CAST for Autism Spectrum Disorder

(CAST Trial)

Overseen By Lisa A Ruble, PhD

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Ball State University

Disqualifiers: Moving, Job change, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

297 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether participants need to stop taking their current medications.

What data supports the effectiveness of the treatment COMPASS Across Settings (CAST) for Autism Spectrum Disorder?

The research suggests that evidence-based practices (EBPs) improve outcomes for autistic children, and the ACT SMART Toolkit, which facilitates the adoption of EBPs, may support the effectiveness of treatments like CAST. Additionally, the ASD Care Pathway showed improved outcomes in psychiatric settings, indicating that structured intervention strategies can be beneficial for individuals with autism. ^{1 2 3 4 5}

How is the CAST treatment different from other treatments for autism spectrum disorder?

The CAST treatment, also known as COMPASS, is unique because it focuses on improving transition outcomes for students with autism by using a collaborative model that involves ongoing teacher coaching and high consultant fidelity, which has shown to improve Individualized Education Program (IEP) outcomes compared to control groups. ^{2 6 7 8 9}

What is the purpose of this trial?

Purpose: The purpose of this project is to develop and test the COMPASS \[Collaborative Model for Competence and Success\] Across Settings (CAST) intervention to enhance the goal setting and attainment skills of autistic youth. Despite federal education law mandating transition services as part of the Individualized Education Program (IEP) for ensuring good outcomes for students with disabilities, current educational practices have been unable to demonstrate that autistic students experience positive postsecondary outcomes. There are existing, evidence-based interventions aimed at supporting positive outcomes for these students. However, these interventions have not systematically provided coaching support to the caregivers, students, and employment specialists. To address these issues, CAST will integrate three evidence-based interventions for supporting student transitions while providing this critical coaching support. By doing so, CAST aims to align the priorities and goals of interventions across home, school, and community settings to better support positive postsecondary outcomes for autistic students.

Eligibility Criteria

This trial is for autistic students with Individualized Education Programs (IEPs), their caregivers, special education teachers, and pre-employment specialists. Participants should not be planning any major life changes like moving or job transitions during the school year.

Inclusion Criteria

Pre-employment specialists of students with autism

Caregivers of students with autism

Students with verified autism and IEPs that designate services for autism

Exclusion Criteria

Not planning to move or leave their job over the school year

Timeline

Development and Focus Groups

Focus groups with administrators, special education teachers, parents, students, and pre-employment transition specialists to integrate plans and services across settings

12 months

Field Test

Conduct a field test of CAST, making further revisions based on feedback

12 months

Randomized Controlled Trial

Conduct a small RCT and network analysis to evaluate CAST for improved postsecondary outcomes

12 months

Follow-up

Participants are monitored for postsecondary outcomes at 3 months and 1 year after high school

12 months

Treatment Details

Interventions

• COMPASS Across Settings (CAST)

Trial Overview The COMPASS Across Settings (CAST) intervention is being tested to improve goal setting and attainment skills in autistic youth. CAST integrates three evidence-based interventions and provides coaching support across home, school, and community settings.

Participant Groups

Group I: Pre-Post study of CAST Experimental Treatment 1 Intervention

The research team will then conduct a field test of CAST in year 2, making further revisions.

Group II: Focus Groups to Inform CAST Active Control 1 Intervention

For the year 1 development activities, the research team will conduct focus groups with administrators, special education teachers, parents, students, and pre-employment transition specialists about how to integrate plans and services across settings.

Group III: Randomized Controlled Study of CAST Active Control 1 Intervention

In year 3, they will use a mixed methods design using a small RCT and network analysis, oversampling African American students and students from rural areas, to evaluate CAST for improved postsecondary outcomes in employment, training, and education.

Who Is Running the Clinical Trial?

Ball State University

Lead Sponsor

Trials

10

Recruited

670+

University of Toledo

Collaborator

Trials

8

Recruited

640+

Indiana University

Collaborator

Trials

1,063

Recruited

1,182,000+

Findings from Research

An inventory of 55 usual care practices for youth with autism spectrum disorder (ASD) was developed through input from 66 expert providers, highlighting the diverse approaches used in treatment.

The study identified 48 practices that experts considered familiar and useful, which can help standardize care and improve the implementation of evidence-based treatments for ASD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Multisite, Multidisciplinary Delphi Consensus Study Describing "Usual Care" Intervention Strategies for School-Age to Transition-Age Youth With Autism. Kerns, CM., Moskowitz, LJ., Rosen, T., et al.[2021]

A study involving 53 expert providers revealed that familiarity with different intervention practices for autism spectrum disorder varies based on the provider's setting and experience, with those outside school settings more familiar with cognitive approaches.

