Research

Dickson, K.S., Galligan, M.L., Holt, T., Anthony, L.G., Kenworthy, L., & Brookman-Frazee, L. (in press). Incorporating Community Perspectives to Inform the Scaling-Out of an Evidence-Based Executive Functioning Intervention from Schools to Community Mental Health Settings. Evidence-Based Practice in Child and Adolescent Mental Health, Advanced Online

• There is a need to adapt effective mental health interventions to better fit community settings, especially for children’s services. This study gathered feedback from caregivers and therapists, recommending simpler materials, more educational content, greater caregiver involvement, and format adjustments to improve Unstuck’s fit and effectiveness. These suggestions were all included in the adaptation process.

Dickson, KS, Kenworthy, L, Anthony, LG, & Brookman-Frazee, L Mental health therapist perspectives on the role of executive functioning in children’s mental health services. Evidence-Based Practice in Child and Adolescent Mental Health. 2022 Advanced Online Publication. doi: 10.1080/23794925.2021.2013142

• Executive functioning is crucial for addressing multiple mental health conditions in community mental health services. Mental health therapists say that they encounter these difficulties frequently, but don’t know how to address them to help their clients. They want more education and better integration of executive functioning interventions in community care so they can be more effective.

Elias R, Murphy HG, Turner KA, White SW. Feasibility and Preliminary Efficacy of an Adapted Transdiagnostic Treatment for Children With Executive Function Deficits. J Cogn Psychother. 2019 Nov 1;33(4):343-356. doi: 10.1891/0889-8391.33.4.343. PMID: 32746396.

• This study adapted Unstuck and On Target! for use in an outpatient clinic with a small sample of children and adolescents who have various diagnoses. The 10-week program showed that the intervention was feasible, well-received, improved executive function, and reduced behavioral and emotional challenges.

Kenworthy, L*, Anthony, LG*, Naiman, DQ, Cannon, L, Wills, MC, Werner, MA, Alexander, K, Strang, J, Bal, E, Sokoloff, JL, & Wallace, GL (2014). Randomized Controlled Effectiveness Trial of Executive Function Invention for Children on the Autism Spectrum. Journal of Child Psychology and Psychiatry 55:374-83. doi: 10.1111/jcpp.12161 *Joint first authors

• This was the first trial to test Unstuck in schools and homes. Compared to a widely-used social skills intervention, Unstuck led to greater improvements in problem-solving, flexibility, and classroom behavior, demonstrating its effectiveness for children with autism.

Kenworthy L, Childress D, Armour AC, Verbalis A, Zhang A, Troxel M, Handsman R, Kocher K, Myrick Y, Werner M, Alexander KC, Cannon L, Anthony LG. Leveraging technology to make parent training more accessible: Randomized trial of in-person versus online executive function training for parents of autistic children. Autism. 2022 Aug 2:13623613221111212. doi: 10.1177/13623613221111212. Epub ahead of print. PMID: 35916246.

• This study compared online and in-person versions of an Unstuck parent training program for helping autistic children with executive function skills. Both formats were well-received and equally effective in reducing parenting strain and improving children’s flexibility, emotional control, and executive function. Though in-person training had higher completion rates, online training is a valuable option for parents facing barriers to in-person sessions.

Ratto, AB, Anthony, BJ, Pugliese, C, Mendez, R, Safer-Lichtenstein, J, Dudley, KM, Kahn, NF, Kenworthy, L, Biel, M, Martucci, JL, & Anthony, LG (2017). Lessons learned: Engaging culturally diverse families in neurodevelopmental disorders intervention research. Autism, 21(5):622-34. DOI: 10.1177/1362361316650394.

• Low-income and ethnic minority families, particularly Latino families, face significant challenges in accessing diagnostic and treatment services for neurodevelopmental conditions like autism and ADHD. This article can provide a roadmap for how researchers can adapt their methods to better recruit and engage these underserved communities. These lessons learned were developed during a trial comparing two effective school-based interventions for executive dysfunction in children (Unstuck versus contingency behavior management).

Rothschild LB, Ratto AB, Kenworthy L, Hardy KK, Verbalis A, Pugliese C, Strang JF, Safer-Lichtenstein J, Anthony BJ, Anthony LG, Guter MM, Haaga DAF. Parents matter: Parent acceptance of school-based executive functions interventions relates to improved child outcomes. J Clin Psychol. Jul;78(7):1388-1406. doi: 10.1002/jclp.23309. Epub 2022 Jan 8. PMID: 34997971; PMCID: PMC9203869.

• School-based interventions with parent training components can help lower-income families access effective treatments for children with neurodevelopmental disorders, but only if parents find these interventions acceptable. The study found that lower-income parents who viewed the treatments as acceptable were more engaged, and this engagement positively influenced treatment outcomes, suggesting providers should prioritize making treatments acceptable to improve access and effectiveness.

Swain, D, Troxel, M, Anthony, LG, Kenworthy, L, Verbalis, A, Hardy, KK, Ratto, A, Myrick, Y, & Anthony, B (2021). School-based executive function interventions reduce caregiver strain. International Review of Research in Developmental Disorders. https://doi.org/10.1016/bs.irrdd.2021.08.001

• Children with Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) often have executive functioning and behavior problems, causing higher stress levels for their caregivers. This study found that school-based interventions for these children (Unstuck and contingency behavior management) improved their executive functioning and reduced caregiver stress, even though it did not significantly change parents’ sense of competency or self-efficacy. This finding highlights the positive impact of child-focused school interventions on caregiver well-being.

Uddin, L.Q. Cognitive and behavioural flexibility: neural mechanisms and clinical considerations. Nat Rev Neurosci 22, 167–179 (2021). https://doi.org/10.1038/s41583-021-00428-w

• Cognitive and behavioral flexibility help adjust thoughts and behaviors to changing situations, supported by large-scale brain networks. These networks can be affected by neurodevelopmental disorders, adolescent clinical conditions, and dementias; the paper examines ways to enhance flexibility through cognitive training, physical activity, and bilingualism and includes Unstuck as an effective treatment.

Weitlauf AS, McPheeters ML, Peters B, Sathe N, Travis R, Aiello R, Williamson E, Veenstra-VanderWeele J, Krishnaswami S, Jerome R, Warren Z. Therapies for Children with Autism Spectrum Disorder: Behavioral Interventions Update. Comparative Effectiveness Review No. 137. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2012-00009-I.) AHRQ Publication No. 14-EHC036-EF. Rockville, MD: Agency for Healthcare Research and Quality; August 2014. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

• This updated systematic review examined recent studies on behavioral interventions for children with autism spectrum disorder (ASD). It found that early intensive behavioral interventions can improve cognitive and language skills, and that cognitive behavioral therapy can reduce anxiety in older children, though further research is needed to better understand and enhance these interventions across various settings.