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

描述（由申请人提供）：先前的研究表明，早期干预可能有助于自闭症的更好结果。回答“多早？”这个问题对于自闭症谱系障碍（ASD）筛查的年龄和对ASD儿童进行早期干预的年龄具有重要的健康和教育意义。随着被确诊为ASD的幼儿数量的增加，迫切需要基于证据的、由父母在自然环境中可获得和实施的人工干预。该项目是由FSU的Amy Wetherby博士和UM的Catherine Lord博士提交的两份相同的、相互关联的申请共同完成的。主要目的是直接比较两种父母干预条件，每种情况为期9个月：1)一种个性化的父母实施干预（PII），每周提供2-3次，教父母如何在日常生活、活动和场所中嵌入策略，以支持每周25小时的社会沟通技能；2)信息、教育和支持小组（IES）每月提供两次。每个站点将招募36对18个月大的新父母-孩子，他们将与18对被招募进行初步研究的夫妇合并，每个站点总共54对夫妇，随机分配到PII或IES作为第一条件。采用交叉设计，所有二人组也将在27个月大时开始接受其他条件，总共进行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36个月时PII和IES联合治疗的疗效。社会沟通和自闭症症状的结果测量将在18到36个月期间每两个月收集一次发育水平和适应行为的测量将在18个月大的治疗前收集，在27个月的交叉点收集，在36个月的第二次治疗条件后收集。将对108对组合样本使用层次线性模型来估计结果测量的生长曲线，并检查不同治疗条件下儿童生长轨迹的差异以及在不同年龄开始强化治疗。本研究的结果将：1)证明，接受人工的、以社区为基础的、具有成本效益的、适当的和有效的干预后，非常年幼的ASD儿童的预后得到改善；2)证实从18个月大开始的强化干预比三岁时的干预效果更好，为幼儿自闭症筛查对有效的早期干预至关重要提供证据。

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.