AIR-P Network Activities - January 2020

December 18, 2019

The Autism Intervention Research Network on Physical Health (AIR-P), led by Karen Kuhlthau, PhD, conducts research on evidence-based interventions to improve the physical health and well-being of children and adolescents with autism spectrum disorders (ASD) and other developmental disabilities, with an emphasis on reaching underserved communities. The key goals for the AIR-P Network are two-fold:

  1. To conduct multi-site research on evidence-based interventions that improve physical health of children and adolescents with ASD and developmental disorders, especially underserved populations.
  2. To transform AIR-P into a multi-site Autism Learning Health Network (ALHN) which will provide a collaborative laboratory for developing and testing evidence-based interventions and accelerating the adoption of effective interventions and system management approaches into practice.

During the current funding cycle, the AIR-P has multiple active research projects and is working collaboratively with Autism Speaks (AS) on network activities including the Autism Learning Health Network project.

RESEARCH ACTIVITIES

ECHO (Extension for Community Healthcare Outcomes) Autism represents an innovative telemedicine-based platform that connects local PCPs with autism specialists across our network medical centers. During ECHO Autism clinics, specialists provide education in best-practice treatment protocols, case-based learning, and co-management. This 10-site study builds upon a pilot study that was conducted at the University of Missouri's Thompson Center for Autism in 2015.

147 primary care physicians were enrolled in the ECHO Autism study. Data collection for the study was completed in September 2018 with data analysis and manuscript preparation currently underway. You can learn more about ECHO Autism in the article "ECHO Autism: Using Technology and Mentorship to Bridge Gaps, Increase Access to Care, and Bring Best Practice Autism Care to Primary Care" (Sohl, Mazurek and Brown, Clin Pediatr (Phila). 2017 Jun;56(6):509-511).

With the success of ECHO Autism, the AIR-P supported a 12-week pilot study aimed at improving healthcare transitions for individuals with ASD. ECHO Autism: Transition to Adulthood connected 16 PCPs (6 Pediatricians, 9 Family Medicine Physicians, and 1 Internal Medicine Physician) with autism experts throughout the US. During the clinics, participants presented case studies and learned best-practices from our expert team on a variety of autism specific and healthcare transition topics. The research team also conducted focus groups with ten of the participants to learn how the program can better address the needs of future participants. The study has been published in Autism (Mazurek, Stobbe, Loftin et al, ECHO Autism Transition: enhancing healthcare for adolescents and young adults with autism spectrum disorder. Autism 2019:1362361319879616. doi: 10.1177/1362361319879616. [Epub ahead of print]

Probiotics have been widely proposed as a possible strategy for treating GI symptoms or even core ASD symptoms in children and adolescents with ASD. AIR-P recently completed a pilot study examining this treatment and found no serious adverse events (AEs), and more nonserious AEs occurred with placebo than with probiotic, including those attributable to treatment. Over the 19-week trial, each outcome improved from baseline and the quality of life measure PedsQL correlated significantly with abundance of Lactobacillus without discernable changes to microbiota composition/diversity. The study has been published and is available (Arnold, Luna, Williams et al, Probiotics for gastrointestinal symptoms and quality of life in autism: a placebo-controlled pilot trial. J Child Adolesc Psychopharmacol. 2019 Nov;29(9):659-669. doi: 10.1089/cap.2018.0156. Epub 2019 Aug 30.)

The AIR-P Dental Study, "Improving Participation in Dental Care and Oral Health Outcomes for Underserved Children with ASD," is a randomized controlled trial to compare the efficacy of the established AIR-P Dental Toolkit to a combined regimen involving the Dental Toolkit and a parent-mediated behavioral intervention. Study objectives include improving home dental hygiene, oral health, and compliance with dental procedures in underserved populations with ASD. The study has completed enrollment (N= 119) and A manuscript has been submitted for publication.

The AIR-P PETRA Study, "Physical Exercise To Reduce Anxiety" successfully completed its initial 1-year pilot phase and has now expanded into a 3-year multi-site study to examine the feasibility and efficacy of a physical exercise intervention to reduce anxiety in children from underserved families. The physical exercise program is designed to incorporate the new key guidelines for physical exercise in children from the Centers for Disease Control. It will wrap up enrollment in the next couple of months.

The one-year pilot study, "Ameliorate Childhood Obesity Risk from Newer Antipsychotics for individuals with Autism Spectrum Disorder (ACORN)" is adapting and testing an empirically-validated pediatric weight management program (Healthy Habits for Life; HH4L) for youth with ASD who gain weight on second-generation antipsychotics. This study will serve as a pilot mechanism to expand upon the findings in multiple ATN sites in a large-scale, randomized control trial while measuring cardiometabolic outcomes.

AUTISM LEARNING NETWORK

The AIR-P continues its transition into a Learning Health Network (LHN) in collaboration with Autism Speaks (AS) and the James M. Anderson Center for Health Systems Excellence (AC) at Cincinnati Children's Hospital Medical Center. LHNs use ongoing and transparent outcome measurement, shared learning across practices, and quality improvement methods, to standardize care processes across systems while customizing care to individual patient needs. They provide data for comparative effectiveness research that can lead to new interventions and rapid implementation of these in treatment of physical conditions. Most recently the network has finalized its registry and is making adjustments to its collection forms and data collection app, the Autism PRISM.

AIR-P DISSEMINATION EFFORTS

The AIR-P continues to provide opportunities for researchers from across the network to collaborate with each other as well as other CAAI sponsored programs such as LEND and Developmental-Behavioral Pediatrics Training Programs. Successful partnerships with these programs have increased AIR-P presence at various scientific meetings, including abstracts at INSAR and PAS, and papers submitted for publication. In May 2019, 11 posters were presented at INSAR and 2 posters were presented at PAS. The AIR-P has also assembled its third supplement to the Pediatrics, to be published in spring 2020. Publication of the supplement through this journal provides dissemination to over 70,000 pediatricians in the US and more internationally, reaching a broad audience of primary care providers serving children and adolescents on the autism spectrum.

The AIR-P continues to host a monthly webinar series titled "Advances in Autism Research & Care (AARC)" which is available to all AIR-P/ATN network members, CAAI-sponsored programs, the entire LEND and DBP Fellowship networks, various other autism and pediatric organizations, collaborators, primary care providers, and autism advocates. Webinars feature both care providers and investigators presenting to a diverse audience of parents, clinicians, researchers, and students. Investigators, including both seasoned and junior investigators at AIR-P, are invited to present their work on various stages of research and study development. Care focused themes cover hot topics in the field of autism and promote idea generation for future research. Surveys are sent to our network as well as parent partners asking for topic suggestions to ensure we are presenting relevant information that our audience can engage with. If you're interested in being added to the distribution list for information on these webinars, please email Lucy Fell, Research Coordinator, at lfell@mgh.harvard.edu. Archived webinars can be viewed by visiting the network's YouTube page: http://www.youtube.com/asatnairpnetwork.

For more information on the AIR-P, please visit our public website: http://www.airpnetwork.org.