1
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Bedford R, Green J, Gliga T, Jones EH, Elsabbagh M, Pasco G, Wan MW, Slonims V, Charman T, Pickles A, Johnson MH. Parent-mediated intervention in infants with an elevated likelihood for autism reduces dwell time during a gaze-following task. Autism Res 2024. [PMID: 39205333 DOI: 10.1002/aur.3223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 08/13/2024] [Indexed: 09/04/2024]
Abstract
Cognitive markers may in theory be more sensitive to the effects of intervention than overt behavioral measures. The current study tests the impact of the Intervention with the British Autism Study of Infant Siblings-Video Interaction for Promoting Positive Parenting (iBASIS-VIPP) on an eye-tracking measure of social attention: dwell time to the referred object in a gaze following task. The original two-site, two-arm, assessor-blinded randomized controlled trial (RCT) of this intervention to increase parental awareness, and responsiveness to their infant, was run with infants who have an elevated familial likelihood for autism (EL). Fifty-four EL infants (28 iBASIS-VIPP intervention, 26 no intervention) were enrolled, and the intervention took place between 9 months (baseline) and 15 months (endpoint), with gaze following behavior measured at 15 months. Secondary intention to treat (ITT) analysis showed that the intervention was associated with significantly reduced dwell time to the referent of another person's gaze (β = -0.32, SE = 0.14, p = 0.03) at 15-month treatment endpoint. Given the established link between gaze following and language, the results are considered in the context of a previously reported, non-significant and transient trend toward lower language scores at the treatment endpoint (Green et al. (2015) The Lancet Psychiatry, 2(2), 133-140). Future intervention trials should aim to include experimental cognitive measures, alongside behavioral measures, to investigate mechanisms associated with intervention effects.
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Affiliation(s)
- Rachael Bedford
- Department of Psychology, University of Bath, Bath, UK
- Centre for Brain and Behaviour, Department of Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
| | - Jonathan Green
- Social Development Research Group, School of Health Sciences, University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester, UK
| | - Teodora Gliga
- Department of Psychology, University of East Anglia, Norwich, UK
| | - Emily H Jones
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK
| | - Mayada Elsabbagh
- Montreal Neurological Institute, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Greg Pasco
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ming Wai Wan
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Vicky Slonims
- Evelina London Children's Hospital and King's College London Neurosciences Centre, London, UK
| | - Tony Charman
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
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2
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Meera SS, Srikar M, Raju R, Swaminathan D, Johnson RE, Watson LR, Nair DB, Kommu JVS, Chopra-McGowan J, Vasuki PP. Feasibility and acceptability of a caregiver-mediated early support program, delivered online, for infants at elevated familial likelihood for autism: A feasibility randomized controlled trial. Autism Res 2024. [PMID: 39205330 DOI: 10.1002/aur.3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
Preliminary evidence indicates potential benefit of providing caregiver-mediated intervention, prior to diagnosis, for infants at elevated familial likelihood for autism and related developmental delays including language delay (EL-A). However, delivering such interventions online and in low-resource settings like India has not been reported. This study aimed to evaluate the feasibility and acceptability of delivering a novel manualized caregiver-mediated early support program, the "LiL' STEPS," online in India, for EL-A infants. LiL' STEPS stands for Language development & Intervention Lab's (LiL') Supporting Early social-communication and language by Promoting caregiver Sensitive responsiveness (STEPS). The program comprised 14 sessions with a focus on social-communication and language, conducted over 12-weeks using demonstration and video feedback. Families of 36 EL-A infants aged 9 to 15-months participated in this feasibility randomized controlled trial (RCT). Families were randomized in a 2:1 ratio (n = 24 LiL' STEPS and n = 12 care as usual groups). Information on feasibility and acceptability was collated following a mixed methods approach from caregiver interviews, fidelity forms, session notes, and study register. Findings indicated the LiL' STEPS study trial as feasible and acceptable with recruitment rate of 4 per month, 100% willingness for randomization, 8.3% attrition, and 3.03% loss of blinding. Interventionist and caregiver fidelity was maintained above 80%. Despite challenges like interruptions during sessions, 100% families found the program acceptable and satisfactory, 86% said they would recommend the program to others, and 71% preferred online modality. Caregivers' perspectives on beneficial components and experience attending the program have been described. Accordingly, recommendations for future definitive RCTs have been presented.
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Affiliation(s)
- Shoba S Meera
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Malavi Srikar
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Reny Raju
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Divya Swaminathan
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rachel Elizabeth Johnson
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Linda R Watson
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - John Vijay Sagar Kommu
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Prathyusha P Vasuki
- Departemnt of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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3
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Papageorgopoulou E, Jones EJH, Johnson MH, Charman T, Green J, Wan MW. Parent-infant interaction trajectories in infants with an elevated likelihood for autism in relation to 3-year clinical outcome. Autism Res 2024. [PMID: 38940216 DOI: 10.1002/aur.3190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/05/2024] [Indexed: 06/29/2024]
Abstract
Developmental antecedents of autism may affect parent-infant interactions (PII), altering the context in which core social skills develop. While studies have identified differences in PII between infants with and without elevated likelihood (EL) for autism, samples have been small. Here, we examined whether previously reported differences are replicable. From a longitudinal study of 113 EL and 27 typical likelihood infants (TL), 6-min videotaped unstructured PII was blind rated at 8 and 14 months on eight interactional qualities. Autism outcome was assessed at 36 months. Linear mixed-effects models found higher parent sensitive responsiveness, nondirectiveness, and mutuality ratings in TL than EL infants with and without later autism. PII qualities at 8 (infant positive affect, parent directiveness) and 14 months (infant attentiveness to parent, mutuality) predicted 3-year autism. Attentiveness to parent decreased between 8 and 14 months in EL infants with later autism. This larger study supports previous findings of emerging alterations in PII in this group and extends on this by detecting earlier (8-month) predictive effects of PII for autism outcome and a more marked trajectory of decreased social attentiveness. The findings strengthen the evidence base to support the implementation of early preemptive interventions to support PII in infants with early autism signs.
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Affiliation(s)
- Eirini Papageorgopoulou
- Centre for Brain and Cognitive Development, School of Psychological Sciences, Birkbeck, University of London, London, UK
- Department of Women & Children's Health, King's College London, London, United Kingdom
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, School of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, School of Psychological Sciences, Birkbeck, University of London, London, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, King's College London, London, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester, Manchester, UK
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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4
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Wu D, Wolff JJ, Ravi S, Elison JT, Estes A, Paterson S, St John T, Abdi H, Moraglia LE, Piven J, Swanson MR. Infants who develop autism show smaller inventories of deictic and symbolic gestures at 12 months of age. Autism Res 2024; 17:838-851. [PMID: 38204321 PMCID: PMC11014769 DOI: 10.1002/aur.3092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
Gestures are an important social communication skill that infants and toddlers use to convey their thoughts, ideas, and intentions. Research suggests that early gesture use has important downstream impacts on developmental processes, such as language learning. However, autistic children are more likely to have challenges in their gestural development. The current study expands upon previous literature on the differences in gesture use between young autistic and non-autistic toddlers by collecting data using a parent-report questionnaire called the MCDI-Words and Gestures at three time points, 12, 18, and 24 months of age. Results (N = 467) showed that high-likelihood infants who later met diagnostic criteria for ASD (n = 73 HL-ASD) have attenuated gesture growth from 12 to 24 months for both deictic gestures and symbolic gestures when compared to high-likelihood infants who later did not meet criteria for ASD (n = 249 HL-Neg) and low-likelihood infants who did not meet criteria for ASD (n = 145 LL-Neg). Other social communicative skills, like play behaviors and imitation, were also found to be impacted in young autistic children when compared to their non-autistic peers. Understanding early differences in social communication growth before a formal autism diagnosis can provide important insights for early intervention.
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Affiliation(s)
- Dennis Wu
- Department of Psychology, University of Texas at Dallas, Richardson, Texas, USA
| | - Jason J Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Shruthi Ravi
- Department of Psychology, University of Texas at Dallas, Richardson, Texas, USA
| | - Jed T Elison
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Annette Estes
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
| | - Sarah Paterson
- James S. McDonnell Foundation, Saint Louis, Missouri, USA
| | - Tanya St John
- Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington, USA
| | - Hervé Abdi
- Department of Psychology, University of Texas at Dallas, Richardson, Texas, USA
| | - Luke E Moraglia
- Department of Psychology, University of Texas at Dallas, Richardson, Texas, USA
| | - Joseph Piven
- Department of Psychiatry, University of North Carolina - Chapel Hill, Chapel Hill, North Carolina, USA
| | - Meghan R Swanson
- Department of Psychology, University of Texas at Dallas, Richardson, Texas, USA
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5
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Pfeiffer DL, Hess CR, Landa RJ. Seeking Validation and Creating Meaningful Interactions: Perceptions of a Parent-Mediated Infant Intervention. INFANTS AND YOUNG CHILDREN 2024; 37:85-100. [PMID: 39006999 PMCID: PMC11244628 DOI: 10.1097/iyc.0000000000000260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Infancy, a formative period for development, has been identified as an advantageous time to provide family-centered support for children with delays. Families should be included as stakeholders during development of such interventions to ensure social value. We describe a preliminary randomized controlled trial evaluating Infant Achievements (IA), an 8-week (16-session) parent-mediated intervention for parents of infants 8-12 months old with social communication delays. This study reports our qualitative examination of the intervention's social validity. We conducted focus groups with 7 IA parent participants and analyzed their responses using conventional content analysis. Five themes emerged: (a) difficulty identifying resources to address concerns, (b) seeking validation of concerns, (c) seeking support to enhance children's development, (d) experiencing a supportive coaching relationship, and (e) creating meaningful interactions to support children's communication and social skills. Our results emphasize the necessity of partnering with families in the development of evidence-based family-centered interventions for infants with developmental delays to maximize their social value.
