Differential Outcomes in an Addressing Disparities Comparative Effectiveness Trial of Community-Based Executive Function Treatments in ASD and ADHD

Friday, May 12, 2017: 4:30 PM
Yerba Buena 7 (Marriott Marquis Hotel)
L. Kenworthy1, L. G. Anthony2, K. Hardy2, J. Safer-Lichtenstein3, A. D. Verbalis2, M. Biel4, S. Seese2, J. F. Strang2, A. B. Ratto5, C. E. Pugliese2, C. K. Kraper2, J. L. Martucci2, M. C. Wills5, C. Luong-Tran6, L. Cannon7, A. C. Sharber6 and B. J. Anthony8, (1)Children's National Medical Center, Rockville, DC, (2)Children's National Health System, Washington, DC, (3)Center for Child and Human Development, Georgetown University, Washington, DC, (4)Georgetown University, Washington, DC, (5)Children's National Medical Center, Washington, DC, (6)Children's National Medical System, Washington, DC, (7)Ivymount School, Rockville, MD, (8)University of Colorado, Denver, Aurora, CO
Background: Economic disparities in access to diagnosis and treatment are prominent in ASD and in ADHD. Both disorders are strongly associated with executive dysfunction, which is itself also an outcome of child poverty. Contingency behavioral management (CBM) is currently considered to be standard care for children with ADHD to treat EF related problems in schools. Unstuck and on Target (UOT) is a cognitive-behavioral executive function (flexibility, goal-setting and planning) intervention, which we found to be effective in middle-income children with ASD (Kenworthy & Anthony et al., 2014). Unlike other cognitive-behavioral treatments, UOT is implemented in school instead of a clinic, making it low cost, accessible and more likely to generalize to real world settings. We adapted UOT and CBM for use with low income and minority families (in either English or Spanish) and children with ASD or ADHD. We developed the CBM intervention, called Parents and Teachers Supporting Students (PATSS) to be accessible/empowering to the students, parents and teachers (e.g. terminology adjusted—“antecedent” changed to “trigger; students participated in the development of their behavior goals), and to specifically target flexibility and other EF problems.

Objectives: Compare the effectiveness of two EF treatments, UOT and PATSS, in typically underserved children with ASD or ADHD and flexibility problems.

Methods: The interventions were embedded in 22 mainstream Title 1 elementary schools in which at least half of the students qualify for free/reduced lunch fees. All children: had IQ>70; were in 3rd-5thgrade; were identified by school staff as being inflexible and having characteristics of ADHD or ASD; and met diagnostic criteria for either ASD (ADOS-2) or ADHD (MINIKid). 145 children (ASD n=48; ADHD n=97) completed the trial. Of those that completed the trial, only 29.7% were White/Non-Hispanic. The intervention groups were equivalent regarding age, sex, and IQ. Both interventions were delivered by school staff to small groups of students in approximately 20 sessions of 30-40 minutes each. The two interventions were matched for amount of parent, teacher and interventionist training (70% of parents attended a parent training). We compared change in both groups from pre- to post-intervention (PRE, POST) via treatment blinded classroom observations, classroom teacher ratings (SKAMP), WASI Block Design and BRIEF scores.

Results: Fidelity ratings were adequate overall. Performance on all measures improved for both ASD and ADHD children following UOT, but PATSS demonstrated more differentiated effects with more improvements in ADHD. See Table below for paired samples t-tests. Blinded classroom observations also showed some important differential effects in specific behavioral targets. See Figure below for percentages of children who improved on each of the classroom behaviors observed.

Conclusions: Children with ASD and ADHD in low-income schools benefit from community-based EF interventions adapted to engage teachers and families.