On Target for Life: An Executive Function Intervention for Adolescents with Autism Spectrum Disorders

Friday, May 13, 2016: 11:30 AM-1:30 PM
Hall A (Baltimore Convention Center)
S. Seese1, K. M. Dudley2, L. Kenworthy3, L. G. Anthony4, M. A. Werner5, L. Cannon5, L. Mohamed6, C. E. Pugliese4 and J. F. Strang7, (1)Center for Autism Spectrum Disorders, Children's National Medical Center, Rockville, MD, (2)Children's National Medical Center, Center for Autism Spectrum Disorders, Ellicott City, MD, (3)Children's Research Institute, Children's National Medical Center, Rockville, MD, (4)Children's National Medical Center, Rockville, MD, (5)Ivymount School, Rockville, MD, (6)Yale Child Study Center, New Haven, CT, (7)Children's National Medical Center, Silver Spring, MD

Executive function (EF) skills are critical for young people as they progress through school. Students with ASD fall further behind their peers in EF skills as they enter middle school. Unstuck and On Target, an elementary school-based cognitive behavioral intervention, has been shown to improve EF skills, behavior and social skills in elementary school students. On Target for Life is an upward age extension of UOT, adapted to address the specific needs of adolescents in middle school. OTL was developed through a participatory process framework targeting EF skills in teens with ASD without intellectual disability. OTL uses scripts, engaging visuals, and in vivo experiments and games in order to apply and generalize EF skills to real world scenarios in the lives of teens with ASD.


1) Evaluate the change in executive functioning skills in adolescents before and after participation in On Target for Life.


17 adolescents received the On Target for Life intervention delivered by school staff over the course of 22 sessions. OTL focuses on teaching adolescents how to set goals, be flexible, and learn how to plan and get what they want/need. Our pilot test of the study compared changes from pre-to-post intervention. Data was collected through standardized and experimental child measures.  Observations from previous studies of UOT have indicated that with increased flexibility skills, children are more efficient at problem solving. As a measure of efficiency and problem solving, we calculated average problem-solving time on a visual problem solving task (Wechsler Block Design) items pre-to-post intervention. The Challenge Task (CT), an in-vivo observational method, challenges adolescents to be flexible and make organized plans. The CT yields scores on planning and flexibility. The DKEFS Verbal Fluency measure provides a standardized difference score between category and switching fluency, measuring the “cost” in efficiency that demands for flexibility/switching.    


Adolescents who completed the On Target for Life intervention demonstrated significant improvement (faster time) solving Block Design items from pre to post intervention (t(16)=2.71, p=.016). Total Block Design t-scores did not improve, t(16)=.-33, p=.744. Students showed improved flexibility skills (t(16)=3.49, p=.003) and planning skills (t(16)=4.89, p=.001) on the Challenge Task from pre to post intervention. Scores on the DKEFS switch cost measure did not show improvement, t(16)=-.71, p=.490.


These results suggest that most adolescents show some improvement after participation in On Target for Life. However, these results should be interpreted cautiously, as the current study represents only a small number of adolescents without a comparison group.  A larger randomized controlled trial (N=36) of adolescents with ASD in main stream schools is currently underway to further evaluate the effectiveness of this intervention. This RCT also includes a companion parent manual and training program to be used in conjunction with the school-based intervention.