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Affiliation(s)
- Danika L Pfeiffer
- School of Communication Sciences and Disorders, Old Dominion University
| | - Christine Reiner Hess
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Johns Hopkins University School of Medicine
| | - Rebecca J Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Johns Hopkins University School of Medicine
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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6
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Chetcuti L, Varcin KJ, Boutrus M, Smith J, Bent CA, Whitehouse AJO, Hudry K. Feasibility of a 2-minute eye-tracking protocol to support the early identification of autism. Sci Rep 2024; 14:5117. [PMID: 38429348 PMCID: PMC10907367 DOI: 10.1038/s41598-024-55643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
We tested the potential for Gazefinder eye-tracking to support early autism identification, including feasible use with infants, and preliminary concurrent validity of trial-level gaze data against clinical assessment scores. We embedded the ~ 2-min 'Scene 1S4' protocol within a comprehensive clinical assessment for 54 consecutively-referred, clinically-indicated infants (prematurity-corrected age 9-14 months). Alongside % tracking rate as a broad indicator of feasible assessment/data capture, we report infant gaze data to pre-specified regions of interest (ROI) across four trial types and associations with scores on established clinical/behavioural tools. Most infants tolerated Gazefinder eye-tracking well, returning high overall % tracking rate. As a group, infants directed more gaze towards social vs. non-social (or more vs. less socially-salient) ROIs within trials. Behavioural autism features were correlated with increased gaze towards non-social/geometry (vs. social/people) scenes. No associations were found for gaze directed to ROIs within other stimulus types. Notably, there were no associations between developmental/cognitive ability or adaptive behaviour with gaze towards any ROI. Gazefinder assessment seems highly feasible with clinically-indicated infants, and the people vs. geometry stimuli show concurrent predictive validity for behavioural autism features. Aggregating data across the ~ 2-min autism identification protocol might plausibly offer greater utility than stimulus-level analysis alone.
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Affiliation(s)
- Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Kandice J Varcin
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Maryam Boutrus
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Jodie Smith
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | | | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
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7
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Smith J, Sulek R, Van Der Wert K, Cincotta-Lee O, Green CC, Bent CA, Chetcuti L, Hudry K. Parental Imitations and Expansions of Child Language Predict Later Language Outcomes of Autistic Preschoolers. J Autism Dev Disord 2023; 53:4107-4120. [PMID: 35976507 PMCID: PMC9382601 DOI: 10.1007/s10803-022-05706-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/26/2022]
Abstract
Both the amount and responsiveness of adult language input contribute to the language development of autistic and non-autistic children. From parent-child interaction footage, we measured the amount of adult language input, overall parent responsiveness, and six discrete parent responsive behaviours (imitations, expansions, open-ended questions, yes/no questions, comments and acknowledgements) to explore which types of responsiveness predicted autistic preschoolers' language five months later, after controlling for adult language input. We found expansions and particularly imitations to be more important for later language than overall responsiveness. This study emphasises the need to capture what exactly about parent language input influences child language acquisition, and adds to the evidence that imitating and expanding early language might be particularly beneficial for autistic preschoolers.
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Affiliation(s)
- Jodie Smith
- School of Allied Health, Human Services and Sport, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia.
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia.
| | - Rhylee Sulek
- School of Allied Health Sciences, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia
| | - Kailia Van Der Wert
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Olivia Cincotta-Lee
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Cherie C Green
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
- School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, La Trobe University, Plenty Road and Kingsbury Drive Bundoora, Melbourne, 3086, Australia
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8
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Alhozyel E, Elbedour L, Balaum R, Meiri G, Michaelovski A, Dinstein I, Davidovitch N, Kerub O, Menashe I. Association Between Early Developmental Milestones and Autism Spectrum Disorder. Res Child Adolesc Psychopathol 2023; 51:1511-1520. [PMID: 37231233 DOI: 10.1007/s10802-023-01085-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Early diagnosis and treatment of autism spectrum disorder (ASD) has been shown to lead to better prognosis. Here, we examined the association of commonly measured early developmental milestones (DMs) with later diagnosis of ASD. We conducted a case-control study of 280 children with ASD (cases) and 560 typically developed children (controls) matched to cases by date of birth, sex, and ethnicity in a control/case ratio of 2:1. Both cases and controls were ascertained from all children whose development was monitored at mother-child health clinics (MCHCs) in southern Israel. DM failure rates during the first 18 months of life in three developmental categories (motor, social, and verbal) were compared between cases and controls. Conditional logistic regression models were used to assess the independent association of specific DMs with the risk of ASD, while adjusting for demographic and birth characteristics.Significant case-control differences in DM failure rates were observed as early as 3 months of age (p < 0.001), and these differences increased with age. Specifically, cases were 2.4 times more likely to fail ≥ 1 DM at 3 months (aOR = 2.39; 95%CI = 1.41-4.06), and 15.3 times more likely to fail ≥ 3 DMs at 18 months (aOR = 15.32; 95%CI = 7.75-30.28). The most notable DM-ASD association was observed for social DM failure at 9-12 months (aOR = 4.59; 95%CI = 2.59-8.13). Importantly, the sex or ethnicity of the participants did not affect these DM-ASD associations. Our findings highlight the potential role of DMs as early signs of ASD that could facilitate earlier referral and diagnosis of ASD.
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Affiliation(s)
- Einav Alhozyel
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Leena Elbedour
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rewaa Balaum
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Meiri
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Analya Michaelovski
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Ilan Dinstein
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Psychology and Brain and Cognition Departments, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Orly Kerub
- The Mother and Child Department, Ministry of Health, Beer-Sheva, Israel
| | - Idan Menashe
- Department of Epidemiology, Biostatistics and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Azrieli National Center for Autism and Neurodevelopment Research, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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9
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Cohenour TL, Gulsrud A, Kasari C. Heterogeneity of autism symptoms in community-referred infants and toddlers at elevated or low familial likelihood of autism. Autism Res 2023; 16:1739-1749. [PMID: 37408377 PMCID: PMC10527623 DOI: 10.1002/aur.2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
Evidence suggests autistic individuals at elevated familial likelihood of autism spectrum disorder (by virtue of having an autistic sibling) have stronger cognitive abilities on average than autistic individuals with no family history of the condition, who have a low familial likelihood of autism. Investigating phenotypic differences between community-referred infants and toddlers with autism symptoms at elevated or low familial likelihood of autism may provide important insight into heterogeneity in the emerging autism phenotype. This study compared behavioral, cognitive, and language abilities of community-referred infants and toddlers with confirmed autism symptoms at elevated (EL) or low familial likelihood of autism (LL). Participants were 121 children aged 12 to 36 months who participated in two larger randomized trials of parent-mediated interventions for children with autism symptoms. Behavioral phenotypes were compared across three groups: children with at least one autistic sibling (EL-Sibs, n = 30), those with at least one older, non-autistic sibling and no family history of autism (LL-Sibs, n = 40), and first-born children with no family history of autism (LL-FB, n = 51). EL-Sibs had less severe autism symptoms and stronger cognitive abilities than children in LL groups. While the rate of receptive language delay was similar across groups, the rate of expressive language delay was markedly lower among EL-Sibs. After controlling for age and nonverbal cognitive ability, EL-Sibs were significantly less likely to present with expressive language delay than LL-Sibs. Familial likelihood of autism may play an important role in shaping the emerging autism phenotype in infancy and toddlerhood.
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Affiliation(s)
| | - Amanda Gulsrud
- University of California, Los Angeles, Los Angeles, California, USA
| | - Connie Kasari
- University of California, Los Angeles, Los Angeles, California, USA
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10
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Constable PA, Lim JKH, Thompson DA. Retinal electrophysiology in central nervous system disorders. A review of human and mouse studies. Front Neurosci 2023; 17:1215097. [PMID: 37600004 PMCID: PMC10433210 DOI: 10.3389/fnins.2023.1215097] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
The retina and brain share similar neurochemistry and neurodevelopmental origins, with the retina, often viewed as a "window to the brain." With retinal measures of structure and function becoming easier to obtain in clinical populations there is a growing interest in using retinal findings as potential biomarkers for disorders affecting the central nervous system. Functional retinal biomarkers, such as the electroretinogram, show promise in neurological disorders, despite having limitations imposed by the existence of overlapping genetic markers, clinical traits or the effects of medications that may reduce their specificity in some conditions. This narrative review summarizes the principal functional retinal findings in central nervous system disorders and related mouse models and provides a background to the main excitatory and inhibitory retinal neurotransmitters that have been implicated to explain the visual electrophysiological findings. These changes in retinal neurochemistry may contribute to our understanding of these conditions based on the findings of retinal electrophysiological tests such as the flash, pattern, multifocal electroretinograms, and electro-oculogram. It is likely that future applications of signal analysis and machine learning algorithms will offer new insights into the pathophysiology, classification, and progression of these clinical disorders including autism, attention deficit/hyperactivity disorder, bipolar disorder, schizophrenia, depression, Parkinson's, and Alzheimer's disease. New clinical applications of visual electrophysiology to this field may lead to earlier, more accurate diagnoses and better targeted therapeutic interventions benefiting individual patients and clinicians managing these individuals and their families.
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Affiliation(s)
- Paul A. Constable
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Jeremiah K. H. Lim
- Discipline of Optometry, School of Allied Health, University of Western Australia, Perth, WA, Australia
| | - Dorothy A. Thompson
- The Tony Kriss Visual Electrophysiology Unit, Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children NHS Trust, London, United Kingdom
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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11
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McGlade A, Whittingham K, Barfoot J, Taylor L, Boyd RN. Efficacy of very early interventions on neurodevelopmental outcomes for infants and toddlers at increased likelihood of or diagnosed with autism: A systematic review and meta-analysis. Autism Res 2023; 16:1145-1160. [PMID: 37036800 PMCID: PMC10946707 DOI: 10.1002/aur.2924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/18/2023] [Indexed: 04/11/2023]
Abstract
The aim of this systematic review was to determine the efficacy of very early interventions for infants and toddlers at increased likelihood of or diagnosed with autism for autism symptomatology, developmental outcomes and/or neurocognitive markers. Eight databases were searched (14 April 2022) with inclusion criteria: (i) RCTs with care as usual (CAU) comparison group, (ii) participants at increased likelihood of or diagnosed with autism and aged <24 months corrected age (CA), (iii) parent-mediated and/or clinician directed interventions, and (iv) outcome measures were autism symptomatology, cognition, language, adaptive skills, or neurocognitive assessments (EEG and eye tracking). Quality was assessed using Risk of Bias 2 and GRADE. Nineteen publications from 12 studies reported on 715 infants and toddlers. There was low to moderate certainty evidence that clinician-assessed outcomes did not show significant treatment effects for: autism symptomatology (ADOS CSS: MD -0.08, 95% CI -0.61, 0.44, p = 0.75), cognitive outcome (Mullen Scales of Early Learning-Early Learning Composite (MSEL-ELC): SMD 0.05, 95% CI -0.19, 0.29, p = 0.67), receptive language (MSEL-Receptive Language: SMD 0.04, 95% CI -0.21, 0.3, p = 0.74) or expressive language (MSEL-Expressive Language: SMD 0.06, 95% CI -0.1, 0.23, p = 0.45). Neurocognitive outcomes (EEG and eye tracking) were heterogeneous, with inconsistent findings. There is low to moderate certainty evidence that very early interventions have limited impact on neurodevelopmental outcomes by age 3 years.
