WO2024205305A1 - Executive function training method and device for asd adults without intellectual disability - Google Patents

Abstract

The present invention relates to an executive function training method and device for ASD adults without intellectual disability, wherein the method and device enable ASD adults without intellectual disability to improve adaptive daily-life behavior through executive function training. The method, performed by the executive function training device which is for ASD adults without intellectual disability and includes at least one processor and at least one memory storing instructions executed by the at least one processor, comprises the steps of: introducing training content of an executive function training program composed of a plurality of sessions by using visual aids, the training content being introduced for each of the sessions; providing a questionnaire for measuring actual daily life execution function and/or adaptation behavior to trainees that have performed the training through the executive function training program, and receiving responses to the questionnaire; and performing an executive function training evaluation on the basis of the responses to the questionnaire.

Description

Executive function training method and device for ASD adults without intellectual disability

[Cross-reference to related application]

This application claims the benefit of Korean Patent Application No. 10-2023-0041252, filed March 29, 2023, and Korean Patent Application No. 10-2024-0032998, filed March 8, 2024, the entire contents of which are incorporated herein by reference.

The present invention relates to a method and device for training executive function for ASD adults without intellectual disabilities, and more particularly, to a method and device for training executive function for ASD adults without intellectual disabilities to improve adaptive behavior in daily life.

Executive function (EF), a high-level cognitive processing required to perform various daily activities throughout life, is closely related to adaptive behavior.

Individuals with autism spectrum disorder (ASD) without intellectual disability (ID) are known to have deficits in executive functioning (EF), which can lead to difficulties in adapting to daily life as adults.

Therefore, in order for adults with ASD to successfully transition to adulthood, it is important to enhance their ability to effectively utilize executive function (EF) to improve daily adaptive behavior.

ASD is a neurodevelopmental disorder characterized by deficits in social communication and interaction and repetitive and restricted behaviors, interests, or activities (American Psychiatric Association, 2013).

According to Baio et al. (2018), 69% of children with ASD are considered to not have ID. Adults with ASD without ID are thought to have better outcomes than those with ID because they have average cognitive abilities, but many studies have shown that they have lower employment rates, limited social relationships, and difficulties maintaining physical and psychological health and quality of life (Howlin and Magiati, 2017; Lord et al., 2020; Schmidt et al., 2015).

As a result, adults with ASD without intellectual disability (ID) rely heavily on their families for support, which may further delay successful transitions into adulthood (Clarke et al., 2020; Duncan et al., 2021; Snell-Rodd et al., 2020).

Difficulties in becoming independent adults are primarily related to deficits in executive functioning (EF) skills (Dipeolu et al., 2015; Shmulsky and Gobbo, 2013; Wisner-Carlson et al., 2020).

Executive function (EF), which develops during childhood and adolescence, is a higher-order cognitive processing process mainly responsible for the prefrontal cortex, and is an executive function responsible for a wide range of abilities such as cognitive function, behavior, emotional control, and social interaction (Miyake and Friedman, 2012; Leung et al., 2016).

“Everyday EF” is a term that describes the behavioral expression of executive function (EF) in the real world (Gardiner and Iarocci, 2018; Gioia et al., 2000).

Everyday EF, measured by self-report and caregiver report, is ecologically valid and is a more useful clinical indicator than neuropsychological assessments that may not fully reflect the EF-related difficulties experienced by individuals with ASD in everyday situations (Demetriou et al., 2018; Johnston et al., 2019).

Accurately measuring executive functions, including planning, following multi-step directions, managing time, and initiating tasks, is critically important, as deficits in executive functions may limit opportunities to learn and master daily living skills (Duncan et al., 2021).

Since real-life executive functions are necessary to detect and overcome obstacles in the process of problem solving, difficulties in these may further limit social adaptation (Dipeolu et al., 2015; Fast, 2004).

Additionally, inadequate real-world executive functioning can lead to difficulties in adaptive behavior in adolescence and adulthood (Kenny et al., 2019; Pugliese et al., 2015; Pugliese et al., 2016). For example, adults with ASD without intellectual disability (ID) may have difficulty with cognitive flexibility and planning skills when faced with unexpected changes, which may lead to heightened anxiety and further limit their ability to successfully perform tasks (Shmulsky and Gobbo, 2013; Wallace et al., 2016).

Additionally, deficits in real-life executive functioning may make it more challenging for adults with ASD to achieve long-term goals, such as employment, as they may have difficulty conceptualizing goals and following through on them step by step (Hume et al., 2009; Noens and van Berckelaer-Onnes, 2004).

People with ASD have a high rate of comorbid conditions that need to be considered to optimize quality of life (Mosner et al., 2019), of which Attention Deficit/Hyperactivity Disorder (ADHD) is a common comorbid condition in adults with autism (Antshel and Russo, 2019).

Although there are no intervention studies for adults with coexisting ASD and ADHD, attempts to improve executive functioning (EF) skills based on cognitive behavioral therapy in individuals with ADHD have been widely studied (Jensen et al., 2021; LaCount et al., 2018; Solanto et al., 2010; Solanto and Scheres, 2020).

Additionally, eating disorders occur at high rates among people with ASD (Kerr-Gaffney et al., 2020).

Because people with eating disorders also have difficulty with set shifting similar to people with ASD, cognitive remediation therapy, which trains cognitive flexibility, has been developed and has been shown to be effective in treating eating disorders (Tchanturia et al., 2014; Tchanturia et al., 2017).

However, most programs to improve executive functioning (EF) skills, which are vulnerable in ASD, are targeted at school-aged children (Bierman et al., 2008; Jacob and Parkinson, 2015), and only a few studies have validated programs for adults with ASD (Baker-Ericzen et al., 2018; Bonete et al., 2015; Nadig et al., 2018).

Two of these programs, SUCCESS (Supported Employment Comprehensive Cognitive Enhancement and Social Skills) and ACCESS (Acquiring Career, Coping, Executive Control, Social Skills), have shown improvement effects on adults with ASD, but there are several aspects to consider.

First, both programs focused on skill sets in the workplace environment. SUCCESS taught strategies applicable to job training and employment settings, while ACCESS focused on social skills and ways to strengthen group bonds with coworkers.

However, because the unemployment rate among ASD adults without intellectual disabilities is five times higher than that of the general population (Espeloer et al., 2022), it is important to address basic skills rather than specific skills required in specific settings, such as adapting to a new environment or managing personal finances, throughout the entire process leading to employment.

Second, because SUCCESS was implemented alongside an ongoing special support employment program without a control group, it is difficult to attribute the program's improvements solely to this program.

Therefore, rigorous research design is needed to verify the effectiveness of the program.

Third, ACCESS required parental involvement, but as ASD individuals transition from adolescence to adulthood, parents also age and the burden on caregivers increases. Requiring parental involvement may limit easy access to the program for ASD adults.

The present invention has been made to solve the above-mentioned conventional problems, and its purpose is to provide a method and device for executive function training for ASD adults without intellectual disabilities, which enables ASD adults without intellectual disabilities to improve their daily life adaptive behavior through executive function training.

In order to achieve the above-described object, the present invention provides a method for training executive function for ASD adults without intellectual disabilities, which is performed by an executive function training device for ASD adults without intellectual disabilities, which comprises: a step of introducing training content for each session using visual aids for an executive function training program consisting of a plurality of sessions; a step of providing a questionnaire for measuring real-life executive function and/or adaptive behavior to a trainee who has undergone training through the executive function training program, and receiving a response thereto; and a step of executing an executive function training evaluation based on the response to the questionnaire.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the method is characterized by further including a step of presenting a step-by-step STEPPING task, consisting of setting a goal, collecting necessary information, creating a to-do list, setting priorities, allocating time, and executing according to a plan, in the order of integrating the executive function skills covered in the present session and the executive function skills covered in the previous session, to the trainee who performed the training for each session, and receiving a response for each step from the trainee.

