Connecting the Dots: An RCT Integrating Standardized ASD Screening, High-Quality Treatment, and Long-Term Outcomes

连接点：整合标准化 ASD 筛查、高质量治疗和长期结果的随机对照试验

• 批准号: 9975220
• 负责人: Diana L Robins
• 金额: $ 224.11万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-07 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9975220
• 关键词: 2 year old; 4 year old; Academy; Address; Advisory Committees; Affect; Age; Age of Onset; American; Attitude; Behavior Therapy; Belief; California; Child; Childhood; Clinical; Cognition; Communities; Conflict (Psychology); Connecticut; Control Groups; Coupled; Data; Detection; Development; Diagnosis; Diagnostic; Early Diagnosis; Early Intervention; Early identification; Early treatment; Educational Intervention; Eligibility Determination; Enrollment; Ethics; Evaluation; Geographic Locations; Goals; Guidelines; Happiness; Health Services Accessibility; Heterogeneity; Individual; Institutes; Intervention; Knowledge; Literature; Longevity; Measures; Medical; Methods; Monitor; Outcome; Outcome Measure; Parent-Child Relations; Parents; Pediatrics; Personal Satisfaction; Physicians; Positioning Attribute; Preventive service; Process; Productivity; Publishing; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Research; Risk; Sampling; Science Policy; Screening procedure; Severities; Site; Social Functioning; Socioeconomic Status; Standardization; Stress; Symptoms; System; Testing; Toddler; Training; Universities; Work; autism spectrum disorder; autistic children; base; cognitive ability; cognitive function; disability; early onset; early screening; empowerment; evidence base; experience; experimental group; improved; improved outcome; intervention effect; kindergarten; primary outcome; satisfaction; screening; screening guidelines; secondary outcome; service delivery; social engagement; social reciprocity; societal costs; targeted treatment; treatment as usual; treatment response; trial design; visual tracking

A growing body of evidence demonstrates that younger age of onset for ASD treatment improves outcomes. Universal toddler screening for autism spectrum disorder (ASD) has been shown to lower the age of ASD diagnosis by two years compared to the national median; this in turn lowers the age of access to ASD-specific treatment. Yet on February 17, 2016, the US Preventive Services Task Force (USPSTF) published a final statement on autism screening in JAMA, in which they found insufficient evidence to recommend universal ASD screening. One of the primary gaps they identified was a lack of randomized controlled trials (RCTs) in which children detected through screening received treatment for ASD, with their outcomes compared to those of children not screened. The current proposal aims to fill this gap, connecting the dots between the screening and treatment literatures, and demonstrating that standardized, high-fidelity, universal screening lowers the age of diagnosis and treatment onset, leading to improved short- and long-term outcomes. The intervention in this RCT is supported deployment of such screening, with immediate evaluation of at-risk children, compared to a control group receiving usual care approaches to early detection of ASD, namely physician surveillance and/or unstandardized screening. In a sample of 8,000 toddlers enrolled through participating pediatric practices near Drexel University, the University of Connecticut, and the University of California Davis MIND Institute, we expect that cognitive functioning and ASD symptom severity will show greater improvements in the experimental group, in which most children will be detected at 18 m screening, compared to the control group, in which children are expected to be detected significantly later. In both groups, missed ASD cases will be detected through screening at 48 m. Across both groups, all children identified as at risk for ASD will receive a diagnostic evaluation, and all children diagnosed with ASD will be enrolled in one year of manualized early intensive behavioral treatment (EIBI). In addition to the primary outcome measures of cognition and symptom severity, exploratory outcomes will include group differences in adaptive functioning, kindergarten readiness, and social reciprocity as measured by experimental eye tracking and parent-child interaction ratings. We also will examine the impact of the screening intervention on physician attitudes and on parent empowerment and stress. Finally, we will examine potential moderators of group differences, to determine whether initial symptom severity, cognitive ability, or SES affects the expected superior response to treatment in the experimental group. Our Autism Centers of Excellence Network is uniquely positioned to carry out this study; our prior work demonstrates our extensive experience and productivity in the field of early screening and treatment in ASD. This study will be the first RCT of toddler ASD screening, and will use rigorous methods that have provided evidence for universal screening protocols in other medical fields. This study will have a significant impact on science, policy, and practice. By demonstrating that universal early screening leads to earlier treatment and better outcomes, this project will provide evidence for the benefits of universal ASD screening, including better social and cognitive functioning, mitigating lifespan disability, reducing societal costs, and improving personal well-being and productivity of individuals with ASD.

越来越多的证据表明，ASD治疗的发病年龄越小，预后越好。通用幼儿 自闭症谱系障碍（ASD）的筛查已被证明可以将ASD诊断的年龄降低两年， 全国中位数;这反过来又降低了获得ASD特定治疗的年龄。2016年2月17日，美国 预防服务工作组（USPSTF）在JAMA上发表了关于自闭症筛查的最终声明，他们发现 没有足够的证据来推荐普遍的ASD筛查。他们发现的主要差距之一是缺乏 随机对照试验（RCT）中，通过筛查发现的儿童接受了ASD治疗， 与未筛查儿童的结果相比。目前的提案旨在填补这一空白，将点连接起来 筛选和治疗文献之间的差异，并证明标准化，高保真，通用 筛查降低了诊断和治疗开始的年龄，从而改善了短期和长期结果。的 这项随机对照试验的干预措施是支持部署这种筛查，并立即评估高危儿童， 对照组接受常规护理方法以早期检测ASD，即医生监测和/或 不规范的筛查在德雷塞尔附近参加儿科实践的8,000名幼儿中， 在美国康涅狄格大学和加州戴维斯大学心理研究所的研究中，我们预计， 功能和ASD症状的严重程度将在实验组中显示出更大的改善，其中大多数儿童 将在18 m筛查时检测到，与对照组相比， 后在两组中，将通过48个月时的筛查检测到漏诊的ASD病例。在这两组中，所有被确认为 有ASD风险的儿童将接受诊断评估，所有被诊断患有ASD的儿童将在一年内登记， 早期强化行为治疗（EIBI）除了主要的认知和 症状严重程度，探索性结果将包括适应功能，幼儿园准备， 通过实验性眼动追踪和亲子互动评级测量的社会互惠。我们还将研究 筛查干预对医生态度和父母赋权及压力的影响。最后，我们将研究 组间差异的潜在调节因子，以确定初始症状严重程度、认知能力或SES是否影响 预期实验组对治疗的反应上级。我们的自闭症卓越中心网络是独一无二的 定位进行这项研究;我们以前的工作证明了我们在早期领域的丰富经验和生产力 ASD的筛查和治疗。这项研究将是第一个儿童ASD筛查的随机对照试验，并将使用严格的方法 为其他医学领域的通用筛查方案提供了证据。这项研究将产生重大影响 关于科学、政策和实践。通过证明普遍的早期筛查可以更早地治疗， 结果，该项目将提供证据证明普遍ASD筛查的好处，包括更好的社会和 认知功能，减轻终身残疾，降低社会成本，改善个人福祉， ASD患者的生产力。