Telehealth Parent-Only Treatment for Youth with Autism Spectrum Disorder and Overweight/Obesity

为患有自闭症谱系障碍和超重/肥胖的青少年提供仅限家长的远程医疗治疗

• 批准号: 10521960
• 负责人: Kerri N Boutelle
• 金额: $ 67.89万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-15 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10521960
• 关键词: Adaptive Behaviors; Adolescent; Adult; Affect; Aftercare; Age; Behavior; Behavior Therapy; Body Size; Body Weight decreased; Body mass index; Child; Child Rearing; Childhood; Clinical; Consumption; Control Groups; Data; Development; Diagnosis; Dietary intake; Educational Status; Family; Gender; Goals; Health; Health Personnel; Health education; Height; Heterogeneity; High Prevalence; Intervention; Language; Mediator of activation protein; Modeling; Obesity; Outcome; Overweight; Parents; Physical activity; Pilot Projects; Play; Population; Public Health; Randomized; Reporting; Research; Research Personnel; Role; Self Efficacy; Severities; Symptoms; Time; United States; Vegetables; Vulnerable Populations; Weight; Weight Gain; Youth; active comparator; adolescent with autism spectrum disorder; autism spectrum disorder; autistic children; base; comparative efficacy; cost; effective therapy; efficacious intervention; executive function; follow-up; individualized medicine; intervention cost; intervention program; obesity in children; pilot test; programs; psychosocial; randomized trial; recruit; satisfaction; skills; telehealth; treatment group; treatment program; treatment response; weight loss program

ABSTRACT Approximately 1 in 54 children in the United States is diagnosed with autism spectrum disorder (ASD). Among children with ASD, estimates of overweight and obesity (OW/OB) range from 19% to as high as 55% with the majority of studies reporting OW/OB rates equal to or greater than typically developing children. OW/OB in childhood tracks well into adulthood and is associated with negative health and psychosocial consequences. To date, the most successful treatment for typically developing children with OW/OB is family-based behavioral treatment (FBT), which delivers weekly group-based treatment to the parent and child separately over a 6- month period. However, children with ASD are typically excluded from these trials and given their unique presentation, require a tailored treatment program. FBT programs for parents without their child (Parent-based treatment [PBT]) are more appropriate for families with a child with ASD and OW/OB, as the functioning and language levels of the children can impact their ability to directly participate in an intensive group-based program. Research shows that PBT is noninferior to FBT on child weight loss and is less costly to implement. Our group has developed and pilot tested a PBT group for children with ASD and OW/OB (called PBT-ASD). Our pilot data showed that the PBT-ASD program was feasible, acceptable and showed initial efficacy on child weight loss. This project is the next step in this program of research, and we will recruit 150 youth with OW/OB and ASD and their parent and randomize them to a 6-month telehealth PBT-ASD or active health education comparator (HE). We will assess main outcomes in children and parents at five time points; baseline, mid- treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12) and 12-month follow-up (month 18). The primary aim of this study is to compare the effect of PBT-ASD and HE on the target child’s weight (BMIz/%BMIp95) over the 18 months of the study. The secondary aim is to determine the extent to which the PBT-ASD and HE affect parent BMI, parent and child physical activity and dietary intake, child mealtime behavior, parenting style and self-efficacy. As an exploratory aim, we will evaluate moderators (e.g. parent and child gender, parent and child age, parent educational level, parent baseline BMI, child baseline BMIz/%BMI p95, parent executive functioning, parenting, child symptom severity, child adaptive behavior skills) and mediators (e.g. parenting, child symptom severity) of the PBT-ASD and the HE treatment on child BMIz/%BMI p95 over time. This program of research could advance the standard of practice for children with ASD, and could result in a tailored intervention for children with both ASD and OW/OB. We believe that by working with parents using a telehealth model, we can potentially provide an effective and durable treatment, which can easily be disseminated to parents with children with both ASD and OW/OB.

抽象的 在美国，大约每 54 名儿童中就有 1 名被诊断患有自闭症谱系障碍 (ASD)。 患有自闭症谱系障碍 (ASD) 的儿童中，超重和肥胖 (OW/OB) 的估计范围从 19% 到高达 55% 大多数研究报告的 OW/OB 率等于或高于正常发育儿童的 OW/OB 率。 童年期一直延续到成年期，并与负面的健康和社会心理后果相关。 迄今为止，对于患有 OW/OB 的典型发育儿童最成功的治疗方法是基于家庭的行为治疗 治疗 (FBT)，每周为父母和孩子提供基于小组的治疗，为期 6- 然而，患有自闭症谱系障碍的儿童通常被排除在这些试验之外，因为他们的独特性。 演示，需要为没有孩子的父母量身定制 FBT 计划（基于父母）。 治疗 [PBT]）更适合有 ASD 和 OW/OB 儿童的家庭，因为功能和 孩子们的语言水平会影响他们直接参与强化小组活动的能力 研究表明，PBT 在儿童减肥方面并不逊色于 FBT，而且实施成本较低。 我们的小组为患有 ASD 和 OW/OB 的儿童开发并试点测试了 PBT 组（称为 PBT-ASD）。 我们的试点数据表明，PBT-ASD 计划是可行的、可接受的，并且对儿童显示出初步疗效。 该项目是该研究计划的下一步，我们将招募 150 名 OW/OB 青少年。 ASD 及其父母，并将他们随机分配接受为期 6 个月的远程医疗 PBT-ASD 或积极的健康教育 我们将在基线、中期的五个时间点评估儿童和家长的主要结果； 治疗（第3个月）、治疗后（第6个月）、6个月随访（第12个月）和12个月随访（第12个月） 18) 本研究的主要目的是比较 PBT-ASD 和 HE 对目标儿童体重的影响。 (BMIz/%BMIp95) 在 18 个月的研究中，次要目的是确定在多大程度上 PBT-ASD 和 HE 影响父母 BMI、父母和孩子的体力活动和饮食摄入量、孩子进餐时间 作为探索性目标，我们将评估调节者（例如父母和孩子）。 儿童性别、亲子年龄、家长受教育程度、家长基线BMI、儿童基线BMIz/%BMI p95、父母执行功能、养育方式、儿童症状严重程度、儿童适应行为技能）和 PBT-ASD 和 HE 治疗对儿童 BMIz/%BMI 的调节因素（例如养育方式、儿童症状严重程度） p95 随着时间的推移，这项研究计划可以提高自闭症谱系障碍儿童的实践标准，并且 我们相信，通过与 ASD 和 OW/OB 儿童合作，可以为患有 ASD 和 OW/OB 的儿童提供量身定制的干预措施。 父母使用远程医疗模式，我们有可能提供有效且持久的治疗，这可以 很容易传播给患有自闭症谱系障碍 (ASD) 和 OW/OB 儿童的家长。