Providers' familiarity with intervention strategies can influence the type of care children with autism receive, highlighting the need for families to understand these differences to ensure effective treatment and reduce disparities in care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Predictors of expert providers' familiarity with intervention practices for school- and transition-age youth with autism spectrum disorder. Cooper, CM., Rosen, T., Kim, H., et al.[2023]

The review highlights that many adults on the autism spectrum experience poor quality of life, emphasizing the need to understand the social-ecological factors that influence their transition outcomes.

Current research on autism outcomes is limited in scope, often focusing on a narrow range of social-ecological factors and relying heavily on a few national datasets, which suggests a need for more diverse and comprehensive studies to improve understanding and outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social-Ecological Correlates in Adult Autism Outcome Studies: A Scoping Review. Anderson, KA., Roux, AM., Kuo, A., et al.[2019]

The implementation of the ASD Care Pathway (ASD-CP) in a public hospital child psychiatric service led to a 40% reduction in the average length of hospital stays for youth with autism spectrum disorder, from 22.4 days to 13.4 days.

Crisis interventions, such as holds and restraints, decreased by 77% after the ASD-CP was implemented, indicating a potential improvement in the management of patients with ASD, although these results approached statistical significance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does an Autism Spectrum Disorder Care Pathway Improve Care for Children and Adolescents with ASD in Inpatient Psychiatric Units? Kuriakose, S., Filton, B., Marr, M., et al.[2018]

The ACT SMART Toolkit, designed to improve the implementation of evidence-based practices for autistic children in community settings, showed high adherence and responsiveness during its pilot study with six agencies in Southern California.

However, the preparation phase of the toolkit had notably lower adherence and dose, indicating that this more intensive phase may need additional support to enhance implementation fidelity.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Fidelity to the ACT SMART Toolkit: an instrumental case study of implementation strategy fidelity. Tschida, JE., Drahota, A.[2023]

The NECC Core Skills Assessment (NECC-CSA) was validated by 245 participants, including parents and professionals, who identified 47 core skills as foundational for individuals with autism, indicating its relevance and importance in skill development.

The assessment highlights differences in perspectives between parents and professionals, suggesting that the NECC-CSA can serve as a reliable framework for creating educational programs tailored to the needs of individuals with autism spectrum disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social validation of the New England Center For Children--Core Skills Assessment. Dickson, CA., MacDonald, RP., Mansfield, R., et al.[2021]

Emerging evidence suggests that social challenges in autistic individuals may stem more from difficulties in social performance rather than a lack of social knowledge, which could change how we assess and support these individuals.

Focusing on performance-related factors rather than just knowledge could lead to more effective interventions and better inclusion strategies for autistic people, addressing their social challenges in a more meaningful way.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Social Knowledge & Performance in Autism: A Critical Review & Recommendations. Gates, JA., McNair, ML., Richards, JK., et al.[2023]

The COMPASS intervention, adapted for transition-age youth with autism spectrum disorder (ASD), significantly improved Individualized Education Program (IEP) outcomes compared to a placebo control group, with a large effect size (d = 2.1).

High fidelity in consultant implementation and improved teacher adherence over time highlight the effectiveness of ongoing coaching in enhancing educational outcomes for students with ASD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Randomized Control Trial of COMPASS for Improving Transition Outcomes of Students with Autism Spectrum Disorder. Ruble, LA., McGrew, JH., Toland, M., et al.[2020]

Group-based social skills interventions (GSSIs) for adolescents with higher-functioning autism spectrum disorder show considerable variability in participant and intervention characteristics, which may affect their effectiveness; future research should explore how these factors influence outcomes.

Current assessments of GSSIs yield largely inconclusive results, highlighting the need for more rigorous methodologies and improved measurement tools to accurately evaluate the efficacy of these interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Group-based social skills interventions for adolescents with higher-functioning autism spectrum disorder: a review and looking to the future. McMahon, CM., Lerner, MD., Britton, N.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

A Multisite, Multidisciplinary Delphi Consensus Study Describing "Usual Care" Intervention Strategies for School-Age to Transition-Age Youth With Autism. [2021]

2. England pubmed.ncbi.nlm.nih.gov

Predictors of expert providers' familiarity with intervention practices for school- and transition-age youth with autism spectrum disorder. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Social-Ecological Correlates in Adult Autism Outcome Studies: A Scoping Review. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Does an Autism Spectrum Disorder Care Pathway Improve Care for Children and Adolescents with ASD in Inpatient Psychiatric Units? [2018]

5. England pubmed.ncbi.nlm.nih.gov

Fidelity to the ACT SMART Toolkit: an instrumental case study of implementation strategy fidelity. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Social validation of the New England Center For Children--Core Skills Assessment. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Social Knowledge & Performance in Autism: A Critical Review & Recommendations. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Randomized Control Trial of COMPASS for Improving Transition Outcomes of Students with Autism Spectrum Disorder. [2020]

9. New Zealand pubmed.ncbi.nlm.nih.gov

Group-based social skills interventions for adolescents with higher-functioning autism spectrum disorder: a review and looking to the future. [2021]