A Pilot Evaluation of Unstuck and On Target: An Executive Functioning Intervention for Children with ASD

Background:  

Difficulties with executive functioning are a commonly observed associated feature of ASD. We have developed a school-based intervention to improve flexibility, goal-setting and planning in students with ASD, the Unstuck and On Target intervention. Our team developed this new intervention using a participatory process informed by a theoretical framework that emphasizes real world interventions to remediate executive function deficits in ASD through cognitive training, self-regulatory scripts, and faded practice and cueing in home and classroom settings. 

Objectives:  

Compare children’s change in executive functioning skills before and after participation in either Jed Baker’s Social Skills Training or Unstuck and On Target.

Methods:  

Twelve children received the Unstuck and On Target intervention, and five children received the Social Skills Training intervention. Both interventions were delivered by school staff with small groups of students in at least 27 sessions of 30-40 minutes each.  The Unstuck and On Target intervention teaches what flexibility is and why it is important, how to be flexible through the use of self-regulatory scripts and vocabulary, goal-setting/prioritizing and coping skills. The social skills intervention uses Jed Baker’s Social Skills Training curriculum. We conducted a small pilot test of the intervention, comparing change from pre- to post-intervention via the Shift and Plan/Org subtests of parent and teacher BRIEF questionnaires. 

Results:  

The children who completed the Unstuck and On Target intervention demonstrated significant improvement in flexibility as rated by their parent on the BRIEF Shift Paired Samples t Score (t= 4.28, p<0.01, df=10; 10 of 11 showed some improvement), but not their teacher on the BRIEF Shift (t= 0.12, df=11, 7 of 12 showed some improvement). Neither parents nor teachers identified significant change in the BRIEF Plan/Org (Parents: t= 1.56, df=10, 7 of 11 showed some improvement; Teacher t= -2.47, df=11, 8 of 11 showed some improvement). Parent and teacher BRIEF scores did not show significant improvement for the Social Skills Training group participants Parent Shift: t=0.03, df=4, 3 or 5 showed improvement; Parent Plan/Org: t=1.34, df=4, 3 of 5 showing improvement; Teacher Shift: t=0.58, df=4, 3 of 5 showed improvement, Teacher Plan/Org: t=0.76, df=4, 3 of 5 showed improvement). Single subject change graphs will be presented. 

Conclusions:  

These results suggest that most children show increased flexibility after participation in either Unstuck and On Target or Social Skills Training group in their school, but parents reported statistically significant improvements in flexibility only in the children receiving Unstuck and On Target at school. These results should be interpreted cautiously, as the current comparison represents only a small number of children. A larger randomized controlled trial (N=69) of children with ASD in mainstream schools is currently underway to evaluate the effectiveness of this curriculum.  This RCT also includes a companion parent manual and training program to be used in conjunction with the school-based intervention.