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Autism Spectrum and Developmental Disorders

Adapting School-Based Executive Function Unstuck and On Target Intervention for use in a Clinic Setting

(PS4-24) Adapting School-based Executive Function Unstuck and on Target Intervention for Use in a Clinic Setting

Friday, November 15, 2024

1:00 PM – 2:00 PM EST

Location: Franklin Hall, Level 4, Marriott Downtown

Author(s)

KS

Kat Sharp, B.A.

Clinical Research Coordinator
Children’s National Health System
Rockville, Maryland, United States

Co-Author(s)

HB

Hannah Behar, B.S.

Clinical Research Coordinator
Children’s National Health System
Rockville, Maryland, United States
AV

Alyssa D. Verbalis, Ph.D.

Project Manager
Children’s National Health System
Rockville, District of Columbia, United States
AL

Andrea Lopez, B.S., B.A.

Clinical Research Coordinator
Children's National Hospital
Arlington, Virginia, United States
Kelsey Dickson, Ph.D.

Associate Professor
San Diego State University
San Diego, California, United States
LB

Lauren Baczewski, Ph.D.

T32 Research Postdoctoral Fellow
Children's National Hospital
Rockville, Maryland, United States
Cara Pugliese, Ph.D.

Clinical Psychologist
Children’s National Health System
Rockville, Maryland, United States
LK

Lauren Kenworthy, Ph.D.

Professor
Children’s National Health System
Rockville, Maryland, United States

Abstract Text: Unstuck & On Target: High School (UOT:HS) is a 25-week executive function intervention, originally designed to be implemented in schools. Data from a pilot effectiveness trial in schools showed that classroom behavior and adaptive skills improved in the autistic students randomized to UOT:HS compared to school supports as usual. However, with smaller group sizes, more parent involvement, and other differences in the setting, modifications were required to deliver the intervention in a clinical setting. The current project examined adaptations to UOT:HS and associated autistic participant’s engagement throughout implementation in a clinic-based trial. Our study examined implementer self-report data from four different clinical UOT groups. The groups were led by four implementers trained in the UOT:HS curriculum who filled out the Modification and Adaptation Checklist (MAC), a self-report adaptation survey whereby implementers reported: how the lesson went overall (“Overall: On a scale of 1-10, where 10 is the best, how do you feel the lesson went?”) and whether a modification was made to the lesson. When implementers indicated a modification was made, they also provided data on the type of modification, and the reason for the modification. Implementers provided adaptation ratings on 19 of the 25 lessons. Implementers also rated each group participant’s engagement (0-4, where 4 was extremely engaged) at the end of every lesson, which was averaged across all participants attending the lesson. Two of the implementers were curriculum authors (50%) and group supervision was provided by the lead author. All implementers were female and white; 75% were clinical psychologists, and 25% were counselors. Descriptive analyses and Welch’s two-sample t-tests are reported on lessons that were modified, and those that were unmodified. In total, group leaders made modifications 45.3% of the time, with spending less time on an activity (25.9%) the most common modification made and the most common reason of increasing engagement (24.7%). The average overall rating of how a modified lesson went was 8.28 (range 6-10) and the average overall rating of an unmodified lesson was 8.66 (range 6-10). Average student engagement was 3.59 (range 2.5-4) for the modified lessons and 3.53 (range 2.5-4) for the unmodified lessons. Whether or not a lesson was modified did not significantly affect implementer ratings of how the lesson went overall or student engagement in the lesson (p’s all > .05). This data indicates frequent adaptations to UOT:HS during clinic-based implementation but adaptations did not significantly affect the implementer’s overall ratings of how the lessons went or the students’ engagement with the material. Overall, this indicates the initial promise for UOT:HS as a clinically-delivered intervention. The clinical UOT:HS groups are ongoing, and as lessons are completed, new data points are being added to this analysis. Participant outcomes and modifications involving parents will be assessed when the clinical trial is completed.