Use of the Weekly Calendar Planning Activity to Assess Executive Function in Adolescents With Autism Spectrum Disorder.

IMPORTANCE: Youths with autism spectrum disorder (ASD) have challenges with executive function (EF). However, there are few measures to objectively assess EF, such as time management and prioritization. The Weekly Calendar Planning Activity (WCPA) is a promising performance-based EF measure that has rarely been used with youths with ASD. OBJECTIVE: To characterize the performance of youths with ASD on the WCPA and the association of WCPA performance with caregiver-rated EF. DESIGN: Observational and summary data obtained during a baseline evaluation for a research study. SETTING: Middle school. PARTICIPANTS: Thirty-nine adolescents with ASD and without an intellectual disability. METHOD: Youth were administered the WCPA; caregivers completed EF ratings. Descriptive statistics characterized WCPA performance. Correlations between WCPA scores and age, IQ, and EF ratings were computed. RESULTS: The majority of youth performed poorly on the WCPA and lacked insight into their poor performance. Many struggled to enter appointments. Appointment accuracy was <30%. The most common errors were location errors. Appointment accuracy and planning time were moderately associated with IQ but not with caregiver-rated EF or age. CONCLUSIONS AND RELEVANCE: Overall, the WCPA was cognitively demanding for youths with ASD without an intellectual disability. These results have implications for using evidence-based strategies to teach adolescents with ASD how to manage their time and plan and prioritize homework assignments, upcoming tests or quizzes, and extracurricular activities. Plain-Language Summary: Youths with autism spectrum disorder have significant problems with executive function, particularly organization, prioritization, time management, and planning. There are few objective, performance-based measures of executive function, especially those that can be used with autistic youths. To our knowledge, this study is the first to use the Weekly Calendar Planning Activity (WCPA) with autistic adolescents who do not have an intellectual disability. The WCPA captured their deficits related to executive function and could be a useful tool for assessment and treatment planning.

Improving academic performance through a school-based intervention targeting academic executive functions - a pilot study.

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.

Achieving Independence and Mastery in School: A School-Based Executive Function Group Intervention for Autistic Middle Schoolers.

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.

School Challenges and Services Related to Executive Functioning for Fully Included Middle Schoolers with Autism.

The educational services available for fully included middle schoolers with autism spectrum disorder (ASD) in the general education setting are not well known. Even less is known about how the executive functioning (EF) deficits of such youth are addressed in the classroom. The current study sought to identify the challenges, including EF, that middle schoolers with ASD face and the services that they receive on their Individualized Education Program (IEP), and also explore specific strategies used to build EF skills at school. A convenience data sample was obtained from focus groups with educational personnel (n = 15), and qualitative analyses of IEPs were conducted in middle schoolers with ASD with EF deficits (n = 23). Results confirmed that social communication and EF challenges are common. Multiple services and accommodations were identified, although EF challenges were rarely targeted on IEPs. Factors that may facilitate the success of EF strategies in the classroom are discussed.