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的益处，以改善神经发育障碍患者的结局 自闭症谱系障碍（ASD）等疾病（NDD）需要广泛有效的早期筛查 和身份识别的做法。尽管几十年来一直在努力确定早期风险标志，但仍然存在重大差距。 从鉴定到治疗的过程中ASD患儿婴儿同胞的前瞻性纵向研究 已经提供了关键的见解，早期症状，复发率，和发展轨迹的风险 婴儿。然而，该领域仍然受到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有类似的家族遗传模式。 扩大早期风险研究范围的一个潜在途径是开发可靠有效的 远程保健评估工具。这将允许前瞻性的纵向调查的婴儿生活 超出大学研究地点的地理界限以及婴儿属于低发病率 高危人群。有支持性证据表明，远程保健方法对诊断 评估和父母介导的治疗自闭症幼儿。目前，没有有效和可靠的 通过远程保健对婴儿发育进行行为评估的工具。 该项目直接比较了一个有前途的远程保健评估工具，TEDI，黄金标准的实验室- 评估工具。TEDI利用父母指导模式，让父母和婴儿参与到一个 一组特定的半结构化交互，从中进行标准化测量和行为评级 可以被制造出来。该项目有两个目标，每个目标都侧重于测试信度，效度， 可接受性和临床效用的TEDI评估婴儿的发展在四个领域：1）社会 沟通; 2）ASD症状; 3）语言和非语言发展;以及4）影响和自我调节。我们 将利用现有的NIH支持的特征良好的婴儿队列， (R01 MH 121416，PI：米勒），将在6或9、12和18个月时在实验室进行评估。在当前 根据这项提议，我们将招募并评估其中110名婴儿（41名有ASD家族风险，41名有ADHD风险，28名有ADHD风险）。 两者的风险均较低）在实验室评估后一周内使用TEDI。建立TEDI作为一个 通过远程保健评估高危婴儿的可靠有效工具有可能显著增加 家庭获得专门评估的机会，并提高早期识别需要帮助的婴儿的能力， 服务它还将为今后开展筛查和干预试验奠定基础， 最终有助于增加获得高质量干预措施的机会，并改善发展成果， 更多得不到充分服务的ASD和其他NDD儿童。

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.