Project Summary/Abstract Children with Autism Spectrum Disorders (ASD) present with numerous deficits in organization, planning, prioritizing, memory, and materials management (OPM). Yet OPMs are critical to successful academic performance. There is a particular demand for these OPM skills as children transition to the middle school environment which is associated with numerous challenges including increased expectations for achievement and behavior, copious homework assignments, increased demands on organization and planning/time management, learning that moves from rote tasks to abstract conceptual learning, etc. Not surprisingly, given their OPM problems and social challenges, children with ASD evidence high levels of academic problems in middle school. In fact, during middle schools years, the academic performance of youth with ASD is on average 5 years below their typical peers. Yet there are no evidence-based interventions for middle school youth with ASD. Using an iterative and collaborative design process, we developed an intervention, Achieving Independence & Mastery in School (AIMS), for middle-school youth with ASD without intellectual disability (ID). AIMS has been tailored to address the unique learning styles of youth with ASD. Preliminary evidence suggests that AIMS improves OPM and that improvements in OPM are associated with improved academic functioning. As a next step, an adequately powered randomized clinical trial comparing AIMS to an active comparison control (ACC) is needed to confirm that AIMS engages OPM and that change in OPM is associated with improvement in academic functioning. Fully included middle school youth with ASD (n=224) will be randomized to AIMS or ACC. At baseline, post, and two critical school year follow-ups, we will comprehensively assess OPM and academic outcomes. The aims are to examine the efficacy of AIMS on 1) improving OPM and 2) academic functioning. We hypothesize that the AIMS group will have higher OPM scores and improved academic functioning compared to the ACC group at post-intervention (primary endpoint) and follow-up. The third aim is to assess whether changes in OPM mediate changes in academic functioning. We hypothesize that the relation between AIMS and academic functioning improvement is mediated by OPM changes. We will also explore maintenance of OPM gains, determine the optimal time to deliver AIMS, and identify moderators of treatment success. AIMS has the potential to impact a large number of youths with ASD since over 50% of the population are fully included in the general education classroom. The lifetime cost for an individual with ASD is estimated to be $1.4 million/patient with the largest costs for special education and parental productivity loss. Thus, NICHD ASD research priorities include developing novel treatments delivered during pivotal transitions (e.g., middle school) to improve outcomes.

PROJECT NARRATIVE Individuals with Autism Spectrum Disorders (ASD) have significant difficulties with organization, planning, prioritizing, memory, and materials management which negatively impacts their educational performance (e.g., academic achievement, grades, etc.). Given that the lifetime cost for an individual with ASD is estimated to be $1.4 million per patient, with the largest of these costs for special education and parental productivity loss, there is a clear need for interventions that target increasing academic skills that lead to more successful outcomes. Developing psychosocial skills-based treatments that target academic success for students with ASD and their parent as they manage the increased demands of middle school may improve immediate academic and educational outcomes as well as buffer long-term impairment.