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Tamm L, Hamik E, Yeung TS, Zoromski AK, Mara CA, Duncan A. Achieving Independence and Mastery in School: A School-Based Executive Function Group Intervention for Autistic Middle Schoolers. J Autism Dev Disord 2023:10.1007/s10803-023-06164-7. [PMID: 37991661 DOI: 10.1007/s10803-023-06164-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/23/2023]
Abstract
Executive functioning (EF) deficits, such as challenges with planning, organization, and materials management, negatively impact academic performance, particularly for middle-school students with autism spectrum disorder (ASD) without intellectual disability (ID). The aim was to assess the initial efficacy of the school-based version of the Achieving Independence and Mastery in School (AIMS) intervention in a pilot randomized clinical trial. 47 autistic middle-schoolers without ID attending nine different schools were randomized to participate in AIMS or to wait to receive AIMS the following semester (waitlist control = WLC). Youth, caregivers, and teachers rated academic EFs and academic functioning, and youth completed an objective EF measure, at baseline and outcome (post). Effect sizes were computed comparing baseline and post measures within each group. Individuals randomized to AIMS improved from baseline to post on academic EF outcome measures with small to moderate effect sizes, compared to WLC, who made some improvements but with generally smaller effect sizes. Analyses with academic functioning measures showed a similar pattern of results. These promising results suggest that AIMS delivered in the school by school-based personnel to small groups of students with ASD without ID can improve academic EF skills.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Department of Pediatrics, Center for ADHD, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 10006, Cincinnati, OH, 45229-3039, USA.
| | - Elizabeth Hamik
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Eastern Michigan University, Ypsilanti, MI, USA
| | - Tat Shing Yeung
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Allison K Zoromski
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Constance A Mara
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amie Duncan
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Tamm L, Risley SM, Hamik E, Combs A, Jones LB, Patronick J, Yeung TS, Zoromski AK, Duncan A. Improving academic performance through a school-based intervention targeting academic executive functions - a pilot study. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2022; 70:549-557. [PMID: 38699503 PMCID: PMC11062275 DOI: 10.1080/20473869.2022.2095690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/22/2022] [Indexed: 05/05/2024]
Abstract
Background Academic challenges such as losing/not turning in assignments, misplacing materials, and inefficient studying are common in middle-school students with autism spectrum disorder (ASD) without intellectual disability. Deficits in organization, planning, prioritizing, memory/materials management, and studying skills [i.e. academic executive functioning (EF) deficits] contribute to these challenges. Objectives To assess the feasibility, satisfaction, and initial efficacy of the school-based version of the Achieving Independence and Mastery in School (AIMS) intervention in a proof-of-concept trial with 6 students with ASD. Methods 6 middle-schoolers with ASD without ID participated in AIMS. Parents and teachers rated academic EFs and functioning. Results Results suggest high feasibility, youth satisfaction, and improved EF skills and academic behaviors by parent and teacher report. Conclusion These promising results support further intervention development and suggest that academic EF skills are malleable in students with ASD.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Elizabeth Hamik
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Angela Combs
- College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | | | - Jamie Patronick
- College of Arts and Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Tat Shing Yeung
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Allison K. Zoromski
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amie Duncan
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Abstract
Youth with autism spectrum disorders (ASD) without intellectual disability frequently experience academic problems, in part due to executive functioning (EF) deficits. There are currently no evidence-based interventions targeting academic EF skills for middle school youth with ASD. An intervention is currently in development. This paper reports on a "proof of concept" uncontrolled trial of the intervention, and focus groups with parents and youth to inform tailoring and adaptation of the intervention. Results of the trial suggest high feasibility/satisfaction, but a need for further adaptation to promote uptake by youth with ASD. Results from the focus groups confirmed the need for an intervention targeting academic EF skills, successful strategies in use, and the need to promote increased youth independence.
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Tamm L, Zoromski AK, Kneeskern EE, Patel M, Lacey HM, Vaughn AJ, Ciesielski HA, Weadick HK, Duncan AW. Achieving Independence and Mastery in School: An Open Trial in the Outpatient Setting. J Autism Dev Disord 2020; 51:1705-1718. [PMID: 32809169 DOI: 10.1007/s10803-020-04652-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Youth with autism spectrum disorders (ASD) without intellectual disability frequently experience academic problems, in part due to executive functioning (EF) deficits. There are currently no evidence-based interventions targeting academic EF skills (e.g., organization, prioritization, etc.) for middle school youth with ASD. The need is critical given increasing demands on these skills during the transition from elementary to middle school. An intervention targeting academic EF skills, Achieving Independence and Mastery in School (AIMS), was recently developed. This paper reports on an open trial of the AIMS-Outpatient intervention with 21 middle schoolers with ASD. Results suggest high feasibility/satisfaction, and improved EF, particularly in the domains of organization and materials management. These promising results support further intervention development work and suggest that academic EF skills are malleable in youth with ASD.
