Teaching Academic Success Skills to Middle School Students with Autism Spectrum Disorders (ASD) with Executive Functioning Deficits

Grant #: R21HD090334-01A1
PI: Leanne Tamm, PhD; Amie Duncan, PhD
Co-I: Aaron Vaughn, PhD; Lori Crosby, PsyD
Collaborators: Kara Hume, PhD (University of North Carolina, Chapel Hill); Lauren Kenworthy, PhD (George Washington University Medical School)

Children with Autism Spectrum Disorders (ASD) present with numerous deficits in executive functioning (EF) including planning, flexibility, inhibition, shifting set, generativity, metacognition, action monitoring, time management, and generalizing information. Yet EFs are critical to successful academic performance. Children must be able to perform multistep sequences of events, demonstrate mental flexibility, reflect, reason, plan (e.g., complete different tasks for several subjects on time), be flexible in their thinking (e.g., select the most effective learning strategy), and monitor their performance (e.g., manage progress and check for mistakes) to succeed in the educational environment. There is a particular demand for these EF skills as children transition to the middle school environment which is associated with numerous challenges including increased expectations for achievement and behavior, copious homework assignments, increasing social complexity, increased demands on organization and planning/time management, learning that moves from rote tasks to abstract conceptual learning, etc. Not surprisingly, given their problems with EF and social competency, children with ASD evidence high levels of academic problems in middle school. In fact, during middle schools years, the academic performance of children with ASD is on average 5 years below their typical peers. Yet there are few EF interventions targeting academic skills for children with ASD and no evidence-based interventions for middle school youth with ASD. Using an iterative and collaborative design process, we intend to adapt intervention content developed for other populations with EF deficits (i.e., ADHD) for high functioning middle-school students (7th graders) diagnosed with ASD. Adapting these academic EF skills interventions for ASD is ideal because they are time-limited, amenable to group administration, and emphasize the crucial role of the parent who confronts the daily academic and behavioral struggles that often come with rearing a student with ASD. Further, it capitalizes on the shared characteristics (e.g., EF deficits) and common evidence-based interventions (e.g., behavioral principles) of the two disorders. By incorporating stakeholder feedback at every step of an iterative design process we will tailor the intervention to directly address the needs of the youth with ASD. We will examine the feasibility and acceptability of the resultant Teaching Academic Skills to Kids (TASK) intervention for parents and youth with ASD, and examine preliminary efficacy on EF, academic skills, and educational outcomes in an open trial. TASK has the potential to impact a large number of youths with ASD since approximately 50% of the population of individuals with ASD are considered “high functioning”, the majority of whom present with EF deficits as severe as their lower functioning counterparts. The lifetime cost for an individual with ASD is estimated to be $1.4 million per patient. Thus, NIH ASD research priorities include developing novel treatments delivered during pivotal transition times (e.g., middle-school) that improve school outcomes.