NLM logo

National Information Center on Health Services Research and Health Care Technology (NICHSR)

HSRProj (Health Services Research Projects in Progress)

Information about ongoing health services research and public health projects


A community-based executive function intervention for low-income children with ADHD and autism spectrum disorders (ASD)
Investigator (PI): Kenworthy, Lauren
Past Investigator: Anthony, Laura
Performing Organization (PO): (Current): Children's National Health System, Children's Research Institute / (202) 476-2389
Supporting Agency (SA): Patient-Centered Outcomes Research Institute (PCORI)
Initial Year: 2013
Final Year: 2019
Record Source/Award ID: PCORI/AD-1304-7379
Funding: Total Award Amount: $1,821,227
Award Type: Contract
Award Information: PCORI: More information and project results (when completed)
Abstract: Background: Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders (ASD) are common, brain-based, and associated with executive function (EF) problems. EF enables people to regulate their emotions, behaviors, and thinking. Poor EF interferes with medical care and is associated with problems in long-term health, school, and independent living. Poverty is linked to increased EF problems, as well as reduced access to care for people with ADHD or ASD. This project addresses the disparity of fewer choices and poorer outcomes for low-income children with ADHD and ASD. Objectives: This project will find out whether a new treatment, Unstuck and On Target (UOT), works better, worse, or the same as the best treatment that is available now, contingency behavioral management (CBM), for low-income children with ASD or ADHD. We know that UOT improves problem-solving, EF, and self-control in middle-class children with ASD. It teaches children to use and understand specific scripts and skills to reduce impulsive, inflexible responses, and increase on-task behaviors. It is the first school-based cognitive-behavioral treatment targeting EF and self-control. Being school- instead of clinic-based makes UOT unique, low-cost, accessible, and much more likely to generalize to real-world settings. CBM emphasizes positive rewards for good behavior and is effective. To help parents and providers choose between the treatments, we will randomly assign schools to UOT or CBM treatment and measure their effectiveness to find out 1) which works better for low-income children with ASD--UOT or CBM; 2) which works better for low-income children with ADHD--UOT or CBM; and 3) are the effects of UOT and CBM sustained over time? Methods: We will make sure that the treatments are acceptable to families and schools by having parent and teacher input throughout the project. There will be 100 third through fifth graders with ASD and 100 with ADHD, in the study. They will come from Title 1 (low-income) schools. School staff will deliver treatments. Study staff will observe and train school staff to make sure that treatments are properly administered. We will measure change in problem solving, EF, behavior, self-control, and use of medical care by getting parent report, classroom observations, and child assessments. We will use statistical methods to make sure that we are measuring meaningful amounts of change. Outcomes: We predict that UOT will be better than CBM for children with ASD and ADHD at improving cognitive problem-solving, EF, self-control and use of medical care, but equal to CBM at improving behavior and coping. We predict UOT's effects will be lasting. If successful in low-income children with ASD or ADHD, UOT will be the first evidence- and community-based EF treatment for this group of school age children that targets skills that can make them more successful in their everyday lives and communities, which is what parents have told us they care about the most.
MeSH Terms:
  • Attention Deficit Disorder with Hyperactivity /*therapy
  • Behavior Therapy /methods
  • Child
  • Child Behavior
  • Child Development Disorders, Pervasive /*therapy
  • Cognition
  • Community Health Services /*organization & administration
  • Health Services Accessibility
  • Healthcare Disparities
  • Humans
  • Models, Statistical
  • Outcome Assessment, Health Care
  • Parents
  • Poverty
  • Problem Solving
  • School Health Services
Country: United States
State: District of Columbia
Zip Code: 20010
UI: 20143392
CTgovId: NCT03003286
Project Status: Completed
Record History: ('2019: Project extended to 2019. 2017: Project extended to 2018.',) ('2018: PI changed to Kenworthy.',)