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Affiliation(s)
- Andrea McGlade
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
| | - Koa Whittingham
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
| | - Jacqui Barfoot
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
| | - Leisa Taylor
- Department of Humanities EducationUniversity of New EnglandArmidaleNew South WalesAustralia
| | - Roslyn N. Boyd
- Faculty of MedicineThe University of Queensland, Queensland Cerebral Palsy and Rehabilitation Research CentreBrisbaneQueenslandAustralia
- Queensland Paediatric Rehabilitation ServiceQueensland Children's HospitalBrisbaneQueenslandAustralia
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12
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Segal L, Green J, Twizeyemariya A, Hudry K, Wan MW, Barbaro J, Iacono T, Varcin KJ, Pillar S, Cooper MN, Billingham W, Upson G, Whitehouse AJO. Estimated Therapy Costs and Downstream Cost Consequences of iBASIS-Video Interaction to Promote Positive Parenting Intervention vs Usual Care Among Children Displaying Early Behavioral Signs of Autism in Australia. JAMA Netw Open 2023; 6:e235847. [PMID: 37017966 PMCID: PMC10077097 DOI: 10.1001/jamanetworkopen.2023.5847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/07/2023] [Indexed: 04/06/2023] Open
Abstract
Importance The growing global prevalence of autism spectrum disorder (ASD) is associated with increasing costs for support services. Ascertaining the effects of a successful preemptive intervention for infants showing early behavioral signs of autism on human services budgets is highly policy relevant. Objective To estimate the net cost impact of the iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP) intervention on the Australian government. Design, Setting, and Participants Infants (aged 12 months) showing early behavioral indicators of autism were recruited through community settings into the multicenter Australian iBASIS-VIPP randomized clinical trial (RCT), a 5- to 6-month preemptive parent-mediated intervention, between June 9, 2016, and March 30, 2018, and were followed up for 18 months to age 3 years. This economic evaluation, including cost analysis (intervention and cost consequences) and cost-effectiveness analyses of iBASIS-VIPP compared with usual care (treatment as usual [TAU]), modeled outcomes observed at age 3 through to 12 years (13th birthday) and was conducted from April 1, 2021, to January 30, 2023. Data analysis was conducted from July 1, 2021, to January 29, 2023. Exposures iBASIS-VIPP intervention. Main Outcomes and Measures To project the diagnostic trajectory and associated disability support costs drawing on the Australian National Disability Insurance Scheme (NDIS), the main outcome was the differential treatment cost of iBASIS-VIPP plus TAU vs TAU and disability-related government costs modeled to age 12 years, using a clinical diagnosis of ASD and developmental delay (with autism traits) at 3 years. Costs were calculated in Australian dollars and converted to US dollars. Economic performance was measured through the following: (1) differential net present value (NPV) cost (iBASIS-VIPP less TAU), (2) investment return (dollars saved for each dollar invested, taking a third-party payer perspective), (3) break-even age when treatment cost was offset by downstream cost savings, and (4) cost-effectiveness in terms of the differential treatment cost per differential ASD diagnosis at age 3 years. Alternate values of key parameters were modeled in 1-way and probabilistic sensitivity analysis, the latter identifying the likelihood of an NPV cost savings. Results Of the 103 infants enrolled in the iBASIS-VIPP RCT, 70 (68.0%) were boys. Follow-up data at age 3 years were available for 89 children who received TAU (44 [49.4%]) or iBASIS-VIPP (45 [50.6%]) and were included in this analysis. The estimated mean differential treatment cost was A $5131 (US $3607) per child for iBASIS-VIPP less TAU. The best estimate of NPV cost savings was A $10 695 (US $7519) per child (discounted at 3% per annum). For each dollar invested in treatment, a savings of A $3.08 (US $3.08) was estimated; the break-even cost occurred at age 5.3 years (approximately 4 years after intervention delivery). The mean differential treatment cost per lower incident case of ASD was A $37 181 (US $26 138). We estimated that there was an 88.9% chance that iBASIS-VIPP would deliver a cost savings for the NDIS, the dominant third-party payer. Conclusions and Relevance The results of this study suggest that iBASIS-VIPP represents a likely good-value societal investment for supporting neurodivergent children. The estimated net cost savings were considered conservative, as they covered only third-party payer costs incurred by the NDIS and outcomes were modeled to just age 12 years. These findings further suggest that preemptive interventions may be a feasible, effective, and efficient new clinical pathway for ASD, reducing disability and the costs of support services. Long-term follow-up of children receiving preemptive intervention is needed to confirm the modeled results.
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Affiliation(s)
- Leonie Segal
- Health Economics and Social Policy Group, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Asterie Twizeyemariya
- Health Economics and Social Policy Group, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Ming Wai Wan
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Teresa Iacono
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Kandice J. Varcin
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Matthew N. Cooper
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Wesley Billingham
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Gemma Upson
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
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13
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Hudry K, Smith J, Pillar S, Varcin KJ, Bent CA, Boutrus M, Chetcuti L, Clark A, Dissanayake C, Iacono T, Kennedy L, Lant A, Robinson Lake J, Segal L, Slonims V, Taylor C, Wan MW, Green J, Whitehouse AJO. The Utility of Natural Language Samples for Assessing Communication and Language in Infants Referred with Early Signs of Autism. Res Child Adolesc Psychopathol 2023; 51:529-539. [PMID: 36602626 DOI: 10.1007/s10802-022-01010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 01/06/2023]
Abstract
Natural Language Sampling (NLS) offers clear potential for communication and language assessment, where other data might be difficult to interpret. We leveraged existing primary data for 18-month-olds showing early signs of autism, to examine the reliability and concurrent construct validity of NLS-derived measures coded from video-of child language, parent linguistic input, and dyadic balance of communicative interaction-against standardised assessment scores. Using Systematic Analysis of Language Transcripts (SALT) software and coding conventions, masked coders achieved good-to-excellent inter-rater agreement across all measures. Associations across concurrent measures of analogous constructs suggested strong validity of NLS applied to 6-min video clips. NLS offers benefits of feasibility and adaptability for validly quantifying emerging skills, and potential for standardisation for clinical use and rigorous research design.
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Affiliation(s)
- Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia.
| | - Jodie Smith
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Sarah Pillar
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Kandice J Varcin
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Maryam Boutrus
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
| | - Alena Clark
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Bendigo, VIC, 3550, Australia
| | - Lyndel Kennedy
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, 3086, Australia
| | - Alicia Lant
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Jemima Robinson Lake
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
| | - Leonie Segal
- Australian Centre for Precision Health Sciences, School of Health Sciences, University of South Australia, Adelaide, SA, 5001, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, SE5 8AF, UK
| | - Carol Taylor
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, M13 PL9, UK
| | - Ming Wai Wan
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, M13 PL9, UK
| | - Jonathan Green
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, M13 PL9, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - Andrew J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, WA, 6009, Australia
- Cooperative Research Centre for Living With Autism, Brisbane, QLD, 4068, Australia
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14
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Chetcuti L, Uljarević M, Varcin KJ, Boutrus M, Dimov S, Pillar S, Barbaro J, Dissanayake C, Green J, Whitehouse AJO, Hudry K. Continuity of temperament subgroup classifications from infancy to toddlerhood in the context of early autism traits. Autism Res 2023; 16:591-604. [PMID: 36511365 DOI: 10.1002/aur.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022]
Abstract
Our previous cross-sectional investigation (Chetcuti et al., 2020) showed that infants with autism traits could be divided into distinct subgroups based on temperament. This longitudinal study builds on this existing work by exploring the continuity of temperament subgroup classifications and their associations with behavioral/clinical phenotypic features from infancy to toddlerhood. 103 infants (68% male) showing early signs of autism were referred to the study by community healthcare professionals and seen for assessments when aged around 12-months (Time 1), 18-months (Time 2), and 24-months (Time 3). Latent profile analysis revealed inhibited/low positive, active/negative reactive, and sociable/well-regulated subgroups at each timepoint, and a unique reactive/regulated subgroup at Time 3. Cross-tabulations indicated a significant likelihood of children having a recurrent subgroup classification from one timepoint to the next, and no apparent patterns to the movement of children who did change from one subgroup to another over time. Temperament subgroups were associated with concurrent child social-emotional functioning and autism traits, but unrelated to child age, sex, or developmental level. These findings suggest that temperament subgroup classifications might represent a reliable and very early indicator of autism characteristics and social-emotional functioning among infants/toddlers with autism traits.
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Affiliation(s)
- Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Mirko Uljarević
- Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, School of Medicine, Stanford University, Palo Alto, USA
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Maryam Boutrus
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Stefanie Dimov
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, The University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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15
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Kulasinghe K, Whittingham K, Mitchell AE, Boyd RN. Psychological interventions targeting mental health and the mother-child relationship in autism: Systematic review and meta-analysis. Dev Med Child Neurol 2023; 65:329-345. [PMID: 36208472 PMCID: PMC10953452 DOI: 10.1111/dmcn.15432] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/28/2022] [Accepted: 09/02/2022] [Indexed: 01/18/2023]
Abstract
AIM To investigate the efficacy of psychological interventions delivered to mothers of young children with autism spectrum disorder (ASD) in improving maternal mental health and the parent-child relationship. METHOD Electronic databases were searched from inception to December 2021. Studies were included if they were randomized controlled trials (RCTs) of psychological interventions that targeted maternal mental health (primary outcome) and/or the parent-child relationship (secondary outcome), delivered to mothers of children (mean age < 60 months) with ASD. Meta-analyses of three parent mental health outcomes (stress, depressive symptomatology, and general mental health) and seven parent-child relationship outcomes (parent responsiveness, affect, directiveness, non-directiveness, child initiation, infant positive affect, and infant attentiveness) were conducted using both mean and standardized mean differences. RESULTS Thirty-two RCTs met the inclusion criteria (2336 participants). Six RCTs showed improved maternal mental health (Cohen's d = 0.41-1.15), with moderate certainty of evidence for improvement in parental stress. There was low and high certainty of evidence of treatment effect on parental depressive symptoms and general mental health respectively, which did not show significant treatment effects post-intervention. Seventeen RCTs showed improved parent-child relationship (d = 0.33-2.28; low certainty of evidence). INTERPRETATION Results demonstrated that parenting interventions promoting responsiveness had the largest positive effect on the parent-child relationship and a moderate effect on overall parenting stress; however, the studies were heterogeneous, making it difficult to identify the intervention components that were responsible for the positive treatment effects. There was no significant treatment effect for studies targeting depression or general mental health, likely due to the lack of an interventional component directly targeting mental health.
