Billet publié sur Twitter/X le 05/04/2013 03:33

Résumé

DESCRIPTION (provided by applicant): High quality, intensive early intervention is a powerful treatment for ASD, improving IQ and language markedly in randomized controlled clinical trials (RCTs), though little long term follow-up data exists. Few core characteristics that affect child change have been tested. Two potential core characteristics that invoke considerable debate among parents, professionals, and administrators are the delivery style of intervention: play-based versus discrete trial teaching, and the intensity (dosage) of intervention. This ACE treatment network will conduct two RCTs to answer two main questions: study 1: what are the effects of intensity and delivery style on developmental progress of toddlers with ASD, and study 2: do toddlers from a previous RCT of a specific intervention approach, the Early Start Denver Model (ESDM), versus community treatment maintain and generalize treatment effects over 3 years? For study 1, a sample of 108 young children with ASD, ages 15-30 months, will be enrolled in one of three national sites (Univ Cal Davis, Vanderbilt, Univ. Washington) and randomized into one of four cells varying on two dimensions: dosage - 15 or 25 hours per week of 1:1 treatment; and direct or play- based teaching. All other aspects of intervention will be hel constant: use of the principles of applied behavior analysis, content of the teaching, location, staff, parent curriculum, and materials. Developmental progress will be measured monthly allowing for growth curve analysis to examine fine-grained differences in groups as well as interactions among major child and family initial variables and these two experimental variables. For study 2, 79 participants from a previous ACE Network project enrolled between 15 and 24 months of age will be followed up at 6-7 years of age. All children were randomized into two years of intensive intervention of either ESDM or community intervention and assessed with a comprehensive diagnostic and behavioral assessment battery at four time points during the original study. Stability of treatment effects and group differences will be examined. Specific aims are: 1. to examine the effect of intensity of treatment, or "dosage", on child progress/ outcomes; 2. to examine the effect of intervention delivery style: play-based or DTT, on child progress/ outcomes; 3. to examine effects of quality and quantity of parent-provided learning opportunities at home on child progress/ outcomes; 4. to test the moderating effects of initial pre-linguistic vocal patterns, autism severity, and developmental rates on child outcomes; 5. to examine maintenance of ESDM treatment child and family effects three years post intervention; 6. to support the scientific development of young investigators with specific interest and expertise in autism science.

Résumé

Goals of the current project: (1) Does the Early Start Denver Model experimental intervention for toddlers with autism reduce disability associated with autism significantly more than standard community interventions?; and (2) What environmental, child, and biological characteristics mediate and moderate intervention response and outcomes at age 4?

Résumé

DESCRIPTION (provided by applicant): Autism is a complex and pervasive disorder with often devastating effects on social, cognitive, and language development. The presence of mental retardation and lack of speech are associated with very poor outcomes. The verbal level that children attain during preschool years is a strong predictor of adult adaptive skill and educational levels. Intensive treatment for autism early in life can improve the development of useful speech and decrease the severity of mental retardation. Thanks to the development of better diagnostic tools and a greater level of professional education, autism is being identified in two year olds and in even younger children, with the rationale that the earlier intervention begins, the better the outcomes may be. However, there are no published outcome data on intervention models or effectiveness for children who begin treatment by or before 24 months. Furthermore, some teaching procedures considered appropriate for older children are considered developmentally inappropriate for toddlers. Drs. Dawson and Rogers have implemented a feasibility study of a treatment designed for toddlers with autism using a randomized controlled design. The manualized approach involves a relationship-based frame to accomplish developmentally based objectives using naturalistic application of applied behavior analytic principles and is delivered 1:1 for 25 or more hours per week to 24 toddlers with autism for a two year period. The contrast group receives standard community based intervention. Preliminary results show large and significant group effects after only 12 months and considerable variability of treatment outcomes in both groups. Specific Aim 1 will conduct a multi-site intent-to-treat randomized control trial of early intensive behavioral intervention (Early Start Denver Model - ESDM) compared to standard community treatment involving 108 toddlers with autism (18-24 months of age), 36 at each of three sites, to evaluate the efficacy of very early intervention for improving child outcomes after 12 and 24 months of treatment; Specific Aim 2 will examine predictors, mediators, and moderators of outcomes for children in both groups, with variables involving social environmental risks and protective features, individual child risk or protective features, and biological risks and protective features. Overall, the study is based on Hypothesis 1: ESDM treatment will result in significantly greater improvements in core autism symptoms and developmental rates of progress in multiple areas than community treatment; and Hypothesis 2: Specific individual child variables, number of biological risks, number of social-environmental risks and opportunities, and parent interaction styles will facilitate or modify child outcomes.