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，自闭症谱系障碍的发病年龄越小，治疗效果越好。通用蹒跚学步的孩子

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

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

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