Optimizing Outcomes through Sequencing Parent-Mediated Interventions for Young Children with Autism

通过对自闭症幼儿进行家长介导的干预进行排序来优化结果

• 批准号: 10501853
• 负责人: Megan Y Roberts
• 金额: $ 69.35万
• 依托单位: NORTHWESTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10501853
• 关键词: 9 year old; Affect; Age-Months; Behavior; Behavior Therapy; Behavioral Research; Characteristics; Child; Communication; Development; Diagnosis; Disruptive Behavior Disorder; Early identification; Educational process of instructing; Exhibits; Family; Feedback; Frequencies; Goals; Individual; Instruction; Intervention; Joints; Learning; Life; Link; Measures; Mediating; Mediator of activation protein; Methods; Mission; Modeling; National Institute on Deafness and Other Communication Disorders; Outcome; Parents; Play; Prevention; Randomized; Research; Role; Sequential Multiple Assignment Randomized Trial; Social support; Training; adaptive intervention; adult with autism spectrum disorder; autism spectrum disorder; autistic children; base; behavioral outcome; cost; design; family burden; implementation intervention; improved; in vivo; randomized trial; skills; social communication; social interventions; social learning; teacher; trial design

PROJECT SUMMARY Despite advances in early identification of and intervention for children with autism spectrum disorders (ASD), the long-term outcomes for children with ASD remain variable. As many as 40% of children with ASD are minimally verbal at 9 years of age, and 75% of adults with ASD have persistent social communication (SC) difficulties. Furthermore, as many as 70% of children with ASD have a co-occurring diagnosis of disruptive behavior (DB) disorder. Parents play an important role in SC development and in the prevention of and intervention for DB. As such, the overarching goal of the proposed study is to: (a) determine how best to sequence two parent-mediated interventions: an SC intervention (Project ImPACT, Improving Parents as Communication Teachers) and a DB intervention (Parent Training for Disruptive Behavior) and (b) examine moderators and mediators of intervention outcomes. While evidence of efficacy and feasibility exist for both of these interventions individually, an adaptive intervention approach that considers and optimizes both interventions has not been evaluated. This type of adaptive intervention approach may be particularly needed in parent-mediated interventions due to the cost, burden, and complexity of teaching parents to use multiple intervention strategies. To determine the optimal intervention sequence that considers parent moderators and parent use of intervention strategies, we propose a sequential, multiple assignment, randomized trial (SMART) design in which we will initially randomly assign 184 children with ASD, between 18 and 36 months of age, to receive either the SC or DB intervention. Following each respective manualized, 12-week intervention (first- stage intervention; SC or DB), the interventionist will measure the parents' use of intervention strategies. At this point, all parents will be re-randomized before starting the second-stage intervention. Second-stage intervention decisions are designed to be responsive to parents' implementation of the first-stage intervention strategies. That is, parents who are implementing the first-stage intervention strategies with high fidelity (high implementers) will be re-randomized to receive the same intervention at a lower frequency (Reduce) or to receive the other intervention (Switch). Parents who are implementing the first-stage intervention strategies with low fidelity (low implementers) will be re-randomized to receive the same intervention with an additional parent instructional method, such as modeling and in-vivo coaching or video feedback (Augment) or to receive the other intervention (Switch). After 24 weeks of intervention (12 weeks for first stage, 12 weeks for second stage), we will assess child SC skills, child DB, and family life participation in everyday activities. We will also measure parent-child joint engagement continually during intervention to examine the extent to which joint engagement mediates intervention outcomes. The proposed research is significant because if an intervention for one domain (SC or DB) has an impact on the other, an intervention sequence that systematically includes both interventions may have an even greater impact on both domains.

项目摘要 尽管在自闭症谱系障碍（ASD）儿童的早期识别和干预方面取得了进展， ASD儿童的长期结果仍然是可变的。多达40%的ASD儿童 9岁时语言能力最低，75%的ASD成年人有持续的社会交流（SC） 困难此外，多达70%的ASD儿童有合并的破坏性诊断， 行为障碍（DB）父母在SC的发展以及预防和 DB的干预。因此，拟议研究的总体目标是：（a）确定如何最好地 顺序两个父母介导的干预：SC干预（项目ImPACT，改善父母作为 沟通教师）和DB干预（家长破坏性行为培训）和（B）检查 干预结果的调节者和中介者。虽然两种药物都有疗效和可行性的证据， 这些干预措施单独进行，这是一种考虑并优化两者的适应性干预方法 干预措施尚未得到评估。这种适应性干预方法可能特别需要 在家长介导的干预措施，由于成本，负担，和复杂的教学家长使用多种 干预策略。为了确定最佳干预顺序，考虑到家长主持人和 父母使用干预策略，我们提出了一个序贯，多分配，随机试验（SMART） 在这项设计中，我们将184名年龄在18到36个月之间的ASD儿童随机分配到 接受SC或DB干预。在每次手动干预后，12周（第一次- 阶段干预; SC或DB），干预者将衡量父母使用干预策略的情况。在 在这一点上，在开始第二阶段干预之前，所有父母都将被重新随机化。二级 干预决策的目的是响应家长的实施第一阶段的干预 战略布局也就是说，实施第一阶段干预策略的父母具有高度的忠诚度（高 实施者）将被重新随机化，以较低的频率接受相同的干预（减少）或 接受其他干预（Switch）。正在实施第一阶段干预策略的家长 低保真度（低实施者）将被重新随机化，接受相同的干预， 父母指导方法，如建模和体内指导或视频反馈（增强）或接受 另一种干预（Switch）。干预24周后（第一阶段12周，第二阶段12周 阶段），我们将评估儿童SC技能，儿童DB和家庭生活参与日常活动。我们还将 在干预期间持续测量亲子关节接合，以检查关节 参与调解干预结果。这项研究的意义重大，因为如果一项干预措施 一个领域（SC或DB）对另一个领域有影响，干预序列系统地包括 这两种干预措施可能对这两个领域产生更大的影响。