Promoting Transactional Supports to Optimize Social Communication Outcomes for Infants and their Families

项目总结 这个治疗项目的首要目标是记录非常早期的交易支持的效果 父母可以通过两个阶段的学习来改变孩子的发展轨迹并优化他们的结果 序贯多分配随机试验(SMART)设计以开发适应性干预。全 Emory ACE中的父母-婴儿二人组将在6个月大时从250个高风险和低风险兄弟姐妹中邀请 并将在阶段1被随机分配给社交通信增长图表(SCGC)，该图表使用 创新的基于网络的技术，向父母传授早期社会沟通的里程碑和如何支持 儿童早期发育与日常护理比较SCGC对亲子关系的影响 反应能力和儿童发展轨迹。12岁时出现自闭症早期症状的儿童家庭 基于使用父母报告和观察测量的定制变量的年龄月份将被重新随机化 到第二阶段比较父母实施(P-I)条件下自然主义发展的有效性 基于早期社会互动模型的行为干预(NDBI)1对临床医生实施的(C-I) 根据12至21个月龄的混合模型建立NDBI条件。社会的结果衡量标准 沟通、自闭症症状、社会视觉参与、发展水平和适应行为将 从6到30个月龄，每6个月收集一次，以衡量治疗效果。父代的度量 交易性支持和儿童主动参与度将在9至30个月至 检查第一阶段和第二阶段条件下以及在21个月和30个月后的随访中的生长轨迹 干预。这项研究的预期影响将有以下重要影响：1)最大限度地 利用技术教所有父母如何支持他们的婴儿早期发展，以优化机会 如果他们的孩子没有达到发育里程碑，可以尽早学习和识别 需要干预；2)记录有ASD早期迹象的极小儿童接受治疗的改善结果 基于证据的手动NDBI干预，成本效益高，适用于基于社区的干预 实施；以及3)证实父母从6岁开始实施的这些适应性干预措施 几个月大的孩子会得到更好的结果，这提供了证据，表明及早发现自闭症对 改善发展成果。

PROJECT SUMMARY The overarching goal of this treatment project is to document the efficacy of very early transactional supports that parents can learn to change developmental trajectories and optimize outcomes of their child using a 2-stage sequential multiple assignment randomized trial (SMART) design to develop an adaptive intervention. All parent-infant dyads in the Emory ACE will be invited at 6 months of age from the pool of 250 high and low risk siblings and will be randomly assigned at Stage 1 to the Social Communication Growth Charts (SCGC) that uses an innovative web-based technology to teach parents early social communication milestones and how to support their child’s very early development or Usual Care to compare efficacy of the SCGC on parent contingent responsiveness and child developmental trajectories. Familes of children who show early signs of ASD at 12 months of age based on tailoring variables using parent report and observational measures will be re-randomized to Stage 2 to compare the efficacy of a parent-implemented (P-I) condition of a naturalistic developmental behavioral intervention (NDBI) based on the Early Social Interaction model1 to a clinician-implemented (C-I) condition NDBI based on a hybrid model from 12 to 21 months of age. Outcome measures of social communication, autism symptoms, social visual engagement, developmental level, and adaptive behavior will be gathered every 6 months from 6 to 30 months of age to measure treatment effects. Measures of parent transactional support and child active engagement will be collected quarterly from 9 to 30 months of age to examine growth trajectories during the Stage 1 and 2 conditions and at follow-up at 21 and 30 months after intervention. The expected impact of this study will have the following important implications: 1) maximize the use of technology to teach all parents how to support their infant’s development early to optimize opportunities for learning and recognize as early as possible if their child is not meeting developmental milestones and may need intervention; 2) document improved outcomes for very young children with early signs of ASD receiving a manualized, evidence-based NDBI intervention that is cost-efficient and feasible for community-based implementation; and 3) substantiate that these adaptive interventions implemented by parents beginning at 6 months of age lead to better child outcomes, providing evidence that very early detection of autism is crucial to improve developmental outcomes.