Preventive Dyadic Intervention to Enhance Communication Development in At-Risk Infants

预防性二元干预促进高危婴儿的沟通发展

• 批准号: 9386577
• 负责人: Rebecca Jean Landa
• 金额: $ 20.2万
• 依托单位: HUGO W. MOSER RES INST KENNEDY KRIEGER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9386577
• 关键词: Academic achievement; Achievement; Address; Adult; Affect; Age; Attenuated; Autistic Disorder; Behavior; Behavior Therapy; Behavioral; Caregiver support; Caregivers; Child; Child Development; Code; Communication; Communication impairment; Development; Developmental Disabilities; Developmental Process; Diagnosis; Disease; Dose; Elements; Ensure; Exhibits; Foundational Skills; Gestures; Goals; High Prevalence; Home environment; Infant; Intervention; Intervention Studies; Joints; Language; Learning; Life; Linguistics; Measurement; Measures; Mediating; Mediator of activation protein; Motor; Neuronal Plasticity; Outcome; Participant; Phonation; Play; Preventive; Preventive Intervention; Production; Program Appropriateness; Publishing; Randomized; Randomized Controlled Trials; Readiness; Research; Research Personnel; Risk; Schools; Science; Structure; Telephone; Testing; Time; Toddler; Toy; Training; United States; autism spectrum disorder; caregiver education; caregiver interventions; cognitive load; design; dynamic system; exoskeleton; experience; experimental study; follow-up; high risk; infancy; infant outcome; innovation; intervention effect; language comprehension; novel; post intervention; prevent; public health priorities; scaffold; skills; social; social communication; successful intervention; theories; therapy design; treatment response; vocalization

Project Summary In the United States, 1 in 13 children are affected by a communication disorder. While behavioral indicators of communication, language, and associated disorders can be observed in the first year of life, diagnosis often cannot be made until after the second or third year. By that point, developmental trajectories may have begun to diverge off course with lifelong, cascading consequences. There is a need for interventions that may be implemented in infancy, a time of enhanced neuroplasticity and emerging foundational skills, in order to prevent full manifestation or exacerbation of communication delays and to promote healthy communication development. Although short-term experimental interventions have positively impacted skills in infant communication (including social, nonverbal, and verbal components), real-world enrichment programs appropriate for infants and tailored for communication development are not available. Successful interventions targeting communication delay and disorder implemented in the second year and beyond cannot be presumed to be appropriate for use in infancy. Thus, we propose a novel communication-targeted preventive intervention, Infant Achievements (IA), for infants at high risk for communication delays. Specific aims are to: (1) assess effects of the IA intervention on caregiver's implementation of targeted child development-enhancing strategies; (2) assess effects of the IA intervention on child communication development; and (3) examine the relation between caregiver fidelity and child outcomes. Participants will be randomized to one of two 8-week in- home treatment conditions: IA (with twice-weekly caregiver coaching) or Caregiver Education (CE) comparison condition (no caregiver coaching). The short-term intervention period is intended to enhance intervention efficiency and permit examination of specific mechanisms of change. Caregivers in the IA group will be trained in the use of communication-supporting strategies adapted from naturalistic developmental behavioral interventions, implemented during joint-action routines supported by the use of innovative strategically- designed toy bundles and user guides. These toy bundles provide the exostructure for the intervention, easing caregiver learning demands and promoting generalization. Caregivers in the CE group will receive weekly in- home Child Development Tutorials plus weekly phone follow-up and toys differing from IA toy bundles. Rigor is attained via a randomized controlled trial (RCT), strong counterfactual, use of targeted and valid measures, fidelity measures, blinding of examiners and coders, and focus on targeted outcomes using dense observation of child and caregiver behaviors. Caregiver and infant outcomes will be assessed pre- and post-intervention, at a 2-month follow-up, and during the intervention. Long-term goals include refining the IA intervention, as needed, examining its efficacy for infants and caregivers in a larger RCT, and examining mediators of treatment response in caregivers and infants.

项目摘要 在美国，每13名儿童中就有1名患有沟通障碍。虽然行为指标 沟通，语言和相关疾病可以在生命的第一年观察到，诊断通常 直到第二年或第三年之后才能进行。到那时，发展轨迹可能已经开始 偏离轨道并带来终身的连锁反应有必要采取干预措施， 在婴儿期实施，这是一个增强神经可塑性和新兴基础技能的时期， 防止通信延迟的充分表现或恶化，并促进健康的通信 发展虽然短期的实验性干预对婴儿的技能有积极的影响， 沟通（包括社会，非语言和语言成分），现实世界的丰富计划 适合于婴儿和适合于沟通发展的产品不可用。成功干预措施 不能假定在第二年及以后实施的针对通信延迟和混乱的措施 适合在婴儿期使用。因此，我们提出了一种新的以沟通为目标的预防性干预措施， 婴儿成就（IA），针对沟通延迟风险高的婴儿。具体目标是：（1）评估 IA干预对照顾者实施有针对性的儿童发展促进措施的影响 （2）评估IA干预对儿童沟通发展的影响;（3）检查 照顾者忠诚度与儿童结局之间的关系。受试者将被随机分配至两个8周的治疗组之一- 家庭治疗条件：IA（每周两次护理人员指导）或护理人员教育（CE）比较 条件（无护理员指导）。短期干预期意在加强干预 效率，并允许审查具体的变化机制。IA组的护理人员将接受培训 在使用沟通支持策略适应自然发展的行为 干预措施，在联合行动程序中实施，并通过使用创新的战略手段加以支持， 设计的玩具包和用户指南。这些玩具束提供了用于干预的外部结构， 照顾者的学习需求和促进泛化。CE组的护理人员每周将接受- 主页儿童发展辅导加每周电话随访和不同于IA玩具捆绑的玩具。尸僵是 通过随机对照试验（RCT）、强反事实、使用有针对性的有效措施获得， 保真度测量，检查员和编码员的盲法，并使用密集观察关注目标结果 孩子和看护者的行为。将在干预前和干预后评估护理人员和婴儿结局， 2个月随访，以及干预期间。长期目标包括完善综合审计干预措施， 需要，在一个更大的RCT中检查其对婴儿和护理人员的疗效，并检查 照顾者和婴儿的治疗反应。