BLOOM: Boosting Language Outcomes of Minimally Verbal Children with ASD

项目摘要 我们知识中的一个主要差距是如何最好地干预患有自闭症谱系障碍(ASD)的儿童 在他们的演讲制作方面进展缓慢。到4岁时，孩子们仍然只会说几个虚词 很可能在6-7岁的学龄前保持最低限度的语言能力。目前近30%的自闭症儿童 被归类为最低限度的言辞(不到20个虚词)，近50%的人继续具有重大意义 他们的语言发展滞后1。几个因素可能在演讲延迟中发挥作用，包括语言前 社交技能(例如，联合注意)和口腔运动障碍7，20，21。社交技巧， 特别是联合注意和请求技能，在患有自闭症的儿童中被延迟，并与他们的 后来的语言发展3、4、《茉莉花》(共同注意、象征性游戏、参与和调节) 干预措施专门针对这些技能，并显示出联合注意力的改善，以及后来的 语言8，11。然而，对于4岁时语言技能最差的孩子来说，提高社交技能 单靠这一点可能不足以改善演讲效果。另一种有希望的干预措施侧重于 具有直接语音提示功能的口述运动声音系统。此干预、提示(提示 重建口腔肌肉发音目标)是一种多维的口头-运动语音方法 生产混乱10.这种干预与贾斯珀的结合可能会对言语产生更大的影响 对于患有自闭症和语言输出最少的4岁和5岁儿童来说，结果比单独使用Jasper要好。因此， 拟议项目的首要目标是确定添加 口腔运动干预(PROMPT)到循证早期干预(Jasper)对言语结果的影响。 具体地说，主要目标是测试联合干预(Jasper+Prompt)是否会导致更大的 社会交际话语(SCU)(主要结果)比贾斯珀单独使用要好。SCU是不提示的， 为分享而指向社交伙伴的生成性(无脚本)言语表达 信息(评论)或提出请求。次要结果包括可理解性和小说数量 字里行间。次要目标侧重于幼儿园年龄的纵向结果，以及哪些儿童可能受益于 大多数来自这种新的干预，包括那些联合注意力更集中或口腔运动发育更好的人。 探索性目标涉及电生理生物标志物的改变与干预以及遗传学 发挥生物调节剂的作用，控制治疗效果。儿童参与者包括80名4-6岁的儿童 ASD和受限语言(&lt；20个功能词)。儿童被随机分配到Jasper或 Jasper+提示每周进行两次干预，为期12周，并进行12周的随访，再次进行一次- 一年后。这项研究有可能极大地改善患有癌症的儿童的沟通结果 ASD，并满足机构间自闭症协调理事会和NIDCD的高度优先需求。

PROJECT ABSTRACT A major gap in our knowledge is how best to intervene with children with autism spectrum disorder (ASD) who are progressing slowly in their speech production. By age 4, children who still only have a few functional words are very likely to remain minimally verbal by school age at 6-7 years. Currently nearly 30% of children with ASD are classified as minimally verbal (fewer than 20 functional words), and nearly 50% continue to have significant lags in their speech development1. Several factors likely play a role in speech delays including prelinguistic social communication skills (e.g., joint attention) and oral motor impairment 7,20,21. Social- communication skills, especially joint attention and requesting skills, are delayed in children with ASD, and have been linked to their later language development3,4. The JASPER (Joint Attention, Symbolic Play, Engagement & Regulation) intervention targets these skills specifically, and has shown improvement in joint attention, and later language8,11. However, for children with minimal speech skills at age 4, improving social-communication skills alone may not be enough to improve speech outcomes. An alternative and promising intervention focuses on the oral motor-sound system with direct prompting of speech. This intervention, PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is a multidimensional oral-motor approach to speech production disorders10. This intervention in combination with JASPER may have greater effect on speech outcomes than JASPER alone for 4 and 5 year- old children with ASD and minimal language production. Thus, the overarching goal of the proposed project is to determine whether there is additional benefit of adding an oral-motor intervention (PROMPT) to an evidence-based early intervention (JASPER) for speech outcomes. Specifically, the primary aim tests whether the combined intervention (JASPER + PROMPT) results in greater social communicative utterances (SCU) (primary outcome) than JASPER alone. SCUs are unprompted, generative (non-scripted) verbal utterances that are directed to a social partner for the purpose of sharing information (comment) or making a request. Secondary outcomes include intelligibility and number of novel words. Secondary aims focus on longitudinal outcome at kindergarten age, and which children might benefit the most from this novel intervention, including those with more joint attention or better oral motor development. Exploratory aims concern electrophysiological biomarkers of change with intervention and whether genetics play a role as a biological moderator of the effects of treatment. Child participants include 80 4-6 year-olds with ASD and limited language (<20 functional words). Children are randomized to JASPER or JASPER+PROMPT for a twice weekly intervention for 12 weeks, with 12 week follow up, and again one - year later. This study has the potential to dramatically improve communication outcomes for children with ASD, and addresses a high priority need of the Interagency Autism Coordinating Council and NIDCD.