In addition, in a method for training executive function for ASD adults without intellectual disability according to the present invention, the method is characterized by further including a step of providing feedback data to a trainer who has performed training for each session, then presenting a CONNECTING task for expressing experiences, thoughts, and emotions according to the 5W1H rule to the trainer, and receiving a response from the trainer.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the method is characterized by further including a step of receiving, after introducing the training content for each session, a training performance result for the training performed by the trainer for each session through one or more set measurement items; and a step of generating and providing feedback data to be provided to the trainer based on the training performance result input for each session.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the method is characterized by further including a step of printing out leaflets necessary for training after introducing the training content for each session.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the executive function training program consisting of said multiple sessions is characterized by including understanding executive function training, understanding how to plan and organize goals, understanding how to manage time, understanding how to regulate emotions and manage stress, understanding the importance of cognitive flexibility, learning how to take care of oneself, learning how to adapt to a new environment, learning how to manage finances, learning how to explore a job, learning how to seek a job, learning how to prepare for an interview, and learning how to adapt to work life.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the session dealing with understanding the executive function training is characterized in that it is implemented to introduce what executive function is, what types of executive function are, and goals and individual-centered planning.

In addition, in the executive function training method for ASD adults without intellectual disabilities according to the present invention, the session dealing with understanding how to plan and organize the goals is characterized in that it is implemented to introduce how to set goals according to the SMART goal setting technique, how to make a plan to achieve the goals, and how to select and use a schedule management notebook.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the session dealing with understanding how to manage time is characterized in that it is implemented to introduce how to set priorities in a schedule management plan, how to create a weekly/daily plan, and how to improve motivation to carry out the plan.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the session dealing with understanding of how to regulate emotions and manage stress is characterized in that it is implemented to introduce how to recognize one's emotions, how to lower the unpleasantness index of emotions, and how to manage stress.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the session dealing with the understanding of the importance of cognitive flexibility is characterized in that it is implemented to introduce the reason why behavior should be changed according to changing situations, how to flexibly accept advice from others, and how to cope with changing situations.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the session dealing with learning how to take care of oneself is characterized in that it is implemented to introduce personal hygiene management methods, health management methods, housekeeping methods, and safety management methods.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the session dealing with learning how to adapt to a new environment is characterized in that it is implemented to introduce strategies for quickly adapting to a new environment, methods for organizing the surrounding environment to adapt to a changing environment, and methods for identifying environmental conditions that fit one's characteristics to easily adapt to the environment.

In addition, in the executive function training method for ASD adults without intellectual disabilities according to the present invention, the session dealing with learning how to manage finances is characterized in that it is implemented to introduce the necessity of managing income and expenditures, how to manage accounts, how to write a household account book, how to make a budget, strategies for rational purchases, and how to decide on leisure activities and make plans for them.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the session dealing with learning how to explore occupations is characterized in that it is implemented to introduce how to select an occupation and how to search for a job.

In addition, in the executive function training method for ASD adults without intellectual disabilities according to the present invention, the session dealing with learning how to conduct job search activities is characterized in that it is implemented to introduce understanding of job application documents including resumes and self-introductions, methods of writing and preparing job application documents, and advantages and disadvantages of disclosing disabilities during the job search process.

In addition, in the executive function training method for ASD adults without intellectual disability according to the present invention, the session dealing with learning how to prepare for an interview is characterized in that it is implemented to introduce how to prepare for an interview, interview posture and attitude, how to deal with interview anxiety, and how to reduce interview anxiety.

In addition, in the executive function training method for ASD adults without intellectual disabilities according to the present invention, the session dealing with learning how to adapt to work life is characterized by being implemented to introduce basic attitudes for work life, etiquette in work life, basic common sense to know in work life, and responsibilities as a worker.

In addition, for achieving the above-mentioned purpose, the executive function training device for ASD adults without intellectual disability according to the present invention comprises: one or more processors; and one or more memories storing commands executed by the one or more processors, wherein the one or more processors introduce training content for each session of an executive function training program consisting of a plurality of sessions using visual auxiliary materials, receive training performance results for training performed by a trainer for each session through one or more set measurement items, and generate and provide feedback data to be provided to the trainer based on the training performance results received for each session.

In addition, in the executive function training device for ASD adults without intellectual disability according to the present invention, the one or more processors are further characterized by presenting a step-by-step STEPPING task, consisting of setting a goal, collecting necessary information, creating a to-do list, setting priorities, allocating time, and executing according to a plan, in the order of integrating the executive function skills covered in the present session and the executive function skills covered in the previous session, to the trainee who performed the training for each session, and receiving a response for each step from the trainee.

In addition, in the executive function training device for ASD adults without intellectual disability according to the present invention, the one or more processors are characterized by further performing the following actions: providing the feedback data to a trainee who has performed training for each session, and then presenting a CONNECTING task to the trainee to express experiences, thoughts, and emotions according to the 5W1H rule, and receiving a response from the trainee.

In addition, in the executive function training device for ASD adults without intellectual disability according to the present invention, the one or more processors are further characterized by providing a questionnaire for measuring real-life executive function and/or adaptive behavior to a trainee who has performed training through the executive function training program, receiving a response thereto, and executing an executive function training evaluation based on the response to the questionnaire.

In addition, in the executive function training device for ASD adults without intellectual disabilities according to the present invention, the one or more processors are characterized by further performing the step of outputting handouts necessary for training after introducing training content for each session.

Specific details of other embodiments are included in the “Specific Details for Carrying Out the Invention” and the attached “Drawings.”

The advantages and/or features of the present invention and the methods for achieving them will become apparent with reference to the various embodiments described in detail below together with the accompanying drawings.

However, the present invention is not limited to the configuration of each embodiment disclosed below, but may be implemented in various different forms, and each embodiment disclosed in this specification is provided only to make the disclosure of the present invention complete, and to fully inform a person having ordinary skill in the art to which the present invention belongs of the scope of the present invention, and it should be understood that the present invention is defined only by the scope of each claim of the claims.

According to the present invention, ASD adults without intellectual disabilities can learn various strategies for utilizing executive function through executive function training, and can apply the learned skills to daily life, thereby increasing the independence of ASD adults.

In addition, executive function training can improve the ability to utilize real-life executive functions, thereby improving the performance of adaptive behavior and leading to a successful transition to adulthood.

FIG. 1 is a process diagram illustrating a method for training executive function for ASD adults without intellectual disabilities according to one embodiment of the present invention.

Figure 2 is a drawing exemplarily showing the executive functions covered in each session of the executive function training program applied to the present invention.

FIG. 3 is a schematic diagram showing the configuration of an executive function training device for ASD adults without intellectual disabilities according to one embodiment of the present invention.

Figure 4 is a schematic diagram showing the procedure of this experiment.

Figure 5 is a diagram showing the demographics of the participants who participated in this experiment.

Figure 6 is a diagram showing changes in executive function (EF) and adaptive behavior between groups.

Figure 7 is a diagram showing changes in executive function and adaptive behavior over time.

Figure 8 is a diagram showing the results of a post-analysis of executive function and adaptive behavior changes over time.

Before describing the present invention in detail, it should be understood that the terms or words used in this specification should not be interpreted as being unconditionally limited to their usual or dictionary meanings, and that the inventor of the present invention may appropriately define and use the concepts of various terms in order to describe his or her invention in the best possible manner, and further that these terms or words should be interpreted as meanings and concepts that are consistent with the technical idea of the present invention.

That is, the terms used in this specification are only used to describe preferred embodiments of the present invention, and are not intended to specifically limit the contents of the present invention. It should be understood that these terms are terms defined in consideration of various possibilities of the present invention.

Additionally, in this specification, it should be noted that a singular expression may include a plural expression unless the context clearly indicates a different meaning, and similarly, even if expressed in a plural manner, it may include a singular meaning.

Throughout this specification, whenever a component is described as "including" another component, this may mean that the component may further include any other component, rather than excluding any other component, unless otherwise specifically stated.

