Child and Adolescent Psychiatry, Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden.
Department of Special Education, Stockholm University, Stockholm, Sweden.
J Med Internet Res. 2024 Nov 28;26:e49305. doi: 10.2196/49305.
Psychoeducation is a recommended first-line intervention for transition-aged autistic youth, but it has not been previously evaluated in an internet-delivered format. SCOPE (Spectrum Computerized Psychoeducation) is an 8-week individual, internet-delivered, therapist-supported psychoeducative intervention.
This study aimed to investigate the effectiveness of SCOPE through a 3-armed randomized controlled trial. The intervention aims to increase participants' understanding of autism and, in doing so, increase their quality of life (QoL).
SCOPE was codeveloped with clinicians and autistic young adults. It contains 8 autism-related modules, each with (1) text describing the module topic, (2) four video vignettes with recurring characters who describe their lives and perspectives on the module topic, (3) a list of neurotypical characteristics related to the module's topic, and (4) self-reflection using 3 or 4 questions about the module topic, answered by multiple-choice bullets and voluntary open-ended written comments. Participants were randomized (2:1:1) to SCOPE, an active control (web-based self-study), or treatment as usual (TAU). The primary outcome was participants' autism knowledge, assessed using the Autism Spectrum Disorder Quiz, and secondary outcomes included acceptance of diagnosis, QoL, and symptoms of mental health problems. All outcomes were assessed at the baseline, postintervention, and 3-month follow-up time points, using mixed-effects models to assess change in outcome measures across time points.
Between 2014 and 2020, a total of 141 participants were randomized to 1 of the 3 treatment arms. The SCOPE participants had significantly greater autism knowledge gains at the posttreatment time point compared to TAU participants with a moderate effect size (d=0.47; P=.05); gains were maintained at the 3-month follow-up (d=0.46; P=.05). The self-study participants also had increased knowledge gains compared to TAU participants at the posttreatment time point with a moderate effect size (d=0.60; P=.03) but did not maintain these gains at the 3-month follow-up, and their autism knowledge scores returned to baseline (mean change score: -0.13, 95% CI -1.20 to 0.94; P=.81). In addition, SCOPE participants reported improved QoL at the postintervention (d=0.37, P=.02) and 3-month follow-up time points (d=0.60; P=.001), compared to the combined controls. The gained autism knowledge was not mirrored by changes in symptoms of anxiety or depression.
Effective internet-delivered interventions may facilitate first-line service access to individuals who are unable or unwilling to use traditional health care interventions or who live in geographically remote locations. Additionally, an intervention such as SCOPE could impart and sustain the knowledge gained through psychoeducation in transition-aged autistic youth. For future research, qualitative studies could further our understanding of the lived experiences of intervention participation and outcomes after internet-delivered psychoeducation.
ClinicalTrials.gov NCT03665363; https://clinicaltrials.gov/study/NCT03665363.
心理教育是为过渡年龄的自闭症青年推荐的一线干预措施，但以前没有在互联网交付的模式下进行评估。SCOPE（光谱计算机心理教育）是一种为期 8 周的个体化、互联网交付、治疗师支持的心理教育干预措施。
本研究旨在通过 3 臂随机对照试验来调查 SCOPE 的有效性。该干预旨在提高参与者对自闭症的理解，从而提高他们的生活质量（QoL）。
SCOPE 是与临床医生和自闭症青年共同开发的。它包含 8 个与自闭症相关的模块，每个模块都有（1）描述模块主题的文本，（2）四个带有重复角色的视频片段，他们描述自己的生活和对模块主题的看法，（3）与模块主题相关的一系列典型特征，以及（4）使用 3 或 4 个关于模块主题的问题进行自我反思，通过多项选择题和自愿的开放式书面评论回答。参与者被随机分为 2:1:1 到 SCOPE、主动对照组（基于网络的自学）或常规治疗（TAU）。主要结果是参与者的自闭症知识，使用自闭症谱系障碍测验进行评估，次要结果包括对诊断的接受程度、QoL 和心理健康问题症状。所有结果都在基线、干预后和 3 个月随访时间点进行评估，使用混合效应模型评估随时间变化的结果测量值。
在 2014 年至 2020 年期间，共有 141 名参与者被随机分配到 3 个治疗组之一。与 TAU 参与者相比，SCOPE 参与者在治疗后时间点的自闭症知识增益显著更大，具有中等效果大小（d=0.47；P=.05）；在 3 个月的随访中保持了这些增益（d=0.46；P=.05）。与 TAU 参与者相比，自学参与者在治疗后时间点的知识增益也有所增加，具有中等效果大小（d=0.60；P=.03），但在 3 个月的随访中没有保持这些增益，他们的自闭症知识得分恢复到基线（平均变化分数：-0.13，95%CI-1.20 至 0.94；P=.81）。此外，与对照组相比，SCOPE 参与者在干预后（d=0.37，P=.02）和 3 个月随访时间点（d=0.60；P=.001）报告了更好的 QoL。获得的自闭症知识并没有反映出焦虑或抑郁症状的变化。
有效的互联网交付干预措施可能会促进无法或不愿意使用传统医疗干预措施或居住在地理位置偏远地区的个人获得一线服务。此外，像 SCOPE 这样的干预措施可以传授和维持过渡年龄自闭症青年通过心理教育获得的知识。对于未来的研究，定性研究可以进一步了解干预参与的生活体验和互联网心理教育后的结果。
ClinicalTrials.gov NCT03665363；https://clinicaltrials.gov/study/NCT03665363。
