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Comparative Effectiveness Trial of School and Home-Based Executive Functioning Versus Social Skills Intervention for Children with Asd; Part 2: Performance-Based Effects

Saturday, 4 May 2013: 10:30
Meeting Room 3 (Kursaal Centre)
L. Kenworthy1, M. A. Werner2, K. C. Alexander2, J. F. Strang1, M. Wills1, C. Luong-Tran1, J. L. Sokoloff1, E. Bal1, L. Cannon2, A. C. Sharber3, M. Rosenthal4, G. L. Wallace5 and L. G. Anthony1, (1)Center for Autism Spectrum Disorders, Children's National Medical Center, Rockville, MD, (2)Ivymount School, Rockville, MD, (3)Children's National Medical Center, Rockville, MD, (4)Child Mind Institute, New York, NY, (5)National Institute of Mental Health, Bethesda, MD

Executive dysfunction is common in autism spectrum disorders (ASD) and is linked to academic, social and adaptive problems. Unaware of any contextually based executive function (EF) intervention for children with ASD without ID, we developed a school/home-based intervention targeting flexibility, goal-setting and planning called Unstuck and On Target (UOT). UOT remediates EF deficits in ASD through a cognitive/behavioral program that emphasizes self-regulatory scripts, guided/faded practice, and visual/verbal cueing in school and at home. 

Objectives:   To evaluate the effectiveness of UOT as compared to a social skills intervention (SS) of equal intensity, and as implemented in mainstream elementary schools.


The interventions occurred in 14 mainstream elementary schools. All children had IQ>70 (mean=108), met criteria for ASD on ADOS or ADI and clinician impression, and were in 3rd-5th grade. Forty-seven (87% male) children received UOT, and 20 children (90% male) received SS. The groups were well-matched at the start of the intervention for age, type of school, parent education, IQ, % minority, and % on psychotropic medication. Comparable proportions of participants completed the intervention (91% of UOT and 95% of SS).  Both interventions were delivered during the school day by school staff in small groups; classroom teachers and parents were trained to reinforce the UOT or SS lessons.  The two interventions were matched for dose of intervention with the child, and on amount of parent, teacher and group leader training. Fidelity was measured through observation of intervention groups and pre-post change was measured through contextual data collection and laboratory measures, specifically the Wechsler Abbreviated Scale of Intelligence Block Design (BD) subtest, and an ADOS-like interview designed to measure EF, The Challenge Task (CT).  The CT challenges children to be flexible and to plan in the context of activities with an examiner (e.g., doing a puzzle), and yields Flexibility and Planning scores, as well as a rating of Social Appropriateness.  Evaluators were blind to intervention type. Pre- post-data were compared through repeated measures ANOVA, with intervention group as the between subjects factor.


See companion IMFAR abstract for findings regarding fidelity and contextual data. There was a significant group (UOT, SS) by time (pre-, post-intervention) interaction for BD (F=4.82,p<0.03) and CT Flexibility (F=6.89,p<0.01) scores; post-hoc paired sample t tests showed a significant improvement in BD and CT flexibility scores for the UOT group (BD t=-2.81,p<0.01; CT Flex t=-7.30,p<.001) but not the SS group. In contrast, there were significant overall time effects indicating that both UOT and SS CT Planning and Social Appropriateness scores improved (CT Plan: F=24.36,p<0.001; CT Social: F=5.22,p<0.03).

Conclusions:   These data indicate that UOT improves flexibility and efficiency of problem solving in children with ASD. The benefits of UOT are significant even when compared to a social skills intervention of equal intensity.  The fact that this intervention was successfully implemented in mainstream educational settings by individuals with variable background and training in ASD, provides further indication that UOT can be a useful tool for improving executive and social skills in children with ASD.

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