Furthermore, when it is described that a component is “existing within, or is installed in connection with” another component, it should be noted that the component may be installed in direct connection with or in contact with the other component, may be installed spaced apart from the other component by a certain distance, and if it is installed spaced apart from the other component by a certain distance, there may be a third component or means for fixing or connecting the component to the other component, and the description of this third component or means may be omitted.

On the other hand, when a component is described as being "directly connected" or "directly connected" to another component, it should be understood that no third component or means is present.

Likewise, other expressions that describe the relationship between each component, such as "between" and "directly between", or "adjacent to" and "directly adjacent to", should be interpreted as having the same meaning.

In addition, it should be noted that the terms “one side,” “the other side,” “one side,” “the other side,” “first,” “second,” etc. in this specification, if used, are used to clearly distinguish one component from other components, and that the meaning of the component is not limited by such terms.

In addition, terms related to position, such as “upper,” “lower,” “left,” and “right,” if used in this specification, should be understood to indicate relative positions of the corresponding components in the corresponding drawings, and unless absolute positions are specified for these positions, these position-related terms should not be understood to refer to absolute positions.

Furthermore, in the specification of the present invention, it should be noted that the terms “part”, “unit”, “module”, “device”, etc., if used, mean a unit capable of processing one or more functions or operations, which may be implemented by hardware or software, or a combination of hardware and software.

In addition, in specifying the drawing symbols for each component in each drawing in this specification, the same component is given the same drawing symbol even if the component is shown in a different drawing, that is, the same reference symbol indicates the same component throughout the specification.

In the drawings attached to this specification, the size, position, connection relationship, etc. of each component constituting the present invention may be described in an exaggerated, reduced, or omitted manner in order to sufficiently clearly convey the idea of the present invention or for convenience of explanation, and therefore the proportions or scales may not be strict.

In addition, in the following description of the present invention, a detailed description of a configuration that is judged to unnecessarily obscure the gist of the present invention, for example, a known technology including a prior art, may be omitted.

Hereinafter, with reference to the attached drawings, a method and device for training executive function for ASD adults without intellectual disabilities according to a preferred embodiment of the present invention will be described in detail.

FIG. 1 is a process diagram illustrating a method for training executive function for ASD adults without intellectual disabilities according to one embodiment of the present invention.

A method for training executive function for an ASD adult without intellectual disability according to one embodiment of the present invention can be performed by an executive function training device for an ASD adult without intellectual disability having at least one processor and at least one memory storing instructions executed by the at least one processor.

First, in step S10, for an executive function training program consisting of multiple sessions (e.g., 12 sessions), the training content for each session can be introduced using visual aids.

The above step S10 can be performed for each session, and from the second session onwards, before introducing the training content for each session, it can start by reviewing the training content covered in the previous session.

After introducing the training content for each session through the above step S10, the flyers required for the training for each session can be printed (S20).

The above step S20 is an optional step and can be performed only when there is a flyer to be used for training.

The trainee (user) who has been introduced to the training content of each session through the above-mentioned step S10 can perform the training according to the introduced training content. At this time, if there is a leaflet printed through the above-mentioned step S20, the trainee can perform the training using the leaflet.

Thereafter, in step S30, the training performance results for the training performed by the trainer for each session can be input through one or more set measurement items.

Specifically, in the above step S30, the training performance results can be input through multiple measurement items configured in terms of quantity, punctuality, and quality of delivery.

In the above step S30, each measurement item can be scored on a scale from 0 to 2, for example.

And in step S40, feedback data to be provided to the trainer can be generated based on the training performance results input for each session through the above step S30, and the generated feedback data can be provided to the trainer.

In the above step S40, it is also possible to decide whether to proceed to the next session or repeat the current session based on the training performance results input for each session through the above step S30.

Specifically, in step S40, if the training performance result is determined to be above a preset level, the training of the next session can be conducted, and if the training performance result is determined to be below the preset level, the training of this session can be repeated.

The above steps S30 and S40 can be performed optionally.

Afterwards, in step S50, in order for the trainees to systematically apply the training content, the pre-set task is presented step by step to the trainees who performed the training for each session, integrating the executive function skills covered in this session and the executive function skills covered in the previous session, and responses can be received from the trainees for each step.

Specifically, in the above step S50, the step-by-step STEPPING task consisting of setting goals, collecting necessary information, making a to-do list, setting priorities, allocating time, and executing according to the plan is presented in order by integrating the executive function skills covered in this session and the executive function skills covered in the previous session for each session, and responses can be input for each step from the trainer.

And in step S60, to help ASD adults without intellectual disabilities to systematize their language expressions, after providing feedback data to the trainer who performed the training for each session, the trainer is given a CONNECTING task to express experiences, thoughts, and feelings according to the 5W1H (Who, When, Where, What, Why, How) rule, and a response to it can be entered by the trainer.

In response to the task of connecting and talking in the above step S60, a response expressed in text form can be input from the trainer through a text input window, and a response expressed in voice form can be input through a microphone or the like.

In the embodiment of the present invention, the step-stepping task is first performed in step S50, and then the connecting and talking task is performed in step S60. However, the order may be changed.

By repeatedly performing the above steps S10 to S60 for all sessions constituting the executive function training program applied to the present invention, when the trainee completes all of the executive function training programs applied to the present invention, a questionnaire for measuring real-life executive function and/or adaptive behavior is provided in step S70, and a response thereto can be entered.

In the above step S70, real-life executive functions can be measured using a questionnaire developed to ecologically validly assess executive functions in adults with ADHD (e.g., Barkley Deficits in Executive Functioning Scale (BDEFS)).

As mentioned above, the BDEFS can be composed of multiple subscales measuring self-organization, time management, emotion regulation, self-motivation, and self-restraint.

Additionally, in the above step S70, the Cognitive Flexibility Inventory (CFI) can be used to measure other areas of executive function that adults with ASD have difficulty with.

As mentioned above, the CFI can be composed of an Alternatives subscale, which measures the ability to provide multiple alternative explanations for events and the ability to devise multiple solutions, and a Control subscale, which measures the tendency to perceive difficult situations as controllable.

In addition, in the above step S70, a questionnaire on knowledge related to executive function and its utilization based on the executive function covered in each session can be used to measure real-life executive function. At this time, the questionnaire used can be composed of a questionnaire that allows one to select one of two answers to a question (for example, including options such as "For efficient time management, (a) you should consider the set deadline and the estimated time required to complete the task, (b) you should consider priorities according to your preference") and a questionnaire that measures the degree of utilization of executive function in daily life by presenting a Likert scale for a question and allowing one to select (for example, including a question and a 5-level scale such as "I can create and follow a weekly schedule based on what I have to do. (1) Not at all, (2) No, (3) Average, (4) Yes, (5) Very much so").

Meanwhile, in the above step S70, adaptive behavior can be measured using the Vineland adaptive behavior scale.

As mentioned above, the Vineland Adaptive Behavior Scale can be divided into areas such as communication, daily living skills, and socialization to measure adaptive behavior.

Additionally, in the above step S70, adaptive behavior can be measured using the Community Adaptation Inventory (CISA-2).

As mentioned above, the community adaptation test evaluates the adaptive skills of people with developmental disabilities and can be divided into sub-domains such as daily living skills, social independence, and occupational life.

Thereafter, in step S80, an executive function training evaluation can be performed based on the responses to the questionnaire entered through step S70 described above.

Figure 2 is a drawing exemplarily showing the executive functions covered in each session of the executive function training program applied to the present invention.

As illustrated in FIG. 2, the executive function training program applied to the present invention can cover, through multiple sessions, the following: understanding executive function training, understanding how to plan and organize goals, understanding how to manage time, understanding how to regulate emotions and manage stress, understanding the importance of cognitive flexibility, learning how to take care of oneself, learning how to adapt to new environments, learning how to manage finances, learning how to explore careers, learning how to job search, learning how to prepare for interviews, learning how to adapt to work life, etc.

