Executive function skills like flexibility, goal setting, planning, organization, big-picture thinking, and task completion are critical to our ability to live independently. Unfortunately, they are often profoundly lacking in individuals with autism spectrum disorder (ASD).
OAR-funded researchers John Strang, Psy.D., and Lauren Kenworthy, Ph.D., from the Center for Autism Spectrum Disorders at the Children’s National Medical Center in Rockville, Md., are conducting a trial to determine the effectiveness of On Target for Life, a school-based executive function intervention they developed for adolescents with ASD. Their goal is to provide an evidence-based intervention that can be used in school settings to reach the largest number of adolescents with ASD possible and provide the appropriate environment for generalization of skills.
Thirty-six students between the ages of 12 and 15 in six Fairfax County Public Schools (Va.) will participate, with 18 participating in the On Target for Life program and 18 receiving general learning support through FCPS.
Students will receive the interventions once a week in 40-minute sessions. An interventionist for each school will learn how to administer the On Target for Life intervention and will participate in monthly phone check-ins with researchers to review upcoming material and discuss any challenges they have encountered. The students’ parents will also participate in a two-hour introductory session that focuses on generalization techniques and how to use the home components of the program. The students’ teachers will participate in a two-hour information session geared to providing simple materials and techniques they can use to generalize the intervention skills to the classroom.
On Target for Life was developed with input from teens with ASD, their parents, and teachers and designed with real-world settings and situations. The program consists of four topics presented over 22 sessions, and uses cognitive-behavioral learning techniques. Cognitive instruction teaches explicitly what flexibility (including compromising and negotiating), 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. Instruction focuses on motivating/engaging in vivo experiments, games, and routines, rather than school-like didactic presentations.
A critical component of the program is the use of self-regulatory scripts, which are short catchy phrases that are presented as “tricks for getting what you want and need.” Scripts compensate for the inner speech and organization/integration deficits in ASD and are practiced repeatedly to achieve automaticity, using games and other activities. The scripts have both written and picture components to support their learning, use, and generalization. Most have self-apparent real-world meaning so that they can be used naturally in everyday conversation/interactions. For example, “what is my plan B?” is a useful routine for people with ASD to have automatized, and is also a script that might be heard in a typical high school classroom or in a professional or interpersonal setting.
Over the course of the intervention, each executive function script takes on more depth and meaning by promoting its application in settings beyond the classroom, like the student’s home or in groups outside of school, helping students to develop generalization skills.
As the students build skills, guided practice moves from teacher cues to self-cues and finally to automatic use of the skills and scripts. Each lesson includes generalization techniques to ensure that students apply the skills in various situations. Techniques that will be used include naturalistic scripts, school staff as interventionists, parent training, home and classroom extension activities, universally displayed visuals, and role-playing the use of strategies in novel situations.
The researchers will use several evaluation tools, including a construction task that requires efficient cognitive problem solving and cognitive flexibility; a planning, prioritizing and efficiency task; an observational method that will be administered and video-recorded; and reports from parents and teachers as well as classroom observations.
If the study shows that the On Target for Life intervention is effective compared to treatment as usual, the researchers plan to create:
Their longer-term goal is to develop a series of evidence-based executive function interventions targeting a full age range of individuals on the full range of the autism spectrum (including high school, adult life, and individuals with significantly impaired language).
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