A study found that children who were diagnosed with Autism Spectrum Disorder (ASD) as well as ADHD had more impairment in day-to-day life. The impairments were observed in executive function (EF) skills, daily living skills, and behavior problems (what psychologists refer to as “maladaptive behaviors”). The findings were significant for researchers and providers because it suggests that a co-occurring condition, like ADHD, influences autism symptoms. Understanding this link can help professionals develop interventions that better target these impairments and lead to better outcomes.
In 2013, a team from Children’s National Medical Center published their findings on a new EF intervention they developed for children diagnosed with ASD. The program, called Unstuck and On Target, is a cognitive-behavioral, school-based intervention that teaches what flexibility, goal setting, and planning are, why they are important, and how to use self-regulating scripts that guide these desired behaviors. Children with ASD (and those with co-occurring ADHD) often have difficulties with these EF skills, and those difficulties interfere with their adaptive behavior (communication, daily living skills, and socialization).
For the study, the researchers randomly assigned participating elementary schools to the Unstuck and On Target intervention or to a social skills intervention. Over the course of one school year, both interventions were provided in 28, 30-40 minute lessons with games, visual supports, role-plays, and positive reinforcement. Parents were given tips on how to employ the assigned interventions at home as well.
At the end of the intervention, the researchers found that while both groups showed improvements, the participants who received the Unstuck and On Target curriculum showed more improvement in their ability to follow directions, transition smoothly, problem solve, and avoid getting stuck. Unexpectedly, the Unstuck and On Target kids also showed improvement in social skills. By learning how to be flexible, the children learned how to better regulate their behaviors. This led to a decrease in negative classroom behaviors, which is thought to have led to less social alienation by their peers.
While the study size was relatively small, the initial findings are encouraging. They showed that an intervention based on cognitive-behavior therapy can effectively target specific impairments associated with ASD. This study is also important because it is the first to tackle EF and self-regulation impairments in ASD with a community-based intervention. The researchers are currently funded by the Patient Centered Outcomes Research Initiative (PCORI) to test this intervention in low-income children with both ASD and ADHD.
Source: Kenworthy, L., Anthony, L. G., Naiman, D.Q., Cannon, L., Wills, M.C., Luong-Tran, C., Adler Werner, M., Alexander, K.C., Strang, J., Bal, E., Sokoloff, J.L., Wallace, G. L. (2013). Randomized controlled effectiveness trial of executive function intervention for children on the autism spectrum. Journal of Child Psychology and Psychiatry, 55(4), 374–383. doi:10.1111/jcpp.12161