The quality of care in public schools and other community settings for school-aged youths on the autism spectrum is variable and often not evidence-based. Training practitioners in these settings to deliver evidence-based practices (EBPs) may improve the quality of care. We developed a free internet-based training and clinical guidance system synthesizing multiple EBPs for youth on the autism spectrum addressing a range of mental health needs and autism-related behaviors, entitled Modular EBPs for Youth on the Autism Spectrum (MEYA; meya.ucla.edu). A multiple baseline study was conducted with seven practitioners recruited from mental health practice settings across the United States who were providing services to children on the autism spectrum (aged 6 to 17 years). Practitioners were randomly assigned to undergo baseline conditions of 2 to 8 weeks. Once online training in MEYA commenced, practitioners engaged in algorithm-guided self-instruction in EBPs for autism. Participants video-recorded sessions. Independent coders used the MEYA Fidelity Scale (MEYA-FS) to rate adherence and competence in EBPs for autism. Practitioners also completed measures pertaining to implementation outcomes and parents rated youth outcomes on personalized target behaviors. Five of seven practitioners increased their adherence to MEYA practices (i.e., MEYA-FS scores) following MEYA training. Findings for competence were similar, though somewhat less robust. Practitioners generally viewed MEYA as feasible, understandable, and acceptable. Most youth outcomes improved during MEYA. A randomized, controlled trial of MEYA would be helpful in characterizing its effectiveness for supporting practitioner EBP implementation and youth outcomes in school and community service settings.

Vaccine hesitancy is a major barrier to vaccination, hindering the success of vaccine efforts and thereby increasing public health risk to viral diseases, including COVID-19. Neurodivergent (ND) individuals, including individuals with an intellectual and/or developmental disability, have demonstrated a heightened risk of hospitalization and death due to COVID-19, highlighting the need for further research specifically on ND communities. We conducted a qualitative analysis using in-depth interviews with medical professionals, non-medical health professionals and communicators, and ND individuals or their caregivers. Using a thematic coding analysis methodology, trained coders identified major themes according to 24 distinct codes spanning across the categories of (1) barriers to vaccination; (2) facilitators to vaccination; and (3) suggestions for improving vaccine confidence. Qualitative findings identify misinformation, perception of vaccine risk, sensory sensitivities, and structural hardship as the most significant barriers to COVID-19 vaccination. We highlight the importance of accommodations to vaccination for the ND community alongside coordinated efforts by healthcare leaders to direct their communities to accurate sources of medical information. This work will inform the direction of future research on vaccine hesitancy, and the development of programs specific to the ND community’s access to vaccines.

Objective Cognitive-behavioral therapy (CBT) is an effective treatment for anxiety in youth with autism spectrum disorder (ASD). However, research has yet to examine what cognitive characteristics may influence treatment response. The current study investigated decision-making ability and social cognition as potential (a) predictors of differential treatment response to two versions of CBT and (b) moderators of the effect of treatment condition. Method The study included 148 children (mean age = 9.8 years) with interfering anxiety and a diagnosis of ASD who were enrolled in a randomized clinical trial comparing two versions of CBT for anxiety (standard and adapted for ASD). Participants completed pretreatment measures of decision-making ability (adapted Iowa Gambling Task) and social cognition (Strange Stories) and analyses tested whether task performance predicted treatment response across and between (moderation) treatment conditions. Results Our findings indicate that decision-making ability moderated treatment outcomes in youth with ASD and anxiety, with a better decision-making performance being associated with higher post-treatment anxiety scores for those who received standard, not adapted, CBT. Conclusions Children with ASD and anxiety who are more sensitive to reward contingencies and reinforcement may benefit more from adapted CBT approaches that work more explicitly with reward.

