Community-based Adaptive autism Intervention for Toddlers

项目总结 这项拟议的研究(CAIT：针对幼儿的社区适应性自闭症干预)旨在 确定最优的干预顺序，以改善社交、语言和 自闭症谱系障碍(ASD)幼儿的认知结果。目标人口包括2-3岁 -患有自闭症的老年儿童在两个真实的社区接受公共资助的早期干预 纽约东哈莱姆区和布朗克斯区被称为纽约婴幼儿中心的教育机构 (NYCIT)。预计将有300名患有自闭症的蹒跚学步的儿童与他们社区招募的准专业人员一起参加 助教(助教)和组长(GL)。这项研究旨在构建最有效的一年制， 两阶段适应性干预，其中干预是基于儿童对 干预。第一阶段，从计划进入到6周或12周(随机)，每天60分钟 基于证据的社交干预，Jasper(联合注意，象征性游戏，参与和 规定)由训练有素的助教对孩子进行一对一的培训。在第一阶段结束时，对干预的反应是 被GLS评为联合行动进展缓慢或快速(早期开发的核心缺陷 患有自闭症的儿童，这是在改善社会沟通和 语言)。在第二阶段(到第24周)，反应迟缓的幼儿被重新随机分配，继续服用Jasper 每天60分钟，或通过直接的、有组织的社交沟通目标教学来加强治疗 每天30分钟，贾斯珀每天30分钟。反应迅速的幼儿有30分钟的时间 贾斯珀和30分钟的茉莉花(贾斯珀和同伴)，以进一步改善社交和社交 沟通。 本研究将采用序贯多任务随机试验(SMART)设计来评估 如何在两个治疗阶段最好地改善患有自闭症的幼儿的社交效果。这个 主要的有效性目标是在反应较慢的患者中确定使用以下药物增强Jasper的效果 关于初级(社会交际话语)和次级(社会交际话语)的结构化教学与继续贾斯珀 结果(共同参与和发挥)。二次有效性目标侧重于(I)确定最佳时间 (6周或12周)以确定儿童的反应速度较慢，以及(Ii)检查儿童是否在 基线缓和了在第6周或第12周测量反应的效果，以及联合注意技能是否在 阶段1对反应缓慢的患者进行阶段2治疗的效果适中(Jasper Plus结构化教学 与继续的贾斯珀)。最后，实施目标将审查干预的障碍和促进者 被NYCIT采用(通过评估实施保真度，细化我们对中心领导层的外部支持，以 可靠地评估儿童反应，培训新员工，并指导助教实施干预措施 Fidelity，并检查NYCIT领导层对干预的支持程度)。

PROJECT SUMMARY The proposed study (CAIT: Community-based Adaptive Autism Intervention for Toddlers) aims to determine the most optimal sequence of interventions for improving the social- communicative, language and cognitive outcomes of toddlers with autism spectrum disorder (ASD). The target population consists of 2-3 year -old children with ASD who receive community based, publicly funded early intervention in two authentic educational settings in East Harlem and the Bronx, NY known as New York Center for Infants & Toddlers (NYCIT). An expected 300 toddlers with ASD will participate with their community-recruited paraprofessional teaching assistants (TAs) and group leaders (GLs). The study aims to construct the most effective one-year, two-phase, adaptive intervention, in which intervention is individualized based on a child's initial response to intervention. Phase 1, from program entry to either 6 or 12 weeks (randomized), involves 60 minutes daily of an evidence based social communication intervention, JASPER (Joint Attention, Symbolic Play, Engagement & Regulation) delivered 1-on-1 to the child by the trained TA. At end of Phase 1, response to intervention is rated by the GLs for slow or fast improvements of joint engagement (a core deficit in the early development of children with ASD, and a significant indicator of good progress toward improving social communication and language). In Phase 2 (to week 24), toddlers responding slowly are re-randomized to continue with JASPER for 60 minutes per day or augment treatment with direct, structured teaching of social communication targets for 30 minutes and JASPER for another 30 minutes per day. Toddlers responding quickly are given 30 minutes of JASPER and 30 minutes of jasPEER (JASPER with a peer) to further improve socialization and social communication. This study will employ a Sequential Multiple Assignment Randomized Trial (SMART) design to evaluate how best to improve social communication outcomes in toddlers with ASD over two treatment phases. The primary effectiveness aim is to determine among slower responders, the effect of augmenting JASPER with structured teaching vs. continuing JASPER on primary (social communicative utterances) and secondary outcomes (joint engagement and play). Secondary effectiveness aims focus on (i) determining the best time (week 6 or 12) to identify a child as a slower responder, and (ii) examining whether child un-engagement at baseline moderates the effect of measuring response at week 6 or 12, and whether joint attention skills in Phase 1 moderate the effect of Phase 2 treatment among slow responders (JASPER plus structured teaching vs. continuing JASPER). Finally, an implementation aim will examine barriers and facilitators to intervention adoption by NYCIT (by assessing implementation fidelity, refining our external support to center leadership to reliably assess child response, train new staff, and coach TAs to implement intervention components with fidelity, and to examine the degree to which NYCIT leadership sustains the interventions).