Parenting Your Young Child with Autism: A Web-Based Tutorial

描述（由申请人提供）：自闭症是一种神经发育障碍，其特征是社会互惠、语言和非语言交流以及行为方面的缺陷。它是所有发育性残疾中最普遍的一种，估计患病率为110分之一。早期发现和干预已被证明可以改善长期结果，包括语言功能、认知/发展技能、社会和适应行为，防止早期缺陷对后期功能造成的一连串影响。从公共卫生的角度来看，早期干预也可能最终减少可观的终生成本和服务系统需求。不幸的是，我们对有效干预策略的了解与这些资源的可用性之间存在差距，部分原因是在这些干预措施方面受过培训的专业人员严重短缺。弥补这一差距的一种方法是教父母如何在与孩子的日常互动中使用这些技术。学习与自闭症儿童互动的有效方法对于改善儿童的长期结果至关重要，因为这可以弥补与自闭症相关的核心缺陷，同时也可以减轻照顾者的压力。最近开发的一个这样的项目（“增强互动”）为照顾3岁以下自闭症儿童的人提供个性化指导。该项目由12个环节组成，具有改善互动和育儿效果的双重目标，同时改善儿童的核心缺陷和长期结果。基于经验验证的技术，这些课程的独特之处在于临床医生到孩子的家中实时观察问题行为，并与孩子一起模拟不同的教学策略，并在父母自己实施策略时指导他们。虽然该计划非常成功，但由于缺乏训练有素的临床医生提供此类服务，它为需要帮助的人提供帮助的能力受到限制。增加该计划可访问性的一种方法是使用基于网络的技术。在第一阶段，我们为照顾自闭症儿童的人开发了一个基于网络的互动教程原型，旨在a)教父母如何促进孩子在核心缺陷领域的发展，b)帮助父母理解和改善孩子可能表现出的具有挑战性的行为，以及c)通过更有效的互动减少照顾者的压力。它强调日常情况是学习的机会，包括常见的家庭惯例和社区活动，并包含以研究为基础的干预设置中教授的技术的录像带插图（建模）。第一阶段的原型机论证了可行性和用户满意度。第二阶段将开发完整的教程，并在100名来自早期干预和学校干预项目、美国军人家庭干预项目、自闭症诊所和直接招募家长的不同样本中评估其效果。

DESCRIPTION (provided by applicant): Autism is a neurodevelopmental disorder characterized by deficits in social reciprocity, verbal and nonverbal communication, and behavior. It is among the most prevalent of all developmental disabilities, with an estimated prevalence of 1 in 110. Early detection and intervention has been shown to improve long-term outcomes, including language functioning, cognitive/developmental skills, and social and adaptive behavior, preventing a cascade of effects that result from early deficits impacting later functioning. From a public health perspective, early intervention may also ultimately reduce the considerable lifetime cost and service system demands. Unfortunately, there is a gap between our knowledge of effective intervention strategies and the availability of these resources, due in part to a critical shortage of professionals trained in these interventions. One way to bridge this gap is to teach parents how to utilize these techniques in their daily interactions with their children. Learning effective ways of interacting with a child with autism is critical both for improving long term outcomes for the child in terms of remediation of the core deficits associated with the disorder, as well as reducing the stress on the caregiver. One such program recently developed ("Enhancing Interactions") provides individualized instruction to caregivers with children under 3 years old with autism. The program consists of 12 sessions and has the dual goals of improving interactions and parenting effectiveness while at the same time improving the core deficits and long term outcomes in the child. Based on empirically validated techniques, the sessions are unique in that the clinicians go the child's home to observe problematic behaviors in real time, and model in vivo different teaching strategies with the child and coach the parents as they implement the strategies themselves. While the program has been highly successful, its ability to provide help to those needing it is limited due to the lack of trained clinicians to provide such services. One way to increase the accessibility to this program is through the use of web-based technologies. In phase I we developed a prototype of a web-based interactive tutorial for caregivers of young children with autism designed to a) teach parents how to promote their child's development in the core deficit areas, b) help parents understand and improve challenging behaviors their child may demonstrate, and c) reduce caregiver stress through more effective interactions. It emphasizes everyday situations as opportunities for learning, including common home routines and community activities and contains videotaped illustrations (modeling) of the techniques taught in research-based intervention settings. Both feasibility and user satisfaction was demonstrated with the Phase I prototype. Phase II will develop the complete tutorial and evaluate its efficacy in a diverse sample of 100 parents recruited from early intervention and school based intervention programs, U.S. Military Family Intervention programs, autism clinics, and direct to parent recruitment.