Personalized, Responsive Intervention Sequences for Minimally Verbal Children with Autism (PRISM)

项目摘要 许多患有自闭症谱系障碍(ASD)的3-4岁儿童(30%-50%)不会继续进行 在5-6岁之前发展与社会相关的单词和短语，并被重新归类为“最低限度的言语”， 永远不要超过20个实用的、没有回音的单词，即使在早期接触到基于证据的单词也是如此 干预措施。尽管对5岁以上的儿童进行了大量研究，但他们已经被归类为最低限度 口头上，很少有研究试图优化对语言能力有限的学龄前儿童的干预 可能更有可能通过适当、有针对性和个性化的干预来发展语言 接近了。因此，我们知识中的一个主要差距仍然是如何将这些患有自闭症的儿童置于 一条在学龄前学会说话的途径，从而减少说话最少的儿童的数量。一把钥匙 这一群体面临的挑战是，一刀切并不适用于所有人：在表现形式和 对干预的反应。要利用这种异构性，必须使用单独的 量身定制的顺序干预方法，根据儿童的情况随着时间的推移调整治疗方法 他回应道。拟议的多站点项目的总体目标是使语言成果最大化 学龄前儿童因发展两阶段、20周的适应能力而有可能维持“最低限度的言语”状态 干预“(包括一系列可复制的治疗决策规则以指导 临床医生对何时以及如何改变干预措施的指导)。这项研究解决了在设计一个 适应性干预，包括如何最好地干预对最初干预反应迟缓的儿童， 四种预先指定的适应性干预措施中哪一种是最好的，哪些主持人对设计 更个人化的适应性干预，更好地理解 适应性干预可能会显示出它们的效果。具体地说，主要目的是测试强化的效果 阶段1单一干预与通过系统地结合和加强改变干预 治疗模块。第1阶段干预包括一种常见的推荐方法，该方法基于 应用行为分析(离散试验训练)和基于证据的早期干预 解决ASD中的社交障碍，Jasper(联合注意象征性游戏 参与度和规章制度)。主要的结果是自发的交流话语，并且 次要结果包括共同参与、接受性语言和单词组合的存在。 我们的次要和探索性目标包括主持人和调解人测试，以及年龄的纵向结果。 5-6年。儿童参与者包括140名患有自闭症和语言受限(20个功能词)的4岁儿童。 分布在3个地点(俄勒冈大学、罗切斯特大学和加州大学洛杉矶分校)。这项研究具有显著改进的潜力 自闭症儿童的沟通结果，并满足机构间的高度优先需求 自闭症协调委员会和美国国立卫生研究院。

PROJECT ABSTRACT Many 3-4 year olds with autism spectrum disorder (ASD) who are `preverbal' (30-50%) do not go on to develop socially related words and phrases by age 5-6 years and are reclassified as `minimally verbal', never moving past 20 functional, non-echoed words, even with exposure to evidence-based early interventions. Despite significant research of children older than 5 who are already classified as minimally verbal, little research has attempted to optimize intervention for limited language preschool children who may be more likely to develop language with appropriate, targeted, and personalized intervention approaches. Therefore, a major gap in our knowledge remains on how to place these children with ASD on a path to becoming verbal by school age, thus reducing the numbers of minimally verbal children. A key challenge in this population is that one size does not fit all: there is vast heterogeneity in presentation and response to intervention. To capitalize on this heterogeneity, it will be necessary to use an individually tailored, sequential approach to intervention whereby treatment is adapted over time based on how the child responds. The overarching goal of the proposed multi-site project is to maximize language outcomes for preschoolers at risk for maintaining `minimally verbal' status by developing a two-stage, 20-week “adaptive intervention” (an intervention that incorporates a replicable sequence of treatment decision rules to guide clinicians on when and how to alter an intervention). This study addresses key questions in designing an adaptive intervention, including how best to intervene with children responding slowly to initial intervention, which of four pre-specified adaptive interventions is best, which moderators are important to designing a more individually tailored adaptive intervention, and better understanding the mechanism by which the adaptive interventions may exhibit their effects. Specifically, the primary aim tests the effect of intensifying stage 1 singular interventions versus changing intervention by systematically combining and enhancing treatment modules. The stage 1 interventions include a commonly recommended approach based on applied behavior analysis (discrete trial training) and an evidence-based early intervention that specifically addresses the social communication impairment in ASD, JASPER (Joint Attention Symbolic Play Engagement & Regulation). The primary outcome is spontaneous communicative utterances, and secondary outcomes include joint engagement, receptive language, and presence of word combinations. Our secondary and exploratory aims include moderator and mediator tests, and longitudinal outcome at age 5-6 years. Child participants include 140 4-year-olds with ASD and limited language (<20 functional words) across 3 sites (U Oregon, Rochester, and UCLA). This study has the potential to dramatically improve communication outcomes for children with ASD, and addresses a high priority need of the Interagency Autism Coordinating Council and NIH.