Few measures of autism-related symptoms have been established as both psychometrically robust and sensitive to the effects of treatment. In the present study, a personalized measure of autism-related symptoms using the Youth Top Problems (YTP) method (Weisz et al., 2011) was evaluated. Participants included 68 children with diagnoses of autism (ages 6-13 years), and their parents, who were randomized to cognitive behavioral therapy (CBT) or enhanced standard community treatment (ESCT) addressing autism-related symptoms. At pretreatment, parents described their child's top autism-related problems (YTPs) in their own words and rated the severity of these problems on a Likert-type scale. Parents also made daily severity ratings on the child's top three YTPs for 5 days prior to treatment and 5 days following treatment while videorecording their child's behavior at home on each of these days. Trained observers coded these videorecordings, focusing on the same YTPs that the parents rated. Parents also completed standardized checklists of autism-related symptoms and general mental health symptoms. There was evidence of convergent and discriminant validity as well as good test-retest reliability for the YTP measures. YTP severity scores converged with the standardized measure of autism-related symptoms. Parent-reported YTP scores predicted observers' YTP scores at the daily level, and both parent-reported and observers' YTP scores decreased from pre- to post treatment. Observers' ratings of the videorecordings exhibited sensitivity to treatment condition. These applications of the YTP method are promising and may complement standardized symptom checklists for clinical trials focusing on autism-related symptoms. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective Assessing treatment fidelity in effectiveness research is critical to interpreting study findings. This paper details the development and initial psychometric evaluation of the Modular Evidence-Based Practices for Youth with Autism Fidelity Scale (MEYA-FS) designed to support the assessment of cognitive-behavioral treatments for youth with autism in effectiveness research.Method Recorded treatment sessions (N = 338) were randomly selected from 77 youth (M age = 9.65 years, SD = 1.87; 50.67% White; 85.33% male) who received the Schema, Emotion, and Behavior-Focused Therapy for Children (SEBASTIEN) (n = 51) or Coping Cat (n = 24) program.Results The MEYA-FS Adherence items displayed acceptable interrater reliability, but more than half of the MEYA-FS Competence items did not. The magnitude and pattern of correlations supported the score validity of the MEYA-FS Adherence and Competence items and subscales. However, some corresponding Adherence and Competence items displayed significant overlap. Scores on each Adherence subscale distinguished between the SEBASTIEN and Coping Cat programs, providing support for discriminant validity. Finally, higher Adherence and Competence subscales predicted significant improvements in youth clinical outcomes (adjustment problems in the school setting, social-communication difficulties, restrictive/repetitive behaviors, and externalizing problems), providing initial evidence for predictive validity.Conclusions The psychometric properties of the MEYA-FS make it appropriate for supporting efforts to evaluate cognitive-behavioral interventions for youth with autism in effectiveness and implementation research.

OBJECTIVE:To date, no one-on-one psychotherapy protocol for elementary and middle school-aged children with autism spectrum disorder (ASD) has been found to be efficacious for treating autism-related symptoms such as failure to initiate social interactions. This study compared modular cognitive behavioral therapy (CBT) with enhanced standard community treatment (ESCT) in terms of impact on the severity of autism-related symptoms.METHOD:Children with ASD (N = 107; aged 6-13 years) were randomly assigned to a treatment condition (CBT or ESCT). Both treatments provided 32 therapy sessions. The CBT condition utilized a modular design, matching specific evidence-based treatment elements to each child's clinical needs (e.g., social-communication symptoms). The ESCT condition provided social skills training and cognitive behavioral training in a structured and linear group therapy format. The primary outcome measure was independent evaluator ratings of peer engagement during school recess using a structured and validated observation system. Parents also made session-by-session ratings on personalized autism-related symptom profiles throughout treatment.RESULTS:CBT outperformed ESCT on the primary outcome measure (p < .001; d = .50; 95% CI [.06, .93]) and the secondary outcome measure (p = .003; d = .87; 95% CI [.45, 1.27]).CONCLUSIONS:The modular one-on-one CBT program evaluated in this study may be beneficial for reducing the severity of autism-related symptoms in some children with ASD. Further research is needed to clarify the extent of the treatment effect and the feasibility of implementation for therapists in the community. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Autism spectrum disorder (ASD) is heterogeneous and likely entails distinct phenotypes with varying etiologies. Identifying these subgroups may contribute to hypotheses about differential treatment responses. The present study aimed to discern subgroups among children with ASD and anxiety in context of the five-factor model of personality (FFM) and evaluate treatment response differences to two cognitive-behavioral therapy treatments. The present study is a secondary data analysis of children with ASD and anxiety (N=202; ages 7-13; 20.8% female) in a cognitive behavioral therapy (CBT) randomized controlled trial (Wood et al., 2020). Subgroups were identified via latent profile analysis of parent-reported FFM data. Treatment groups included standard-of-practice CBT (CC), designed for children with anxiety, and adapted CBT (BIACA), designed for children with ASD and comorbid anxiety. Five subgroups with distinct profiles were extracted. Analysis of covariance revealed CBT response was contingent on subgroup membership. Two subgroups responded better to BIACA on the primary outcome measure and a third responded better to BIACA on a peer-social adaptation measure, while a fourth subgroup responded better to CC on a school-related adaptation measure. These findings suggest that the FFM may be useful in empirically identifying subgroups of children with ASD, which could inform intervention selection decisions for children with ASD and anxiety.

