The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum.
The earlier the better: An RCT of treatment timing effects for toddlers on the autism spectrum.
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DOI：
10.1177/13623613231159153
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发表时间：
2023-03-15
期刊：
影响因子：
5.2
通讯作者：
Lord, Catherine E.
中科院分区：
文献类型：
--
作者：
Guthrie, Whitney;Wetherby, Amy M.;Woods, Juliann;Schatschneider, Christopher;Holland, Renee D.;Morgan, Lindee;Lord, Catherine E.
有力的证据支持早期自闭症干预的有效性。尽管人们普遍认为早期干预会带来更好的结果，但这方面的证据仅限于相关研究。本研究采用完全交叉随机对照试验（RCT）检验了父母实施的早期社会互动（ESI）模型的时间效应。在18或27月龄时，比较了个体- esi的效果，并与较低强度的Group-ESI作为主动对照条件的效果进行了对比。参与者包括82名自闭症幼儿，他们接受了9个月的个体- esi和9个月的群体- esi，时间/顺序随机化。盲法临床医生在基线（18个月大）、病情1结束（27个月）和病情2结束（36个月）时完成评估。在18个月时随机分配到个体- esi的幼儿在治疗期间比在27个月时开始个体- esi的幼儿在接受/表达语言、社会沟通和日常生活技能方面取得了更大的进步。在Group-ESI中没有观察到这种模式，这表明时间效应是个体- esi特有的，并排除了成熟效应。这项随机对照试验表明，早期的密集、个性化干预导致了更大的改善，并表明即使是18个月与27个月的狭窄窗口也可能影响儿童的预后。结合自然主义、发展策略的行为干预已被证明可以改善被诊断为自闭症谱系障碍（ASD）的幼儿的预后。尽管人们普遍认为自闭症儿童应该尽快开始支持治疗，但这方面的经验证据相对有限，而且人们对开始针对自闭症的干预的最佳年龄知之甚少。我们的团队进行了一项随机对照试验（RCT），以测试在不同年龄开始干预的效果，使用早期社会互动（ESI）模型，这是一种父母实施的对谱系幼儿的干预。参与者包括82名自闭症幼儿和他们的照顾者，他们接受了9个月的个体- esi和9个月的群体- esi，这两种治疗条件的时间/顺序是随机的。因此，家庭在18个月或27个月时接受了更密集和个性化的个体- esi。结果显示，较早接受个体esi的儿童比较晚接受这种干预的儿童表现出更大的治疗效果。成绩体现在几个方面，包括语言的使用和理解、社交沟通技巧和自助技巧。重要的是，与基于群体的治疗相比，这些发现是针对强化和个性化的父母指导模式的，这使我们能够排除这些时间效应是由于儿童年龄增长而不是治疗本身造成的可能性。我们的研究结果表明，即使是18个月和27个月的狭窄窗口也可能对结果产生影响，并强调了尽可能年轻筛查和评估的重要性。
Robust evidence supports the efficacy of early autism intervention. Despite broad consensus that earlier intervention leads to better outcomes, evidence for this has been limited to correlational studies. This study examined timing effects of the Early Social Interaction (ESI) model, a parent-implemented intervention, using a complete crossover randomized controlled trial (RCT). Effects of Individual-ESI were compared when initiated at 18 or 27 months of age, and also contrasted with effects of the less intensive Group-ESI as an active control condition. Participants included 82 autistic toddlers who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order randomized. Blinded clinicians completed assessments at baseline (18 months of age), end of Condition 1 (27 months), and end of Condition 2 (36 months). Toddlers randomized to Individual-ESI at 18 months showed greater gains during treatment than those starting Individual-ESI at 27 months in receptive/expressive language, social communication, and daily living skills. This pattern was not observed for Group-ESI, demonstrating that timing effects were specific to Individual-ESI and ruling out maturation effects. This RCT demonstrated that earlier intensive, individualized intervention led to greater improvements, and suggests that even a narrow window of 18 versus 27 months may impact child outcomes. Behavioral interventions that incorporate naturalistic, developmental strategies have been shown to improve outcomes for young children who receive an autism spectrum disorder (ASD) diagnosis. Although there is broad consensus that children on the spectrum should begin supports as soon as possible, the empirical evidence for this is relatively limited and little is known about the optimal age to start autism-specific interventions. Our team conducted a randomized controlled trial (RCT) to test the effects of starting intervention at different ages, using the Early Social Interaction (ESI) model, a parent-implemented intervention for toddlers on the spectrum. Participants included 82 autistic toddlers and their caregiver(s) who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order of these two treatment conditions randomized. Thus, families received the more intensive and individualized Individual-ESI at either 18 or 27 months of age. Results revealed that children who received Individual-ESI earlier showed greater treatment gains than those who received this intervention later. Gains were demonstrated in several areas, which included the use and understanding of language, social use of communication skills, and self-help skills. Importantly, these findings were specific to the intensive and individualized parent coaching model compared to group-based treatment, allowing us to rule out the possibility that these timing effects were due to children getting older rather than the treatment itself. Our results suggest that even a narrow window of 18 versus 27 months may have an impact on outcomes and underscore the importance of screening and evaluation as young as possible.
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影响因子：
4.9
作者：
Dawson G;Bernier R;Ring RH
通讯作者：
Ring RH
DOI：
10.1080/09540261.2018.1432574
发表时间：
2018-03
期刊：
International review of psychiatry (Abingdon, England)
影响因子：
--
作者：
Landa RJ
通讯作者：
Landa RJ
DOI：
10.1111/j.1469-7610.2006.01531.x
发表时间：
2006-06-01
影响因子：
7.6
作者：
Landa, Rebecca;Garrett-Mayer, Elizabeth
通讯作者：
Garrett-Mayer, Elizabeth
影响因子：
3.9
作者：
Esler, Amy N.;Bal, Vanessa Hus;Lord, Catherine
通讯作者：
Lord, Catherine
影响因子：
3.3
作者：
Klin A;Micheletti M;Klaiman C;Shultz S;Constantino JN;Jones W
通讯作者：
Jones W