace, G. L., Lawson, R., Wills, M. C., Yerys, B. E., & Kenworthy, L. (2013). Impairments in Real World executive function increase from Childhood to Adolescence in Autism Spectrum disorders. Neuropsychology, 27(1), 13–18. https://doi.org/10.1037/a0031299.Impairments.CrossRefPubMedPubMedCentral

Rothschild, L. B., Ratto, A. B., Kenworthy, L., Hardy, K. K., Verbalis, A., Pugliese, C., Strang, J. F., Safer-Lichtenstein, J., Anthony, B. J., Anthony, L. G., Guter, M. M., & Haaga, D. A. F. (2022). Parents matter: Parent acceptance of school-based executive functions interventions relates to improved child outcomes. Journal of Clinical Psychology, 78(7), 1388–1406. https://doi.org/10.1002/jclp.23309Epub 2022 Jan 8. PMID: 34997971; PMCID: PMC9203869.CrossRefPubMedPubMedCentral

Roudbarani, F., Modica, P. T., Bohr, Y., Weiss, J. A., & Maddox, B. B. (2022). Clinician factors related to the delivery of psychotherapy for autistic youth and youth with attention-deficit hyperactivity disorder. https://doi.org/10.1177/13623613221106400.

Smith, J. V. (2024). Supporting families in a pandemic: Executive function videos for caregivers of children with flexibility challenges. Journal of Child and Family Studies doihttps://doi.org/10.1007/s10826-023-02768-w. Holmes J.Armour, A. C., Verbalis, A., Ratto, A., Hardy, K. K., Gunn, M., Elliott, T., Werner, M. A., Alexander, K. C., Cannon, L., Anthony, B. J., Kenworthy, L., Anthony, L. G.CrossRef

Snyder, H. R., Friedman, N. P., & Hankin, B. L. (2019). Transdiagnostic Mechanisms of Psychopathology in Youth: Executive functions, dependent stress, and rumination. Cognitive Therapy and Research, 43(5), 834–851. https://doi.org/10.1007/s10608-019-10016-z.CrossRefPubMedPubMedCentral

Strang, J. F., Kenworthy, L., Cannon, L., Alexander, K., Werner, M., Pugliese, C. E., & Anthony, L. G. (2024). Unstuck and on target! Ages 11–15: An executive function curriculum to support flexibility, planning, and Organization. Paul H. Brookes Publishing Co., Inc.

Swain, D., Troxel, M., Anthony, L. G., Kenworthy, L., Verbalis, A., Hardy, K. K., Ratto, A., Myrick, Y., & Anthony, B. J. (2021). School-based executive function interventions reduce caregiver strain. In International Review of Research in Developmental Disabilities (Vol. 60, pp. 189–211). https://doi.org/10.1016/bs.irrdd.2021.08.001.

Troxel, M., Kraper, C., Verbalis, A., Safer-Lichtenstein, J., Seese, S., Ratto, A., Myrick, Y., Armour, A. C., Pugliese, C. E., Strang, J. F., Ba, C., Martucci, J., Biel, M. G., Jackson, V., Hardy, K. K., Mandell, D., Goode, T. D., Anthony, B. J., Kenworthy, L., & Anthony, L. G. (2024). Reaching the other half: Teacher referral increases inclusivity in Intervention Research for Neurodivergent School-Age Children. Journal of Clinical Child and Adolescent Psychology, 00(00), 1–14. https://doi.org/10.1080/15374416.2024.2303723.CrossRef

Wechsler, D. (2011). Wechsler Abbreviated Scale of Intelligence II. Harcourt Brace & Company.

White, S. W., Simmons, G. L., Gotham, K. O., Conner, C. M., Smith, I. C., Beck, K. B., & Mazefsky, C. A. (2018). Psychosocial treatments targeting anxiety and depression in adolescents and adults on the Autism Spectrum: Review of the latest research and recommended future directions. Current Psychiatry Reports, 20(10). https://doi.org/10.1007/s11920-018-0949-0.

Wood, J. J., McLeod, B. D., Klebanoff, S., & Brookman-Frazee, L. (2015). Toward the implementation of evidence-based interventions for Youth with Autism Spectrum disorders in Schools and Community agencies. Behavior Therapy, 46(1), 83–95. https://doi.org/10.1016/j.beth.2014.07.003.CrossRefPubMed

Zelazo, P. D., Anderson, J. E., Richler, J., Wallner-Allen, K., Beaumont, J. L., & Weintraub, S. (2013). Ii. Nih Toolbox Cognition Battery (cb): Measuring executive function and attention. Monographs of the Society for Research in Child Development, 78(4), 16–33. https://doi.org/10.1111/mono.12032.CrossRefPubMed

Titel: Randomized Feasibility Pilot of an Executive Functioning Intervention Adapted for Children’s Mental Health Settings
Auteurs: Kelsey S. Dickson
Megan Galligan
Tana Holt
Lauren Kenworthy
Laura Anthony
Scott Roesch
Lauren Brookman-Frazee
Publicatiedatum: 28-04-2024
Uitgeverij: Springer US
Gepubliceerd in: Journal of Autism and Developmental Disorders
Print ISSN: 0162-3257
Elektronisch ISSN: 1573-3432
DOI: https://doi.org/10.1007/s10803-024-06365-8

Bohn Stafleu van Loghum

Deel dit onderdeel of sectie (kopieer de link)

Abstract

Log in om toegang te krijgen