†Dr. Hudson and Emily Hotez are co-first authors.The COVID-19 pandemic shed light on and exacerbated health disparities experienced by Black, Indigenous, and People of Color (BIPOC) [1Wrigley-Field E Garcia S Leider JP Van Riper D. COVID-19 Mortality At The Neighborhood Level: Racial And Ethnic Inequalities Deepened In Minnesota In 2020: Study examines COVID-19 racial and ethnic inequalities in Minnesota communities.Health Aff (Millwood). 2021; 40: 1644-1653Crossref PubMed Scopus (0) Google Scholar, 2Norris K Gonzalez C. COVID-19, health disparities and the US election.EClinicalMedicine. 2020; 28100617Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 3Rusoja EA Thomas BA. The COVID-19 pandemic, Black mistrust, and a path forward.EClinicalMedicine. 2021; 35100868Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar], particularly BIPOC with multiple and intersectional marginalized identities (BIPOC/MIMI) [[4]Samra R Hankivsky O. Adopting an intersectionality framework to address power and equity in medicine.The Lancet. 2021; 397: 857-859Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar]. Indeed, disparate access to vaccination during the early rollout and persistent disparate access to quality health care are especially pronounced for BIPOC with intellectual and/or developmental disabilities, those who identify as lesbian, gay, bisexual, transgender, and/or queer, as well as myriad other marginalized groups [[5]Rodriguez-Seijas C Eaton NR Pachankis JE. Prevalence of psychiatric disorders at the intersection of race and sexual orientation: Results from the National Epidemiologic Survey of Alcohol and Related Conditions-III.J Consult Clin Psychol. 2019; 87: 321Crossref PubMed Scopus (42) Google Scholar]. During the pandemic, Hood Medicine Initiative (HMI)—a nonprofit public health collective comprised of experts in science, policy, technology, and marketing—was born out of the need to tackle health disparities for BIPOC/MIMI. In response to The Lancet's commitment to anti-racism, we highlight HMI as a scalable model for combating the heightened inequities for BIPOC/MIMI spurred by the pandemic. In June 2020, the racial inequities amplified by the pandemic converged with the murder of George Floyd and the expansion of the Black Lives Matter movement. Despite heightened public discourse on their increased risk of COVID-19 infection, hospitalization, and mortality [[1]Wrigley-Field E Garcia S Leider JP Van Riper D. COVID-19 Mortality At The Neighborhood Level: Racial And Ethnic Inequalities Deepened In Minnesota In 2020: Study examines COVID-19 racial and ethnic inequalities in Minnesota communities.Health Aff (Millwood). 2021; 40: 1644-1653Crossref PubMed Scopus (0) Google Scholar], public health officials were challenged to effectively communicate to BIPOC/MIMI. Indeed, traditional public health messaging has historically lacked the nuance required to reach a marginalized populace, attributable to both systematic medical malfeasance and a lack of data-driven communication approaches. It was therefore not surprising that tracking by the Kaiser Family Foundation and other researchers confirmed significant rates of vaccine hesitancy and inequitable vaccine access in BIPOC communities [1Wrigley-Field E Garcia S Leider JP Van Riper D. COVID-19 Mortality At The Neighborhood Level: Racial And Ethnic Inequalities Deepened In Minnesota In 2020: Study examines COVID-19 racial and ethnic inequalities in Minnesota communities.Health Aff (Millwood). 2021; 40: 1644-1653Crossref PubMed Scopus (0) Google Scholar, 2Norris K Gonzalez C. COVID-19, health disparities and the US election.EClinicalMedicine. 2020; 28100617Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar, 3Rusoja EA Thomas BA. The COVID-19 pandemic, Black mistrust, and a path forward.EClinicalMedicine. 2021; 35100868Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar]. Given the unmet needs of BIPOC/MIMI, HMI coalesced around a mission to develop innovative ways of using media and technology to improve communication of the benefits of vaccination. HMI began to create and disseminate live podcasts (https://tinyurl.com/Hood-Med-Chats-YouTube) featuring health professionals and community activists to target these groups directly. HMI quickly expanded its programming over the course of the pandemic to include infographics and compelling public health messaging. Currently, HMI develops culturally tailored public health messaging for BIPOC/MIMI. HMI forges authentic collaborations with grassroots stakeholders to influence public health behaviors and aid diverse communities in practical and actionable ways. These efforts are complemented by efforts to create, translate, and disseminate sustainable research-driven solutions for diverse BIPOC sub-segments. HMI seeks to integrate these efforts across health disciplines—including maternal and child health, preventive medicine, genetic counseling, and community education—to