Development of a Prospective Video-Based Measure to Identify ASD Risk in Infancy

描述(由申请人提供)：有强有力的证据表明，自闭症谱系障碍(ASD)的迹象存在，并可在生命的第一年末和第二年早些时候检测到。父母在平均14个月大的时候首先发现了对发育的担忧。尽管如此，美国ASD首次诊断的平均年龄在41/2岁到51/2岁之间(CDC，2012)。早期强化干预对患有自闭症的幼儿非常有效，但仅限于有正式诊断的儿童，因此必须及早识别。一种可以在全套症状出现之前识别ASD风险的方法，为大脑具有最大可塑性时的干预提供了机会。然而，由于测量问题，更早识别的希望仍然受到阻碍。尽管父母可以可靠地报告学龄儿童的ASD症状，但对于3岁以下的儿童，父母评估个体差异要困难得多。我们建议开发一种新的基于视频的评估早期发展的方法。利用已经收集和编码的数千小时的ASD风险婴儿的视频，我们建议创建一个视频库，描述从非常典型的到明显延迟的发育的社交、交流和重复行为的连续体。我们将与一家为自闭症儿童家庭开发软件的公司合作，创建一项通过安全网站实施的措施，父母可以通过该措施对与婴儿行为相似的程度进行评级，并识别最能代表他们孩子的视频。这项措施对家庭来说负担很轻，因为它很简短，可以通过互联网以安全的方式实施。第一年 资金的一部分将用于开发这一新措施(目标1)，称为自闭症视频参考婴儿评级系统(VRISA)，该系统将从6个月到18个月。在最初的验证过程后，将对90名有ASD家族风险的婴儿和45名没有ASD家族史的婴儿的父母进行三次(6、12和18个月)Virsa(目标2)，然后对这些婴儿进行跟踪，直到36个月大，届时将进行诊断结果评估。我们将比较VERSA的心理测量学特性和预测有效性与其他测量方法，并确定识别的最佳分界点。我们将检查父母和专家评级之间的一致性，以确定该措施在有和没有自闭症经验的父母中的有效性。该项目的最终目标是开发一种低成本、低负担的测量方法，可以在婴儿时期检测ASD风险。这种措施具有重大的公共卫生应用，包括早期诊断、纵向跟踪发育以确定需要评估的儿童、筛查以社区为基础的大样本以及监测个人干预进展情况。

DESCRIPTION (provided by applicant): There is strong evidence that signs of autism spectrum disorders (ASD) are present and detectable late in the first year and early in the second year of life. Parents first identify concerns about development at a mean age of 14 months. Despite this, the mean age of first diagnosis of ASD in the United States is between 41/2 and 51/2 years (CDC, 2012). Early intensive intervention can be highly effective for young children with ASD, but is reserved for children with a formal diagnosis, making early identification imperative. A measure that could identify ASD risk before the full set of symptoms has emerged offers the opportunity for intervention when the brain has the greatest plasticity. The promise of earlier identification remains hampered, however, by measurement issues. Although ASD symptoms can be reliably reported by parents in school-age children, individual variation is much more difficult for parents to assess in children under the age of 3 years. We propose to develop a new video-based method of assessing early development. Taking advantage of thousands of hours of already collected and coded video of infants at risk for ASD, we propose to create a video library depicting a continuum of social, communication, and repetitive behaviors, from very typical to clearly delayed development. In collaboration with a company that develops software for families of children with autism, we will create a measure, implemented through a secure website, with which parents can rate similarity to their infant's behaviors and identify video that best represents their child. This measure will be of low burden to families, as it is brief and can be administered in a secure manner via internet. The first year of funding will be used to develop this new measure (Aim 1), called the Video-Referenced Infant Rating System for Autism (VIRSA), which will extend from 6 to 18 months of age. After an initial validation process, the VIRSA will be administered three times (6, 12, and 18 months) to parents of 90 infants at familial risk for ASD and 45 infants with no family history of ASD (Aim 2) The infants will then be followed to 36 months of age, when diagnostic outcome evaluations will be performed. We will compare the psychometric properties and predictive validity of the VIRSA to other measures and identify best cutoffs for identification. We will examine agreement between parent- and expert-ratings to determine the validity of the measure in parents with and without experience of ASD. The ultimate goal of the project is to develop a low-cost, low-burden measure that can detect ASD risk in infancy. Such a measure has significant public health applications, including earlier diagnosis, longitudinal tracking of development to identify childre requiring evaluation, screening of large community-based samples, and monitoring of individual intervention progress.