Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism

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Whitehouse, A., Varcin, K. J., Pillar, S., Billingham, W., Alvares, G. A., Barbaro, J., Bent, C., Blenkley, D., Boutrus, M., Chee, A., Chetcuti, L., Clark, A., Davidson, E., Dimov, S., Dissanayake, C., Doyle, J., Grant, M., Green, C., Harrap, M.,..., & Hudry, K. (2021). Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism. JAMA Pediatrics, 175(11), e213298. https://doi.org/10.1001/jamapediatrics.2021.3298

Publication date: 20 Sep 2021 Added to AutiHub: 7 Sep 2026 Type: Article Article language: English
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Authors

Publication authors
36
Publication authors identified as autistic
1 / 36 (2.8%)
  1. Andrew Whitehouse
  2. Kandice J Varcin
  3. Sarah Pillar
  4. Wesley Billingham
  5. Gail A Alvares
  6. Josephine Barbaro *
  7. Catherine Bent
  8. Daniel Blenkley
  9. Maryam Boutrus
  10. Abby Chee
  11. Lacey Chetcuti
  12. Alena Clark
  1. Emma Davidson
  2. Stefanie Dimov
  3. Cheryl Dissanayake
  4. Jane Doyle
  5. Megan Grant
  6. Cherie Green
  7. Megan Harrap
  8. Teresa Iacono
  9. Lisa Matys
  10. Murray Maybery
  11. Daniel F. Pope
  12. Michelle Renton
  1. Catherine Rowbottam
  2. Nancy Sadka
  3. Leonie Segal
  4. Vicky Slonims
  5. Jodie Smith
  6. Carol Taylor
  7. Scott Wakeling
  8. Ming Wai Wan
  9. John Wray
  10. Matthew N Cooper
  11. Jonathan Green
  12. Kristelle Hudry

Abstract

Importance: Intervention for individuals with autism spectrum disorder (ASD) typically commences after diagnosis. No trial of an intervention administered to infants before diagnosis has shown an effect on diagnostic outcomes to date. Objective: To determine the efficacy of a preemptive intervention for ASD beginning during the prodromal period. Design, Setting, and Participants: This 2-site, single rater-blinded randomized clinical trial of a preemptive intervention vs usual care was conducted at 2 Australian research centers (Perth, Melbourne). Community sampling was used to recruit 104 infants aged 9 to 14 months showing early behaviors associated with later ASD, as measured by the Social Attention and Communication Surveillance-Revised. Recruitment occurred from June 9, 2016, to March 30, 2018. Final follow-up data were collected on April 15, 2020. Interventions: Infants were randomized on a 1:1 ratio to receive either a preemptive intervention plus usual care or usual care only over a 5-month period. The preemptive intervention group received a 10-session social communication intervention, iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP). Usual care comprised services delivered by community clinicians. Main Outcomes and Measures: Infants were assessed at baseline (approximate age, 12 months), treatment end point (approximate age, 18 months), age 2 years, and age 3 years. Primary outcome was the combined blinded measure of ASD behavior severity (the Autism Observation Scale for Infants and the Autism Diagnostic Observation Schedule, second edition) across the 4 assessment points. Secondary outcomes were an independent blinded clinical ASD diagnosis at age 3 years and measures of child development. Analyses were preregistered and comprised 1-tailed tests with an α level of.05. Results: Of 171 infants assessed for eligibility, 104 were randomized; 50 infants (mean [SD] chronological age, 12.40 [1.93] months; 38 boys [76.0%]) received the iBASIS-VIPP preemptive intervention plus usual care (1 infant was excluded after randomization), and 53 infants (mean [SD] age, 12.38 [2.02] months; 32 boys [60.4%]) received usual care only. A total of 89 participants (45 in the iBASIS-VIPP group and 44 in the usual care group) were reassessed at age 3 years. The iBASIS-VIPP intervention led to a reduction in ASD symptom severity (area between curves, -5.53; 95% CI, -∞ to -0.28; P =.04). Reduced odds of ASD classification at age 3 years was found in the iBASIS-VIPP group (3 of 45 participants [6.7%]) vs the usual care group (9 of 44 participants [20.5%]; odds ratio, 0.18; 95% CI, 0-0.68; P =.02). Number needed to treat to reduce ASD classification was 7.2 participants. Improvements in caregiver responsiveness and language outcomes were also observed in the iBASIS-VIPP group. Conclusions and Relevance: Receipt of a preemptive intervention for ASD from age 9 months among a sample of infants showing early signs of ASD led to reduced ASD symptom severity across early childhood and reduced the odds of an ASD diagnosis at age 3 years. Trial Registration: http://anzctr.org.au identifier: ACTRN12616000819426.

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Cited references
59
With a DOI
48
Without a DOI, from raw bibliography text
8
5 / 59 (8.5%) cited references include at least one author identified as autistic.
References with data to complete
4 / 59 (6.8%)
References with detected author names
57 / 59 (96.6%)
Without detected author names
2
Without a structured title
3
Without a stable identifier
8
References with raw author names still to review
1
References with external metadata lookup issues
2
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
316
From DOI or external metadata
316
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
1
117 / 316 (37.0%) names are linked to an author already present in AutiHub. 199 / 316 (63.0%) names are not yet linked.
Names linked to a person identified as autistic
5 / 316 (1.6%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 5 / 117 (4.3%). Distinct people identified as autistic: 1 / 235 (0.4%).
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