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Affiliation(s)
- Kavindri Kulasinghe
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Amy E. Mitchell
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQLDAustralia
- Menzies Health Institute QueenslandGriffith UniversityBrisbaneQLDAustralia
- Parenting and Family Support Centre, School of PsychologyUniversity of QueenslandBrisbaneQLDAustralia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
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Wright B, Fearon P, Garside M, Tsappis E, Amoah E, Glaser D, Allgar V, Minnis H, Woolgar M, Churchill R, McMillan D, Fonagy P, O’Sullivan A, McHale M. Routinely used interventions to improve attachment in infants and young children: a national survey and two systematic reviews. Health Technol Assess 2023; 27:1-226. [PMID: 36722615 PMCID: PMC9900465 DOI: 10.3310/ivcn8847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful. OBJECTIVES This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice. DESIGN AND METHODS We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey. RESULTS The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used. CONCLUSIONS There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment. LIMITATIONS Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this. FUTURE WORK There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments. STUDY REGISTRATION This study is registered as PROSPERO CRD42019137362. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Barry Wright
- Hull York Medical School, University of York, York, UK
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Megan Garside
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Eleni Tsappis
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Elaine Amoah
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Danya Glaser
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Victoria Allgar
- Peninsula Medical School, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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17
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Franchini M, Smith IM, Sacrey L, Duku E, Brian J, Bryson SE, Vaillancourt T, Armstrong V, Szatmari P, Roberts W, Roncadin C, Zwaigenbaum L. Continuity of trajectories of autism symptom severity from infancy to childhood. J Child Psychol Psychiatry 2022; 64:895-906. [PMID: 36562606 DOI: 10.1111/jcpp.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Behavioral symptom trajectories are informative of the development of young children at increased likelihood for autism spectrum disorder (ASD). METHODS Developmental trajectories of early signs were examined in a cohort of siblings of children diagnosed with ASD (n = 502) from 6 to 18 months using the Autism Observation Scale for Infants (AOSI), and from 18 months to 5-7 years using the Autism Diagnostic Observation Schedule (ADOS). Diagnostic outcomes for ASD at age 3 confirmed diagnosis for 137 children. We further analyzed the conditional probability of a switch from a trajectory measured with the AOSI to a trajectory measured with the ADOS as well as predictors from age 6 months. RESULTS We derived three early trajectories of behavioral signs ("Low," "Intermediate," and "Increasing") from 6 to 18 months using the AOSI. We then derived three similar, distinct trajectories for the evolution of symptom severity between 18 and 60-84 months of age (Low, Intermediate, Increasing) using the ADOS. Globally, the Low trajectory included children showing fewer ASD signs or symptoms and the Increasing trajectory included children showing more severe symptoms. We also found that most children in the Low AOSI trajectory stayed in the corresponding ADOS trajectory, whereas children in an Increasing AOSI trajectory tended to transition to an Intermediate or Increasing ADOS trajectory. Developmental measures taken at 6 months (early signs of ASD, Fine Motor, and Visual Reception skills) were predictive of trajectory membership. CONCLUSIONS Results confirm substantial heterogeneity in the early emergence of ASD signs in children at increased likelihood for ASD. Moreover, we showed that the way those early behavioral signs emerge in infants is predictive of later symptomatology. Results yield clear clinical implications, supporting the need to repeatedly assess infants at increased likelihood for ASD as this can be highly indicative of their later development and behavior.
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Affiliation(s)
- Martina Franchini
- Fondation Pôle Autisme and Faculty of Educational Psychology and Sciences, University of Geneva, Geneva, Switzerland
| | - Isabel M Smith
- Autism Research Centre, IWK Health Centre, Halifax, Canada.,Departments of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Lori Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Eric Duku
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jessica Brian
- Bloorview Research Institute and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bryson
- Autism Research Centre, IWK Health Centre, Halifax, Canada.,Departments of Pediatrics and Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Peter Szatmari
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Wendy Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, ON, Canada
| | - Caroline Roncadin
- McMaster Children's Hospital Autism Program, Hamilton Health Sciences, Hamilton, Canada
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18
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Smith J, Chetcuti L, Kennedy L, Varcin KJ, Slonims V, Bent CA, Green J, Iacono T, Pillar S, Taylor C, Wan MW, Whitehouse AJO, Hudry K. Caregiver sensitivity predicts infant language use, and infant language complexity predicts caregiver language complexity, in the context of possible emerging autism. Autism Res 2022; 16:745-756. [PMID: 36563289 DOI: 10.1002/aur.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
While theory supports bidirectional effects between caregiver sensitivity and language use, and infant language acquisition-both caregiver-to-infant and also infant-to-caregiver effects-empirical research has chiefly explored the former unidirectional path. In the context of infants showing early signs of autism, we investigated prospective bidirectional associations with 6-min free-play interaction samples collected for 103 caregivers and their infants (mean age 12-months; and followed up 6-months later). We anticipated that measures of caregiver sensitivity/language input and infant language would show within-domain temporal stability/continuity, but also that there would be predictive associations from earlier caregiver input to subsequent child language, and vice versa. Caregiver sensitive responsiveness (from the Manchester Assessment of Caregiver-Infant interaction [MACI]) predicted subsequent infant word tokens (i.e., amount of language, coded following the Systematic Analysis of Language Transcripts [SALT]). Further, earlier infant Mean Length of Utterance (MLU; reflecting language complexity, also derived from SALT coding) predicted later caregiver MLU, even when controlling for variability in infant ages and clear within-domain temporal stability/continuity in key measures (i.e., caregiver sensitive responsiveness and infant word tokens; and infant and caregiver MLU). These data add empirical support to theorization on how caregiver input can be both supportive of, and potentially influenced by, infant capacities, when infants have social-communication differences and/or communication/language delays suggestive of possible emerging autism.
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Affiliation(s)
- Jodie Smith
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Lacey Chetcuti
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
| | - Lyndel Kennedy
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kandice J Varcin
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Vicky Slonims
- Children's Neurosciences, Evelina London Children's Hospital, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | - Catherine A Bent
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Jonathan Green
- School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Teresa Iacono
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Pillar
- School of Biological Sciences, University of Manchester, Manchester, UK
| | - Carol Taylor
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Kristelle Hudry
- Department of Psychology, Counselling and Therapy, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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19
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Smith CG, Jones EJH, Wass SV, Pasco G, Johnson MH, Charman T, Wan MW. Infant Effortful Control Mediates Relations Between Nondirective Parenting and Internalising-Related Child Behaviours in an Autism-Enriched Infant Cohort. J Autism Dev Disord 2022; 52:3496-3511. [PMID: 34448110 PMCID: PMC9296408 DOI: 10.1007/s10803-021-05219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 11/12/2022]
Abstract
Internalising problems are common within Autism Spectrum Disorder (ASD); early intervention to support those with emerging signs may be warranted. One promising signal lies in how individual differences in temperament are shaped by parenting. Our longitudinal study of infants with and without an older sibling with ASD investigated how parenting associates with infant behavioural inhibition (8-14 months) and later effortful control (24 months) in relation to 3-year internalising symptoms. Mediation analyses suggest nondirective parenting (8 months) was related to fewer internalising problems through an increase in effortful control. Parenting did not moderate the stable predictive relation of behavioural inhibition on later internalising. We discuss the potential for parenting to strengthen protective factors against internalising in infants from an ASD-enriched cohort.
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Affiliation(s)
- C G Smith
- Henry Wellcome Building, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - E J H Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - S V Wass
- School of Psychology, University of East London, London, UK
| | - G Pasco
- Henry Wellcome Building, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - M H Johnson
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK.,Department of Psychology, University of Cambridge, Cambridge, UK
| | - T Charman
- Henry Wellcome Building, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - M W Wan
- School of Health Sciences, University of Manchester, Manchester, UK
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20
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Cleary DB, Bunney A, Henry L, Renton M, Granich J, Green J, Maybery MT, Whitehouse AJO. A Parent-Mediated Intervention for Newborns at Familial Likelihood of Autism: Initial Feasibility Study in the General Population. ADVANCES IN NEURODEVELOPMENTAL DISORDERS 2022; 6:494-505. [PMID: 35698574 PMCID: PMC9178338 DOI: 10.1007/s41252-022-00262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Developmental theory and previous studies support the potential value of prodromal interventions for infants at elevated likelihood of developing autism. Past research has supported the efficacy of parent-mediated prodromal therapies with infants from as early as 7 months. We outline the rationale for implementing interventions following this model from even earlier in development and report on the feasibility of a novel intervention developed following this model of parent-mediated infant interventions. METHODS We report a feasibility study (n = 13) of a parent-mediated, video-aided intervention, beginning during pregnancy, focussed on parent-infant interactions. The study evaluated the feasibility of this intervention initially with a general population sample. Feasibility was assessed across four domains (acceptability, implementation, practicality and integration) using self-report questionnaire, semi-structured interviews with parents and therapists, attendance and assessment completion. RESULTS Feasibility assessment shows that the intervention was acceptable, with all participants reporting that they had benefited from the program, with perceived positive benefits to their understanding of and communication with their infant, and that they had integrated program teachings into everyday life. The intervention was implemented as planned with 100% attendance for the core sessions. Changes to minimise the number of antenatal sessions was suggested to improve practicality. CONCLUSIONS This study found initial feasibility for this intervention in a general population sample. This suggests parent-mediated video feedback interventions are a promising format to be implemented within the perinatal developmental time period.
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Affiliation(s)
- Dominique B. Cleary
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Angela Bunney
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Lindy Henry
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Michelle Renton
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Joanna Granich
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, UK
| | - Murray T. Maybery
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Andrew J. O. Whitehouse
- Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Western Australia 6008 Australia
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21
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Law ML, Singh J, Mastroianni M, Santosh P. Parent-Mediated Interventions for Infants under 24 Months at Risk for Autism Spectrum Disorder: A Systematic Review of Randomized Controlled Trials. J Autism Dev Disord 2022; 52:2553-2574. [PMID: 34236590 PMCID: PMC9114042 DOI: 10.1007/s10803-021-05148-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
Prodromal symptoms of Autism Spectrum Disorder (ASD) have been detected within the first year of life. This review evaluated evidence from randomized controlled trials (RCTs) of parent-mediated interventions for infants under 24 months who are at risk for ASD. Electronic databases, including grey literature, were searched up till November 2019. Seven RCTs were identified. There was substantial heterogeneity in recruitment, outcome measures and effect size calculations. Interventions did not reduce the risk of later ASD diagnosis and post-intervention effects on infant outcomes were inconsistent, with five studies reporting significant improvements across both treatment and control groups. Moderate level of evidence of intervention effects on parental interaction skills and the small number of RCTs, and significant limitations restrict generalizability across studies.
