Co-Principal Investigator: Duncan, Amie

Purpose: The purpose of this project is to adapt and test a school-based executive functioning (EF) and study skills intervention, Teaching Academic Skills to Kids—School-based (TASK-S), for high-functioning middle school students with autism spectrum disorders (ASD). Youth with ASD experience significant academic problems in a variety of domains including writing, attention, and complex processing related to problem solving, numerical operations, listening comprehension, and reading comprehension. A primary contributor to academic difficulties for students with ASD is a lack of EF skills such as planning, organization, mental flexibility, and time management, yet there are few EF interventions targeting academic skills for students with ASD. In particular, there are no evidence-based EF interventions for middle school studentswith ASD. The transition to middle school is associated with increased expectations for achievement and behavior, and adolescents with ASD and their parents struggle to manage academic behaviors (e.g., binder organization, homework). Thus, developing an intervention targeting both adolescents and their parents with a focus on improving the EF skills important for school success is warranted. An initial version of the TASK intervention has been adapted from existing EF interventions for students with attention-deficit hyperactivity disorder (ADHD). This research will further adapt TASK to be a school-based intervention that meets the unique needs of middle school students with ASD, focused on improving EF, academic behaviors (e.g., homework completion), and academic outcomes (e.g., grades) for these students. Because the intervention targets both parents and students, the research team will also explore whether participating in TASK-S is associated with changes in parenting practices and parent-child communication.

Project Activities: The project will iteratively develop and test TASK-S across 4 years. In the first year, the research team will solicit feedback from students, parents, and school personnel (e.g., teachers, administrators) through focus groups and interviews, and use their feedback to revise the existing EF intervention materials and procedures. The revised intervention materials will be used in Year 2 to conduct three trials to further refine the intervention and procedures as well as to examine issues related to treatment fidelity. In the third year, the research team will conduct a pilot randomized controlled trial to determine the promise of TASK-S for improving the EF and academic outcomes of high-functioning middle school students with ASD. In the fourth year, follow-up data will be collected approximately 6 months post-intervention.

Products: The products of this project will include the fully developed TASK-S intervention for middle school students with ASD, as well as peer-reviewed publications and presentations.

Structured Abstract

Setting: The research will take place in middle schools in southern Ohio and northern Kentucky.

Sample: Across the 4 project years, approximately 90 middle school students (Grades 6-8) with high-functioning ASD and their parents will participate. Students will be screened to confirm at least average IQ and presence of problems in EF skills. School mental health professionals, school administrators, and teachers (approximately six to eight of each type of school personnel) will participate in the development activities and feasibility studies in Years 1 and 2. In addition, a panel of six professionals, with expertise in the academic needs of students with ASD and developing and implementing school-based interventions, will also participate in the development activities and feasibility studies.

Intervention: The current version ofTASK is based on two existing interventions designed for students with ADHD: Academic Success for Young Adolescents Group and Homework, Organization, and Planning Skills (HOPS). Students and their parents participate jointly for 7 weekly, 90-minute sessions, all designed to target EF skills important for academic achievement. The TASK-S intervention includes the following activities: 1) teaching students and parents about EF skills and why they are important, 2) using behavior contracts related to the use of learned skills, 3) communication/problem solving, 4) binder organization and use of a planner, 5) flash cards, 6) summarizing skills (e.g., acronyms), and 7) planning for generalization. TASK-S will incorporate strategies known to be helpful for students with ASD, including visual schedules and supports (e.g., homework work space organized using labels and lists that the parent and adolescent develop together; use of video clips and live modeling of key study skills). TASK-S will also incorporate content addressing parent-teacher communication to ensure consistency between the home and school setting.

Research Design and Methods: During the first 2 years of the project, the investigators will engage in iterative development and refinement of the intervention. The research team will begin by soliciting feedback from experts on the existing TASK materials and then conduct a series of focus groups with school stakeholders (teachers, mental health professionals, and school administrators), parents of students with ASD, and students with ASD. Based on the information collected, revisions will be made to the intervention materials and procedures. This will be followed by a series of three trials conducted with students with ASD and their parents to allow the research team to make modifications to the intervention in an ongoing, successive fashion, incorporating feedback iteratively from the family and school personnel implementing TASK. In Year 3, the investigators will conduct a small randomized controlled trial in which schools are randomly assigned to TASK-S or a control condition. Outcome data will be collected pre- and post-test, and in Year 4, at approximately 6-month post-intervention. In addition, the research team will provide the students in the control condition with the TASK-S intervention in the final year.

Control Condition: For the pilot study, schools randomly assigned to the waitlist will provide business-as-usual services for students with ASD.

Key Measures: Students will be screened for eligibility through a review of records (e.g., ASD diagnosis and IQ) and administration of the Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2) to confirm the existence of EF problems. Student academic behaviors will be measured with the Homework Problems Checklist, the Classroom Performance Survey, the Academic Performance Rating Scale, and the Academic Competence subtest of the Social Skills Improvement System (SSIS). Student organization and time management skills will be assessed with the Children's Organizational Skills Scale (COSS), the Organization Checklist, and the Time Management Checklist. Student problem solving and critical thinking will be assessed with the Test of Problem Solving 2-Adolescent (TOPS2-A). The Greenberger's Psychosocial Maturity Inventory will be use to collect student self-report of self-reliance, identity, and work orientation. Student achievement will be assessed with the Woodcock Johnson Tests of Achievement III and educational records (e.g., grades, state test scores). To explore changes in parenting practices, parent-child relationships, and parenting skill and attitude, the Helicopter Parenting Scale and the Parent-Child Relationship Inventory will be used. The Services Use in Children and Adolescents — Parent Interview will be used to identify any additional services received by students.Intervention acceptability will be collected with the Parent & Student Acceptability of Intervention Questionnaire.

Data Analytic Strategy: A content analysis approach will be used to analyze data from focus groups, and qualitative and quantitative data from the trials will be analyzed using descriptive and inferential statistical techniques. The pilot study will analyze Cohen's d effect sizes, comparing the scores of the TASK-S group with those of the control group at the post assessment, and within group pre-post effect sizes, to evaluate the promise of the program in improving students' academic functioning and academic gains. The research team will also explore correlations between TASK-S participation and any changes in parenting practices and parent-child relationships.