Preventive Dyadic Intervention to Enhance Communication Development in At-Risk Infants

项目摘要 在美国，每13名儿童中就有1名受到沟通障碍的影响。而行为指标 沟通、语言和相关的障碍可以在生命的第一年观察到，诊断通常 在第二年或第三年之后才能制作。到那时，发展轨迹可能已经开始 偏离航道，造成终身连锁后果。有必要进行干预，这可能是 在婴儿期实施，这是一个神经可塑性增强和基础技能新兴的时期，以便 防止沟通延迟的充分表现或恶化，促进健康沟通 发展。尽管短期实验干预对婴儿的技能产生了积极的影响 交流(包括社交、非语言和语言组件)、真实世界丰富程序 不提供适合婴儿和为沟通发展量身定做的产品。成功的干预措施 不能推定第二年及以后实施的目标通信延迟和混乱 适合婴儿期使用。因此，我们提出了一种新的以沟通为目标的预防性干预方法， 婴儿成就(IA)，适用于沟通延迟的高危婴儿。具体目标是：(1)评估 IA干预对照顾者实施促进儿童发展目标的影响 策略；(2)评估IA干预对儿童沟通发展的影响；以及(3)研究 照顾者忠诚度与子女结局之间的关系。参与者将被随机分配到两个为期8周的- 家庭治疗条件：IA(每周两次照顾者辅导)或照顾者教育(CE)比较 情况(没有护理员指导)。短期干预期旨在加强干预 效率和许可审查具体的变革机制。IA组的护理员将接受培训 使用改编自自然主义发展行为的交际支持策略 在联合行动例行公事中实施的干预措施，在战略上支持使用创新的 设计了玩具捆绑包和用户指南。这些玩具包为干预、放松提供了外部结构 护理者的学习需求和推广推广。CE组的照顾者每周将在- 家庭儿童发展教程加上每周的电话跟踪和玩具不同于IA的玩具捆绑。严谨是 通过随机对照试验(RCT)获得，强反事实，使用有针对性的有效措施， 保真度测量，使考官和编码员失明，并使用密集观察专注于目标结果 儿童和照顾者的行为。护理人员和婴儿的结局将在干预前和干预后进行评估 2个月的随访，并在干预期间进行。长期目标包括完善IA干预，如 需要，在更大的随机对照试验中检查其对婴儿和照顾者的有效性，并检查 照顾者和婴儿的治疗反应。

Project Summary In the United States, 1 in 13 children are affected by a communication disorder. While behavioral indicators of communication, language, and associated disorders can be observed in the first year of life, diagnosis often cannot be made until after the second or third year. By that point, developmental trajectories may have begun to diverge off course with lifelong, cascading consequences. There is a need for interventions that may be implemented in infancy, a time of enhanced neuroplasticity and emerging foundational skills, in order to prevent full manifestation or exacerbation of communication delays and to promote healthy communication development. Although short-term experimental interventions have positively impacted skills in infant communication (including social, nonverbal, and verbal components), real-world enrichment programs appropriate for infants and tailored for communication development are not available. Successful interventions targeting communication delay and disorder implemented in the second year and beyond cannot be presumed to be appropriate for use in infancy. Thus, we propose a novel communication-targeted preventive intervention, Infant Achievements (IA), for infants at high risk for communication delays. Specific aims are to: (1) assess effects of the IA intervention on caregiver's implementation of targeted child development-enhancing strategies; (2) assess effects of the IA intervention on child communication development; and (3) examine the relation between caregiver fidelity and child outcomes. Participants will be randomized to one of two 8-week in- home treatment conditions: IA (with twice-weekly caregiver coaching) or Caregiver Education (CE) comparison condition (no caregiver coaching). The short-term intervention period is intended to enhance intervention efficiency and permit examination of specific mechanisms of change. Caregivers in the IA group will be trained in the use of communication-supporting strategies adapted from naturalistic developmental behavioral interventions, implemented during joint-action routines supported by the use of innovative strategically- designed toy bundles and user guides. These toy bundles provide the exostructure for the intervention, easing caregiver learning demands and promoting generalization. Caregivers in the CE group will receive weekly in- home Child Development Tutorials plus weekly phone follow-up and toys differing from IA toy bundles. Rigor is attained via a randomized controlled trial (RCT), strong counterfactual, use of targeted and valid measures, fidelity measures, blinding of examiners and coders, and focus on targeted outcomes using dense observation of child and caregiver behaviors. Caregiver and infant outcomes will be assessed pre- and post-intervention, at a 2-month follow-up, and during the intervention. Long-term goals include refining the IA intervention, as needed, examining its efficacy for infants and caregivers in a larger RCT, and examining mediators of treatment response in caregivers and infants.