The Feasibility and Effectiveness of PASS Plus, A Lay Health Worker Delivered Comprehensive Intervention for Autism Spectrum Disorders: Pilot RCT in a Rural Low and Middle Income Country Setting
The Feasibility and Effectiveness of PASS Plus, A Lay Health Worker Delivered Comprehensive Intervention for Autism Spectrum Disorders: Pilot RCT in a Rural Low and Middle Income Country Setting
复制标题
DOI：
10.1002/aur.1978
复制
发表时间：
2019-02-01
期刊：
影响因子：
4.7
通讯作者：
Green, Jonathan
中科院分区：
文献类型：
--
作者：
Divan, Gauri;Vajaratkar, Vivek;Green, Jonathan
全球范围内自闭症的治疗差距很大。我们以前由社区非专业卫生工作者提供的PASS干预显示出了效果。本文报道了一种新的“PASS +”干预措施在印度农村人口中的发展和评估。使用形成性研究方法，我们用额外的（Plus）模块来补充PASS干预，以解决自闭症合并症。这是第一次使用严格的方法来评估中低收入国家的自闭症症状结果。在一项针对常规护理的试点随机对照试验中招募了40对亲子对(平均年龄65个月（34名男孩）；n = 19 PASS Plus, n = 21 UC)。89%的干预家庭部分或全部完成了12期干预。意向治疗分析显示自闭症症状严重程度的平均评分降低，尽管置信区间为零（校正平均差AMD -2.42 95% CI -7.75, 2.92; ES 0.22）；治疗对父母同步反应比例（AMD 0.35; 95% CI 0.18, 0.52；效应量ES 3.97）和儿童与父母开始沟通的比例（AMD 0中心点17；95% CI 0.03, 0.32; ES 1.02）的近端结果有较大影响。相互共同关注（AMD 0.10; 95% CI -0.07, 0.27; ES 0.5）和共病症状（AMD -9.0; 95% CI -24.26, 6.26; ES 0.32）影响的置信区间为零。对改善父母心理健康有显著效果。PASS Plus显示出良好的可行性，并进一步证明了印度非专业卫生工作者分担复杂自闭症干预任务的有效性。自闭症研究进展，2019,12:328-339 (c) 2018。本文描述了一种全面的、社区提供的幼儿自闭症干预方法的发展，该方法结合了先前开发的父母介导的沟通干预方法，以及对诸如挑战性行为和感觉敏感性等共病问题的支持。这种干预措施的独特之处在于，它可以由社区卫生工作者提供，解决了资源匮乏地区缺乏专家的问题。我们的研究报告了一项试点试验的令人鼓舞的结果，评估了其可行性和有效性。
The treatment gap for autism globally is high. Our previous PASS intervention, delivered by community based lay health workers, showed effectiveness. This article reports the development and evaluation of a new "PASS 'Plus'" intervention in a rural population in India. Using formative research methods, we supplemented the PASS intervention with additional (Plus) modules to address autism comorbidities. This is the first time that a rigorous methodology has been used to evaluate autism symptom outcomes in a low and middle-income country setting. 40 parent-child dyads were recruited in a pilot randomized controlled trial against usual care (mean age 65 months (34 boys); n = 19 PASS Plus, n = 21 UC). 89% of intervention families partially or entirely completed the 12-session intervention. Intention to treat analysis showed a reduction in mean scores of autism symptom severity, though the confidence interval contains zero, (adjusted mean difference AMD -2.42 95% CI -7.75, 2.92; ES 0.22); large treatment effects on proximal outcomes of proportion of parent synchronous responses (AMD 0.35; 95% CI 0.18, 0.52; effect size ES 3.97) and proportion of child communication initiations with parent (AMD 0 center dot 17; 95% CI 0.03, 0.32; ES 1.02). Confidence intervals for effects on mutual shared attention (AMD 0.10; 95% CI -0.07, 0.27; ES 0.5) and co-morbid symptoms (AMD -9.0; 95% CI -24.26, 6.26; ES 0.32) contained zero. There were significant effects to improve parental mental health. PASS Plus shows good feasibility and adds to the evidence of the effectiveness of task sharing complex autism interventions to lay health workers in India. Autism Res 2019, 12: 328-339 (c) 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary This article describes the development of a comprehensive, community-delivered, intervention for young children with autism, which combines a previously developed parent-mediated communication intervention with support for co-morbid problems like challenging behaviors and sensory sensitivities. The unique aspect of this intervention is that it can be delivered by community health workers, addressing the lack of specialists in low resource settings. Our study reports the encouraging findings of a pilot trial evaluating its feasibility and effectiveness.