Pivotal Response Treatment for Infants at Risk for ASD: A Pilot Intervention

描述(由申请人提供)：拟议的项目旨在评估一种新的行为干预措施-婴幼儿时期关键反应治疗(ity-PRT)的可行性和可接受性，旨在提高自闭症谱系障碍儿童(ASD；SIBSASD)的婴儿兄弟姐妹的沟通和社交参与的频率。遗传学研究表明，SIBSASD面临各种发育挑战，患自闭症(Bailey，Phillips，&Rutter，1996)和其他社交、认知和语言障碍的风险显著增加(Bailey等人，1995；Bolton等人，1994)。鉴于遗传风险高，已开始对婴儿SIBSASD进行前瞻性研究，以阐明ASD的发育过程，并加强早期识别。新出现的研究表明，ASD的症状可能早在12个月大的时候就出现了(Rogers，2009)。虽然我们还不能将12个月大的儿童最终发展为自闭症与其他发育迟缓或暂时性问题的儿童区分开来，但根据他们的风险状况和临床表现，这些儿童需要进行干预。因此，未来的研究在 耶鲁大学儿童研究中心和全国各地的其他主要研究中心正在记录自闭症症状的早期出现，并确定哪些婴儿可能面临发育挑战，需要在12个月大的时候就转诊到临床服务。然而，目前对婴儿SIBSASD的经验支持的干预措施很少，这促使有必要为高危婴儿设计适合发育的干预措施。为了配合耶鲁儿童研究中心(PI：Katarzyna Chawarska)正在进行的婴儿SIBSASD前瞻性研究，我们将试行ITE-PRT，这是Pivotal Response Treatment(PRT)的向下延伸。PRT是一种经验性支持的针对自闭症儿童的干预措施，国家研究委员会(NRC)将其记录为ASD的10种综合干预模式之一(NRC，2001)。采用随机对照小组设计，30名在12-15个月大时表现出沟通和/或社交显著延迟的SIBSASD婴儿将被随机分配到在标准转诊到社区治疗(TAU)的基础上接受ITY-PRT，或者被分配只接受TAU。ITY-PRT将包括为期六个月的每周五个小时的家长教育(包括两个小时的集体家长教育和三个小时的个人课程)。结果将集中于这一计划的可行性和可接受性，包括出勤率的衡量标准，干预课程外干预程序的利用，以及家长的总体满意度。我们还将通过分析亲子互动调查期间儿童沟通的频率、儿童社交行为和父母对沟通的出价，以及从治疗前到治疗后以及跨治疗组和对照组的发展和社会行为标准化测量的变化，来评估ITY-PRT的初步效果。

DESCRIPTION (provided by applicant): The proposed project aims to evaluate the feasibility and acceptability of a novel behavioral intervention, Infant-Toddler Years Pivotal Response Treatment (ITY-PRT), designed to enhance the frequency of communication and social engagement in infant siblings of children with Autism Spectrum Disorders (ASD; SIBSASD). Genetic studies reveal that SIBSASD are at risk for a variety of developmental challenges, with a significantly increased risk for ASD (Bailey, Phillips, & Rutter, 1996) and other social, cognitive, and language difficulties (Bailey et al., 1995; Bolton et al., 1994). Given the high genetic risk, prospective studies of infant SIBSASD have beeninitiated in order to elucidate the developmental processes in ASD and enhance early identification. Emerging research indicates that symptoms of ASD may be present as early as 12 months of age (Rogers, 2009). While we are not yet able to differentiate children at 12 months of age who will ultimately develop ASD from those with other developmental delays or transient issues, these children warrant intervention based on their risk status and clinical presentation. Thus, prospective studies at the Yale Child Study and other major research centers around the country are documenting the early emergence of the symptoms of ASD and identifying infants who are likely to face developmental challenges and warrant referrals for clinical services as early as 12 months of age. However, there is currently a paucity of empirically-supported interventions available for infant SIBSASD, urging the need to design developmentally appropriate interventions for at-risk infants. In synergy with the ongoing prospective studies for infant SIBSASD at the Yale Child Study Center (PI: Katarzyna Chawarska), we will pilot ITY-PRT, a downward extension of Pivotal Response Treatment (PRT). PRT is an empirically supported intervention for children with ASD and is documented by the National Research Council (NRC) as one of 10 comprehensive intervention models for ASD (NRC, 2001). Utilizing a randomized-controlled group design, 30 infant SIBSASD who demonstrate significant delays in communication and/or social interaction at 12-15 months of age will be randomly assigned to receive either ITY-PRT in addition to a standard referral to community treatment, Treatment As Usual (TAU), or assigned to receive TAU only. ITY-PRT will consist of five hours/week of parent education (including two hours of group parent education, and three hours of individual sessions) over the course of six months. Outcomes will be focused on the feasibility and acceptability of this program, including measures of attendance, utilization of intervention procedures outside of intervention sessions, and overall parent satisfaction. We will also evaluate the preliminary efficacy of ITY-PRT by analyzing the frequency of child communication, child social interaction behaviors, and parental bids for communication during parent-child interaction probes, as well as changes in standardized measures of development and social behavior both from pre to post and across treatment and control groups.