address widespread disparities in BIPOC/MIMI. To further disseminate this tailored approach, HMI developed the HMI Framework (Figure 1)—geared towards scientists, practitioners, and policymakers—that describes the process of developing culturally-tailored public health messages. The HMI Framework—adapted from the National Institute on Minority Health and Health Disparities (NIMHD) [[6]National Minority Health and Health Disparities Research Framework. NIMHD. Accessed October 12, 2021. https://www.nimhd.nih.gov/researchFrameworkGoogle Scholar] and grounded in social psychology, communication, and Human Centered Design—posits that creating effective public health messaging necessitates establishing a sustainable connection to BIPOC/MIMI, which requires addressing the underlying structural issues facing specific sub-segments. The HMI Framework guides the creation of public health messages for BIPOC/MIMI at the community and population levels, via the following sequential process:1)Identify the target population and sub-segments: The cornerstone of HMI's approach is a nuanced and strategic approach to reaching BIPOC/MIMI. This necessitates a messaging approach that conceptualizes marginalized communities as heterogeneous rather than monolithic.2)Identify barriers and challenges: HMI identifies barriers and challenges for the overall target population as well as the target sub-segment(s), prioritizing stakeholder and community outreach in order to accomplish this goal. This may include the deployment of a diverse range of participatory strategies—including stakeholder interviews, system mapping, and qualitative research—selected based on existing resources and project goals.3)Determine target outcomes: Taking into account the population and sub-segment needs, experiences, and challenges, HMI devises messaging approaches to achieve Public Health Emergency Preparedness (PHEP) outcomes to facilitate the effectiveness of messaging on behavioral change [[7]Revere D Nelson K Thiede H Duchin J Stergachis A Baseman J. Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review.BMC Public Health. 2011; 11: 337Crossref PubMed Scopus (22) Google Scholar]. HMI also deploys a range of strategies to maximize effectiveness across all steps.1)Community connection: HMI engages with trusted messengers and community organizers at each step. HMI also signals allyship to the target communities and provides a platform to collaborate on messaging. This ensures that approaches are aligned with communities’ needs and promote activism within communities.2)Data-driven approaches: HMI integrates data-driven and algorithmic approaches to complement community-oriented efforts. This includes the use of natural processing research protocols to analyze digital chatter, understand messages that are most resonant with population sub-segments, and iteratively revise the messaging strategy.3)Wide-scale dissemination strategies: HMI utilizes multiple virtual and technological platforms, including podcasts, blogging, targeted social media engagement, satellite radio programming, webinars, and video infographics (examples provided in Table 1). In these efforts, partnerships with media platforms and civic organizations have promoted viewership, engagement, and increased access to relevant audiences.Table 1HMI Infographics SamplesMessaging FocusDescriptionExampleHealth & Science LiteracyCommunicating information pertaining to the COVID-19 virus and vaccine, public health and safety, and government regulations and guidelines in an accessible and easy-to-understand manner.“COVID-19 Vaccines & Herd Immunity.” (Posted on 4/29/2021; https://www.instagram.com/p/COQe1W2Liki/?utm_source=ig_web_copy_link)Personal HealthEmphasizing conscious decisions to improve physical, mental, and spiritual self-care, including safe hygiene and health practices.“There are 3 holes in yo face. Cover ALL of them. This ain't it fam.” (Posted on 4/3/2021; https://www.instagram.com/p/CNOESHDrgXc/?utm_source=ig_web_copy_link)Common GroundCentering the issues of COVID-19 as shared challenges faced by all communities, as well as the importance of addressing possible inequities together.“Vaccine Diplomacy. A look at the pandemic crisis in India and the importance of ensuring global vaccine equity.” (Posted on 6/7/2021; https://youtu.be/VU9yFmCOAms)Self-AdvocacyPromoting individuals and communities to practice and fight for equitable and safe standards within their respective settings.“Making sure your school is doing the MOST.” (Posted on 7/27/2021; https://www.instagram.com/p/CR2SnnNqHFc/?utm_source=ig_web_copy_link)Community Care & AdvocacyPromoting the health and advocacy of underserved communities and highlighting the individual's potential role and impact they may have on their community, and vice-versa.