In an embodiment of the present invention, an executive function training program may be implemented as, for example, 12 sessions, with 5 sessions focusing on various skills related to executive function, and the remaining 7 sessions focusing on applying the learned executive function skills to everyday environments.

A session addressing understanding executive function training might include introducing executive function training programs and goals, explaining executive functions and their subdomains, and learning how to create goals.

A session addressing understanding executive function training might consist of understanding what executive function is, setting goals, and guiding tasks.

The Understanding What Executive Functions Are introduces the trainer to what executive functions are and the types of executive functions (for example, planning ability (the ability to set a goal, make a plan (steps) to achieve the goal, carry out the planned activities in order, monitor and reevaluate them, and update them), organizational ability (the ability to integrate and organize according to a specific purpose), time management ability (the ability to divide and manage the limited time given to us so that we can use it for daily activities or for learning and work), cognitive flexibility (the ability to change existing thoughts or actions to different thoughts or actions as the situation changes), emotion regulation (the ability to intentionally control and change emotional responses), etc.) and helps the trainer learn them.

The goal setting section introduces the setting of goals that individuals set to achieve at some point in the future, as well as long-term and short-term goals, and introduces and enables trainers to learn about person-centered planning, a goal setting method that can help them understand themselves and demonstrate how to develop their special talents and abilities.

The task guidance section can guide the trainee through tasks such as writing a personal-centered plan, imagining where he or she will be in 10 years based on the personal-centered plan and setting long-term goals and short-term goals to achieve in one year to achieve the long-term goals, discussing them with family and friends and evaluating the feasibility, and setting essential sub-steps to achieve the goals.

A session that addresses understanding how to plan and organize goals might cover learning how to concretize goal setting, learning how to make specific plans to achieve goals, and learning how to choose and use a schedule planner.

A session that addresses understanding how to plan and organize goals might consist of concretizing goal setting, making a plan to achieve the goal, choosing a schedule, using a schedule, creating habits, and guiding assignments.

The section on concretizing goal setting introduces and enables trainers to learn goal setting techniques based on the SMART goal setting technique.

The SMART goal setting technique is as follows:

S Specific: Goals must be specific.

M Measurable: The goal must be able to measure the degree to which it has been achieved (quantity, period, number of times, etc.).

A Attainable: The goal must be actually achievable.

R Relevant: The goal must be related to what I want.

T Time-bounded: Goals must be time-bound.

The section on making a plan to achieve a goal introduces and enables trainers to learn how to make a plan, including setting a major goal to be achieved, breaking the major goal into several sub-goals or sequential steps, breaking each sub-goal or step into detailed tasks, setting a completion date for each sub-goal or detailed task, and identifying the reasons why it is difficult to carry out a plan that has not been carried out.

The section on selecting a schedule management notebook introduces the types of notebooks (e.g., paper notebooks, electronic notebooks) and the pros and cons of each notebook so that the trainer can learn about them.

The section on using a schedule management notebook introduces the principles of using a schedule management notebook (e.g., use only one schedule management notebook; always carry the notebook with you and write down all appointments and to-dos in the notebook; always refer to the notebook every morning, lunch, and dinner; use the schedule management notebook efficiently, but do not spend too much time managing it or become obsessed with it, etc.) and helps the trainer learn them.

In the habit-building section, you can, for example, revise your plan for achieving your long-term goals and short-term goals for one year by imagining where you want to be in 10 years.

In the task guidance section, you can guide the trainee through tasks such as solving practice problems to modify goals based on the SMART technique mentioned above, starting to implement plans that can be implemented right away, identifying the reasons that make it difficult to implement plans that have not been implemented, choosing a schedule management notebook that suits you, and writing down your weekly schedule and to-do list.

A session that addresses understanding how to manage your time might cover things like learning how to prioritize based on importance, learning how to plan your week, and learning how to create a reward list to motivate yourself.

A session that addresses understanding how to manage your time might consist of setting priorities on a calendar, creating weekly/daily plans, increasing motivation to stick to plans, creating habits, and guiding you through tasks.

The section on setting priorities in the schedule management plan introduces and enables the trainer to learn how to make a list of things to do according to the goal, write down the expected time and deadline for each task, prioritize the tasks, mark the priorities on the schedule, mark whether the tasks have been carried out and record the actual time taken, and re-plan the tasks that have not been carried out.

The section on creating a weekly/daily planner introduces and allows trainers to learn tips for creating a weekly planner, including creating a weekly schedule, recording regularly repeated activities, scheduling high-priority activities from the to-do list into free time, scheduling break times as well, and marking what was and was not followed on the schedule after executing the plan.

The section on improving motivation to carry out plans introduces and enables the trainer to learn how to create a list of rewards (e.g., list things or activities that you like, rate the size and level of enjoyment of rewards, pair tasks with rewards based on their size and level of enjoyment, etc.) and things to be careful of when rewarding yourself (e.g., do not reward before achieving the plan, reward quickly after achieving the plan, do not give a reward that is too small or large compared to the plan, do not use the same reward too often, etc.).

In the Habit Building section, you can practice setting goals based on the SMART technique described above, and add or modify actionable plans in making plans to achieve the goals.

The task guidance section can guide trainees through tasks such as practicing time estimation, creating a to-do list, creating and evaluating weekly and daily schedules, and completing a reward list and rewarding themselves.

Sessions that address understanding how to regulate emotions and manage stress may include learning how to recognize your emotions, learning how to use self-soothing techniques, learning about flexible thinking, and learning how to use stress management strategies.

A session that addresses understanding how to regulate emotions and manage stress might consist of recognizing my emotions, lowering my emotional distress level, managing stress, creating habits, and guiding me through homework.

The section on recognizing my emotions introduces and teaches learners how to distinguish between anxiety and anger and how to recognize the intensity of their emotions using the emotional discomfort index.

The lowering of emotional discomfort index section introduces breathing techniques that help lower emotional discomfort index (e.g., deep breathing, abdominal breathing, etc.), imaginative methods that imagine situations that bring about the most comfortable or satisfying emotions in one's mind, and thinking differently, and helps learners learn these.

Here, Thinking Differently introduces and enables the trainer to learn about the distinction between thoughts and feelings, the link between thoughts-feelings-actions, changing thoughts, and the SODA technique for thinking differently.

The SODA technique is as follows:

Stop : Stop for a moment

Observe: Observe the situation carefully

Deliberate : Consider carefully

Action : Take action

Meanwhile, the Stress Management Strategy section introduces and teaches you how to recognize stress cues and create your own stress management strategies.

In the Habit Building section, you can do things like train yourself to estimate time, modify sub-steps or sub-plans when making plans to achieve your goals, and create a weekly plan by setting priorities and making a to-do list for the next week.

In the task guidance section, you can guide the trainee to tasks such as choosing to practice breathing or visualization techniques when there is a situation where the emotional discomfort index is high, practicing thinking differently about a situation where the emotional discomfort index is high, and completing your own stress management strategy.

A session addressing the importance of cognitive flexibility might cover learning to recognize your own behavioral patterns, learning to accept advice from others, and practicing regulating your behavior in response to unexpected situations.

Sessions addressing the importance of cognitive flexibility might include noticing the consequences of inappropriate behavior or fixed behavior patterns, being flexible in accepting advice from others, coping with changing situations, creating habits, and guiding tasks.

The section on recognizing the consequences of behaviors that are out of sync with changing situations or fixed behavior patterns introduces and teaches you why you need to change your behavior as situations change.

The section on being flexible in taking advice from others introduces and teaches you about the Donkey Rule below.

The donkey rules are as follows:

- The judgment of several people is more likely to be correct than the judgment of one person.

- When making a decision, you can make a better decision if you think of the people around you whom you trust the most and ask for their opinions.

- Someone I can trust

● A person who knows my characteristics well

● Someone who is interested in my problems and can give me advice.

● Someone I can trust

- Just because the thoughts of people around me are different from mine, it doesn't mean I'm wrong or incorrect.

