1/2-Effects of Parent-Implemented Intervention for Toddlers with Autism Spectrum

描述（由申请人提供）：以前的研究表明，早期干预可能有助于自闭症的更好结果。回答“多早？“对自闭症谱系障碍（ASD）筛查年龄和ASD儿童早期干预年龄具有重要的健康和教育意义。随着越来越多的幼儿被确定患有ASD，迫切需要基于证据的手动干预，这些干预可以由父母在自然环境中获得并实施。这个项目是与两个相同的，由艾米·韦瑟比博士在FSU和博士提交的链接应用程序合作。主要目标是直接比较两种家长干预条件，每种干预条件持续9个月：1）每周2-3次的个性化家长实施干预（PII），教导家长如何在日常生活，活动和场所中每周25小时嵌入支持社交技能的策略; 2）每月两次的信息，教育和支持小组（IES）。每个研究中心将招募36名18月龄的新父母-子女二人组，这些二人组将与招募用于正在进行的初步研究的18名二人组合并，每个研究中心共54名二人组，随机分配至PII或IES作为第一个条件。使用交叉设计，所有二对儿也将在27个月大时开始接受其他条件，总共18个月的干预。本研究的具体目的是：1）比较PII和IES在27个月时的有效性; 2）比较PII和IES组合在36个月时的有效性。从18至36个月的年龄，每两个月收集一次社会沟通和自闭症症状的结果测量值，并在18个月的治疗前、27个月的交叉点和36个月的第二次治疗条件后收集发育水平和适应行为的测量值。将对108对组合样本使用分层线性模型，以估计结局指标的生长曲线，并检查不同治疗条件下和不同年龄开始强化治疗时儿童生长轨迹的差异。这项研究的结果将：1）记录接受手动，以社区为基础，具有成本效益，适当和有效干预的ASD幼儿的改善结果; 2）证实从18个月开始的强化干预比在生命的第三年进行干预的结果更好，提供证据表明自闭症筛查对有效的早期干预至关重要。

DESCRIPTION (provided by applicant): Previous research has suggested that earlier intervention may contribute to better outcomes in autism. Answering the question "how early?" has significant health and educational implications for age of screening for autism spectrum disorders (ASD) and age of entry into early intervention for children with ASD. With the increased number of young children identified with ASD, there is a pressing need for evidence-based, manualized intervention that is accessible to and implemented by parents within their natural environments. This project is collaborative with two identical, linked applications submitted by Dr. Amy Wetherby at FSU and Dr. Catherine Lord at UM. The major objective is to directly compare two parent intervention conditions for 9 months each: 1) an individualized parent-implemented intervention (PII) offered in 2-3 weekly sessions to teach parents how to embed strategies to support social communication skills for 25 hours a week within everyday routines, activities, and places; and 2) an information, education and support group (IES) offered twice monthly. Each site will recruit 36 new parent-child dyads at 18 months of age, who will be pooled with 18 dyads recruited for a preliminary ongoing study, totaling 54 dyads at each site, randomly assigned to either PII or IES as the first condition. Using a crossover design, all dyads will also receive the other condition beginning at 27 months of age, totaling 18 months of intervention. The specific aims of this investigation are: 1) to compare the effectiveness of PII and IES at 27 months; and 2) to compare the effectiveness of the combination of PII and IES at 36 months. Outcome measures of social communication and autism symptoms will be gathered bi-monthly from 18 to 36 months of age and measures of developmental levels and adaptive behavior will be gathered before treatment at 18 months of age, at the point of crossover at 27 months, and after the 2nd treatment condition at 36 months. Hierarchical linear modeling will be used on the combined sample of 108 dyads to estimate growth curves of the outcome measures and to examine differences in growth trajectories for children during the different treatment conditions and starting intensive treatment at different ages. The findings of this study will: 1) document improved outcomes for very young children with ASD receiving a manualized, community-based, cost efficient, appropriate, and effective intervention; and 2) substantiate that intensive intervention beginning by 18 months of age leads to better outcomes than intervention in the third year of life, providing evidence that autism screening for toddlers is crucial to effective early intervention.