Validation of the TEDI: A Telehealth Evaluation of Development for Infants.

项目摘要 最大限度地发挥早期干预对改善神经发育患者预后的益处 自闭症谱系障碍(ASD)等精神障碍(NDD)需要广泛而有效的早期筛查 和身份识别的做法。尽管几十年来一直在努力识别早期风险标记，但仍存在显著差距。 在从鉴定到治疗的过程中。自闭症患儿婴儿兄弟姐妹前瞻性纵向研究 对高危患者的早期症状、复发率和发展轨迹提供了关键的见解 婴儿。然而，这一领域仍然受到近乎完全专注于患有自闭症儿童的婴儿兄弟姐妹的限制， 尽管在其他神经发育和精神健康障碍中存在类似的家族遗传模式。 扩展早期风险研究范围的一个潜在途径是开发可靠和有效的 基于远程健康的评估工具。这将允许对生活在婴儿中的前瞻性纵向调查 超越大学研究地点的地理界限以及属于低发病率的婴儿 高危人群。有支持的证据表明远程医疗方法对诊断的有效性 儿童自闭症的评估和家长干预治疗。目前，还不存在有效和可靠的 通过远程保健对婴儿发育进行行为评估的工具。 该项目直接将有前景的远程健康评估工具TEDI与黄金标准实验室进行比较- 基于评估工具。TEDI采用家长辅导模式，让父母和婴儿参与到 对标准化测量和行为评级进行评分的一组特定的半结构化交互 是可以做到的。提出的项目有两个目标，每个目标都集中在测试信度、效度、 TEDI在四个领域评估婴儿发育的可接受性和临床应用：1)社会 沟通；2)自闭症症状；3)言语和非言语发展；4)情感和自我调节。我们 将利用美国国立卫生研究院支持的现有的具有良好特征的婴儿队列，这些婴儿具有丰富的发育风险 (R01 MH121416，PI：Miller)将在6个月或9个月、12个月和18个月时在实验室进行评估。在当前 建议，我们将招募和评估其中110名婴儿(41名有ASD家族风险的婴儿，41名有ADHD风险的婴儿，28名有ADHD风险的婴儿 两者的风险都很低)在实验室评估后一周内使用TEDI。建立TEDI作为一种 通过远程保健评估高危婴儿的可靠而有效的工具有可能显著增加 家庭获得专门评估的机会，并提高早期识别有需要的婴儿的能力 服务。它还将为未来进行筛查和干预试验的努力奠定基础，并可能 最终有助于增加获得高质量干预措施的机会，并改善 更多患有自闭症和其他新城疫的儿童没有得到足够的服务。

Project Summary Maximizing the benefits of early intervention for improving outcomes of individuals with neurodevelopmental disorders (NDD) such as autism spectrum disorder (ASD) requires widespread and efficacious early screening and identification practices. Despite decades of effort to identify early risk markers, there remain significant gaps in the identification-to-treatment pipeline. Prospective longitudinal studies of infant siblings of children with ASD have provided critical insights into the early symptoms, recurrence rate, and developmental trajectories of at-risk infants. However, the field remains limited by the near exclusive focus on infant siblings of children with ASD, despite similar patterns of familial inheritance within other neurodevelopmental and mental health disorders. One potential route to expanding the scope of early risk studies is the development of reliable and valid telehealth-based assessment tools. This would allow for prospective longitudinal investigation of infants living beyond the geographical bounds of University research sites as well as infants belonging to low incidence high-risk groups. There is supportive evidence for the efficacy of telehealth approaches for diagnostic evaluation and parent-mediated treatment for toddlers with ASD. Currently, there exist no valid and reliable tools for conducting behavioral assessments of infants' development via telehealth. This project directly compares a promising telehealth assessment tool, the TEDI, to gold-standard laboratory- based assessment tools. The TEDI utilizes a parent-coaching model to engage parents and infants in a specific set of semi-structured interactions from which standardized measures are scored and behavior ratings can be made. The proposed project has two aims, each of which focus on testing the reliability, validity, acceptability, and clinical utility of the TEDI for evaluating infants' development in four domains: 1) social communication; 2) ASD symptoms; 3) verbal and nonverbal development; and 4) affect and self-regulation. We will leverage an existing NIH-supported cohort of well-characterized infants enriched for developmental risk (R01 MH121416, PI: Miller) who will be assessed in the laboratory at 6 or 9, 12, and 18 months. In the current proposal, we will enroll and assess 110 of these infants (41 at familial risk for ASD, 41 at risk for ADHD, and 28 low risk for both) using the TEDI within a week of the laboratory assessments. Establishing the TEDI as a reliable and valid tool for assessing infants at-risk via telehealth has the potential to significantly increase families' access to specialized evaluations and increase the capacity for early identification of infants in need of services. It will also lay the groundwork for future efforts to conduct screening and intervention trials and may ultimately help to increase access to high-quality interventions and improve the developmental outcomes of many more underserved children with ASD and other NDD's.