Self-Regulation as a Transdiagnostic Predictor of Treatment Response for Preschoolers with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder

The current work examined the feasibility and initial efficacy of the Summer Treatment Program for Pre-kindergarteners (STP-PreK) for 37 preschoolers with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). Parents and teachers reported on children’s behavior, social/adaptive skills, executive functioning (EF), and emotion regulation (ER). Children completed a standardized achievement and EF battery and an emotion knowledge task. Improvements were reported in parent rated hyperactivity, inattention, aggression, and social and adaptive skills. Children also improved performance across achievement, emotion knowledge, and EF, and were rated by parents as having better EF and ER. Findings highlight the initial efficacy of an established treatment in improving outcomes for preschoolers with ASD. An additional aim of the current work was to identify profiles of self-regulation across EF and ER and examine whether profiles are predictive of treatment response. Participants for the second study included 100 preschoolers (Mage = 4.73, 75% Male, 79% Hispanic) including 37 diagnosed with ASD+ADHD (whom participated in the Study 1), 32 with ADHD-only, and 31 typically developing children (TD). Parents and teachers reported on children’s EF, ER, and ASD and ADHD symptoms. Children were administered an EF battery and observed for ER during a frustration task. LPA analyses produced 4 profiles: (1) Low ER and EF Deficits, (2) High ER Deficits, (3) High EF Deficits, and (4) Moderate ER and EF Deficits. ASD and ADHD symptoms were predictive of lower probability of membership within the Low ER and EF Deficits Profile and higher probability of membership within the Moderate ER and EF Deficits Profile. However, only ASD symptoms were predictive of membership within the High EF Deficits Profile and only ADHD symptoms were predictive of membership within the High ER Deficits Profile. Even after accounting for diagnostic symptoms, self-regulation profile membership was predictive of treatment response across behavioral and academic domains, such that children in the High EF Deficits Profile experienced the largest gains. Results highlight the specificity of self- regulation deficits within and across diagnoses. Self-regulation profiles demonstrated clinical utility in predicting treatment response above traditional symptom based classifications, providing evidence for the use of more transdiagnostic approaches.