PETAL: Promoting Early Intervention Timing and Attention to Language

项目摘要 这项拟议的研究(Petal：促进早期干预时机和对语言的关注)旨在 在自闭症风险增加的婴儿中确定父母干预的时机 (Ila)(由于有一个患有自闭症的哥哥而有自闭症风险)在沟通和语言方面 在24个月时的结果。ILA婴儿可能经历语言延迟，约40%的婴儿有语言障碍的风险 ASD的延迟和/或延迟诊断。然而，对ILA婴儿的干预仍然很少见，目前没有 干预措施明确侧重于语言，或包括许多来自较低社会经济环境的婴儿 他们可能面临着更大的语言延迟风险。尽管人们对早期干预的热情很高 由于已知的大脑可塑性在生命的头几年，我们不知道什么时候或用什么措施 确定对尚未表现出自闭症或迟缓迹象的ILA婴儿是否适合进行干预。 拟议研究的首要目标是确定最合适的时机。 对ILA婴儿的干预(从9个月、12个月或15个月开始)，明确针对沟通和 语言。我们将使用一组基于大脑和行为的标记来确定变化的组合 在语言、行为和大脑测量中，可以预测24个月后语言表达的结果。140名婴儿 从6个月大开始，将在洛杉矶和波士顿两个地点参加，许多人来自 传统上被边缘化和小型化的家庭。所有父母都将接受婴儿发育监测 从6个月开始，然后使用四阶段、顺序多分配随机试验设计， 父母将在9个月、12个月或15个月时接受专门的语言辅导干预； 婴儿父母二人组在15个月大的时候接受指导。将招募不同的二元样本；评估 将在6个月、9个月、12个月、15个月、18个月和24个月时在家中发生，使用基于大脑的脑电测量，社交- 沟通，以及语言衡量标准。干预支持将由临床医生远程提供。这个 这项研究解决了关键问题，即早期干预在小学语言和中学语言上是否更好 支持语言发展的社交行为的结果(例如，联合参与， 发声、单词、对象播放)以及哪些措施将通知向干预的理想过渡 24个月时的语言结果。此外，使用Lena捕捉家庭语言环境，成人 考查字数和话轮对语言结果的调节作用。这样做的结果是 研究有可能确定何时(9vs12vs15)，以及基于哪些测量(大脑、语言或 他们的组合)，通过专门的父母中介的指导干预来增加父母的支持。

PROJECT ABSTRACT The proposed study (PETAL: Promoting Early intervention Timing and Attention to Language) aims to determine the timing of a parent mediated intervention among infants with Increased Likelihood for Autism (ILA) (at risk for autism by virtue of having an older sibling with autism) on communication and language outcomes at 24 months. ILA infants are likely to experience delays in language with ~ 40% at risk for language delay and/or later diagnosis of ASD. However, interventions for ILA infants remain rare and none of the current interventions explicitly focus on language or include many infants from lower socioeconomic circumstances who may be at even greater risk for language delays. Although enthusiasm is high for very early interventions due to known brain plasticity in the first years of life, we do not know WHEN or with WHAT MEASURES to determine if an intervention is appropriate for ILA infants who are not yet showing signs of autism or delay. The overarching goal of the proposed study is to determine the optimal timing of very early intervention for ILA infants (starting at 9, 12 or 15 months) that explicitly targets communication and language. We will use a battery of brain- and behavioral-based markers to identify the combination of change in language, behaviors and brain measures that predict expressive language outcomes at 24 months. 140 infants beginning at 6 months of age will participate at two sites, Los Angeles and Boston areas with many from traditionally marginalized and minoritized families. All parents will receive infant developmental monitoring beginning at 6 months, and then using a four-phase, sequential multiple assignment randomized trial design, parents will receive augmentation with a specialized language coaching intervention at 9, 12 or 15 months; all infant parent dyads receive coaching by 15 months. A diverse sample of dyads will be recruited; assessments will occur at home at 6-,9-,12-,15-, 18- and 24-months using brain-based EEG measures, social- communication, and language measures. Intervention support will be provided by clinicians remotely. The study addresses key questions of whether earlier intervention is better on primary language and secondary outcomes of social communication behaviors that support language development (e.g., joint engagement, vocalizations, words, object play) and which measures will inform the ideal transition to intervention on language outcomes at 24 months. Moreover, using LENA to capture the home language environment, adult word count and conversational turns will be examined for mediation on language outcome. Results of this study have potential for determining when (9 vs 12 vs 15), and based on which measures (brain, language, or their combination), to augment parental support with a specialized parent-mediated coaching intervention.