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: 10205984
• 负责人: Diana L Robins
• 金额: $ 221.38万
• 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 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10205984
• 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; 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; individuals with autism spectrum disorder; 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治疗的发病年龄越早，结果越好。环球学步儿童 自闭症谱系障碍(ASD)筛查显示，与传统的自闭症谱系障碍筛查相比，自闭症谱系障碍(ASD)的诊断年龄降低了两年 全国中位数；这反过来又降低了获得针对自闭症的治疗的年龄。然而，在2016年2月17日，美国 预防服务工作组(USPSTF)在JAMA上发表了一份关于自闭症筛查的最终声明，他们在声明中发现 没有足够的证据建议进行全面的ASD筛查。他们发现的主要差距之一是缺乏 随机对照试验(RCT)，其中通过筛查发现的儿童接受ASD治疗，他们的 与未进行筛查的儿童的结果进行比较。目前的提案旨在填补这一空白，将这些点连接起来 在筛选和治疗文献之间，展示了标准化、高保真、通用性 筛查降低了诊断和治疗的开始年龄，从而改善了短期和长期结果。这个 这项随机对照试验的干预措施是支持部署这种筛查，与对高危儿童的即时评估进行比较 给接受ASD早期检测的常规护理方法的对照组，即医生监测和/或 筛查不规范。在德雷克塞尔附近参与儿科实践的8000名幼儿样本中 康涅狄格大学和加州大学戴维斯精神研究所，我们预计认知 试验组的功能和ASD症状严重程度将显示出更大的改善，其中大多数儿童 将在18米筛查时检测到，与对照组相比，在控制组中儿童预计会被显著检测到 后来。在两组中，漏诊的ASD病例将通过48米处的筛查而被发现。在两组中，所有确诊的儿童 AS有ASD风险的儿童将接受诊断评估，所有被诊断为ASD的儿童将在 早期强化行为治疗(EIBI)。除了认知和认知的主要结果衡量标准 症状严重程度、探索性结果将包括适应功能、幼儿园准备情况和 通过实验眼球跟踪和亲子互动评分来衡量社交互惠程度。我们还将研究 筛查干预对医生态度、父母赋权和压力的影响。最后，我们将检查 潜在的群体差异调节因素，以确定初始症状严重性、认知能力或SES是否影响 预期试验组对治疗有较好的反应。我们的孤独症卓越中心网络是独一无二的 我们之前的工作证明了我们在早期研究领域的丰富经验和生产力 房间隔缺损的筛查和治疗。这项研究将是儿童ASD筛查的第一次随机对照试验，并将使用严格的方法 这为其他医学领域的普遍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导致更早的治疗和更好的 结果，该项目将提供证据证明普遍的ASD筛查的好处，包括更好的社会和 认知功能，减轻寿命残疾，降低社会成本，改善个人福祉和 自闭症患者的生产力。

项目成果

Does Treatment Fidelity of the Early Start Denver Model Impact Skill Acquisition in Young Children with Autism?

• DOI: 10.1007/s10803-021-05371-4
• 发表时间: 2021-12
• 期刊: Journal of Autism and Developmental Disorders
• 影响因子: 3.9
• 作者: Ashley Zitter;Hezekiah Rinn;Ž. Szapuová;Vanessa M Avila-Pons;Kirsty L Coulter;Aubyn C. Stahmer;D. Robins;G. Vivanti

Connecting the Dots: a cluster-randomized clinical trial integrating standardized autism spectrum disorders screening, high-quality treatment, and long-term outcomes.

连接点：一项集群临床试验，整合了标准化的自闭症谱系筛查，高质量治疗和长期结局。

• DOI: 10.1186/s13063-021-05286-6
• 发表时间: 2021-05-02
• 期刊: Trials
• 影响因子: 2.5
• 作者: McClure LA;Lee NL;Sand K;Vivanti G;Fein D;Stahmer A;Robins DL
• 通讯作者: Robins DL

The Toddler Autism Symptom Inventory: Use in diagnostic evaluations of toddlers.

幼儿自闭症症状量表：用于幼儿的诊断评估。

• DOI: 10.1177/13623613211021699
• 发表时间: 2021-11
• 期刊: Autism : the international journal of research and practice
• 作者: Coulter KL;Barton ML;Boorstein H;Cordeaux C;Dumont-Mathieu T;Haisley L;Herlihy L;Jashar DT;Robins DL;Stone WL;Fein DA
• 通讯作者: Fein DA

The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children.

• DOI: 10.1002/aur.2536
• 发表时间: 2021-09
• 期刊: Autism research : official journal of the International Society for Autism Research
• 作者: Wieckowski AT;de Marchena A;Algur Y;Nichols L;Fernandes S;Thomas RP;McClure LA;Dufek S;Fein D;Adamson LB;Stahmer A;Robins DL
• 通讯作者: Robins DL

Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity.

受训者在自闭症评估过程中的初步诊断印象：特异性高，但敏感性低。

• DOI: 10.1002/aur.2933
• 发表时间: 2023
• 期刊: Autism research : official journal of the International Society for Autism Research
• 作者: deMarchena,Ashley;Wieckowski,AndreaTrubanova;Algur,Yasemin;Williams,LashaeN;Fernandes,Sherira;Thomas,RebeccaP;McClure,LeslieA;Dufek,Sarah;Fein,Deborah;Stahmer,AubynC;Robins,DianaL
• 通讯作者: Robins,DianaL