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

 描述（由申请人提供）：一个重大的全球挑战是为自闭症谱系障碍（ASD）开发可扩展的，可行的早期干预措施，这些干预措施可以在多样化和低资源社区实施。人们对创新的丹佛介导的早期干预策略越来越感兴趣，例如由Geraldine Dawson博士共同开发的父母早期启动丹佛模型（P-ESDM），我在这个应用程序中的主要顾问。看护者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，并降低ASD的严重程度。重要的是，照顾者的参与有望为解决全球能力障碍提供新的途径。我计划的研究生涯轨迹是成为开发和实施自闭症和其他儿童神经精神疾病在不同的和低资源社区的干预措施的领导者。本建议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，这项工作与全球精神卫生优先事项中的两个重大挑战密切相关：1）通过制定对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）改善儿童获得循证精神卫生保健的机会。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：支持以社区为基础的研究，评估干预措施和服务在更广泛的社区环境中的有效性，包括可扩展的早期干预计划，用于在服务不足，低资源和低识字率的人群中实施（12）。我计划：1）培训实施科学和社区参与性研究，2）培训临床研究和研究伦理学，3）通过在低资源非洲环境中使用原始循证干预的文化适应版本进行ASD干预试验获得实践经验。我召集了一个优秀的顾问团队，他们在ASD方面具有专业知识，（道森博士（杜克）、德弗里斯博士（开普敦大学），罗杰斯博士（加州大学戴维斯分校心理研究所），全球健康（德弗里斯博士，西克马博士（杜克）），儿童精神病学（Egger博士（杜克）、de弗里斯博士）、干预研究（Dawson博士、Rogers博士、Sikkema博士）和社区参与研究（Sikkema博士）。与非洲自闭症研究中心合作，我建议调整父母早期启动丹佛模型（P-ESDM）治疗手册和培训方法，并进行试点研究，以探讨可接受性，可行性，以及这种适应性干预对非洲儿童和照顾者结果的影响。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（见隆德支持信）。通过该奖项获得的基础指导，培训和经验将为专注于提高神经发育障碍儿童生活质量的职业生涯奠定基础，并使我具备成为独立临床研究人员的技能。

 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.