BLOOM: Boosting Language Outcomes of Minimally Verbal Children with ASD

项目摘要 我们知识的一个主要空白是如何最好地干预患有自闭症谱系障碍（ASD）的儿童， 在他们的语言表达上进展缓慢。到4岁时，仍然只有几个功能词的孩子 很可能在6-7岁的学龄前保持最低限度的语言能力。目前，近30%的ASD儿童 被归类为最低限度的口头（少于20个功能词），近50%的人继续有重要的 语言发展滞后1.有几个因素可能在言语延迟中起作用， 社会沟通技能（例如，联合注意力）和口腔运动障碍7，20，21。社交能力， 特别是共同关注和请求技能，在ASD儿童中延迟，并与他们的 后期语言发展3，4.碧玉（Joint Attention，Symbolic Play，Engagement & Regulation） 干预具体针对这些技能，并显示出联合注意力的改善， 语言8，11.然而，对于4岁时语言技能最低的儿童， 单独使用可能不足以改善语音效果。另一种有希望的干预措施侧重于 具有直接语音提示的口腔运动-声音系统。本次干预，PROMPT（ 重建口腔肌肉语音目标）是一个多维的口腔运动的讲话方法 生产障碍10.这种干预结合碧玉可能对言语产生更大的影响 结果比碧玉单独为4和5岁的自闭症儿童和最小的语言生产。因此，在本发明中， 拟议项目的总体目标是确定增加一个 针对言语结果的口腔运动干预（PROMPT）到基于证据的早期干预（碧玉）。 具体来说，主要目的是测试联合干预（碧玉+ PROMPT）是否会导致更大的 社会交际话语（SCU）（主要结果）比碧玉单独。SCU是自动提示的， 生成（非脚本）口头话语，针对社会合作伙伴的目的是分享 信息（评论）或提出请求。次要结果包括可懂度和新的 话次要目标集中在幼儿园年龄的纵向结果，以及哪些儿童可能受益于 大多数人来自这种新的干预，包括那些有更多的联合注意力或更好的口腔运动发育。 探索性的目的涉及电生理学生物标志物的变化与干预，以及是否遗传 作为治疗效果的生物调节剂。儿童参与者包括80名4-6岁的儿童， ASD和有限的语言（<20个功能词）。儿童随机接受碧玉或 碧玉+PROMPT，每周两次干预，持续12周，随访12周，再次随访1周- 一年后。这项研究有可能大大改善儿童的沟通结果， ASD，并解决了机构间自闭症协调理事会和NIDCD的高度优先需要。

PROJECT ABSTRACT A major gap in our knowledge is how best to intervene with children with autism spectrum disorder (ASD) who are progressing slowly in their speech production. By age 4, children who still only have a few functional words are very likely to remain minimally verbal by school age at 6-7 years. Currently nearly 30% of children with ASD are classified as minimally verbal (fewer than 20 functional words), and nearly 50% continue to have significant lags in their speech development1. Several factors likely play a role in speech delays including prelinguistic social communication skills (e.g., joint attention) and oral motor impairment 7,20,21. Social- communication skills, especially joint attention and requesting skills, are delayed in children with ASD, and have been linked to their later language development3,4. The JASPER (Joint Attention, Symbolic Play, Engagement & Regulation) intervention targets these skills specifically, and has shown improvement in joint attention, and later language8,11. However, for children with minimal speech skills at age 4, improving social-communication skills alone may not be enough to improve speech outcomes. An alternative and promising intervention focuses on the oral motor-sound system with direct prompting of speech. This intervention, PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is a multidimensional oral-motor approach to speech production disorders10. This intervention in combination with JASPER may have greater effect on speech outcomes than JASPER alone for 4 and 5 year- old children with ASD and minimal language production. Thus, the overarching goal of the proposed project is to determine whether there is additional benefit of adding an oral-motor intervention (PROMPT) to an evidence-based early intervention (JASPER) for speech outcomes. Specifically, the primary aim tests whether the combined intervention (JASPER + PROMPT) results in greater social communicative utterances (SCU) (primary outcome) than JASPER alone. SCUs are unprompted, generative (non-scripted) verbal utterances that are directed to a social partner for the purpose of sharing information (comment) or making a request. Secondary outcomes include intelligibility and number of novel words. Secondary aims focus on longitudinal outcome at kindergarten age, and which children might benefit the most from this novel intervention, including those with more joint attention or better oral motor development. Exploratory aims concern electrophysiological biomarkers of change with intervention and whether genetics play a role as a biological moderator of the effects of treatment. Child participants include 80 4-6 year-olds with ASD and limited language (<20 functional words). Children are randomized to JASPER or JASPER+PROMPT for a twice weekly intervention for 12 weeks, with 12 week follow up, and again one - year later. 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 NIDCD.