Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years
Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years
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DOI：
10.1111/jcpp.12728
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发表时间：
2017-12-01
影响因子：
7.6
通讯作者：
Johnson, Mark
中科院分区：
文献类型：
--
作者：
Green, Jonathan;Pickles, Andrew;Johnson, Mark
背景：人们对对自闭症先兆进行预防性干预的可能性越来越感兴趣，但对其影响的研究很少。方法：一项两点、双臂评估随机对照试验(RCT)，对9至14个月大婴儿进行为期12个疗程的父母中介的社交干预(英国婴儿兄弟姐妹自闭症研究中的干预-促进积极育儿的视频互动)，对照不干预。在9个月的基线、15个月的治疗终点、27个月和39个月的随访中，对54名具有自闭症家族风险但未被选为发育不典型的婴儿(28名干预，26名非干预)进行了评估。主要结果：四个评估点的自闭症先兆症状的严重程度，婴儿自闭症观察计划或自闭症诊断观察计划第二版。次要结果：失明的亲子互动和孩子的语言；非失明的父母评价的沟通和社会化。预先指定的意向治疗分析结合了相关回归中重复测量的估计，以估计随着时间的推移婴儿期干预的总体效果。结果：支持对自闭症先兆症状进行干预的效果估计，在27个月时最大，在每个单独的时间点(包括零)都有可信区间(CI)，但在干预过程和随访期内显示出显著的总体效果(效果大小[ES]=0.32；95%可信区间0.04，0.60；P=0.026)。父母非指向性/同步性(ES=0.33；CI=0.04，0.63；p=.013)和儿童注意/沟通启动(ES=0.36；95%CI=0.04，0.68；p=.015)对近距离干预目标的影响也显示出类似的结果。这对明确的诊断结果或正式的语言测量没有影响。结论：对家族性自闭症高危婴儿进行早期社会沟通干预的首次随机对照试验(RCT)3a的随访显示出治疗效果，干预结束24个月后，可降低自闭症先兆症状的总体严重程度，并在此期间加强亲子双方的社会沟通。我们强调了对早期干预试验进行长期随访和重复评估的价值。
Background: There has been increasing interest in the potential for pre-emptive interventions in the prodrome of autism, but little investigation as to their effect. Methods:A two-site, two-arm assessor-blinded randomised controlled trial (RCT) of a 12-session parent-mediated social communication intervention delivered between 9 and 14months of age (Intervention in the British Autism Study of Infant Siblings-Video Interaction for Promoting Positive Parenting), against no intervention. Fifty-four infants (28 intervention, 26 nonintervention) at familial risk of autism but not otherwise selected for developmental atypicality were assessed at 9-month baseline, 15-month treatment endpoint, and 27- and 39-month follow-up. Primary outcome: severity of autism prodromal symptoms, blind-rated on Autism Observation Schedule for Infants or Autism Diagnostic Observation Schedule 2nd Edition across the four assessment points. Secondary outcomes: blind-rated parent-child interaction and child language; nonblind parent-rated communication and socialisation. Prespecified intention-to-treat analysis combined estimates from repeated measures within correlated regressions to estimate the overall effect of the infancy intervention over time. Results: Effect estimates in favour of intervention on autism prodromal symptoms, maximal at 27months, had confidence intervals (CIs) at each separate time point including the null, but showed a significant overall effect over the course of the intervention and follow-up period (effect size [ES]=0.32; 95% CI 0.04, 0.60; p=.026). Effects on proximal intervention targets of parent nondirectiveness/synchrony (ES=0.33; CI 0.04, 0.63; p=.013) and child attentiveness/communication initiation (ES=0.36; 95% CI 0.04, 0.68; p=.015) showed similar results. There was no effect on categorical diagnostic outcome or formal language measures. Conclusions: Follow-up to 3years of the first RCT of a very early social communication intervention for infants at familial risk of developing autism has shown a treatment effect, extending 24months after intervention end, to reduce the overall severity of autism prodromal symptoms and enhance parent-child dyadic social communication over this period. We highlight the value of extended follow-up and repeat assessment for early intervention trials.