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Affiliation(s)
- Mei L Law
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jatinder Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mathilde Mastroianni
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, Addiction Sciences Building, 1-4 Windsor Walk, Denmark Hill, London, London, SE5 8BB, UK.
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK.
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22
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Green J, Leadbitter K, Ainsworth J, Bucci S. An integrated early care pathway for autism. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:335-344. [PMID: 35303486 DOI: 10.1016/s2352-4642(22)00037-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 01/17/2023]
Abstract
In this Viewpoint, we argue for the need to reconceptualise an integrated early-care provision for autistic children in the light of their enduring support needs and relevant new findings from developmental and intervention research. This model goes beyond short-term reactive care to outline an early proactive, evidenced, developmentally phased, and scalable programme of support for autistic children and their families from the earliest opportunity, with timely access to later step-up care when needed. We also integrate this model with emerging opportunities from data science and digital health technologies as a potential facilitator of such a pathway. Building on this work, we argue that the best current autism intervention evidence can be integrated with concepts and evidence gained in the management of other enduring health conditions to support an autistic child and their family through their early development. The aim is to improve those children's social communication abilities, expand their range and flexibility of interests, and mitigate any negative impacts of sensory difficulties and restricted, repetitive behaviours on the child and their family wellbeing. The pathway solutions described could also be adapted for older adolescents and adults and could be used within the health systems of different countries, including within low-income and middle-income contexts.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK; Department of Child and Adolescent Mental Health, Manchester Royal Children's Hospital, Manchester, UK.
| | - Kathy Leadbitter
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester, UK
| | - John Ainsworth
- Division of Imaging, Informatics and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine, and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK; Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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23
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Coaching While Waiting for Autism Spectrum Disorder Assessment: A Pilot Feasibility Study for a Randomized Controlled Trial on Occupational Performance Coaching and Service Navigation. J Autism Dev Disord 2022:10.1007/s10803-022-05558-3. [PMID: 35488977 PMCID: PMC9055011 DOI: 10.1007/s10803-022-05558-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/18/2022]
Abstract
Aim To determine whether short-phase Occupational Performance Coaching combined with service navigation support is feasible for families waiting for autism assessment. Method A pilot feasibility study was conducted using a blinded randomization procedure that allocated participants to one of three trial arms: (1) face-to-face coaching, (2) videoconference coaching, and (3) usual care. Outcomes included a retention aim of 70–80%, goal attainment and secondary standardised measures of adaptive behaviour, social skills, parenting stress, service access and family quality of life. Results Caregivers and children (n = 16, child mean age of 3 years 7 months) were recruited following referral for an autism assessment. Retention was 75%, with change scores in performance and satisfaction of selected goals higher in the intervention groups than the usual care group. Interpretation Findings support progression to a future randomized controlled trial assessing intervention efficacy.
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24
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Waddington H, Macaskill E, Whitehouse AJO, Billingham W, Alvares GA. Parent-reported atypical development in the first year of life and age of autism diagnosis. J Autism Dev Disord 2022:10.1007/s10803-022-05506-1. [PMID: 35441920 DOI: 10.1007/s10803-022-05506-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
This study examined whether parent-reported atypical development in their child's first year was associated with age of diagnosis and age when parents first needed to consult a specialist about their child's development. It involved 423 children who participated in the Australian Autism Biobank. Most parents retrospectively identified ≥ 1 domain of atypical child development. Atypical development in most domains was associated with an earlier age when parents felt specialist consultation was needed. Atypical development in the "gaze abnormalities", "lack of response to social stimuli", and "no social communication" subdomains within the social domain was associated with an earlier age of diagnosis, as was atypical development in the "hypo/hypersensitivity" and "preoccupation with parts of objects" subdomains within the stereotyped/restricted behavior domain.
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Affiliation(s)
- Hannah Waddington
- School of Education, Victoria University of Wellington, Wellington, New Zealand.
| | - Ella Macaskill
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Andrew J O Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Long Pocket, Brisbane, Queensland, Australia
| | - Wesley Billingham
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Gail A Alvares
- Telethon Kids Institute, University of Western Australia, Perth, Australia
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25
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Research-Based Intervention (RBI) for Autism Spectrum Disorder: Looking beyond Traditional Models and Outcome Measures for Clinical Trials. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030430. [PMID: 35327802 PMCID: PMC8947461 DOI: 10.3390/children9030430] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 02/05/2023]
Abstract
The rising prevalence of Autism Spectrum Disorders (ASD) has led to a quickly increasing need for effective interventions. Several criteria and measures have been developed to critically assess these interventions with particular focus on the evaluation of the efficacy. Given the huge diversity of ASD symptoms and the different levels of severity across individuals, identifying a one size fits all intervention approach is challenging, and the question What works and for whom? Remains still unanswered. Why do we seem to be dragging our feet on this fundamental issue? The main aim of this paper is to answer this question through four non-alternative points. First, there are a scarce number of studies with a solid methodology. Secondly, most trials on intervention efficacy for ASD are designed exclusively in terms of behavioral outcomes. Thirdly, there is a reduced use of biologically oriented outcome measures. Fourthly, in most clinical trials, appropriate practices emerging from research evidence are not systematically applied. A strong effort to improve the methodology of clinical trials is mandatory for the future of autism research. The development of a research-based intervention (RBI) perspective aimed at better integrating: (a) evidence-based approaches; (b) more sensitive behavioral outcome measures; and (c) biomarkers, with the aim of increasing a more detailed clustering of phenotypes, may strongly improve our approach to a precision medicine.
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26
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Cooper MN, Whitehouse AJO, Billingham W. Reporting Both Unadjusted and Adjusted Estimates Is Essential to the Interpretation of Randomized Clinical Trial Results-Reply. JAMA Pediatr 2022; 176:326-327. [PMID: 35006264 DOI: 10.1001/jamapediatrics.2021.5541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Matthew N Cooper
- Telethon Kids Institute, University of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Andrew J O Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Wesley Billingham
- Telethon Kids Institute, University of Western Australia, Perth Children's Hospital, Nedlands, Western Australia, Australia
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27
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Stuart N, Whitehouse A, Palermo R, Bothe E, Badcock N. Eye Gaze in Autism Spectrum Disorder: A Review of Neural Evidence for the Eye Avoidance Hypothesis. J Autism Dev Disord 2022; 53:1884-1905. [PMID: 35119604 PMCID: PMC10123036 DOI: 10.1007/s10803-022-05443-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/27/2022]
Abstract
Reduced eye contact early in life may play a role in the developmental pathways that culminate in a diagnosis of autism spectrum disorder. However, there are contradictory theories regarding the neural mechanisms involved. According to the amygdala theory of autism, reduced eye contact results from a hypoactive amygdala that fails to flag eyes as salient. However, the eye avoidance hypothesis proposes the opposite-that amygdala hyperactivity causes eye avoidance. This review evaluated studies that measured the relationship between eye gaze and activity in the 'social brain' when viewing facial stimuli. Of the reviewed studies, eight of eleven supported the eye avoidance hypothesis. These results suggest eye avoidance may be used to reduce amygdala-related hyperarousal among people on the autism spectrum.
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Affiliation(s)
- Nicole Stuart
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.
| | - Andrew Whitehouse
- Telethon Kids Institute, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia
| | - Romina Palermo
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Ellen Bothe
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Nicholas Badcock
- University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
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28
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Davis PH, Elsayed H, Crais ER, Watson LR, Grzadzinski R. Caregiver responsiveness as a mechanism to improve social communication in toddlers: Secondary analysis of a randomized controlled trial. Autism Res 2022; 15:366-378. [PMID: 34799999 PMCID: PMC8821206 DOI: 10.1002/aur.2640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 02/03/2023]
Abstract
Early intensive behavioral interventions (EIBI) for children at elevated likelihood for a later diagnosis of autism spectrum disorder (EL-ASD), are often delivered through parent-mediated models. An area of current exploration is whether changes in caregiver behaviors are a mechanism through which to improve and track child behaviors in these interventions. Toddlers and their caregivers participated in an intervention trial (randomized controlled trial) and were randomized to either a parent-mediated intervention (adapted responsive teaching; ART) or a control condition (referral to early intervention and monitoring; REIM). Changes in toddler social communication (SC) behaviors and characteristics of caregiver responsiveness (CR) were quantified over 8 months. Analyses were conducted to assess whether changes in CR mediated the relation between group (ART vs. REIM) and changes in child SC. Results of the current study indicated that caregivers who participated in a parent-mediated intervention improved in three domains of CR (contingent verbal sensitivity, responsivity, affect). CR was also found to be a mechanism through which children's SC skills improved. This work provides evidence that qualities of CR serve as mechanisms through which to improve and monitor child behaviors over the course of EIBIs. These results may lead to novel intervention targets, methods for tracking change, and tailored treatment planning for toddlers with EL-ASD. The data used in this study comes from a clinical trial that was prospectively registered with the Registry of Efficacy and Effectiveness Studies (Registry ID: 316.1v1). LAY SUMMARY: Interventions for toddlers with high likelihood for a later diagnosis of autism often include the caregiver as an active participant in the intervention. In this study, we aimed to understand qualities of caregiver responsiveness (CR) that facilitate improvements in child behaviors during intervention. Results show that increasing verbal CR and affect are ways to improve child social skills over the course of intervention.
