Molehill Mountain feasibility study: Protocol for a non-randomised pilot trial of a novel app-based anxiety intervention for autistic people.

Up to 50% of autistic people experience co-occurring anxiety, which significantly impacts their quality of life. Consequently, developing new interventions (and/ or adapting existing ones) that improve anxiety has been indicated as a priority for clinical research and practice by the autistic community. Despite this, there are very few effective, evidence-based therapies available to autistic people that target anxiety; and those that are available (e.g., autism adapted Cognitive Behavioural Therapy; CBT) can be challenging to access. Thus, the current study will provide an early-stage proof of concept for the feasibility and acceptability of a novel app-based therapeutic approach that has been developed with, and adapted for, autistic people to support them in managing anxiety using UK National Institute for Health and Care Excellence (NICE) recommended adapted CBT approaches. This paper describes the design and methodology of an ethically approved (22/LO/0291) ongoing non-randomised pilot trial that aims to enrol approximately 100 participants aged ≥16-years with an existing autism diagnosis and mild-to-severe self-reported anxiety symptoms (trial registration NCT05302167). Participants will be invited to engage with a self-guided app-based intervention-'Molehill Mountain'. Primary (Generalised Anxiety Disorder Assessment, Hospital Anxiety and Depression Scale) and secondary outcomes (medication/ service use and Goal Attainment Scaling) will be assessed at baseline (Week 2 +/- 2), endpoint (Week 15 +/- 2) and three follow-ups (Weeks 24, 32 and 41 +/- 4). Participants will also be invited to complete an app acceptability survey/ interview at the study endpoint. Analyses will address: 1) app acceptability/ useability and feasibility (via survey/ interview and app usage data); and 2) target population, performance of outcome measures and ideal timing/ duration of intervention (via primary/ secondary outcome measures and survey/ interview)-with both objectives further informed by a dedicated stakeholder advisory group. The evidence from this study will inform the future optimisation and implementation of Molehill Mountain in a randomised-controlled trial, to provide a novel tool that can be accessed easily by autistic adults and may improve mental health outcomes.

Age-related changes in the interference between cognitive task components and concurrent sensorimotor coordination.

Continuous sensorimotor coordinations (CSCs) such as driving, walking, using control interfaces or maintaining the body's balance are often performed alongside concurrent cognitive tasks involving attention and executive function. A range of these task combinations show interference, particularly in older adults, but the timing, direction and reciprocity of interference is not yet understood at the level of the tasks' information-processing operations. This paper compares the chronometry of dual task interference between a visual oddball task and a continuous visuomanual tracking task performed by young and older adults. The oddball task's constituent operations were identified using electrophysiological correlates, and deviations in the tracking task reflected perturbations to state monitoring and adjustment characteristics of CSC tasks. Despite instructions to give equal priority to both tasks, older participants maintained a high level of resourcing of the oddball task when dual tasking whereas young participants reduced resourcing to accommodate the demands of the tracking task. Older participants had a longer period of tracking inaccuracy during the executive function component of the oddball task, and unlike in young participants, this decrement was also observed when the stimulus was not a target and the executive function of updating the target tally was not required. These detailed chronometric results clarify that age-related amplification of CSC-cognitive interference are largely due to greater inflexibility in task prioritization. Prioritization of the cognitive task over the CSC in this type of dual tasking may have safety implications in everyday task settings.

Feasibility and acceptability of an intervention for enhancing reintegration in adults with experience of homelessness.

BACKGROUND: Service centres for homeless adults are potential settings for implementation of reintegration interventions. This study aimed to evaluate (i) the acceptability of a group-based programme among individuals from the broad population of homeless people and (ii) if a future study of its feasibility and acceptability for re-housed homeless people is warranted. METHODS: Recruiting participants and intervention facilitators from partnering service centres was thought to improve recruitment and retention, cost-effectiveness and social interactions compared to professional-led interventions. Seven adults with experience of homelessness (three females, four males, mean age 39 years, range 18-63) were recruited to participate in the intervention. The research protocol comprised completion pre/post of scales [Recovering Quality of Life questionnaire; Working Alliance Inventory-short form revised (WAI-SR)] and focus groups, and WAI-SR and focus groups after sessions 3 and 6. RESULTS: The intervention and research protocols were feasible, with all participants engaging in all sessions, completing all scales and attending all focus groups. The quantitative data demonstrated the feasibility of obtaining practically useful measures of relevant outcomes. In the four focus groups, the intervention received very favourable feedback. CONCLUSIONS: This study demonstrated initial feasibility and acceptability of an intervention that places minimal burden on infrastructure and promotes user autonomy. This is an important advance as there is increasing recognition that the challenge of reintegration is as much a psychological and social problem as a housing problem. If effective, this style of intervention may serve as a template for future interventions with similar populations.

Low-Frequency Repetitive Transcranial Magnetic Stimulation to Right Parietal Cortex Disrupts Perception of Briefly Presented Stimuli.

Right parietal cortex has recently been linked to the temporal resolution of attention. We therefore sought to investigate whether disruption to right parietal cortex would affect attention to visual stimuli presented for brief durations. Participants performed a visual discrimination task before and after 10 minutes repetitive transcranial magnetic stimulation (1 Hz) to right or central parietal cortex as well as 20 minutes after the second block of trials. Participants reported the spatial frequency of a masked Gabor patch presented for a brief duration of 60, 120, or 240 ms. We calculated error magnitudes by comparing accuracy to a guessing model. We then compared error magnitudes to blocks with no stimulation, producing a measure of baselined performance. Baselined performance was poorer at longer stimulus durations after right parietal than central parietal stimulation, suggesting that right parietal cortex is involved in attention to briefly presented stimuli, particularly in situations where rapid accumulation of visual evidence is needed.