Risk and Resiliency for Youth With Autism During the Transition to Adulthood

自闭症青少年在向成年过渡期间的风险和恢复能力

• 批准号: 9251023
• 负责人: Julie Lounds Taylor
• 金额: $ 5.09万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-16 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9251023
• 关键词: Risk; Resiliency; Youth; Autism; During

DESCRIPTION (provided by applicant): This application for an NIMH Mentored Research Scientist Career Development (K01) award seeks support to develop a program of research focused on the roles of biological stress response, behavioral functioning, and environmental resources in promoting a successful transition to adulthood for youth with autism spectrum disorders (ASD). Exiting high school is a challenging time for these youth, given the loss of services through the school system. Because the hypothalamic-pituitary-adrenal (HPA) axis modulates an individual's ability to react emotionally and physiologically to challenging environments, its dysfunction is a promising biological factor that might exacerbate poor outcomes for these young adults. Thus, a central component of the training plan is mentorship in HPA axis functioning and stress response as it relates to ASD. The second key component of the training plan is mentoring in clinical research skills. The candidate is a developmental psychologist with no clinical training, and thus she has relied on clinicians to recognize autism symptoms and diagnose ASD in her research. Furthermore, comorbid psychiatric disorders are extremely common in youth with ASD but can be difficult to recognize because their symptoms often overlap with symptoms of ASD. Because the absence of comorbid psychiatric disorders is an important component of positive adult outcomes, it is important to recognize their occurrence. The candidate will also pursue training in: 1) Measuring the quality and availability of disability-related services in the school and adult-service systems; 2) Conducting longitudinal research among families of youth with ASD; 3) Developing additional methodological and statistical expertise to analyze complex diurnal cortisol and longitudinal data; and 4) Behavioral intervention research. Together, this training will allow for the identification of risk factors for poor transition that are malleable (such as stress response or family environment). As part of the candidate's career development plan, she proposes a longitudinal study of youth with ASD who are preparing to exit high school. This project aims to: 1) Investigate the changes in and inter-relations among stress response profiles, behavioral profiles, and environmental resources as youth with ASD transition to adulthood; and 2) Investigate how adult outcomes are predicted by baseline measures (collected while in high school) and changes in stress response profiles, behavioral profiles, and environmental resources. Youth will be recruited during their final year of high school, with data collection at approximately 6 months before they exit school as well as 6 and 18 months after exit. At each time point, semi-structured observations will be used to examine autism symptoms and diagnosis, and diurnal cortisol will be collected. Mothers will report on their son or daughter's autism symptoms, behavior problems, daily activities, disability-related services, family warmth and criticism, and their own mental health. At the second time point (6 months after exit), a social stressor paradigm will be used (along with cortisol collection) to measure acute biological stress response among these youth. As a result of this research, the candidate will be able to identify malleable risk factors, that when aided could promote positive adult outcomes and better transitions to adulthood. So far, poor outcomes for adults with ASD have been linked only to static, unchanging risk factors such as low IQ and poor early language. Yet due to the surge of children with ASD exiting school systems and the high public costs of ASD, it is critical to examine risk factors that are amenable to intervention. The candidate plans to use the expertise gained through this award to develop an R01 grant proposal investigating long-term patterns of biological, behavioral, and family risk and resiliency following high school exit for youth with ASD compared to peers without ASD, with the long-term goal of developing and studying interventions to promote transition success.

描述（由申请人提供）：NIMH指导研究科学家职业发展（K01）奖的申请寻求支持，以开发一项研究计划，重点介绍生物压力反应，行为功能以及环境资源在促进自闭症谱系障碍（ASD）成功过渡到成年期的成年期间的成年过渡方面的作用。鉴于学校系统失去了服务，因此对这些年轻人来说是一个充满挑战的时刻。由于下丘脑 - 垂体 - 肾上腺（HPA）轴可以调节个人在情感和生理上对充满挑战的环境的反应能力，因此其功能障碍是一个有希望的生物学因素，可能会加剧这些年轻人的差异。因此，培训计划的一个核心组成部分是与ASD有关的HPA轴功能和应力响应的指导。培训计划的第二个关键组成部分是指导临床研究技能。候选人是一名没有临床培训的发展心理学家，因此她依靠临床医生来识别自闭症症状并在研究中诊断ASD。此外，合并症的精神疾病在ASD的年轻人中非常普遍，但很难识别，因为它们的症状通常与ASD症状重叠。由于缺乏合并症的精神疾病是成人积极结果的重要组成部分，因此必须认识到它们的发生非常重要。候选人还将在：1）衡量学校和成人服务系统中与残疾相关服务的质量和可用性； 2）在ASD的青年家庭中进行纵向研究； 3）开发其他方法论和统计专业知识，以分析复杂的昼夜皮质醇和纵向数据； 4）行为干预研究。这项培训将允许识别可延展的不良过渡（例如压力反应或家庭环境）的风险因素。作为候选人职业发展计划的一部分，她提出了一项纵向研究，该研究对正在准备退学高中的ASD青年。该项目的目的是：1）研究压力反应概况，行为概况和环境资源之间的变化和相互关系，因为年轻人的ASD过渡到成年； 2）研究如何通过基线度量（在高中时收集）以及压力反应概况，行为概况和环境资源的变化来预测成年结果。年轻人将在高中的最后一年中招募，并在退出学校以及退出后的6和18个月之前大约6个月收集数据。在每个时间点，半结构化观察结果将用于检查自闭症症状和诊断，并收集昼夜皮质醇。母亲将报告其儿子或女儿的自闭症症状，行为问题，日常活动，与残疾相关的服务，家庭温暖和批评以及自己的心理健康。在第二个时间点（退出后6个月），将使用社会压力范式（以及皮质醇收集）来测量这些年轻人的急性生物压力反应。这项研究的结果是，候选人将能够识别可延展的风险因素，而当辅助方面可以促进成人积极的结果并更好地过渡到成年。到目前为止，患有ASD的成年人的不良结果仅与静态，不变的危险因素（例如智商低和早期语言差的差异）有关。然而，由于ASD退出学校系统的儿童激增和ASD的高公共成本，检查可容纳干预的危险因素至关重要。候选人计划利用通过该奖项获得的专业知识来开发R01赠款提案，以调查与没有ASD的同伴相比，高中毕业后，在高中年轻人退出ASD的年轻人之后，研究生物，行为和家庭风险和弹性，其长期目标是发展和研究干预措施以促进过渡成功。

项目成果

A systematic review of vocational interventions for young adults with autism spectrum disorders.

对患有自闭症谱系障碍的年轻人的职业干预的系统评价。

• DOI: 10.1542/peds.2012-0682
• 发表时间: 2012
• 期刊: Pediatrics
• 影响因子: 8
• 作者: Taylor,JulieLounds;McPheeters,MelissaL;Sathe,NilaA;Dove,Dwayne;Veenstra-Vanderweele,Jeremy;Warren,Zachary
• 通讯作者: Warren,Zachary