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Affiliation(s)
- Paige Huguely Davis
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC
| | - Heba Elsayed
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,Phoniatrics unit, ENT Department, Faculty of Medicine, Alexandria University, Egypt
| | - Elizabeth R. Crais
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Linda R. Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Division of Speech and Hearing Sciences
| | - Rebecca Grzadzinski
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina at Chapel Hill, NC,University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, NC
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29
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 258] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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30
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Early Developmental Signs in Children with Autism Spectrum Disorder: Results from the Japan Environment and Children’s Study. CHILDREN 2022; 9:children9010090. [PMID: 35053715 PMCID: PMC8774672 DOI: 10.3390/children9010090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/25/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022]
Abstract
Autism spectrum disorder (ASD) is a developmental disability in early childhood. Early identification and intervention in children with ASD are essential for children and their families. This study aimed to identify the earliest signs of ASD. Using a large cohort including data from 104,062 fetal records in the Japan Environment and Children’s Study, we examined the Ages and Stages Questionnaires® (ASQ-3TM) scores of children with and without ASD. The ASQ-3 comprises five domains: communication, gross motor, fine motor, problem solving, and personal-social. The ASQ-3 scores were obtained at ages 6 months, 1 year, and 3 years. There were 64,501 children with available ASQ-3 data. The number of children diagnosed with ASD was 188 (0.29%) at 3 years of age. The highest relative risk (RR) for any domain below the monitoring score at 6 months was in the communication (RR 1.90, 95% CI 1.29–2.78, p = 0.0041), followed by fine motor (RR 1.50, 95% CI 1.28–1.76, p < 0.0001) domain. A low ASQ-3 score in the communication domain at 6 months was related to an ASD diagnosis at 3 years of age. The ASQ-3 score at 6 months can contribute to the early identification of and intervention for ASD.
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31
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Zwaigenbaum L, Brian J, Smith IM, Sacrey LAR, Franchini M, Bryson SE, Vaillancourt T, Armstrong V, Duku E, Szatmari P, Roberts W, Roncadin C. Symptom trajectories in the first 18 months and autism risk in a prospective high-risk cohort. J Child Psychol Psychiatry 2021; 62:1435-1443. [PMID: 33782970 DOI: 10.1111/jcpp.13417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Although early autism spectrum disorder (ASD) detection strategies tend to focus on differences at a point in time, behavioral symptom trajectories may also be informative. METHODS Developmental trajectories of early signs of ASD were examined in younger siblings of children diagnosed with ASD (n = 499) and infants with no family history of ASD (n = 177). Participants were assessed using the Autism Observation Scale for Infants (AOSI) from 6 to 18 months. Diagnostic outcomes were determined at age 3 years blind to previous assessments. RESULTS Semiparametric group-based modeling using AOSI scores identified three distinct trajectories: Group 1 ('Low', n = 435, 64.3%) was characterized by a low level and stable evolution of ASD signs, group 2 ('Intermediate', n = 180, 26.6%) had intermediate and stable levels, and group 3 ('Inclining', n = 61, 9.3%) had higher and progressively elevated levels of ASD signs. Among younger siblings, ASD rates at age 3 varied by trajectory of early signs and were highest in the Inclining group, membership in which was highly specific (94.5%) but poorly sensitive (28.5%) to ASD. Children with ASD assigned to the inclining trajectory had more severe symptoms at age 3, but developmental and adaptive functioning did not differ by trajectory membership. CONCLUSIONS These prospective data emphasize variable early-onset patterns and the importance of a multipronged approach to early surveillance and screening for ASD.
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Affiliation(s)
| | - Jessica Brian
- Department of Paediatrics, Bloorview Research Institute, University of Toronto, Toronto, ON, Canada
| | - Isabel M Smith
- Departments of Pediatrics and Psychology and Neuroscience, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Lori-Ann R Sacrey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Susan E Bryson
- Departments of Pediatrics and Psychology and Neuroscience, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Tracy Vaillancourt
- Counselling Psychology, Faculty of Education, University of Ottawa, Ottawa, ON, Canada
| | | | - Eric Duku
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Peter Szatmari
- Department of Psychiatry, Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Wendy Roberts
- Integrated Services for Autism and Neurodevelopmental Disorders, Toronto, ON, Canada
| | - Caroline Roncadin
- McMaster Children's Hospital Autism Program, Hamilton Health Sciences, Hamilton, ON, Canada
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Brief Report: Training New Zealand Well Child/Tamariki Ora Nurses on Early Autism Signs Using the Social Attention and Communication Surveillance-Revised. J Autism Dev Disord 2021; 52:5050-5057. [PMID: 34748134 PMCID: PMC8574927 DOI: 10.1007/s10803-021-05344-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/23/2022]
Abstract
Universal developmental surveillance is considered best practice for early identification of autism. We analysed data from 175 New Zealand Well-Child/Tamariki Ora nurses who attended a 1-day training in developmental surveillance for autism using the social attention and communication surveillance-revised (SACS-R) tool. We used a survey to measure nurses’ knowledge of typical development, knowledge of early signs of autism, general autism knowledge, and confidence in identifying and discussing early signs, prior to the workshop, after the workshop, and at follow-up. We measured perceived acceptability of the SACS-R after the workshop and at follow-up. Nurses showed improvements on all measures from pre-workshop to post-workshop and pre-workshop to follow-up. Implementation of the SACS-R across different contexts appears feasible and acceptable.
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Whitehouse AJO, Varcin KJ, Pillar S, Billingham W, Alvares GA, Barbaro J, Bent CA, Blenkley D, Boutrus M, Chee A, Chetcuti L, Clark A, Davidson E, Dimov S, Dissanayake C, Doyle J, Grant M, Green CC, Harrap M, Iacono T, Matys L, Maybery M, Pope DF, Renton M, Rowbottam C, Sadka N, Segal L, Slonims V, Smith J, Taylor C, Wakeling S, Wan MW, Wray J, Cooper MN, Green J, Hudry K. Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism: A Randomized Clinical Trial of Outcomes to Diagnosis. JAMA Pediatr 2021; 175:e213298. [PMID: 34542577 PMCID: PMC8453361 DOI: 10.1001/jamapediatrics.2021.3298] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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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Affiliation(s)
- Andrew J. O. Whitehouse
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,University of Western Australia, Crawley, Western Australia, Australia,Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia
| | - Kandice J. Varcin
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Sarah Pillar
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Wesley Billingham
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Gail A. Alvares
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Catherine A. Bent
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Daniel Blenkley
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Maryam Boutrus
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Abby Chee
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Lacey Chetcuti
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Alena Clark
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Emma Davidson
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Stefanie Dimov
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Jane Doyle
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Megan Grant
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Cherie C. Green
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Megan Harrap
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Teresa Iacono
- Living with Disability Research Centre, College of Science, Health, and Engineering, Victoria, Australia
| | - Lisa Matys
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Murray Maybery
- School of Psychological Science, University of Western Australia, Crawley, Western Australia, Australia
| | - Daniel F. Pope
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Michelle Renton
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia,Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Catherine Rowbottam
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Nancy Sadka
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Leonie Segal
- Australian Centre for Precision Health, Allied Health and Human Movement, University of South Australia, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, Australia
| | - Vicky Slonims
- Children’s Neurosciences, Evelina London Children’s Hospital/Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Jodie Smith
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Carol Taylor
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Scott Wakeling
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Ming Wai Wan
- Perinatal Mental Health and Parenting Research Unit, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - John Wray
- Child and Adolescent Health Service, Child Development Service, West Perth, Western Australia, Australia
| | - Matthew N. Cooper
- CliniKids, Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, United Kingdom,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
| | - Kristelle Hudry
- Cooperative Research Centre for Living with Autism, Long Pocket, Indooroopilly, Queensland, Australia,Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
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Manzini A, Jones EJ, Charman T, Elsabbagh M, Johnson MH, Singh I. Ethical dimensions of translational developmental neuroscience research in autism. J Child Psychol Psychiatry 2021; 62:1363-1373. [PMID: 34405894 PMCID: PMC7611913 DOI: 10.1111/jcpp.13494] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Since the 1990s, increasing research has been devoted to the identification of biomarkers for autism to help attain more objective diagnosis; enable early prediction of prognosis; and guide individualized intervention options. Early studies focused on the identification of genetic variants associated with autism, but more recently, research has expanded to investigate neurodevelopmental markers. While ethicists have extensively discussed issues around advances in autism genomics, much less ethical scrutiny has focused on research on early neurodevelopment and on the interventions being developed as a result. OBJECTIVES We summarize the current state of the science on the identification of early markers for autism and its potential clinical applications, before providing an overview of the ethical issues arising from increasing understanding of children's neurodevelopment in very early life. RESULTS Advances in the understanding of brain and behavioral trajectories preceding later autism diagnosis raise ethical concerns around three themes: (a) New models for understanding autism; (b) Risks and benefits of early identification and intervention; and (c) Communication of early concerns to families. These ethical issues should be further investigated in research conducted in partnership with autistic people and their families. CONCLUSIONS This paper highlights the need for ethical scrutiny of early neurodevelopmental research in autism. Scrutiny requires expertise and methods from the basic sciences and bioethics, as well as constructive collaborations among autistic people, their parents, and autism researchers to anticipate early interventions that serve the community's interests and accommodate the varied experiences and preferences of people on the spectrum and their families.
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Affiliation(s)
- Arianna Manzini
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
- Radcliffe Department of Medicine, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK
| | - Emily J.H. Jones
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Mayada Elsabbagh
- Azrieli Centre for Autism Research, Montreal Neurological Institute-Hospital, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Mark H. Johnson
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
- Department of Psychology, University of Cambridge, UK
| | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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Grzadzinski R, Amso D, Landa R, Watson L, Guralnick M, Zwaigenbaum L, Deák G, Estes A, Brian J, Bath K, Elison J, Abbeduto L, Wolff J, Piven J. Pre-symptomatic intervention for autism spectrum disorder (ASD): defining a research agenda. J Neurodev Disord 2021; 13:49. [PMID: 34654371 PMCID: PMC8520312 DOI: 10.1186/s11689-021-09393-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/16/2021] [Indexed: 12/26/2022] Open
Abstract
Autism spectrum disorder (ASD) impacts an individual's ability to socialize, communicate, and interact with, and adapt to, the environment. Over the last two decades, research has focused on early identification of ASD with significant progress being made in understanding the early behavioral and biological markers that precede a diagnosis, providing a catalyst for pre-symptomatic identification and intervention. Evidence from preclinical trials suggest that intervention prior to the onset of ASD symptoms may yield more improved developmental outcomes, and clinical studies suggest that the earlier intervention is administered, the better the outcomes. This article brings together a multidisciplinary group of experts to develop a conceptual framework for behavioral intervention, during the pre-symptomatic period prior to the consolidation of symptoms into diagnosis, in infants at very-high-likelihood for developing ASD (VHL-ASD). The overarching goals of this paper are to promote the development of new intervention approaches, empirical research, and policy efforts aimed at VHL-ASD infants during the pre-symptomatic period (i.e., prior to the consolidation of the defining features of ASD).
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Affiliation(s)
- Rebecca Grzadzinski
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA.
