Development of a Prospective Video-Based Measure to Identify ASD Risk in Infancy

描述（由申请人提供）：有强有力的证据表明，自闭症谱系障碍（ASD）的迹象存在，并在生命的第一年后期和第二年早期检测到。父母在平均14个月大时首次发现对发育的担忧。尽管如此，在美国首次诊断ASD的平均年龄在41/2和51/2岁之间（CDC，2012）。早期强化干预对ASD幼儿非常有效，但仅适用于正式诊断的儿童，因此早期识别势在必行。一项可以在全套症状出现之前识别ASD风险的措施，为大脑具有最大可塑性时的干预提供了机会。然而，由于计量问题，早期识别的承诺仍然受到阻碍。虽然学龄儿童的父母可以可靠地报告ASD症状，但父母评估3岁以下儿童的个体差异要困难得多。我们建议开发一种新的基于视频的方法来评估早期发展。利用数千小时已经收集和编码的ASD风险婴儿的视频，我们建议创建一个视频库，描述从非常典型到明显延迟的社会，沟通和重复行为的连续性。我们将与一家为自闭症儿童家庭开发软件的公司合作，通过一个安全的网站创建一个衡量标准，父母可以通过这个标准来评估与婴儿行为的相似性，并识别最能代表他们孩子的视频。这项措施对家庭的负担很小，因为它很简短，可以通过互联网以安全的方式管理。第一年 的资金将用于开发这项新措施（目标1），称为自闭症视频参考婴儿评级系统（VIRSA），该系统将从6个月大扩展到18个月大。在初始验证过程后，将对90名有ASD家族风险的婴儿和45名无ASD家族史的婴儿的父母进行三次（6、12和18个月）VIRSA（目的2）。然后将对婴儿进行随访至36个月，届时将进行诊断结果评估。我们将比较VIRSA的心理测量特性和预测有效性，以其他措施，并确定识别的最佳截止值。我们将检查父母和专家评级之间的协议，以确定该措施在有和没有ASD经验的父母中的有效性。该项目的最终目标是开发一种低成本，低负担的措施，可以在婴儿期检测ASD风险。这种措施具有重要的公共卫生应用价值，包括早期诊断、纵向跟踪发展以确定需要评估的儿童、筛选大型社区样本和监测个人干预进展。

DESCRIPTION (provided by applicant): There is strong evidence that signs of autism spectrum disorders (ASD) are present and detectable late in the first year and early in the second year of life. Parents first identify concerns about development at a mean age of 14 months. Despite this, the mean age of first diagnosis of ASD in the United States is between 41/2 and 51/2 years (CDC, 2012). Early intensive intervention can be highly effective for young children with ASD, but is reserved for children with a formal diagnosis, making early identification imperative. A measure that could identify ASD risk before the full set of symptoms has emerged offers the opportunity for intervention when the brain has the greatest plasticity. The promise of earlier identification remains hampered, however, by measurement issues. Although ASD symptoms can be reliably reported by parents in school-age children, individual variation is much more difficult for parents to assess in children under the age of 3 years. We propose to develop a new video-based method of assessing early development. Taking advantage of thousands of hours of already collected and coded video of infants at risk for ASD, we propose to create a video library depicting a continuum of social, communication, and repetitive behaviors, from very typical to clearly delayed development. In collaboration with a company that develops software for families of children with autism, we will create a measure, implemented through a secure website, with which parents can rate similarity to their infant's behaviors and identify video that best represents their child. This measure will be of low burden to families, as it is brief and can be administered in a secure manner via internet. The first year of funding will be used to develop this new measure (Aim 1), called the Video-Referenced Infant Rating System for Autism (VIRSA), which will extend from 6 to 18 months of age. After an initial validation process, the VIRSA will be administered three times (6, 12, and 18 months) to parents of 90 infants at familial risk for ASD and 45 infants with no family history of ASD (Aim 2) The infants will then be followed to 36 months of age, when diagnostic outcome evaluations will be performed. We will compare the psychometric properties and predictive validity of the VIRSA to other measures and identify best cutoffs for identification. We will examine agreement between parent- and expert-ratings to determine the validity of the measure in parents with and without experience of ASD. The ultimate goal of the project is to develop a low-cost, low-burden measure that can detect ASD risk in infancy. Such a measure has significant public health applications, including earlier diagnosis, longitudinal tracking of development to identify childre requiring evaluation, screening of large community-based samples, and monitoring of individual intervention progress.