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Affiliation(s)
- Leanne Tamm
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Allison K Zoromski
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ellen E Kneeskern
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Meera Patel
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Heather M Lacey
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Aaron J Vaughn
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Heather A Ciesielski
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Hannah K Weadick
- University of Cincinnati College of Arts and Sciences, 155 B McMicken Hall, Cincinnati, OH, 45221, USA
| | - Amie W Duncan
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Hogue A, Horan Fisher J, Dauber S, Bobek M, Porter N, Henderson CE, Evans SW. Randomized Trial of Academic Training and Medication Decision-Making for Adolescents with ADHD in Usual Care. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:874-887. [PMID: 32078394 DOI: 10.1080/15374416.2020.1716362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Objective: This study tested two family-based interventions designed for delivery in usual care: Changing Academic Support in the Home for Adolescents with ADHD (CASH-AA), containing motivational interventions, homework management and schoolwork organization training, and family-school partnership building; and Medication Integration Protocol (MIP), containing ADHD psychoeducation, medication decision-making, and integrated medication management.Method: This study used a cluster randomized design to test CASH-AA + MIP versus CASH-AA Only for adolescents with ADHD in five sites. Therapists (N = 49) were site clinicians randomized to condition. Clients (N = 145) included 72% males; 42% White Non-Hispanic, 37% Hispanic American, 15% African American, and 6% more than one race; average age was 14.8 years. Fidelity data confirmed protocol adherence and between-condition differentiation.Results: One-year improvements were observed across conditions in several outcomes. Overall, CASH-AA + MIP produced greater declines in adolescent-report inattentive symptoms and delinquent acts. Similarly, among non-substance users, CASH-AA + MIP clients attended more treatment sessions. In contrast, among substance users, CASH-AA Only clients showed greater declines in caregiver-report hyperactive symptoms and externalizing.Conclusions: This study provides initial experimental support for family-based ADHD medication decision-making when coupled with academic training in usual care. The treatment protocols, CASH-AA and MIP, showed positive effects in addressing not only ADHD symptoms but also common co-occurring problems, and youth with substance use problems benefitted along with non-using peers.
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Hogue A, Evans SW, Levin FR. A Clinician's Guide to Co-occurring ADHD among Adolescent Substance Users: Comorbidity, Neurodevelopmental Risk, and Evidence-based Treatment Options. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017; 26:277-292. [PMID: 30828239 PMCID: PMC6392461 DOI: 10.1080/1067828x.2017.1305930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This article introduces neurodevelopmental and clinical considerations for treating adolescents with co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) and substance use (ASU) in outpatient settings. We first describe neurobiological impairments common to ADHD and ASU, including comorbidity with conduct disorder, that evoke a profile of multiplicative developmental risk. We then present two evidence-based options for targeting ADHD-related problems during ASU treatment. Medication integration interventions utilize family ADHD psychoeducation to prompt decision-making about ADHD medication and integrate medication management into behavioral services. Clinic-based academic training interventions utilize family interventions to improve the home academic environment and boost organization skills. We conclude with recommendations for ADHD assessment and intervention sequencing.
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Affiliation(s)
- Aaron Hogue
- National Center on Addiction and Substance Abuse, New York, NY, USA
| | | | - Frances R Levin
- Columbia University, New York, NY, USA, New York State Psychiatric Institute
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Morales-Hidalgo P, Hernández-Martínez C, Vera M, Voltas N, Canals J. Psychometric properties of the Conners-3 and Conners Early Childhood Indexes in a Spanish school population. Int J Clin Health Psychol 2017; 17:85-96. [PMID: 30487884 PMCID: PMC6236327 DOI: 10.1016/j.ijchp.2016.07.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/20/2016] [Indexed: 12/01/2022] Open
Abstract
Ba#ckground/Obje#ctive: To examine the psychometric properties of the Conners 3 ADHD Index (Conners 3 AI) and the Conners Early Children Global Index (Conners ECGI) parents' form (PF) and teachers' form (TF) in Spanish schoolers. Method: Two-phase cross-sectional study. In the first phase, information was gathered from teachers (n = 1,796) and parents (n = 882) of 4-5 and 10-11 year-old children. In the second phase (n = 196), children at risk of ADHD and controls were individually assessed. Results: The results confirmed the two-factor structure of the Conners 3 ADHD Index, which contains hyperactive-impulsive and inattentive symptoms, and the two-factor structure of the Conners ECGI PF, consisting of emotional lability and restless-impulsive symptoms. In contrast with the original version, the Conners ECGI TF presented an additional inattentive factor. Moderate-to-high rates of evidence of convergent validity with Child Behavior Checklist and Kiddie-Schedule for Affective Disorders & Schizophrenia, and evidence of external validity (academic achievement) were found. Scores were significantly higher in boys than in girls, for both indexes. Raw scores corresponding to clinical T-scores were higher than the original version. Conclusions: The Conners indexes may be considered reliable and valid instruments for detecting ADHD symptoms in Spanish populations.
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Affiliation(s)
- Paula Morales-Hidalgo
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
| | - Carmen Hernández-Martínez
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
| | - Magally Vera
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
- Faculty of Humanities and Education, Universidad de los Andes, Venezuela
| | - Núria Voltas
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
| | - Josefa Canals
- Research Center for Behavioral Assessment (CRAMC), Nutrition and Mental Health Research Group (NUTRISAM), Universitat Rovira i Virgili, Spain
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