Efficacy of Parent-implemented Treatment in Infant Siblings of Children With ASD

描述(由申请人提供)：预防或减轻社交和语言交流障碍高危儿童(例如，患有自闭症谱系障碍儿童的年幼兄弟姐妹，SIBS-ASD)的严重程度的一种方法是在大脑仍在发育的年龄(即婴儿期)对他们进行治疗。目前的筛查方法过度识别哪些SIBS-ASD需要昂贵的治疗。“渐进式治疗方法”(1)对所有风险组成员使用具有成本效益的治疗，(2)确定那些在具有成本效益的治疗后在重要技能上没有改变的人(即，无应答者)，以及(3)为无应答者提供更密集(和昂贵)的治疗。该项目将涉及增量治疗方法的前两个步骤。实施前两个步骤可以避免对高危婴儿亚群进行昂贵的治疗，这些婴儿可能会在没有密集和昂贵的干预的情况下得到改善。一种可以让我们完成第二步的经济有效的治疗方法是针对特定的儿童能力，这些能力可以促进沟通发展(即关键技能)。此外，确定哪些特征最有可能从需要更密集干预的同胞自闭症患者的成本效益治疗中受益，这将促进今后有效和高效地实施渐进治疗方法，以解决社会和语言障碍问题。最后，评估经济有效的治疗改善语言延迟和ASD症状的机制将有助于我们更好地理解社会环境如何影响SIBS-ASD的发展轨迹。在两个地点(华盛顿大学，西雅图；范德比尔特大学，纳什维尔)招募的120名自闭症同胞(12-15个月)样本中，该项目将实现以下目标：(A)测试一种成本效益高的治疗方法的有效性，该疗法有望治疗自闭症患者的社会和语言障碍(IMPACT)；(B)确定受益最大的亚群的特征；(C)评估关键技能的改进是否对更远端的口语技能和自闭症症状学产生预期的影响；(D)确定治疗改善关键技能的有效成分。治疗效果目标将通过对包括ASD在内的沟通障碍的初始累积风险状态的SIBS-ASD进行分层，然后随机分配到治疗组或对照组。治疗将由家长在研究人员的监督下进行，为期3个月。治疗后立即进行评估，随后将进行3个月和6个月的后续评估。考官和编码员将对治疗任务视而不见。将进行意向治疗分析。将使用最先进的统计方法来确定与冲击反应有关的特征，并测试治疗的关键技能和有效成分是否调节治疗效果。研究团队在方法方面经验丰富，并有卓有成效的合作历史。

DESCRIPTION (provided by applicant): One way to prevent or reduce the severity of social and linguistic communication disorders in children at high risk for these disorders (e.g., younger siblings of children with autism spectrum disorders, Sibs-ASD) is to treat them at an age when the brain is still developing (i.e., infancy). Current screening methods over-identify which Sibs-ASD need expensive treatments. An "Incremental Treatment Approach" (1) uses a cost-effective treatment with all risk group members, (2) identifies those who do not change on important skills after cost- effective treatment (i.e., nonresponders), and (3) provides nonresponders with a more intensive (and expensive) treatment. This project will address the first two steps of the Incremental Treatment Approach. Implementing the first two steps may avoid costly treatment of a subgroup of at-risk infants who may improve without intensive and expensive intervention. One type of cost-effective treatment that may allow us to accomplish the 2nd step targets specific child abilities that promote communicative development (i.e., pivotal skills). Furthermore, identifying the characteristics that distinguish Sibs-ASD most likely to benefit from the cost-effective treatment from Sibs-ASD who will require more intensive intervention will promote effective and efficient implementation of the Incremental Treatment Approach to address social and linguistic disorders in the future. Finally, evaluating the mechanisms by which the cost-effective treatment ameliorates language delay and ASD symptomatology will improve our understanding of how the social environment can affect the developmental trajectories of Sibs-ASD. In a sample of 120 Sibs-ASD (12-15 mos), recruited at two sites (University of Washington, Seattle; Vanderbilt University, Nashville), this project will accomplish the following goals: (a) test the efficacy of a cost-effective treatment that shows promise for treatment of social and linguistic impairments in Sibs-ASD (ImPACT); (b) identify characteristics of the subgroup most benefiting from ImPACT; (c) evaluate whether improvements in pivotal skills produce anticipated effects on more distal spoken language skills and ASD symptomatology; (d) identify the active ingredients in ImPACT by which the treatment improves pivotal skills. Treatment efficacy goals will be addressed by stratifying Sibs-ASD on initial cumulative-risk status for communication disorder, including ASD, and then randomly assigning them to treatment or control groups. Treatment will be provided by parents under the supervision of research staff for 3 months. Immediate post-treatment evaluations will be followed by 3 month and 6 month follow-up assessments. Examiners and coders will be blind to treatment assignment. Intent to treat analyses will be conducted. State-of-the-art statistical methods will be used to identify the characteristics associated with response to ImPACT and to test whether pivotal skills and active ingredients of the treatment mediate treatment effects. The research team is experienced with the methods and has a productive collaborative history.