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA.
| | - Dima Amso
- Department of Psychology, Columbia University, New York, NY, USA
| | - Rebecca Landa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Linda Watson
- Program for Early Autism Research Leadership and Service (PEARLS), University of North Carolina, Chapel Hill, NC, USA
- Division of Speech and Hearing Sciences, University of North Carolina, Chapel Hill, NC, USA
| | - Michael Guralnick
- Center on Human Development and Disability, University of Washington, Seattle, WA, USA
| | | | - Gedeon Deák
- Department of Cognitive Science, University of California, San Diego, San Diego, CA, USA
| | - Annette Estes
- Department of Speech and Hearing Sciences, University of Washington Autism Center, University of Washington, Seattle, WA, USA
| | - Jessica Brian
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Kevin Bath
- Department of Neuroscience, Brown University, Providence, RI, USA
| | - Jed Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Leonard Abbeduto
- University of California, Davis, MIND Institute, University of California, Davis, Sacramento, CA, USA
| | - Jason Wolff
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Piven
- Carolina Institute for Developmental Disabilities, University of North Carolina, Chapel Hill, NC, USA
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36
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Hampton LH, Rodriguez EM. Preemptive interventions for infants and toddlers with a high likelihood for autism: A systematic review and meta-analysis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1364-1378. [PMID: 34628968 DOI: 10.1177/13623613211050433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Interventions to address core symptoms for young children on the autism spectrum have a strong and growing evidence base. Adapting and delivering evidence-based interventions to infants and toddlers with a high likelihood for autism is a logical next step. This systematic review and meta-analysis summarize the association between infant and toddler interventions and developmental and family outcomes. Results indicate that these early interventions are effective for improving parent implementation of core strategies, yet the effects do not readily translate to child outcomes. However, key studies demonstrate conditional results that indicate that parent implementation is associated with child outcome. Implications for research and practice toward building adaptive interventions that respond to parent implementation and changing child characteristics are discussed.
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37
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Wieckowski AT, Thomas RP, Chen CMA, Zitter A, Fein DA, Barton ML, Adamson LB, Robins DL. Effect of Brief Training to Identify Autism Spectrum Disorder During Toddler Well-Child Care Visits. J Dev Behav Pediatr 2021; 42:666-671. [PMID: 34618724 PMCID: PMC8497937 DOI: 10.1097/dbp.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effect of a brief Enhanced training using the information-motivation-behavior (IMB) change model on improving providers' surveillance rates and accuracy of autism spectrum disorder (ASD) detection. METHOD Toddlers (n = 5,672) were screened for ASD during their pediatric well-child visits. Pediatric providers (n = 120) were randomized to receive Enhanced (incorporating components of the IMB model) or Control training. Providers indicated whether they had an ASD concern at each well-child visit. Toddlers who were positive on any screener and/or whose provider indicated ASD concern were invited for a diagnostic evaluation. Differences in provider-indicated ASD concerns before and after training were evaluated using log-linear analyses. RESULTS The Enhanced training did not have a significant effect on provider-endorsed ASD concerns (p = 0.615) or accuracy of endorsing concerns (p = 0.619). Providers in the Control training showed a significant reduction in indicating whether or not they had concerns after the training (from 71.9% to 64.3%), which did not occur in the Enhanced group. The Enhanced training led to more frequent endorsements of language (χ2 = 8.772, p = 0.003) and restricted and repetitive behavior (χ2 = 7.918, p = 0.005) concerns for children seen after training. CONCLUSION Provider training had limited impact on ASD surveillance, indicating the importance of using formal screening instruments that rely on parent report during well-child visits to complement developmental surveillance. Future research should examine whether providers who indicate specific concerns are more likely to accurately refer children for ASD evaluations.
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Affiliation(s)
| | - Rebecca P. Thomas
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Chi-Ming A. Chen
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Ashley Zitter
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
| | - Deborah A. Fein
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | - Marianne L. Barton
- Department of Psychological Sciences, University of Connecticut, Storrs, CT
| | | | - Diana L. Robins
- A.J. Drexel Autism Institute, Drexel University, Philadelphia, PA
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Talbott MR, Dufek S, Young G, Rogers SJ. Leveraging telehealth to evaluate infants with prodromal autism spectrum disorder characteristics using the telehealth evaluation of development for infants. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:1242-1254. [PMID: 34549613 DOI: 10.1177/13623613211045596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Many families seeking early evaluations for autism spectrum disorder face long waitlists, must often travel to centers with appropriate expertise, and are frequently told by providers to "wait and see." This results in significant stress for families and delayed supports to infants and their caregivers who could benefit. This study evaluated whether telehealth could be used to identify and evaluate infants with early autism spectrum disorder characteristics in the first year of life. In this study, we evaluated 41 infants via telehealth using a standard set of probes and scored behavior related to social communication, play, imitation, and other developmental domains. We found the majority of infants demonstrated elevated likelihood of autism spectrum disorder on both parent-reported questionnaires and examiner-rated behavior. Caregiver ratings of the overall utility of the protocol used in this study were high. Overall, this study demonstrates the feasibility for telehealth-based approaches to evaluate infants' with elevated likelihood of autism spectrum disorder in the first year of life, which could help to improve families' access to care and to expand our capacity to conduct studies evaluating possible intervention supports.
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Janusz JA, Klein-Tasman BP, Payne JM, Wolters PL, Thompson HL, Martin S, de Blank P, Ullrich N, Del Castillo A, Hussey M, Hardy KK, Haebich K, Rosser T, Toledo-Tamula MA, Walsh KS. Recommendations for Social Skills End Points for Clinical Trials in Neurofibromatosis Type 1. Neurology 2021; 97:S73-S80. [PMID: 34230205 PMCID: PMC8594002 DOI: 10.1212/wnl.0000000000012422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 06/07/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review parent-report social skills measures to identify and recommend consensus outcomes for use in clinical trials of social deficit in children and adolescents (ages 6-18 years) with neurofibromatosis type 1 (NF1). METHODS Searches were conducted via PubMed and ClinicalTrials.gov to identity social skills outcome measures with English language versions used in clinical trials in the past 5 years with populations with known social skills deficits, including attention-deficit/hyperactivity disorder and autism spectrum disorder (ASD). Measures were rated by the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) Neurocognitive Committee on patient characteristics, use in published studies, domains assessed, availability of standard scores, psychometric properties, and feasibility to determine their appropriateness for use in NF1 clinical trials. RESULTS Two measures were ultimately recommended by the committee: the Social Responsiveness Scale-2 (SRS-2) and the Social Skills Improvement System-Rating Scale (SSIS-RS). CONCLUSIONS Each of the 2 measures assesses different aspects of social functioning. The SSIS-RS is appropriate for studies focused on broader social functioning; the SRS-2 is best for studies targeting problematic social behaviors associated with ASD. Researchers will need to consider the goals of their study when choosing a measure, and specific recommendations for their use are provided.
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Affiliation(s)
- Jennifer A Janusz
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD.
| | - Bonita P Klein-Tasman
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Jonathan M Payne
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Pamela L Wolters
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Heather L Thompson
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Staci Martin
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Peter de Blank
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Nicole Ullrich
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Allison Del Castillo
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Maureen Hussey
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Kristina K Hardy
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Kristina Haebich
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Tena Rosser
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Mary Anne Toledo-Tamula
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
| | - Karin S Walsh
- From the Children's Hospital Colorado and University of Colorado School of Medicine (J.A.J.), Aurora; Department of Psychology (B.P.K.-T.), University of Wisconsin-Milwaukee; Murdoch Children's Research Institute and Department of Pediatrics (J.M.P., K.H.), University of Melbourne, Australia; Pediatric Oncology Branch (P.L.W., S.M., M.A.T.-T.), National Cancer Institute, Bethesda, MD; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; University of Cincinnati Medical Center (P.d.B.), OH; Boston Children's Hospital (N.U.), MA; Children's National Hospital, Gilbert NF Institute (A.d.C., K.K.H., K.S.W.), Washington, DC; Children's Tumor Foundation (M.H.), New York, NY; The George Washington School of Medicine (K.K.H., K.S.W.), Washington, DC; Children's Hospital Los Angeles (T.R.), CA; and Leidos Biomedical Research, Inc. (M.A.T.-T.), Frederick, MD
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Waddington H, Reynolds JE, Macaskill E, Curtis S, Taylor LJ, Whitehouse AJ. The effects of JASPER intervention for children with autism spectrum disorder: A systematic review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2370-2385. [PMID: 34348479 DOI: 10.1177/13623613211019162] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Naturalistic developmental behavioural interventions are promising approaches for young children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation intervention (JASPER) is a well-researched naturalistic developmental behavioural intervention but, to date, no reviews have specifically evaluated its effects. This systematic literature review examined the effects of JASPER intervention and its components on child, parent and educator outcomes. Of the 96 articles screened, 19 were eligible for inclusion in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills and language skills compared to the comparison group. Implementation outcomes for parents and educators were generally positive. There were no consistent predictors or mediators of treatment effects. None of the studies met all of the quality indicators outlined by the Council of Exceptional Children, and the majority of outcome measures were classified as proximal. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.Lay abstractInterventions which are delivered in natural contexts and use both developmental and behavioural techniques may be helpful for children with, or suspected of having, autism spectrum disorder. Joint attention, symbolic play, engagement and regulation (JASPER) is a type of intervention, which falls under this category. Although several studies have examined the effects of JASPER, this has not yet been summarised in a review. This systematic literature review examined the effects of JASPER intervention, and the techniques that make up JASPER, on child, parent and educator outcomes. We screened 96 articles and, of these, 19 were included in the review. Most studies found that children who received JASPER intervention showed significantly greater improvements in at least one outcome related to child joint attention, joint engagement, play skills, and language skills compared to children who did not receive JASPER intervention. Parents and educators were mostly able to use the JASPER techniques. There were no consistent child, parent, teacher or treatment characteristics that influenced the effects of the JASPER intervention. None of the studies met all of the indicators of being a good quality study outlined by the Council of Exceptional Children. Overall, JASPER intervention appears promising in improving child outcomes directly targeted during treatment. More research is needed to determine whether it is also effective in improving a wider range of outcomes for children with autism spectrum disorder.
