Community-based Adaptive autism Intervention for Toddlers

项目摘要 这项拟议的研究（CAIT：幼儿社区自适应自闭症干预）旨在 确定最佳的干预顺序，以改善社会-沟通，语言和 自闭症谱系障碍（ASD）幼儿的认知结果。目标人群为2-3岁 - 患有ASD的老年儿童，他们在两个真实的社区接受基于社区的公共资助的早期干预， 位于纽约东哈莱姆和布朗克斯的教育机构，称为纽约婴幼儿中心 （NYCIT）。预计将有300名患有ASD的幼儿与他们的社区招募的准专业人员一起参加 教学助理（TA）和小组领导人（GL）。该研究旨在构建最有效的一年， 两阶段，适应性干预，其中干预是个性化的基础上，儿童的初步反应， 干预第1阶段，从程序进入到6周或12周（随机化），包括每天60分钟的 基于证据的社会沟通干预，碧玉（联合注意，象征性游戏，参与和 法规）由受过培训的TA 1对1向儿童提供。在第1阶段结束时，对干预的反应是 GLS对联合作战的缓慢或快速改进进行了评级（早期开发中的核心缺陷）， ASD儿童，以及改善社会沟通和 语言）。在第2阶段（至第24周），反应缓慢的幼儿被重新随机化，继续使用碧玉 每天60分钟，或通过直接，结构化的社交目标教学来加强治疗 每天30分钟，碧玉每天30分钟。反应迅速的幼儿有30分钟的时间 碧玉和30分钟的JasPEER（碧玉与同龄人），以进一步改善社交和社交 通信 本研究将采用序贯多重分配随机试验（SMART）设计， 如何在两个治疗阶段最好地改善ASD幼儿的社会沟通结果。的 主要有效性目标是确定在反应较慢的患者中， 结构化教学与持续碧玉对小学（社会交际话语）和中学 共同参与（Joint Engagement and Play）次要的有效性目标侧重于（一）确定最佳时间 (week（二）研究儿童在不同年龄段的不参与情况， 基线调节了第6周或第12周测量反应的效果， 第1阶段缓解了第2阶段治疗对慢反应者的影响（碧玉加结构化教学 vs.继续碧玉）。最后，实施目标将审查干预的障碍和促进因素 NYCIT的采用（通过评估实施保真度，完善我们对中心领导层的外部支持， 可靠地评估儿童的反应，培训新的工作人员，并指导助教实施干预措施， 忠诚度，并检查NYCIT领导层维持干预措施的程度）。

PROJECT SUMMARY The proposed study (CAIT: Community-based Adaptive Autism Intervention for Toddlers) aims to determine the most optimal sequence of interventions for improving the social- communicative, language and cognitive outcomes of toddlers with autism spectrum disorder (ASD). The target population consists of 2-3 year -old children with ASD who receive community based, publicly funded early intervention in two authentic educational settings in East Harlem and the Bronx, NY known as New York Center for Infants & Toddlers (NYCIT). An expected 300 toddlers with ASD will participate with their community-recruited paraprofessional teaching assistants (TAs) and group leaders (GLs). The study aims to construct the most effective one-year, two-phase, adaptive intervention, in which intervention is individualized based on a child's initial response to intervention. Phase 1, from program entry to either 6 or 12 weeks (randomized), involves 60 minutes daily of an evidence based social communication intervention, JASPER (Joint Attention, Symbolic Play, Engagement & Regulation) delivered 1-on-1 to the child by the trained TA. At end of Phase 1, response to intervention is rated by the GLs for slow or fast improvements of joint engagement (a core deficit in the early development of children with ASD, and a significant indicator of good progress toward improving social communication and language). In Phase 2 (to week 24), toddlers responding slowly are re-randomized to continue with JASPER for 60 minutes per day or augment treatment with direct, structured teaching of social communication targets for 30 minutes and JASPER for another 30 minutes per day. Toddlers responding quickly are given 30 minutes of JASPER and 30 minutes of jasPEER (JASPER with a peer) to further improve socialization and social communication. This study will employ a Sequential Multiple Assignment Randomized Trial (SMART) design to evaluate how best to improve social communication outcomes in toddlers with ASD over two treatment phases. The primary effectiveness aim is to determine among slower responders, the effect of augmenting JASPER with structured teaching vs. continuing JASPER on primary (social communicative utterances) and secondary outcomes (joint engagement and play). Secondary effectiveness aims focus on (i) determining the best time (week 6 or 12) to identify a child as a slower responder, and (ii) examining whether child un-engagement at baseline moderates the effect of measuring response at week 6 or 12, and whether joint attention skills in Phase 1 moderate the effect of Phase 2 treatment among slow responders (JASPER plus structured teaching vs. continuing JASPER). Finally, an implementation aim will examine barriers and facilitators to intervention adoption by NYCIT (by assessing implementation fidelity, refining our external support to center leadership to reliably assess child response, train new staff, and coach TAs to implement intervention components with fidelity, and to examine the degree to which NYCIT leadership sustains the interventions).