Adaptive Interventions for Minimally Verbal Children with ASD in the Community

描述(由申请人提供)：估计有30%-40%患有自闭症谱系障碍(ASD)的学龄儿童在接受多年干预后仍保持最低限度的语言能力。这些儿童需要一种干预办法，同时(A)巩固治疗的早期成功，(B)在早期出现无反应迹象的情况下加强治疗，以便使所有儿童走上积极的长期道路。这项网络研究的总体目标是构建一种适应性干预，它利用两种有效的干预措施(JASP-EMT和CORE-DTT)，这两种干预措施依赖于不同的干预程序，并显示出优化ASD儿童独特的社交沟通和自发说话的数量的希望。JASP-EMT(联合注意、象征性游戏和增强环境教学)侧重于在自然发生的、由儿童主导的游戏活动中为共同参与创造一个环境。核心-DTT(针对核心特征的离散试验训练 ASD)强调教化的、成人主导的教学。本研究利用一种新的序贯多重分配随机试验来评估和构建最优适应性干预措施。儿童最初将随机接受6周的JASP-EMT或CORE-DTT(第一阶段治疗)。六周后，儿童将接受早期无反应/反应评估。早期应答者将被随机分为接受治疗师干预的第一阶段治疗或 治疗师加上家长培训。任何一种第一阶段治疗的早期无应答者都将接受JASP-EMT和CORE-DTT，试图最大化语言结果。儿童将在总共4个月的时间里每天在学校接受干预。结果评估将在4个月和8个月进行。在加州大学洛杉矶分校和密歇根大学SIStat参与的数据协调中心的支持下，这项研究将在洛杉矶、纳什维尔、纽约和罗切斯特四个地点招募192名患有自闭症的儿童。这项研究的具体目的是：a)确定哪种干预措施(JASP-EMT和CORE-DTT)在社会交际自发话语(SCU；这项研究的目的是：(A)通过测试(主要结果)和符号输入的联合参与程度(主要结果)、独特词汇的数量和对象游戏水平(次要结果)；b)确定增加父母训练成分是否在对JASP-EMT或CORE-DTT表现出积极早期反应的参与者中提供额外的好处；c)比较和对比四种预先指定的适应性干预措施在主要和次要结果方面的差异；以及d)确定特定干预的基线重复行为、基线对象兴趣和父母期望是否为适度的干预结果。这项研究有可能极大地改善患有自闭症的儿童的沟通结果，这些儿童的语言能力很低，并满足了机构间自闭症协调委员会(2011)的高度优先需求。有必要建立一个由经验丰富、具有互补专业知识的研究人员组成的网络，以解决这一未得到满足的优先事项。

DESCRIPTION (provided by applicant): An estimated 30-40% of school-aged children with an autism spectrum disorder (ASD) remain minimally verbal even after receiving years of interventions. These children require an intervention approach that simultaneously (a) consolidates early success in treatment and (b) intensifies treatment given signs of early non-response in order to place all children on a positive, long-term course. The overarching aim of this Network study is to construct an adaptive intervention that utilizes two efficacious interventions (JASP-EMT and CORE-DTT) that rely on distinct intervention procedures and that show promise for optimizing the number of unique socially communicative and spontaneously spoken words in minimally verbal children with ASD. JASP-EMT (Joint Attention, Symbolic Play and Enhanced Milieu Teaching) focuses on creating a context for joint engagement within naturally occurring, child-led play activities. CORE-DTT (discrete trial training for core features of ASD) emphasizes didactic, adult-led instruction. The study utilizes a novel sequential multiple assignment randomized trial to evaluate and construct an optimal adaptive intervention. Children will be initially randomized to six weeks of JASP-EMT or CORE-DTT (first-phase treatment). After six weeks, children will be assessed for early non/response. Early responders will be randomized to staying the course on first-phase treatment with therapist intervention or to therapist plus parent training. Early non-responders to either first- phase treatment will receive both JASP-EMT and CORE-DTT in an attempt to maximize language outcomes. Children will receive intervention daily at school for 4 months total. Outcome assessments will occur at 4 and 8 months. With support from a Data Coordinating Center involving SIStat at UCLA and University of Michigan, the study will enroll 192 children with ASD across four sites, Los Angeles, Nashville, New York and Rochester. The specific aims of the study are a) to determine which intervention (JASP-EMT vs. CORE-DTT) produces greater increases in socially communicative spontaneous utterances (SCU; primary outcome) and symbol- infused joint engagement, number of unique words, and object play level (secondary outcomes), b) to determine whether adding a parent training component provides additional benefit among participants who demonstrate a positive early response to either JASP-EMT or CORE-DTT, c) to compare and contrast four pre-specified adaptive interventions in terms of primary and secondary outcomes, and d) to determine whether baseline repetitive behavior, baseline object interest and parent expectancies for the specific intervention moderate intervention outcomes. This study has the potential to dramatically improve communication outcomes for children with ASD who are minimally verbal, and addresses a high priority need of the Interagency Autism Coordinating Council (2011). A Network of experienced researchers with complementary expertise is necessary to address this unmet priority.