“COVID is not the only plague of our era…hate is just as contagious as COVID. Stop spreading it!” (Posted on 4/11/2021; https://www.instagram.com/p/CNiWFV4LkYZ/?utm_source=ig_web_copy_link)Translated ContentTranslating English content into other languages to improve accessibility for non-English speaking communities.“La ivermectina no esta aprobada para COVID (Ivermectin is not approved for COVID).” (Posted on 9/4/2021; https://www.instagram.com/p/CTLXuA3oOqH/)Herd ImmunityEducating individuals on the science of herd immunity and the importance of vaccinations to protect oneself and others in the community, especially immunocompromised individuals and those without access to the vaccine yet.“If it were the zombie virus…you would eat your whole family! Stop giving the virus new hosts!” (Posted on 7/5/2021; https://www.instagram.com/p/CQ8_7M_KYXU/)Define IssuesDefining both the explicit and implicit social, political, and public health issues that contribute to inequities with regard to the COVID-19 pandemic and vaccination efforts.“Equitable care starts with CARE providers…you AREN'T a good doctor if you can't diagnose your own biases.” (Posted on 4/28/2021; https://www.instagram.com/p/COOHtCaqFM2/)Informed ChoicesEncouraging individuals to make scientifically informed and healthy decisions that are specific to themselves as well as their families and communities.“The CDC updated mask & social distancing guidelines…they say…if you're fully vaccinated…you can take your mask off indoors & outdoors. But do you really want to?” (Posted on 7/2/2021; https://www.instagram.com/p/CQ6Nb92qfZo/)Empathy & Social SupportOffering supportive resources (including emotional and mental comfort) in light of sociopolitical and public health challenges and disparities.“Pump Up Those Antibodies! COVID-19 vaccines are safe for pregnant & lactating mothers...” (Posted on 8/29/2021; https://www.instagram.com/p/CTLLqGgKCiY/)PHEP & ResponseBroadcasting of Public Health Emergency Preparedness communications and response to ensure individuals are adequately prepared throughout the pandemic.“CAUTION. There are still settings where you should mask regardless. There are still mutant variants…everywhere, which could cause these guidelines to change.” (Posted on 5/19/2021; https://www.instagram.com/p/CPEQsr6lFkF/)Identify Villain(s)Identifying the causes or antagonists that perpetuate dis/misinformation, inequities, and other barriers for BIPOC/MIMI.“We get it. You don't want to get vaccinated. Feels a lot like Tuskegee… Tuskegee is just one of America's many crimes against humanity involving unethical human experimentation & patient cruelty. It's hard to separate the instinctive apprehension these acts provoke in all of us from the reality of how science is conducted in the modern era. Contemporary medical bias, racism, and lingering apartheid have corrupted our trust in health professionals…” (Posted on 7/27/2021; https://www.instagram.com/p/CR1Vhuolckr/)Examples of segmented messaging relating to the PHEP and other health behavior outcomes. Posting dates refer to the organizational Instagram account (https://www.instagram.com/hood_medicine/). Open table in a new tab 4)Iterative message refinement: HMI messaging is continually refined via ongoing collaborations and dialogues with community members and leaders as well as epidemiological findings. Examples of segmented messaging relating to the PHEP and other health behavior outcomes. Posting dates refer to the organizational Instagram account (https://www.instagram.com/hood_medicine/). The pandemic was a stark reminder of the persistent structural disparities endured by BIPOC/MIMI. Targeted mal/dis/misinformation by various anti-vaccine organizations and other actors further accelerated inequities [[8]Covid's devastation of Black community used as “marketing” in new anti-vaccine film. Accessed August 27, 2021. https://www.nbcnews.com/news/nbcblk/covid-s-devastation-black-community-used-marketing-new-anti-vaxxer-n1260724Google Scholar]. Ultimately, both non-governmental and governmental organizations (e.g., the Rockefeller Foundation) stepped in to try to address these inequities and the Biden Administration formed a Health Equity Task Force—comprised of senior leadership in health equity [[9]Biden Picks Dr. Nunez-Smith to Lead Health Equity Task Force - The New York Times. Accessed August 27, 2021. https://www.nytimes.com/2021/01/08/health/coronavirus-marcella-nunez-smith.htmlGoogle Scholar,[10]New Vaccine Equity Cooperative Launches to Advance Covid-19 Vaccine Access and Readiness. The Rockefeller Foundation. Accessed August 27, 2021. https://www.rockefellerfoundation.org/news/new-vaccine-equity-cooperative-launches-to-advance-covid-19-vaccine-access-and-readiness/Google Scholar]—in August 2021 to address COVID-19 inequities. With this increased momentum, we must prioritize approaches that are both community-oriented and data-driven. Adapting and scaling the HMI model holds potential for combating health disparities for BIPOC/MIMI during and post-pandemic. The authors have no declarations to make.