Pilot Study to Improve Access to Early Intervention for Autism in Africa

改善非洲自闭症早期干预的试点研究

• 批准号: 8959281
• 负责人: Lauren Franz
• 金额: $ 18.36万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-07 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8959281
• 关键词: Adaptive Behaviors; Address; Africa; Africa South of the Sahara; African; Autistic Disorder; Award; Caregiver Burden; Caregivers; Caring; Child; Child Language; Child Mental Health; Child Psychiatry; Childhood; Clinical; Clinical Research; Cognitive; Collaborations; Communication; Communities; Country; Data; Development; Disease; Early Intervention; Educational Intervention; Effectiveness of Interventions; Evidence based intervention; Family; Foundations; Goals; Health Priorities; Healthcare; Improve Access; Income; Individual; Institutes; Intervention; Intervention Studies; Intervention Trial; K-Series Research Career Programs; Language; Learning; Letters; Life; Location; Low Literacy Population; Low income; Manuals; Mediating; Mental Health; Mentors; Mentorship; Methods; Mind; Modeling; Modification; National Institute of Mental Health; Neurodevelopmental Disorder; Nursery Schools; Outcome; Parent-Child Relations; Parents; Performance; Pilot Projects; Procedures; Protocols documentation; Quality of life; Research; Research Ethics; Research Infrastructure; Research Personnel; Resources; Services; Severities; Staging; Strategic Planning; Structure; Symptoms; Time; Training; Training Support; Universities; Work; aged; autism spectrum disorder; base; burden of illness; career; community setting; cost; cost effective; developmental disease; effective intervention; evidence base; experience; global health; implementation science; improved; innovation; intervention program; language comprehension; neuropsychiatry; programs; public health relevance; social; success

 DESCRIPTION (provided by applicant): A significant global challenge is to develop scalable, feasible, early interventions for autism spectrum disorders (ASD) that can be implemented in diverse and low resource communities. There is growing excitement around innovative caregiver-mediated early intervention strategies, for example the Parent Early Start Denver Model (P-ESDM) co-developed by Dr. Geraldine Dawson, my primary advisor on this application. Caregiver-mediated interventions have been shown to improve parent-child interactions and child language comprehension, and reduce the severity of ASD. Importantly, engagement of caregivers promises new ways to address the capacity barrier globally. My planned research career trajectory is to become a leader in the development and implementation of caregiver-mediated interventions for ASD and other childhood neuropsychiatric disorders in diverse and low resource communities. The highly structured mentorship and training plan outlined in this proposal would set the foundation for achieving this goal. Importantly, this work is closely aligned with 2 of the top Grand Challenges in Global Mental Health priorities: 1) to reduce the duration of untreated illness by developing culturally-sensitive early interventions, and 2) to improve child access to evidence-based mental health care (11). In addition, this work aligns with an objective of the Federal Interagency Autism Coordinating Committee Strategic Plan: to support community-based studies that assess the effectiveness of interventions and services in broader community settings including scalable early intervention programs for implementation in underserved, low-resource, and low-literacy populations (12). I plan to: 1) train in implementation science and community participatory research, 2) train in clinical research and research ethics, and 3) obtain hands-on experience by conducting an ASD intervention trial using a culturally adapted version of the original evidence-based intervention in a low resource African setting. I have brought together an outstanding team of advisors with expertise in ASD (Dr. Dawson (Duke), Dr. de Vries (University of Cape Town), Dr. Rogers (UC Davis Mind Institute)), global health (Dr. de Vries, Dr. Sikkema (Duke)), child psychiatry (Dr. Egger (Duke), Dr. de Vries), intervention research (Dr. Dawson, Dr. Rogers, Dr. Sikkema), and community participatory research (Dr. Sikkema). Working in collaboration with the Center for Autism Research in Africa, I propose to adapt the Parent Early Start Denver Model (P-ESDM) treatment manual, and training approach, and conduct a pilot study to explore the acceptability, feasibility, and impact of this adapted intervention on child and caregiver outcomes in an African setting. In addition, I will capitalize on existing research infrastructure supported by the NIMH through the University of Cape Town AFFIRM Hub (see Lund letter of support). The foundational mentorship, training and experience gained through this award will set the stage for a career focused on enhancing the quality of life for children wih neurodevelopmental disorders and equip me with the skillset to become an independent clinical researcher.

 描述（由申请人提供）：一项重大的全球挑战是开发可扩展的、可行的、可在多样化和资源匮乏的社区实施的自闭症谱系障碍 (ASD) 早期干预措施。人们对护理人员介导的创新性早期干预策略越来越感兴趣，例如由我在该应用程序上的主要顾问杰拉尔丁·道森 (Geraldine Dawson) 博士共同开发的家长早期启动丹佛模型 (P-ESDM)。护理人员介导的干预措施已被证明可以改善亲子互动和儿童语言理解，并减轻自闭症谱系障碍的严重程度。重要的是，护理人员的参与带来了解决全球能力障碍的新方法。我计划的研究职业轨迹是成为在多元化和资源匮乏的社区中开发和实施针对自闭症谱系障碍和其他儿童神经精神疾病的护理人员介导干预措施的领导者。该提案中概述的高度结构化的指导和培训计划将为实现这一目标奠定基础。重要的是，这项工作与全球心理健康优先事项中的两个重大挑战密切相关：1）通过制定文化敏感的早期干预措施来减少未经治疗的疾病的持续时间，2）改善儿童获得循证心理卫生保健的机会（11）。此外，这项工作符合联邦机构间自闭症协调委员会战略计划的目标：支持基于社区的研究，评估更广泛社区环境中干预措施和服务的有效性，包括在服务不足、资源匮乏和识字率低的人群中实施可扩展的早期干预计划（12）。我计划：1）接受实施科学和社区参与性研究方面的培训，2）接受临床研究和研究伦理方面的培训，3）通过在资源匮乏的非洲环境中使用原始循证干预措施的文化适应版本进行 ASD 干预试验来获得实践经验。我聚集了一支优秀的顾问团队，他们在自闭症谱系障碍（Dawson 博士（杜克大学）、de Vries 博士（开普敦大学）、Rogers 博士（加州大学戴维斯分校心灵研究所））、全球健康（de Vries 博士、Sikkema 博士（杜克大学））、儿童精神病学（Egger 博士（杜克大学）、de Vries 博士）、干预研究（Dawson 博士、Rogers 博士、Dr. Sikkema）和社区 参与式研究（Sikkema 博士）。我与非洲自闭症研究中心合作，建议调整家长早期开始丹佛模式 (P-ESDM) 治疗手册和培训方法，并进行一项试点研究，以探讨这种调整后的干预措施对非洲儿童和护理人员结果的可接受性、可行性和影响。此外，我将利用 NIMH 通过开普敦大学 AFFIRM 中心支持的现有研究基础设施（参见隆德支持信）。通过该奖项获得的基础指导、培训和经验将为我的职业生涯奠定基础，重点是提高患有神经发育障碍的儿童的生活质量，并使我具备成为一名独立临床研究员的技能。