- If the majority opinion points in a different direction than yours, following the majority opinion is likely to lead to better results.

Meanwhile, the section on coping with changing situations introduces and teaches you how to cope with changing situations.

Here are some steps to take to deal with changing circumstances:

Situation: Make it clear what the problem situation is.

Alternatives: Explore three or more alternatives to solve the problem situation.

Pros: Think about the pros/positive outcomes of each alternative.

Cons: Think about the cons/negative consequences of each alternative.

Solution: Choose and implement a solution that has greater benefits/positive outcomes and less drawbacks/negative outcomes.

In the habit creation section, you can do things like modifying sub-steps or sub-plans in making a plan to achieve your goal, making a weekly plan by setting regular lifestyle items and a to-do list and priorities for the next week, practicing thinking differently about situations where your emotional discomfort index is high, and using your own stress management strategy when you have the chance.

The task guidance section can guide the trainer through tasks such as identifying what the family thinks is their fixed behavioral pattern, practicing coping with changing situations, identifying situations that require decision-making, and asking for opinions from trusted people.

Sessions that address learning how to care for yourself might include practicing personal hygiene and health, taking care of household chores, and keeping yourself safe.

Sessions that address learning how to care for yourself may include personal hygiene, health care, household management, and safety management.

The personal hygiene section introduces and teaches you about bad breath management (e.g., how to maintain oral hygiene, how to maintain dental health, etc.), body odor management (e.g., washing hair, showering, etc.), and foot odor management.

The health management section introduces and allows you to learn about diet management, reducing the intake of unhealthy foods, checking nutritional information, eating healthy foods, weight management, writing a food diary for weight management, exercising for weight management, and disease management (e.g., washing hands to prevent diseases, how to prevent colds and flu, etc.).

The household management section introduces and teaches about cleaning, laundry and clothing care, and waste separation.

The safety management section introduces and teaches you how to deal with voice phishing, how to be careful with personal information in chats or games, etc.

The habit-building section might involve writing a to-do list and weekly plan for the next week, practicing thinking differently about situations that make you feel emotionally uncomfortable, and practicing coping with changing situations.

In the task guidance section, you can guide the trainer through tasks such as asking the family what they need most in terms of personal hygiene, health, and household management, choosing one of the most necessary management items, writing a step-by-step guide and implementing it accordingly, explaining the process of implementing it according to the step-by-step guide to the family, and writing down the family's feedback.

A session that addresses learning how to adapt to new environments might include practicing adapting to new settings (environments), practicing organizing your surroundings, and practicing identifying environmental conditions that meet your needs.

A session that deals with learning how to adapt to a new environment could consist of strategies for quickly adapting to a new environment, organizing the surroundings to adapt to a changing environment, identifying environmental conditions that fit my characteristics to easily adapt to the environment, creating habits, and guiding tasks.

The strategy section for quickly adapting to a new environment introduces and allows you to learn about getting used to a new space, getting used to a changed time (schedule), getting used to new people, and changing your behavior to fit the changed space and situation.

In the section on organizing your surroundings to adapt to a changing environment, we introduce and enable you to learn about classifying by necessity (FAT: File-Action-Trash), classifying by content (e.g., type, subject, color, size, date, etc.), using devices to divide space (e.g., color-coded bins, files with name tags, separate spaces in a bag, computer folders, etc.), organizing frequently used items or materials so that they are closest, and putting items or materials back where they are after use.

In the section on identifying environmental conditions that suit my characteristics to easily adapt to the environment, we introduce and enable learning about methods for identifying my characteristics (for example, writing about my unique (ASD) characteristics, thinking about the environments I prefer and those I find difficult in relation to these characteristics, evaluating the importance of how much influence each characteristic has on me, etc.), and methods for confirming environmental conditions that suit my characteristics (for example, organizing the elements or conditions of the environment that I prefer or want to avoid according to my characteristics, prioritizing the conditions by considering the importance of the conditions I want, etc.).

In the habit creation section, you can write a to-do list and weekly plan for the next week, practice thinking differently and coping with changing situations, choose one of the personal hygiene, health, and household management that you did not do last week, write down the steps to do it, take a picture of the process you did and send it as a text message, and get feedback from your family.

In the task guidance section, you can guide the trainee through tasks such as making and executing a plan to adapt to a new environment, organizing the surrounding environment, identifying environmental conditions that fit your characteristics, and bringing in a household account book if you are using one.

A session that covers learning how to manage your finances might include practicing taking care of your finances, practicing financial planning, practicing planning your purchases, and practicing financial planning for leisure activities.

A session that addresses learning how to manage finances might include the need to manage income and expenses, managing accounts, keeping a household ledger, creating a budget, strategies for making reasonable purchases, deciding on and planning leisure activities, creating habits, and guiding homework assignments.

The Necessity of Income and Expense Management section introduces and teaches you about the necessity of income and expense management and the importance of fixed income.

The Account Management section introduces and teaches you about accounts, types of passbooks, etc.

The section on writing a household account book introduces and teaches you about the advantages of writing a household account book, tips for writing a household account book, etc.

The budgeting section introduces and teaches you how to organize your monthly income, organize your monthly expenses, and create a monthly spending plan (budget).

The section on strategies for rational purchasing introduces and teaches you how to plan your purchases, find information about the items you want to buy, and strategies to avoid impulse buying.

The section on deciding on leisure activities and making plans for them introduces and teaches you about factors that go into deciding on leisure activities, making plans for these activities, etc.

The habit-building section might involve creating a to-do list and weekly planner for the coming week, practicing thinking differently and coping with changing situations, and organizing your environment.

The task guidance section can guide the trainee through tasks such as opening a bank account, creating a weekly expenditure list (household ledger) for budgeting, creating a monthly budget, completing a purchase plan, and choosing one leisure activity from among your own stress management strategies and implementing them.

A session that addresses learning how to explore careers might include practicing thinking about different career fields, thinking about careers that fit your needs, and finding careers that fit your criteria.

Sessions that address learning how to explore careers might include starting a career, learning how to do a job search, creating habits, and guiding you through homework.

The beginning section of career selection introduces and teaches you about self-awareness and understanding (e.g., interests, aptitude, etc.) and understanding of the career field that should be considered when choosing a career.

The section on how to find a job introduces and teaches you how to find a job yourself (e.g., using job information websites, understanding job postings, etc.) and how to find a job by seeking help from organizations that support employment for the disabled.

In the habit-building section, you can write down a to-do list and weekly plan for the next week, practice thinking differently and coping with changing situations, write down your spending for the week to create a budget, and choose one leisure activity from your personal stress management strategy and implement it by following the steps.

The task guidance section can guide the trainer through tasks such as completing a connection between my interests and careers, selecting a career field that matches my interests/aptitude/characteristics, and creating a list of jobs.

A session that covers learning how to job search might include practicing how to introduce yourself, practicing writing a resume and cover letter, and considering the pros and cons of disclosing your disability status.

Sessions that address learning how to job search might include understanding job application documents (resume, cover letter, etc.), the pros and cons of disclosing a disability when job searching, creating habits, and guidance on assignments.

The section on understanding job application documents (resume, self-introduction, etc.) introduces and allows you to learn about understanding resumes, what should be included in a resume, things to keep in mind when writing a resume, understanding self-introductions, how to write self-introductions, understanding other supporting documents, how to prepare other supporting documents, and how to submit documents.

The section on pros and cons of disclosing a disability during the job search process introduces and teaches you how to compare and contrast the pros and cons of disclosing a disability, as well as what to watch out for when disclosing a disability.

In the habit creation section, you can do things like create a to-do list and weekly plan for the next week, write a weekly spending list (household ledger) to budget, and create a list of jobs.

In the assignment guidance section, you can guide trainees with tasks such as writing a resume, completing a self-introduction, preparing a self-introduction for the next mock interview, attending the program wearing interview attire (suit or smart clothes) for the next mock interview, and preparing answers to expected interview questions in advance.

