Pilot Study to Improve Access to Early Intervention for Autism in Africa

 描述(由申请人提供)：一个重大的全球挑战是开发可扩展的、可行的、可在多样化和低资源社区实施的自闭症谱系障碍(ASD)早期干预措施。创新的照顾者调解的早期干预策略越来越令人兴奋，例如由我的这一应用程序的主要顾问Geraldine Dawson博士共同开发的父母早期启动丹佛模型(P-ESDM)。护理者介入的干预已被证明可以改善亲子互动和儿童语言理解，并降低自闭症的严重程度。重要的是，照顾者的参与有望为解决全球能力障碍提供新的途径。我计划的研究生涯轨迹是成为在不同和低资源社区中开发和实施照顾者中介的干预措施以治疗自闭症和其他儿童神经精神障碍的领导者。该提案中概述的高度结构化的指导和培训计划将为实现这一目标奠定基础。重要的是，这项工作与全球精神卫生优先事项中的两大挑战密切相关：1)通过制定对文化敏感的早期干预措施减少未治疗疾病的持续时间；2)改善儿童获得循证精神卫生保健的机会(11)。此外，这项工作与联邦机构间自闭症协调委员会战略计划的目标一致：支持以社区为基础的研究，评估干预和服务在更广泛的社区环境中的有效性，包括可扩展的早期干预计划，以便在服务不足、资源不足和识字率低的人群中实施(12)。我计划：1)在实施科学和社区参与性研究方面进行培训，2)在临床研究和研究伦理方面进行培训，以及3)通过在低资源的非洲环境中进行ASD干预试验，使用原始循证干预的文化适应版本来获得实践经验。我汇聚了一支出色的顾问团队，他们的专长包括自闭症(杜克大学)、德弗里斯博士(开普敦大学)、罗杰斯博士(加州大学戴维斯分校精神研究所)、全球健康(德弗里斯博士、西克马博士)、儿童精神病学(埃格博士(杜克)、德弗里斯博士)、干预研究(道森博士、罗杰斯博士、西克凯马博士)及社区参与性研究(西凯马博士)。与非洲自闭症研究中心合作，我提议调整父母早期启动丹佛模式(P-ESDM)治疗手册和培训方法，并进行一项试点研究，以探索这种调整后的干预措施在非洲环境下对儿童和照顾者结局的可接受性、可行性和影响。此外，我将通过开普敦大学确认中心利用NIMH支持的现有研究基础设施(见隆德的支持信)。通过该奖项获得的基础指导、培训和经验将为我专注于提高神经发育障碍儿童的生活质量的职业生涯奠定基础，并使我具备成为一名独立临床研究人员的技能。

 DESCRIPTION (provided by applicant): A significant global challenge is to develop scalable, feasible, early interventions for autism spectrum disorders (ASD) that can be implemented in diverse and low resource communities. There is growing excitement around innovative caregiver-mediated early intervention strategies, for example the Parent Early Start Denver Model (P-ESDM) co-developed by Dr. Geraldine Dawson, my primary advisor on this application. Caregiver-mediated interventions have been shown to improve parent-child interactions and child language comprehension, and reduce the severity of ASD. Importantly, engagement of caregivers promises new ways to address the capacity barrier globally. My planned research career trajectory is to become a leader in the development and implementation of caregiver-mediated interventions for ASD and other childhood neuropsychiatric disorders in diverse and low resource communities. The highly structured mentorship and training plan outlined in this proposal would set the foundation for achieving this goal. Importantly, this work is closely aligned with 2 of the top Grand Challenges in Global Mental Health priorities: 1) to reduce the duration of untreated illness by developing culturally-sensitive early interventions, and 2) to improve child access to evidence-based mental health care (11). In addition, this work aligns with an objective of the Federal Interagency Autism Coordinating Committee Strategic Plan: to support community-based studies that assess the effectiveness of interventions and services in broader community settings including scalable early intervention programs for implementation in underserved, low-resource, and low-literacy populations (12). I plan to: 1) train in implementation science and community participatory research, 2) train in clinical research and research ethics, and 3) obtain hands-on experience by conducting an ASD intervention trial using a culturally adapted version of the original evidence-based intervention in a low resource African setting. I have brought together an outstanding team of advisors with expertise in ASD (Dr. Dawson (Duke), Dr. de Vries (University of Cape Town), Dr. Rogers (UC Davis Mind Institute)), global health (Dr. de Vries, Dr. Sikkema (Duke)), child psychiatry (Dr. Egger (Duke), Dr. de Vries), intervention research (Dr. Dawson, Dr. Rogers, Dr. Sikkema), and community participatory research (Dr. Sikkema). Working in collaboration with the Center for Autism Research in Africa, I propose to adapt the Parent Early Start Denver Model (P-ESDM) treatment manual, and training approach, and conduct a pilot study to explore the acceptability, feasibility, and impact of this adapted intervention on child and caregiver outcomes in an African setting. In addition, I will capitalize on existing research infrastructure supported by the NIMH through the University of Cape Town AFFIRM Hub (see Lund letter of support). The foundational mentorship, training and experience gained through this award will set the stage for a career focused on enhancing the quality of life for children wih neurodevelopmental disorders and equip me with the skillset to become an independent clinical researcher.