Promoting Transactional Supports to Optimize Social Communication Outcomes for Infants and their Families

项目摘要 这个治疗项目的首要目标是记录非常早期的事务支持的功效 父母可以学习改变发展轨迹，并使用2阶段优化孩子的结果， 序贯多分配随机试验（SMART）设计，以开发适应性干预措施。所有 Emory ACE中的父母-婴儿配对将在6个月大时从250名高风险和低风险兄弟姐妹中被邀请 并将在第一阶段随机分配到社会沟通增长图表（SCGC），该图表使用 创新的基于网络的技术，教父母早期社会沟通的里程碑，以及如何支持 他们的孩子的早期发展或产后护理，以比较SCGC对父母的疗效 反应能力和儿童发展轨迹。12岁时出现ASD早期迹象的儿童家庭 基于使用父母报告和观察指标的定制变量，将对月龄进行重新随机化 阶段2比较父母实施的（P-I）条件的自然发展 行为干预（NDBI）基于早期社会互动模型1，以临床医生实施（C-I） 基于12至21月龄的混合模型的条件NDBI。社会发展成果计量 沟通，自闭症症状，社会视觉参与，发展水平和适应行为将 从6至30个月龄每6个月收集一次，以测量治疗效果。家长措施 交易支持和儿童积极参与将每季度收集9至30个月的年龄， 检查第1阶段和第2阶段条件下以及术后21个月和30个月随访时的生长轨迹 干预本研究的预期影响将具有以下重要意义：1）最大限度地提高 利用技术教导所有父母如何支持婴儿的早期发展，以优化机会 如果他们的孩子没有达到发展的里程碑， 需要干预; 2）记录患有ASD早期迹象的非常年幼的儿童接受 手动的，基于证据的NDBI干预，具有成本效益，适合社区 实施; 3）证实父母从6岁开始实施的这些适应性干预措施 个月的年龄导致更好的儿童结果，提供证据表明，自闭症的早期发现是至关重要的， 改善发展成果。

PROJECT SUMMARY The overarching goal of this treatment project is to document the efficacy of very early transactional supports that parents can learn to change developmental trajectories and optimize outcomes of their child using a 2-stage sequential multiple assignment randomized trial (SMART) design to develop an adaptive intervention. All parent-infant dyads in the Emory ACE will be invited at 6 months of age from the pool of 250 high and low risk siblings and will be randomly assigned at Stage 1 to the Social Communication Growth Charts (SCGC) that uses an innovative web-based technology to teach parents early social communication milestones and how to support their child’s very early development or Usual Care to compare efficacy of the SCGC on parent contingent responsiveness and child developmental trajectories. Familes of children who show early signs of ASD at 12 months of age based on tailoring variables using parent report and observational measures will be re-randomized to Stage 2 to compare the efficacy of a parent-implemented (P-I) condition of a naturalistic developmental behavioral intervention (NDBI) based on the Early Social Interaction model1 to a clinician-implemented (C-I) condition NDBI based on a hybrid model from 12 to 21 months of age. Outcome measures of social communication, autism symptoms, social visual engagement, developmental level, and adaptive behavior will be gathered every 6 months from 6 to 30 months of age to measure treatment effects. Measures of parent transactional support and child active engagement will be collected quarterly from 9 to 30 months of age to examine growth trajectories during the Stage 1 and 2 conditions and at follow-up at 21 and 30 months after intervention. The expected impact of this study will have the following important implications: 1) maximize the use of technology to teach all parents how to support their infant’s development early to optimize opportunities for learning and recognize as early as possible if their child is not meeting developmental milestones and may need intervention; 2) document improved outcomes for very young children with early signs of ASD receiving a manualized, evidence-based NDBI intervention that is cost-efficient and feasible for community-based implementation; and 3) substantiate that these adaptive interventions implemented by parents beginning at 6 months of age lead to better child outcomes, providing evidence that very early detection of autism is crucial to improve developmental outcomes.