A session that covers learning how to prepare for an interview might cover things like practicing your attitude and answers for a job interview, practicing coping with interview anxiety, and participating in mock interviews.

A session that covers learning how to prepare for an interview could consist of topics such as preparing for an interview, interview posture and attitude, dealing with interview anxiety, how to reduce interview anxiety, creating habits, and guidance on assignments.

The section on preparing for an interview introduces and enables learning about understanding interviews, interview preparation procedures (e.g., things to prepare the day before the interview, things to check before leaving for the interview, behavior in the interview waiting room after arriving at the interview venue, behavior from the time your name is called until you enter the room, behavior when asking and answering questions, behavior at the end of the interview, etc.), and frequently asked questions during interviews.

The interview posture and attitude section introduces and teaches you about posture and attitude during an interview.

In the section on coping with interview anxiety, you can imagine an interview situation and measure how high your anxiety level goes on the discomfort index, and learn about ways to lower your anxiety level based on the level of anxiety.

The How to Lower Interview Anxiety section introduces and teaches you how to thoroughly prepare for an interview to lower your interview anxiety, how to think differently, how to breathe deeply, how to use visualization, and other methods to lower your interview anxiety.

In the Habit Building section, you can do things like create a to-do list and weekly plan for the next week, write down your spending for the week and summarize your spending for the next four weeks, and create a job list.

In the task guidance section, you can guide the trainee through tasks such as writing response comments to frequently asked questions in interviews, listening to feedback from mock interviews and practicing what is lacking in your interview response attitude, selecting what you think is lacking in your response attitude, practicing answering the items you selected as lacking with care, asking a family member to act as the interviewer to respond to the interview and receive feedback on the corresponding item, and preparing a self-reward for the graduation ceremony.

Sessions that address learning how to adapt to work life might cover learning ground rules and responsibilities in a work environment, learning professional etiquette, etc.

A session that deals with learning how to adapt to work life could consist of basic attitudes for work life, etiquette in work life, basic common sense to know in work life, and responsibilities as a working person.

The basic attitude for work life section introduces and allows you to learn about things like how to dress for work, what time you go to work, your work attitude, how to use break time, and how to prepare to leave work.

The etiquette section for workplace life introduces and allows you to learn about hygiene etiquette, greeting etiquette, conversation etiquette, respect for others, sexual etiquette, company dinner etiquette, investigation etiquette, and etiquette for maintaining boundaries with others.

The basic common sense items you need to know in work life introduce and enable you to learn about salary management, training you must receive from the company, types of situations where you quit a company, and what to do when you quit a company.

The section on responsibilities as a working person introduces and enables learning about responsibilities for work, responsibilities in relationships, and responsibilities when quitting a job. FIG. 3 is a diagram schematically showing the configuration of an executive function training device for ASD adults without intellectual disabilities according to one embodiment of the present invention.

As shown in FIG. 3, the executive function training device (100) for ASD adults without intellectual disabilities according to the present invention may include a display unit (110), a user input unit (120), and a control unit (130).

The display unit (110) can display information processed in the executive function training device (100) according to the present invention. For example, the display unit (110) can display the execution screen of the executive function training program, which is an application program run in the executive function training device (100) of the present invention.

The display unit (110) can be implemented as a touch screen that forms a mutual layer structure with the touch sensor or is formed as an integral part.

When the display unit (110) is implemented as a touch screen, it can function as a user input unit (120) that provides an input interface between the executive function training device (100) of the present invention and a user (trainer), and at the same time, it can provide an output interface between the executive function training device (100) of the present invention and a user.

The user input unit (120) can receive various types of information from the user and send it to the control unit (130).

The control unit (130) can control the operation of the execution function training device (100) according to the present invention in response to information input through the user input unit (120).

The control unit (130) may be implemented with one or more memories (133) and one or more processors (135).

The method for training executive functions for ASD adults without intellectual disabilities according to the present invention may be implemented as an application or in the form of program instructions that can be executed through various computer components (e.g., a processor) and stored in a memory (133) that is a computer-readable recording medium.

The processor (135) can introduce the training content for each session using visual aids for an executive function training program consisting of multiple sessions.

Additionally, the processor (135) can output flyers necessary for training after introducing the training content for each session.

In addition, the processor (135) can receive training performance results for training performed by the trainer for each session through one or more set measurement items, generate feedback data to be provided to the trainer based on the training performance results received for each session, and provide the generated feedback data to the trainer.

In addition, the processor (135) can present a step-by-step STEPPING task consisting of setting goals, collecting necessary information, creating a to-do list, setting priorities, allocating time, and executing according to a plan, in order, to the trainee who performed the training for each session, by integrating the executive function skills covered in this session and the executive function skills covered in the previous session, and can receive responses for each step from the trainee.

In addition, the processor (135) can provide feedback data to a trainee who has performed training for each session, then present a CONNECTING task to the trainee to express experiences, thoughts, and emotions according to the 5W1H rule, and receive a response from the trainee.

In addition, the processor (135) can provide a questionnaire for measuring real-life executive function and/or adaptive behavior to a trainee who has performed training through an executive function training program, receive a response thereto, and perform an executive function training evaluation based on the response to the questionnaire.

The method according to the embodiment described above and the operation by the device performing the same can be implemented at least partially as a computer program and stored in a computer-readable recording medium.

For example, it may be implemented with a program product comprising a computer-readable medium including program code, which may be executed by a processor to perform any or all of the steps, operations, or processes described.

The computer may be any computing device, such as a desktop computer, a laptop computer, a notebook, a smart phone, or the like, or may be integrated into any such device. The computer is a device having one or more alternative and special purpose processors, memory, storage, and networking components (either wireless or wired). The computer may run an operating system, such as, for example, a Windows compatible operating system from Microsoft, Apple OS X or iOS, a Linux distribution, or Google's Android OS.

The computer-readable recording medium includes all kinds of recording identification devices that store data that can be read by a computer. Examples of the computer-readable recording medium include ROM, RAM, CD-ROM, magnetic tape, floppy disk, optical data storage identification devices, etc. In addition, the computer-readable recording medium may be distributed over network-connected computer systems, so that computer-readable codes can be stored and executed in a distributed manner. In addition, functional programs, codes, and code segments for implementing the present embodiment may be easily understood by a person skilled in the art to which the present embodiment belongs.

[Experimental example]

This experiment was conducted to more fundamentally verify the effectiveness of an executive function training program to improve adaptive behavior through real-life executive functions in ASD adults without intellectual disabilities.

The research team conducted in-depth group interviews to explore the areas in which adults with ASD needed support, and developed a 10-session pilot program based on the results. The pilot study confirmed the applicability and acceptability of the executive function training program, and found significant improvements in time management, organization, inhibition, and emotion regulation.

Based on these results, feedback from participants, and advice from experts, the executive function training program was modified and supplemented, the final 12-session program was completed, and a randomized controlled trial (RCT) was conducted to more fundamentally verify the effectiveness of the improved executive function training program.

Experimental method

Subjects

Inclusion criteria for experimental subjects were as follows: (1) adults aged 18 years or older, (2) diagnosed with ASD using the diagnostic tools Autism Diagnostic Observation Schedule-2 (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R), and (3) obtained an FSIQ score of 70 or higher on the Wechsler Adult Intelligence Scale-4. Participants with clinically significant behavioral problems or those who were a risk to themselves or others were excluded.

A total of 30 people participated in the experiment, of which 26 completed the program.

Experimental Procedure

Experimental design

Selected participants completed questionnaires and assessments to measure real-life executive functioning and adaptive behaviors.

Participants were randomly assigned to experimental and waiting groups as shown in Figure 4, and each group was further divided into three subgroups of five individuals.

Outcome measurements were conducted at three time points (before, after, and after 12 weeks), and an interim assessment was conducted before the start of the 6th session, just after completing the full-scale executive function training and before starting to apply executive function to daily life, to examine whether changes were progressing in the ability to efficiently use executive functions only for the Korean version of the Barkley Deficits in Executive Functioning Scale (K-BDEFS).

