News and Knowledge

In 2015, OAR’s Board of Directors authorized funding for eight new applied autism research studies in 2016. These new grants, totaling $229,827, bring OAR’s total research funding to over $3.5 million since 2002. This is the final preview of the eight featured in The OARacle this year.

Individuals without intellectual disability comprise the fastest growing subgroup of people with autism spectrum disorder (ASD), but as few as 9 percent of them reach full functional independence as adults. While they have important skills to share with society, many are unable to do so because they lack basic skills for setting a goal, making a plan, and following through with it.

A deficit in executive function plays a role in that lack of basic skills. Executive functions include flexibility, goal setting, planning, organization, big picture thinking, and task completion.

Researcher Cara Pugliese, Ph.D., a postdoctoral research fellow in clinical developmental neuroscience at the Children’s National Medical Center in Washington, D.C., recently created Flexible Futures, an intervention program that she believes can help improve executive function in young people. Flexible Futures specifically targets the executive function skills teens need most: self-advocacy, motivation, time management, and planning. She will test the program over the course of her OAR-funded study, “Effectiveness of a School-Based Executive Function Intervention for High School Students with ASD.”

Using everyday living situations, Flexible Futures builds on established ASD intervention strategies, overcoming the common problem people with ASD have demonstrating new skills in real-world settings. Flexible Futures is designed to be administered in schools, the setting where executive function skills are most in demand, to maximize generalization of skills and increase the number of adolescents who can access the intervention. By providing treatment in schools instead of clinics, Flexible Futures overcomes major economic disparities in access to health care settings.

Methodology

For the pilot project, Dr. Pugliese is recruiting 36 high school juniors and seniors with ASD in six Fairfax County (Va.) high schools to participate. Eighteen of those students will complete the Flexible Futures program while the remaining students will participate in the social skills programs currently offered by Fairfax County Public Schools.

Flexible Futures consists of 20 sessions and uses empirically supported cognitive-behavioral techniques combined with proven ABA principles for shaping and reinforcing behavior to optimize learning in adolescents with ASD. Cognitive instruction teaches explicitly what flexibility, goal setting, planning, and “big picture” thinking are, how these skills help people get what they want and need, and how to use scripts and routines to be more flexible and goal directed. Skills are practiced through structured planning for a student-selected goal.

Flexible Futures focuses on key functions needed for college success, such as:

• Intrinsic sources of motivation
• Management of time and priorities across weeks
• Practice and application of compromise and negotiation skills needed for success on college campuses and in the workplace
• Importance of flexibility and big picture thinking for independence
• Application of flexibility and organization scripts and strategies in the service of a long-term goal
• Self-advocacy skills necessary to promote independence

Dr. Pugliese’s research team will provide:

• Content-specific two-hour trainings for school staff who will administer the program prior to the start of the intervention period. The research team will also meet monthly with those staff members to provide coaching/support and review upcoming intervention materials.
• A content-specific one-hour face-to-face or webinar training for all staff.
• A two-hour training for parents focused on curriculum content, generalization techniques, and how to make use of the program’s home components.

Evaluation

The program will be evaluated by the staff members who administered the program, use of pre- and post-measures, and pre- and post-intervention classroom observation. In addition, parents and teachers will provide assessments.

Staff evaluators will provide ratings of the ease of implementation/helpfulness of each intervention activity. Each intervention activity will have two ratings beside it so that it can be rated on how easy it was to conduct and how well it helped the students to learn. At least 75 percent of participants must agree that an activity is easily conducted and that it is helpful in the student acquiring new skills, or the activity will be revised/dropped. Suggestions for revision will also be collected.

The research team will use pre- and post-measures to determine participants’ improvement in efficient cognitive problem solving, flexibility, and organized planning. In addition, parents and teachers will provide assessments of participants’ executive function skills and social functioning in school and at home.

Pre- and post-intervention classroom observations of specific executive function-related behaviors will occur in the students’ mainstream academic classes to assess student cognitive/behavioral flexibility, planning, goal-directed behavior, and self-advocacy.

Outcomes

If the results of the study show that the Flexible Futures intervention is effective, Dr. Pugliese plans to use the data to apply for funding for a larger trial.

Her ultimate aim is to provide:

• An intervention that can be easily implemented in high schools (as well as clinic-based therapy settings)
• Teacher and parent training workshops that provide hands-on instruction in the importance of executive function in ASD, integrating executive function instruction in the high school classroom and at home, and the most effective techniques for supporting and coaching new skills in teens with ASD

Establishing the first effective school-based executive function intervention for high school students with ASD will provide critical and generalizable transition-related support to help people with ASD to function independently in school, the community, and the workplace.