Using the Theory of Change framework to map active ingredients and mechanisms of change underlying an early parent-implemented intervention for autism spectrum disorder

项目总结 自闭症谱系障碍(ASD)是一种终生神经发育障碍，每59名儿童中就有1名受到影响 美国。早期干预对于改善这一人群的结果至关重要。一个不断增长的早期身体 干预研究支持使用自然主义发展行为干预(NDBI)，这是 整合发展和行为技术。对照顾者参与早期干预的关注导致 对父母实现的NDBI(PI-NDBI)的开发，在PI-NDBI中，教父母提供NDBI 与他们的孩子相处的技巧。然而，还需要更多的研究来了解如何最好地支持 照顾者在促进孩子在家学习方面发挥着重要作用。而PI-NDBI拥有越来越多的证据基础 为了改善儿童结果，这些复杂的干预措施尚未在社区环境中得到广泛采用。 这项研究的长期目标是为PI-NDBIS的优化提供信息，以实现效率的最大化， 支持更广泛的社区实施，并支持这些干预措施在 社区设置。这些与NICHD的研究优先事项保持一致，以促进发展， 传播和实施将影响临床的发育性残疾治疗 在社区环境中提供关怀，提高生活质量。络合物评价的最新进展 干预措施强调混合方法的效用，以了解复杂的治疗方法 工作。该研究的目标是使用混合方法来阐明潜在的有效成分和 经验性支持的解决核心缺陷的早期干预的相关变化机制 自闭症患者。首先，将利用与关键利益相关者的访谈和随后的定性分析来制定 描述潜在的积极因素和变化机制的综合变化理论 基础项目影响，基于证据的PI-NDBI。这将阐明父级和提供商级因素如何 可能会影响干预结果。接下来，将使用三角测量协议来整合理论和研究 证据和利益相关者的数据。这些结果将在变化理论模型中可视化。最后，我们 将使用以下归档数据测试选定的路径，从而提供变革理论的概念验证 项目影响的干预试验。拟议的研究和多方面培训计划包括正在进行的 与干预和实施科学方面的专家进行指导，在定性和混合方面进行高级培训 方法研究，接触评估科学领域，指导临床经验和经验 让社区利益相关者参与研究。活性成分的鉴定及其相关机制 变革具有优化有效性和简化干预措施的潜力，以增加这些人获得 有限的资源和对高保真治疗的最大需求。这将有助于解决长期问题 自闭症患者早期社会沟通障碍对公共健康的影响。

PROJECT SUMMARY Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disability that affects 1 in 59 children in the United States. Early intervention is crucial for improving outcomes in this population. A growing body of early intervention research supports the use of Naturalistic Developmental Behavioral Interventions (NDBIs), which integrate developmental and behavioral techniques. A focus on caregiver involvement in early intervention led to the development of parent-implemented NDBIs (PI-NDBIs), in which parents are taught to deliver NDBI techniques with their children. However, more research is needed to understand how best to support caregivers in promoting their children’s learning at home. While PI-NDBIs have a growing evidence base for improving child outcomes, these complex interventions have not been widely adopted in community settings. The long-term goal of this research is to inform the optimization of PI-NDBIs in order to maximize efficacy, enable more widespread community implementation, and support planned adaptation of these interventions in community settings. These align with NICHD research priorities to promote the development, dissemination, and implementation of treatments for developmental disabilities that will impact clinical care in community settings and improve quality of life. Recent advances in the evaluation of complex interventions emphasize the utility of mixed method approaches for understanding how complex treatments work. The study objective is to use a mixed methods approach to elucidate potential active ingredients and associated mechanisms of change of an empirically supported early intervention which addresses core deficits of ASD. First, interviews with key stakeholders and subsequent qualitative analysis will be used to develop a comprehensive Theory of Change describing the potential active ingredients and mechanisms of change underlying Project ImPACT, an evidence-based PI-NDBI. This will clarify how parent- and provider-level factors may impact intervention outcomes. Next, a triangulation protocol will be used to integrate theory and research evidence with data from stakeholders. These results will be visualized in a Theory of Change model. Last, we will provide proof-of-concept of the Theory of Change by testing select pathways using archival data from intervention trials of Project ImPACT. The proposed research and multifaceted training plan include ongoing mentorship with experts in intervention and implementation science, advanced training in qualitative and mixed methods research, exposure to the field of evaluation science, supervised clinical experience, and experience engaging community stakeholders in research. Identification of active ingredients and associated mechanisms of change has the potential to optimize effectiveness and streamline interventions to increase access for those with limited resources and the greatest need for high fidelity treatments. This would help address the long-term public health impacts of early social communication deficits in ASD.