Participants and caregivers used a Likert scale to rate the program and provide feedback based on their experiences, and the waiting list group followed the same procedure.

Perform executive function training

Participants randomly assigned to an experimental group and a waiting group will perform executive function training covered in each session according to the present invention, and after completing the executive function training program according to the present invention, real-life executive function and adaptive behavior will be measured using a questionnaire provided according to the present invention.

Data Analysis

Group characteristics between the experimental and control groups were compared using independent-samples t tests and chi-square tests.

For variables that did not meet the assumption of normality, the Mann-Whitney U test was used.

We controlled for ASD symptom severity measured by IQ and ADOS-2 scores, and applied linear mixed-effect modeling to compare pre- and post-training changes between the two selected groups.

Additionally, the effect size was calculated using Hedges's g to prevent overestimation due to relatively small sample sizes.

Additionally, linear mixed-effects models were used to explore changes over time in real-life executive function and adaptive behaviors for all participants (n=26) who completed the executive function training program.

Post hoc analysis applied Bonferroni correction.

Because there were dropouts in the waiting group (i.e., one participant dropped out before the start of the program and three others discontinued the program after sessions 2, 6, and 9, respectively), missing outcome variables were imputed based on the last observation carried forward method.

Attendance rates and program satisfaction were calculated for participants who completed all program sessions. Analyses were conducted using SPSS version 25.0 and SAS version 9.4.

result

Through Figure 5, it can be confirmed that there are no differences between the experimental group and the waiting group participants in terms of population characteristics and ASD symptom severity.

Changes in real-life performance and adaptive behavior across groups

Through Figure 6, it can be confirmed that there was a significant difference in the executive function utilization scale score (F=5.46, p=.027) between the experimental group and the waiting group (Hedges' g=.906), showing a large effect size.

However, there was no group × time interaction effect for other executive function and adaptive behavior measures, and there were no significant differences in parent-report questionnaires.

Changes in executive function and adaptive behavior over time

Through Figures 7 and 8, it can be confirmed that the results of the linear mixed effects model analysis show significant temporal differences in the total and sub-domain scores of K-BDEFS, CFI, and K-Vineland-Ⅱ.

Data submitted from self- and parent-report scales also showed changes in real-life executive functioning and adaptive behavior from pre- to post-assessment.

Acceptance and satisfaction with executive function training program

The attendance rates of the experimental and waiting groups were 96.11% and 99.33%, respectively, and the satisfaction scores for both groups were 4.5 out of 5.

Participants who completed the executive function training program gave positive evaluations of the session content, with 16 of the 26 participants rating it as “very helpful” and 8 rating it as “helpful.” Parent-reported satisfaction scores were 4.13 for the experimental group and 4 for the waiting group. In addition, 21 participants and 25 guardians said they would recommend the program to others.

argument

This experiment was conducted to develop and verify the effectiveness of an executive function training program to improve adaptive behavior by enhancing real-life executive functions.

The executive function training program was modified based on the pilot study results and feedback.

A randomized controlled trial involving 30 autistic adults without intellectual disabilities verified the effectiveness of an executive function training program, showing a significant difference in executive function utilization scale scores between the experimental and waiting groups, with a large effect size.

We hypothesized that repetition of the STEPPING and CONNECTING skills, which integrate a variety of skills relevant to executive function in communication and everyday social situations, and the addition of visual aids and handouts to assist in the application of executive function would be associated with positive outcomes.

In other youth and adult ASD programs that involve the participation of parents or social coaches to drive change, participants have shown greater improvement when they receive guidance and support from their parents during the treatment process, but caregiver involvement may hinder the ease of program participation for ASD adults without intellectual disabilities. Participants in this trial completed the program independently, and the results of increased use of executive function support the increased independence of ASD adults without intellectual disabilities. This is consistent with the program's goals of strengthening individuals' independence as they transition to adulthood and emphasizing the extent to which they utilize the skill sets taught in the sessions.

Significant changes in real-life executive function, executive function knowledge, executive function utilization, and adaptive behavior scores, as confirmed by linear mixed-effects model analysis, were achieved in a shorter period of time compared to ACCESS and SUCCESS. The ACCESS program takes 19 weeks to improve self-determination skills, stress coping, and self-efficacy, while SUCCESS consists of 13 sessions to improve executive and memory skills and 12 sessions to improve social cognition and communication skills. Because there was no comparison group to assess the change in executive function over time, these results should be interpreted cautiously, but the changes confirmed in this experiment are noteworthy because executive function has been shown to be relatively stable in previous studies.

After completing the executive function training program, participants and their caregivers reported progressive changes in real-life executive functions and adaptive behaviors, supporting the idea that executive function training is effective in promoting positive change.

These results suggest that changes in real-life executive functions and adaptive behaviors occur over a long period of time, and that participants maintained and applied the acquired skills in their daily lives after completing the executive function training program.

Overall, executive function training had high attendance and satisfaction rates among participants and caregivers, and parent comments reflected a high desire for this opportunity given the limited availability of interventions for ASD adults without intellectual disabilities in the country (“I am glad that there is an opportunity to participate in a program like this for adults with limited resources”; “It was great to be able to participate in a program that had the content my child needed”).

Despite positive ratings from participants and caregivers, no time × group interaction effects emerged for variables related to real-life executive functioning and adaptive behavior.

This suggests that a 12-week training program may not be sufficient to bring about changes in real-life executive function and adaptive behavior compared to the waiting group.

The ACCESS program consists of three modules: stress and anxiety coping skills, self-determination skills, and adaptation and social skills, and is conducted over a period of 19 sessions.

The executive function training program of the present invention devoted only two sessions to topics such as hygiene, self-care, and finances, whereas the STRW program, which was developed to improve daily living skills in individuals with ASD, devoted 14 sessions to cover similar topics.

Additionally, although statistically insignificant, participants reported increased difficulty regulating their emotions at follow-up assessments, suggesting that the initial positive changes from the program were not maintained over time.

These results suggest that changes in complex domains such as emotion regulation cannot be achieved in a single session, and that more intensive interventions focusing on emotion regulation may be more effective.

Therefore, while it is good for executive function training programs to cover a variety of topics, it is necessary to focus on specific areas with more emphasis on applying skills in real-world situations. For example, there are few specialized training programs for job preparation for ASD youth without intellectual disabilities as they transition to adulthood, so programs should be modified to include content related to job exploration, exploring various job fields, and adapting to the workplace environment.

Additionally, it may be helpful to focus on topics that are closely related to areas of executive functioning that are vulnerable in ASD, such as cognitive flexibility.

On the CFI scale, a small effect size was found for the Control subscale, which measures the tendency to perceive difficult situations as controllable, suggesting that participants needed more support and practice in this area.

To address this, it is necessary to provide examples of problem-solving situations, repeatedly practice finding alternatives, and help them practice gaining confidence in controlling various situations.

Therefore, to maximize effectiveness by modifying the program content, it may be better to spend more time practicing specific areas repeatedly rather than complex areas that require long-term concentration.

Although this trial is the first intervention study aimed at improving executive function in ASD adults without intellectual disability, it has several limitations. First, some participants withdrew due to concerns about COVID-19, which prevented sufficient statistical significance. Second, most of the participants were college students and were interested in employment-related sessions, which may have made others less sympathetic to the topic. Future studies should explore the influence of demographic factors such as age or current education level on the effectiveness of the program, especially by utilizing a large sample size. Third, although we assessed executive function skills using standardized assessment tools and newly developed tools in Korea, these tools have not yet been validated for adults with ASD. In addition, all assessments were based on self-report questionnaires by participants or their caregivers, so more objective methods such as direct observation or real-time monitoring are needed to measure executive function. Fourth, our participants were not blinded to the treatment because it was an RCT design using a waitlist control group. Future studies should consider applying a crossover RCT design to reduce participant and assessor bias while ensuring that everyone receives the intervention.

conclusion

This study is significant as the first evidence-based intervention program in Korea to improve adaptive behavior by improving the skills of utilizing real-life executive functions in ASD adults without intellectual disabilities. The results of the study show that positive changes are possible in ASD adults even when they participate in the program alone without the direct participation of caregivers.

