Communication-centered Parent-mediated treatment for Autism Spectrum Disorder in South Asia (COMPASS).

南亚以沟通为中心、家长介导的自闭症谱系障碍治疗（COMPASS）。

• 批准号: MR/R006164/1
• 负责人: Jonathan Green
• 金额: $ 297.33万
• 依托单位: University of Manchester
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR006164%2F1
• 关键词: Communication; centered; Parent; mediated; treatment

Eighty percent of the world's children with Autism Spectrum Disorders (ASD) live in low resource settings. Recent evidence from high-income countries supports the effectiveness of targeted parent-mediated interventions for the early treatment of children with ASD. Interventions that are delivered through parents have the additional advantages of improving parental knowledge and morale, potentially promoting the social empowerment of mothers, generalising into improvements in the family environment for the child and thus potentially conferring long-term impacts on the social context, the child's environment and functional outcomes. The Pre-school Autism Communication Therapy (PACT) trial conducted in the UK is the largest yet trial of this kind. It is targeted at getting parents to recognize their child's social communication difficulties and create an environment which gives the child a space and time to communicate at their own pace. This intervention uses video feedback techniques to work with parents to enhance their understanding and responsiveness to the atypical communications of young children with autism. The trial showed that children with ASD who received this treatment benefited from the enriched communication environment that their parents were able to create; this in turn had a positive impact on the social interactions the children initiated. More importantly these changes, in the parent child interaction and independent communication from the child, were sustained in a follow up study after six years which demonstrated a decrease in autism symptoms in children who received the intervention. The intervention has now been successfully adapted for use in South Asia, including relevant cultural adaptation to enhance parental acceptability, developing a supervision and training cascade to allow the intervention to be delivered by community based non-specialist workers, and delivery of the intervention at home. The resulting Parent mediated intervention for Autism Spectrum Disorders in South Asia (PASS) was subsequently evaluated in a pilot trial which demonstrated its acceptability, feasibility and efficacy. Subsequently, the team in India have developed and piloted a complementary comorbidity package creating a comprehensive intervention for children with ASD in the 2-9 year age group (PASS Plus). Evaluation methods have also been adapted and tested in both of these pilot studies. Most children with ASD in India and other low resource settings do not receive evidence based care which the proposal investigators have shown can reduce the symptoms of ASD and is feasible and acceptable for delivery in the proposed study setting. The proposed trial will build on this pilot work already carried out in India, and will carry out the largest, definitive, trial of the intervention, involving 240 participants recruited through two tertiary government hospitals in the capital city of New Delhi, which cater to an urban poor population. The intervention will be delivered through existing health system frontline workers. The trial will evaluate the effectiveness and cost effectiveness of the intervention on symptoms of ASD and parent-child interaction as well as more general impacts on child functioning, parental well-being and social empowerment. COMPASS will be the largest trial of its kind for ASD in any low resource setting and the evidence generated will have an impact not only health policy and practice in India, home to over 5 million children with ASD, but also other low resource settings in the region.

世界上 80% 患有自闭症谱系障碍 (ASD) 的儿童生活在资源匮乏的环境中。来自高收入国家的最新证据支持有针对性的家长介导的干预措施对于自闭症谱系障碍儿童的早期治疗的有效性。通过父母提供的干预措施还有一个额外的优势，即提高父母的知识和士气，有可能促进母亲的社会赋权，进而改善儿童的家庭环境，从而可能对社会背景、儿童的环境和功能结果产生长期影响。在英国进行的学前自闭症沟通治疗（PACT）试验是迄今为止规模最大的此类试验。它的目的是让父母认识到孩子的社交沟通困难，并创造一个环境，让孩子有空间和时间按照自己的节奏进行沟通。这种干预措施使用视频反馈技术与家长合作，以增强他们对自闭症幼儿非典型沟通的理解和反应。试验表明，接受这种治疗的自闭症儿童受益于父母能够创造的丰富的沟通环境；这反过来又对孩子们发起的社交互动产生了积极影响。更重要的是，六年后的一项后续研究中，亲子互动和孩子独立沟通方面的这些变化得以维持，表明接受干预的儿童自闭症症状有所减轻。该干预措施现已成功适应在南亚使用，包括进行相关文化调整以提高家长的可接受性、制定监督和培训级联以允许社区非专业工作人员实施干预措施以及在家中实施干预措施。由此产生的针对南亚自闭症谱系障碍的家长介导干预措施 (PASS) 随后在一项试点试验中进行了评估，证明了其可接受性、可行性和有效性。随后，印度团队开发并试行了一套补充性合并症方案，为 2-9 岁自闭症谱系障碍儿童创建全面干预措施 (PASS Plus)。这两项试点研究也对评估方法进行了调整和测试。印度和其他资源匮乏地区的大多数患有自闭症谱系障碍的儿童没有接受基于证据的护理，该提案的调查人员已经证明，这种护理可以减轻自闭症谱系障碍的症状，并且在拟议的研究环境中交付是可行和可接受的。拟议的试验将建立在印度已经开展的试点工作的基础上，并将进行最大规模、最权威的干预试验，涉及通过首都新德里的两家三级政府医院招募的 240 名参与者，这些医院主要服务于城市贫困人口。干预措施将通过现有的卫生系统一线工作人员进行。该试验将评估干预措施对自闭症谱系障碍症状和亲子互动的有效性和成本效益，以及对儿童功能、父母福祉和社会赋权的更普遍影响。 COMPASS 将是在任何资源匮乏环境下针对 ASD 进行的同类试验中规模最大的一次，所产生的证据不仅会影响印度（拥有超过 500 万 ASD 儿童）的卫生政策和实践，还会影响该地区其他资源匮乏的环境。

项目成果

ACHIEVING UNIVERSAL HEALTH COVERAGE FOR YOUNG CHILDREN WITH AUTISM SPECTRUM DISORDER IN LOW- AND MIDDLE-INCOME COUNTRIES: A SCOPING REVIEW OF REVIEWS

在低收入和中等收入国家实现自闭症谱系障碍幼儿的全民健康覆盖：对审查的范围界定审查

• 发表时间: 2021
• 期刊: Journal of Child Psychology and Psychiatry
• 影响因子: 7.6
• 作者: Divan G

The preschool autism communication therapy - an evidence-based approach to enhancing early autistic development and empowering families

学前自闭症沟通疗法——一种促进自闭症早期发展并赋予家庭权力的循证方法

• DOI: 10.3917/enf2.191.0119
• 发表时间: 2019
• 期刊: Enfance
• 影响因子: 0.2
• 作者: Aldred C

An adapted social communication intervention at home and education to promote social communication change in children with severe autism: the PACT-G RCT

适应家庭和教育的社会沟通干预，以促进严重自闭症儿童的社会沟通改变：PACT-G RCT

• DOI: 10.3310/lbxi2342
• 发表时间: 2022
• 期刊: Efficacy and Mechanism Evaluation
• 作者: Green J