Improving access to early intervention for autism: findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa.
Improving access to early intervention for autism: findings from a proof-of-principle cascaded task-sharing naturalistic developmental behavioural intervention in South Africa.
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DOI：
10.1186/s13034-023-00611-0
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发表时间：
2023-05-20
影响因子：
5.6
通讯作者：
Franz, Lauren
中科院分区：
文献类型：
--
作者：
Rieder, Amber D.;Viljoen, Marisa;Seris, Noleen;Shabalala, Nokuthula;Ndlovu, Minkateko;Turner, Elizabeth L.;Simmons, Ryan;de Vries, Petrus J.;Franz, Lauren
关键词：
尽管撒哈拉以南非洲有大量患有神经发育障碍的儿童，但几乎不存在获得早期干预的机会。因此，重要的是开发可行的、可扩展的早期自闭症干预措施，并将其纳入护理系统。虽然自然主义发展行为干预（NDBI）已成为一种基于证据的干预方法，但全球范围内存在实施差距，任务共享方法可以解决获取差距。在这项南非的原理验证试点研究中，我们着手回答关于12次级联任务共享nbi的两个问题——该方法是否能够忠实地交付，以及我们是否能够识别儿童和照顾者结果变化的信号。我们采用单臂前后设计。在基线（T1）和随访（T2）时测量保真度（非专业人员、照顾者）、照顾者结果（压力、能力感）和儿童结果（发展、适应）。10名照顾者和4名非专业人士参与了这项研究。前后的汇总统计数据与个人轨迹一起提出。采用配对样本的非参数Wilcoxon符号秩检验比较T1和T2之间的组中位数。10/10的参与者中，照顾者履行忠诚度增加。非专业人士的教练忠诚度显著提高（增加7/10对）。在两个Griffiths-III子量表（语言/交流- 9/10改善，学习基础- 10/10改善）和一般发展商数（9/10改善）上取得了显著进展。在两个Vineland适应行为量表（第三版）子量表（沟通- 9/10改善，社交- 6/10改善）和适应行为标准分数（9/10改善）上也有显著的收获。7/10名照顾者的能力感有所改善，6/10名照顾者的压力有所改善。这项在撒哈拉以南非洲进行的第一个级联任务共享NDBI的原理验证试点研究提供了保真度和干预结果数据，支持了这种方法在低资源环境下的潜力。需要更大规模的研究来扩大证据基础，并回答有关干预有效性和实施结果的问题。
Despite the high number of children living with neurodevelopmental disabilities in sub–Saharan Africa, access to early intervention is almost non-existent. It is therefore important to develop feasible, scalable early autism intervention that can be integrated into systems of care. While Naturalistic Developmental Behavioural Intervention (NDBI) has emerged as an evidence-based intervention approach, implementation gaps exist globally, and task-sharing approaches may address access gaps. In this South African proof-of-principle pilot study, we set out to answer two questions about a 12-session cascaded task-sharing NDBI—whether the approach could be delivered with fidelity, and whether we could identify signals of change in child and caregiver outcomes. We utilized a single-arm pre-post design. Fidelity (non-specialists, caregivers), caregiver outcomes (stress, sense of competence), and child outcomes (developmental, adaptive) were measured at baseline (T1) and follow-up (T2). Ten caregiver-child dyads and four non-specialists participated. Pre-to-post summary statistics were presented alongside individual trajectories. Non-parametric Wilcoxon signed rank test for paired samples was used to compare group medians between T1 and T2. Caregiver implementation fidelity increased in 10/10 participants. Non-specialists demonstrated a significant increase in coaching fidelity (increases in 7/10 dyads). Significant gains were seen on two Griffiths-III subscales (Language/Communication—9/10 improved, Foundations of Learning—10/10 improved) and on the General Developmental Quotient (9/10 improved). Significant gains were also seen on two Vineland Adaptive Behaviour Scales (Third Edition) subscales (Communication—9/10 improved, Socialization—6/10 improved) and in the Adaptive Behaviour Standard Score (9/10 improved). Caregiver sense of competence improved in 7/10 caregivers and caregiver stress in 6/10 caregivers. This proof-of-principle pilot study of the first cascaded task-sharing NDBI in Sub-Saharan Africa provided fidelity and intervention outcome data which supported the potential of such approaches in low-resource contexts. Larger studies are needed to expand on the evidence-base and answer questions on intervention effectiveness and implementation outcomes.
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DOI：
10.1177/13623613211022585
发表时间：
2022-01
期刊：
Autism : the international journal of research and practice
影响因子：
--
作者：
Franz L;Howard J;Viljoen M;Sikich L;Chandrasekhar T;Kollins SH;Lee L;Ndlovu M;Sabatos-DeVito M;Seris N;Shabalala N;Spanos M;de Vries PJ;Dawson G
通讯作者：
Dawson G
DOI：
10.2989/17280583.2018.1525386
发表时间：
2018-01-01
影响因子：
--
作者：
Franz, Lauren;Adewumi, Konyin;de Vries, Petrus J.
通讯作者：
de Vries, Petrus J.
DOI：
10.1207/s15374424jccp1802_8
发表时间：
1989-06-01
期刊：
JOURNAL OF CLINICAL CHILD PSYCHOLOGY
影响因子：
--
作者：
JOHNSTON, C;MASH, EJ
通讯作者：
MASH, EJ
影响因子：
3.8
作者：
通讯作者：
--
影响因子：
4
作者：
Barker, Erin T.;Hartley, Sigan L.;Orsmond, Gael I.
通讯作者：
Orsmond, Gael I.