Above, although some examples have been given and various preferred embodiments of the present invention have been described, the description of various embodiments described in the “Specific Details for Carrying Out the Invention” section is merely exemplary, and those skilled in the art to which the present invention pertains will readily understand that various modifications of the present invention can be implemented or equivalent implementations of the present invention can be implemented based on the above description.

In addition, since the present invention can be implemented in various other forms, the present invention is not limited by the above description, and the above description is provided only to make the disclosure of the present invention complete and to fully inform a person having ordinary skill in the art to which the present invention belongs of the scope of the present invention, and it should be understood that the present invention is defined only by each claim of the claims.

[Explanation of symbols]

100. Executive function training device,

110. Display section,

120. User input section,

130. Control unit,

133. Memory,

135. Processor

Claims (23)

one or more processors; and A method performed by an executive function training device for an ASD adult without intellectual disability having one or more memories storing instructions executed by said one or more processors, A step of introducing the training content of each session using visual aids for an executive function training program consisting of multiple sessions; A step of providing a questionnaire for measuring real-life executive function and/or adaptive behavior to a trainee who has completed training through the above executive function training program and receiving a response thereto; and A method for training executive function for ASD adults without intellectual disability, characterized by comprising the step of conducting an executive function training evaluation based on responses to the above questionnaire. In the first paragraph, The above method, A method for training executive functions for ASD adults without intellectual disability, characterized by further including a step of presenting a STEPPING task, consisting of setting goals, collecting necessary information, making a to-do list, setting priorities, allocating time, and executing according to the plan, in order, to a trainee who has performed training for each session by integrating the executive function skills covered in this session and the executive function skills covered in the previous session, and receiving responses for each step from the trainee. In the first paragraph, The above method, A method for training executive functions for ASD adults without intellectual disability, characterized by further including the step of providing the above feedback data to a trainee who has performed training for each session, presenting a CONNECTING task to the trainee to express experiences, thoughts, and emotions according to the 5W1H rule, and receiving a response from the trainee. In the first paragraph, The above method comprises the steps of: introducing training content for each session; and then receiving training performance results for the training performed by the trainer for each session through one or more set measurement items; and A method for training executive function for ASD adults without intellectual disability, characterized in that it further includes a step of generating and providing feedback data to be provided to the trainer based on the training performance results input for each session. In the first paragraph, The above method, A method for training executive function for ASD adults without intellectual disability, characterized in that it further includes a step of printing out handouts required for training after introducing the training content for each session. In the first paragraph, The executive function training program consisting of the above multiple sessions is: A method of executive function training for adults with ASD without intellectual disability, characterized by including understanding executive function training, understanding how to plan and organize goals, understanding how to manage time, understanding how to regulate emotions and manage stress, understanding the importance of cognitive flexibility, learning how to take care of oneself, learning how to adapt to new environments, learning how to manage finances, learning how to explore careers, learning how to job search, learning how to prepare for interviews, and learning how to adapt to work life. In Article 6, The session that covers understanding the above executive function training is: A method of training executive functions for adults with ASD without intellectual disability, characterized by being implemented to introduce what executive functions are, what types of executive functions there are, and goal and individual-centered planning. In Article 6, Sessions that cover understanding how to plan and structure the above goals, A method for training executive functions for ASD adults without intellectual disabilities, characterized in that it is implemented to introduce how to set goals according to the SMART goal setting technique, how to make a plan to achieve the goal, and how to select and use a schedule management notebook. In Article 6, The session that covers understanding how to manage the above time is, A method of executive function training for adults with ASD without intellectual disability, characterized by being implemented to introduce how to set priorities in a schedule management planner, how to create a weekly/daily planner, and how to improve motivation to carry out the plan. In Article 6, Sessions that address understanding how to regulate emotions and manage stress include: A method of executive function training for ASD adults without intellectual disability, characterized by being implemented to introduce how to recognize one's own emotions, how to lower the unpleasantness index of emotions, and how to manage stress. In Article 6, The session that addresses the importance of understanding the above cognitive flexibility is: An executive function training method for adults with ASD without intellectual disability, characterized by introducing reasons for changing behavior to suit changing situations, how to flexibly accept advice from others, and how to cope with changing situations. In Article 6, The session that deals with learning how to take care of yourself is: A method of executive function training for adults with ASD without intellectual disability, characterized in that it is implemented to introduce personal hygiene management methods, health management methods, household management methods, and safety management methods. In Article 6, The session that deals with learning how to adapt to the new environment is: An executive function training method for ASD adults without intellectual disability, characterized by introducing strategies for quickly adapting to a new environment, methods for organizing the surrounding environment to adapt to a changing environment, and methods for identifying environmental conditions that fit one's characteristics to easily adapt to the environment. In Article 6, The session that covers learning how to manage the above finances is: A method of executive function training for adults with ASD without intellectual disability, characterized by being implemented to introduce the need for income and expenditure management, how to manage accounts, how to write a household account book, how to make a budget, strategies for reasonable purchases, and how to decide on and plan leisure activities. In Article 6, The session that covers learning how to explore the above careers is: A method of executive function training for adults with ASD without intellectual disability, characterized in that it is implemented to introduce how to choose a career and how to search for a job. In Article 6, The session that covers learning how to do the above job search activities is, An executive function training method for adults with ASD without intellectual disability, characterized by implementing an understanding of job application documents including resumes and self-introductions, how to write and prepare job application documents, and an introduction to the pros and cons of disability disclosure during the job search process. In Article 6, The session that covers learning how to prepare for the above interview is, A method of executive function training for adults with ASD without intellectual disability, characterized by being implemented to introduce how to prepare for an interview, interview posture and attitude, how to deal with interview anxiety, and how to reduce interview anxiety. In Article 6, The session that deals with learning how to adapt to the aforementioned work life is, A method of executive function training for ASD adults without intellectual disability, characterized by introducing basic attitudes for work life, etiquette in work life, basic common sense to know in work life, and responsibilities as a worker. one or more processors; and An executive function training device for adults with ASD without intellectual disability, comprising one or more memories storing instructions executed by the one or more processors, One or more of the above processors, For the executive function training program consisting of multiple sessions, the training content for each session is introduced using visual aids. For each session, the results of the training performed by the trainer are input through one or more set measurement items. An executive function training device for ASD adults without intellectual disability, characterized in that it generates and provides feedback data to be provided to the trainer based on the training performance results input for each session. In Article 19, One or more of the above processors, An executive function training device for ASD adults without intellectual disability, characterized in that it presents a step-by-step STEPPING task consisting of setting goals, gathering necessary information, making a to-do list, setting priorities, allocating time, and executing according to the plan, in the order of integrating the executive function skills covered in this session and the executive function skills covered in the previous session, to the trainee who performed the training for each session, and further performs receiving responses for each step from the trainee. In Article 19, One or more of the above processors, An executive function training device for ASD adults without intellectual disability, characterized in that after providing the above feedback data to a trainee who has performed training for each session, the device presents a CONNECTING task to the trainee to express experiences, thoughts, and emotions according to the 5W1H rule, and further performs the task of receiving a response from the trainee. In Article 19, One or more of the above processors, An executive function training device for ASD adults without intellectual disability, characterized in that it further provides a questionnaire for measuring real-life executive function and/or adaptive behavior to a trainee who has completed training through the above executive function training program, receives responses thereto, and performs an executive function training evaluation based on the responses to the questionnaire. In Article 19, An executive function training device for ASD adults without intellectual disability, characterized in that the one or more processors further perform the task of outputting handouts required for training after introducing training content for each session.

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