Examining adaptive peer-mediated interventions for preschoolers with autism spectrum disorder and limited or no spoken language: A Sequential Multiple Assignment Randomized Trial

检查对患有自闭症谱系障碍且口语有限或没有口语的学龄前儿童的适应性同伴介导干预措施：序贯多重分配随机试验

• 批准号: 10491421
• 负责人: Kathy Thiemann-Bourque
• 金额: $ 57.75万
• 依托单位: UNIVERSITY OF KANSAS LAWRENCE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10491421
• 关键词: Academic achievement; Address; Adopted; Adult; Aftercare; Age; Apple; Blinded; Child; Child Development; Clinical Trials; Communication; Communities; Complex; Data; Development; Early Intervention; Educational Activities; Educational process of instructing; Emotional; Ensure; Environment; Goals; Growth; Instruction; Intervention; Joints; Knowledge; Language; Lead; Learning; Learning Disorders; Length; Measures; Mediating; Modeling; Nodal; Nursery Schools; Outcome; Output; Participant; Phase; Play; Prediction of Response to Therapy; Problem behavior; Public Health; Randomized; Reporting; Research; Research Personnel; Sequential Multiple Assignment Randomized Trial; Series; Site; Speech; Teaching Method; Testing; Training; Vocabulary; Voice; Work; adaptive intervention; autism spectrum disorder; autistic children; base; disability; effective intervention; elementary school; flexibility; follow-up; improved; innovation; input device; novel; peer; peer coaching; primary outcome; reinforcer; response; service providers; skills; social; social communication; social communication impairment; social inclusion; social interventions; social skills; statistics; teacher; treatment response; trial design; virtual vocal tract; vocalization

PROJECT SUMMARY Impaired social communication is a core feature of autism spectrum disorder (ASD). This proposal will evaluate a series of peer-mediated interventions for preschool-age children (3 to 6 years) with ASD and limited or no spoken language, using an innovative Sequential Multiple Assignment Randomized Trial (SMART) design. Available evidence supports the beneficial effects of peer-mediated interventions for improving social communication skills in children with ASD.1, 2 Peer-related social competence is vital to a wide range of child outcomes.3 Children who achieve positive peer interactions in preschool show improved social communication and fewer behavioral problems in elementary school.4 In spite of considerable early intervention efforts, approximately 30% of children with ASD remain minimally-verbal in kindergarten5, restricting participation in inclusive activities. Recent studies report improved communication between children with ASD and peers after a speech-generating device (SGD) is included in treatment.6-9 A repertoire of effective interventions that can be applied and modified is necessary to ensure optimal social communication outcomes when children do not make anticipated progress. A strength of the study is that these interventions can be adopted by community- based, early service providers. All participants will receive an adapted Stay-Play-Talk (SPT)7, 10-12 peer- mediated intervention that varies in active ingredients examined by the PI in preliminary studies. Now, with SMART designs, it is possible to test and identify alternative combinations of peer-mediated approaches, such as the addition of a SGD to improve social communication of children with ASD and complex communication needs.7, 8, 13 In the current proposal, 132 preschoolers with ASD (and N=264 peers without disabilities) will be initially randomized to SPT and SGD with spoken peer input only (SPT Basic; peers taught to model language) or SPT and SGD with augmented peer input in which peers are taught to model verbal responses while simultaneously selecting screen icons (SPT Plus; peers taught to use verbal language models concurrently with the SGD). Each child’s response to treatment after 5 weeks will determine that child’s next phase in the SMART design. Children showing a positive response will continue in their originally assigned group. Children who are slow responders after 5 weeks will be randomly assigned to receive added treatment components to improve peer-directed communication (either SPT Plus or SPT Advanced). SPT Advanced adds direct instruction strategies for the children with ASD (i.e., adult prompts, reinforcers, and teaching trials) shown to increase child vocalizations in SGD interventions.9, 14 The use of a SMART design extends our prior work by testing the systematic addition of selected peer-mediated strategies in combination with an SGD8 that allows for flexible application of interventions based on child response measured at important nodal points.15-17 We have assembled an outstanding team of highly qualified investigators with complementary skills in preschool assessment, language intervention, clinical trials, and statistics.

项目总结 社交障碍是自闭症谱系障碍(ASD)的核心特征。这份提案将对 对患有自闭症的学龄前儿童(3-6岁)进行的一系列同伴干预措施 口语，采用创新的顺序多任务随机试验(SMART)设计。 现有证据支持同伴调解的干预对改善社会生活的有益影响 1、2与同伴相关的社交能力对广泛的儿童至关重要 结果。3在学龄前获得积极同伴互动的儿童表现出更好的社交能力 4尽管进行了相当大的早期干预努力， 大约30%的自闭症儿童在幼儿园时仍然保持着最低限度的语言5，限制了参与 包容性活动。最近的研究报告称，患有自闭症的儿童与同龄人之间的沟通在 治疗中包括语音生成设备(SGD)。6-9可以 应用和修改是必要的，以确保在儿童不这样做时获得最佳的社交效果 取得预期的进展。这项研究的一个优势是，这些干预措施可以被社区采用- 以早期服务提供商为基础。所有参与者将收到经过改编的逗留播放对话(SPT)7、10-12对等- 由PI在初步研究中检查的不同有效成分的中介干预。现在，随着 智能设计，可以测试和识别对等调解方法的替代组合，例如 由于增加了SGD以改善ASD儿童的社交沟通和复杂的沟通 7、8、13在目前的提案中，132名患有自闭症的学龄前儿童(以及N=264名非残疾儿童)将是 最初随机分配到SPT和SGD，只有口头同行输入(SPT Basic；同伴学习建模语言) 或SPT和SGD具有增强的同伴输入，在其中教导同伴建模言语反应，同时 同时选择屏幕图标(SPT Plus；被教导同时使用语言模型的同龄人 与SGD合作)。每个儿童在5周后对治疗的反应将决定该儿童下一阶段的 智能设计。反应积极的儿童将继续留在他们最初分配的小组中。儿童 5周后反应迟缓的患者将被随机分配接受增加的治疗成分 改善对等通信(SPT Plus或SPT Advanced)。SPT Advanced增加了直接 针对患有自闭症儿童的指导策略(即成人提示、增强剂和教学试验)显示如下 在SGD干预中增加儿童发声。9，14智能设计的使用扩展了我们之前的工作 测试与SGD8相结合的系统添加的选定同行中介策略，该SGD8允许 根据在重要节点处测量的儿童反应灵活应用干预措施。15-17我们 已经组建了一支优秀的高素质调查人员团队，他们在学前班的技能互补 评估、语言干预、临床试验和统计。