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Affiliation(s)
| | | | | | | | | | - Andrew Jo Whitehouse
- Telethon Kids Institute, Australia.,The University of Western Australia, Australia
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Chetcuti L, Uljarević M, Varcin KJ, Boutrus M, Pillar S, Dimov S, Barbaro J, Dissanayake C, Green J, Wan MW, Segal L, Slonims V, Whitehouse AJO, Hudry K. Caregiver Psychological Distress Predicts Temperament and Social-Emotional Outcomes in Infants with Autism Traits. Res Child Adolesc Psychopathol 2021; 49:1669-1681. [PMID: 34216330 DOI: 10.1007/s10802-021-00838-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 01/10/2023]
Abstract
Child temperament and caregiver psychological distress have been independently associated with social-emotional difficulties among individuals with autism. However, the interrelationship among these risk factors has rarely been investigated. We explored the reciprocal interplay between child temperament (surgency, negative affectivity, and self-regulation) and caregiver psychological distress in the development of child internalizing and externalizing symptoms, in a cohort of 103 infants showing early autism traits. Caregivers completed questionnaires when children were aged around 12-months (Time 1 [T1]), 18-months (Time 2 [T2]), and 24-months (Time 3 [T3]). Cross-lagged path models revealed a significant pathway from T1 caregiver psychological distress through lower T2 child self-regulation to subsequently greater T3 child internalizing symptoms. No such caregiver-driven pathway was evident through T2 child negative affectivity or in the prediction of T3 child externalizing symptoms. Further, no support was found for temperament-driven pathways through caregiver psychological distress to child social-emotional difficulties. Child surgency was mostly unrelated to caregiver psychological distress and social-emotional difficulties. These findings implicate the need to support the mental health of caregivers with an infant with autism traits in order to enhance the emotion regulation and social-emotional development of their infants.
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Affiliation(s)
- Lacey Chetcuti
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia. .,Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.
| | - Mirko Uljarević
- Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, School of Medicine, Stanford University, Stanford Autism Center, Stanford, California, USA.,School of Psychological Sciences, Faculty of Medicine, The University of Melbourne, Dentistry and Health Sciences, Melbourne, Australia
| | - Kandice J Varcin
- School of Allied Health Sciences, Griffith University, Brisbane, Australia
| | - Maryam Boutrus
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Sarah Pillar
- Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Stefanie Dimov
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Josephine Barbaro
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Cheryl Dissanayake
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Jonathan Green
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester Mental Health NHS Trust, Manchester, UK
| | - Ming Wai Wan
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Leonie Segal
- Australian Centre for Precision Health, Division of Health Sciences, University of South Australia, Adelaide, Australia
| | - Vicky Slonims
- Evelina Children's Hospital / Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, UK
| | - Andrew J O Whitehouse
- Cooperative Research Centre for Living With Autism (Autism CRC), Brisbane, Australia.,Telethon Kids Institute, University of Western Australia, Nedlands, Australia
| | - Kristelle Hudry
- Department of Psychology and Counseling, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
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A white paper on a neurodevelopmental framework for drug discovery in autism and other neurodevelopmental disorders. Eur Neuropsychopharmacol 2021; 48:49-88. [PMID: 33781629 DOI: 10.1016/j.euroneuro.2021.02.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 12/20/2022]
Abstract
In the last decade there has been a revolution in terms of genetic findings in neurodevelopmental disorders (NDDs), with many discoveries critical for understanding their aetiology and pathophysiology. Clinical trials in single-gene disorders such as fragile X syndrome highlight the challenges of investigating new drug targets in NDDs. Incorporating a developmental perspective into the process of drug development for NDDs could help to overcome some of the current difficulties in identifying and testing new treatments. This paper provides a summary of the proceedings of the 'New Frontiers Meeting' on neurodevelopmental disorders organised by the European College of Neuropsychopharmacology in conjunction with the Innovative Medicines Initiative-sponsored AIMS-2-TRIALS consortium. It brought together experts in developmental genetics, autism, NDDs, and clinical trials from academia and industry, regulators, patient and family associations, and other stakeholders. The meeting sought to provide a platform for focused communication on scientific insights, challenges, and methodologies that might be applicable to the development of CNS treatments from a neurodevelopmental perspective. Multidisciplinary translational consortia to develop basic and clinical research in parallel could be pivotal to advance knowledge in the field. Although implementation of clinical trials for NDDs in paediatric populations is widely acknowledged as essential, safety concerns should guide each aspect of their design. Industry and academia should join forces to improve knowledge of the biology of brain development, identify the optimal timing of interventions, and translate these findings into new drugs, allowing for the needs of users and families, with support from regulatory agencies.
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Grzadzinski R, Nowell SW, Crais ER, Baranek GT, Turner-Brown L, Watson LR. Parent responsiveness mediates the association between hyporeactivity at age 1 year and communication at age 2 years in children at elevated likelihood of ASD. Autism Res 2021; 14:2027-2037. [PMID: 34128355 DOI: 10.1002/aur.2557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/05/2021] [Accepted: 05/18/2021] [Indexed: 11/11/2022]
Abstract
Studies suggest that higher parent responsiveness is associated with higher child language abilities. Infants and toddlers later diagnosed with autism spectrum disorder (ASD) often display hyporeactivity to sensory stimuli, which has also been associated with lower child communication abilities and lower parent responsiveness. Yet, whether parent responsiveness mediates the relationship between child hyporeactivity and later communication outcomes remains unexplored. This study is a secondary data analysis which includes children (n = 83; 56 males) identified as at elevated likelihood of later ASD. Children completed an observational measure of sensory reactivity and a standard developmental assessment at 14 (Time 1) and 23 months old (Time 2). At each time point, parents reported on the child's adaptive communication behaviors and sensory behaviors, and Parent Verbal Responsiveness (AvgPVR) was coded from parent-child free-play videos. Results indicated that the association between child sensory hyporeactivity at Time 1 (observed and parent-reported) and communication at Time 2 (observed and parent reported) was significantly mediated by AvgPVR. Although child hyporeactivity predicts poorer communication outcomes, increased parent verbal responsiveness may attenuate this negative impact. Parent responsiveness, a focus of many parent-mediated interventions, may be an important mechanism of treatment response that should be directly tested in future research. LAY SUMMARY: Toddlers at elevated likelihood of autism spectrum disorder (ASD) are often under-reactive (hyporeactive) to sensory stimuli. This hyporeactivity slows learning of communication skills and provides parents with fewer opportunities to respond to their children. In this study, children with hyporeactivity at 14 months generally had poorer communication at 23 months; however, the more responsive their parents were, the weaker the relationship between early hyporeactivity and later communication. Thus, increasing parent responsiveness may lead to better communication outcomes for toddlers with the early ASD symptom of hyporeactivity.
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Affiliation(s)
- Rebecca Grzadzinski
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina, Carolina Institute for Developmental Disabilities, Chapel Hill, North Carolina, USA
| | - Sallie W Nowell
- University of North Carolina, Frank Porter Graham Child Development Institute, Chapel Hill, North Carolina, USA
| | - Elizabeth R Crais
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Speech and Hearing Sciences, University of North Carolina
| | - Grace T Baranek
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,The Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Lauren Turner-Brown
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,University of North Carolina, TEACCH Autism Program, Chapel Hill, North Carolina, USA
| | - Linda R Watson
- Program for Early Autism Research, Leadership, and Service (PEARLS), University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Speech and Hearing Sciences, University of North Carolina
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Licari MK, Varcin K, Hudry K, Leonard HC, Alvares GA, Pillar SV, Stevenson PG, Cooper MN, Whitehouse AJO. The course and prognostic capability of motor difficulties in infants showing early signs of autism. Autism Res 2021; 14:1759-1768. [PMID: 34021977 DOI: 10.1002/aur.2545] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 04/01/2021] [Accepted: 05/03/2021] [Indexed: 11/12/2022]
Abstract
Delays within the motor domain are often overlooked as an early surveillance marker for autism. The present study evaluated motor difficulties and its potential as an early predictive marker for later autism likelihood in a cohort of infants (N = 96) showing early behavioral signs of autism aged 9-14 months. The motor domain was evaluated using the motor subscales of the Mullen Scales of Early Learning at baseline, and at a 6-month follow-up. The Autism Diagnostic Observation Schedule - Toddler Module (ADOS-T) was completed at follow-up as a measure of autism likelihood. Motor difficulties were common at baseline, with 63/96 (65.6%) infants scoring very low or below average in the gross motor domain and 29/96 (30.2%) in the fine motor domain. At follow-up, gross motor difficulties had resolved for many, with 23/63 (36.5%) infants maintaining these difficulties. Fine motor difficulties resolved in fewer infants, with 20/29 (69.0%) continuing to present with fine motor delays at follow-up. Adjusted linear regression models suggested that fine motor scores at baseline (β = -0.12, SE = 0.04) and follow-up (β = -0.17, SE = 0.05) were associated with higher ADOS-T scores; with difficulties across both timepoints (β = 5.60, SE = 1.35) the strongest (largest in magnitude) association with ADOS-T scores of the predictors examined. Motor difficulties are prominent in children displaying emerging signs of autism, with persistent fine motor difficulties predictive of the developing autism phenotype. The findings indicate the potential clinical value of including evaluation of motor skills within early autism surveillance measures. LAY SUMMARY: This prospective study evaluated motor development over a 6-month period in infants showing early behavioral signs of autism. Atypical motor development was a common feature of infants showing early signs of autism and persistent fine motor difficulties were predictive of the emerging autism phenotype.
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Affiliation(s)
- Melissa K Licari
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kandice Varcin
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Kristelle Hudry
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | | | - Gail A Alvares
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Sarah V Pillar
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Paul G Stevenson
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew N Cooper
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Andrew J O Whitehouse
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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45
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Constantino JN, Charman T, Jones EJH. Clinical and Translational Implications of an Emerging Developmental Substructure for Autism. Annu Rev Clin Psychol 2021; 17:365-389. [PMID: 33577349 PMCID: PMC9014692 DOI: 10.1146/annurev-clinpsy-081219-110503] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A vast share of the population-attributable risk for autism relates to inherited polygenic risk. A growing number of studies in the past five years have indicated that inherited susceptibility may operate through a finite number of early developmental liabilities that, in various permutations and combinations, jointly predict familial recurrence of the convergent syndrome of social communication disability that defines the condition. Here, we synthesize this body of research to derive evidence for a novel developmental substructure for autism, which has profound implications for ongoing discovery efforts to elucidate its neurobiological causes, and to inform future clinical and biomarker studies, early interventions, and personalized approaches to therapy.
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Affiliation(s)
- John N Constantino
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63110, USA;
| | - Tony Charman
- Department of Psychology, King's College London Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF, United Kingdom
| | - Emily J H Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London WC1E 7HX, United Kingdom
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46
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The associations between autistic and communication traits in parents and developmental outcomes in children at familial risk of autism at 6 and 24 months of age. Infant Behav Dev 2021; 63:101570. [PMID: 33946013 DOI: 10.1016/j.infbeh.2021.101570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Several studies have explored relationships between parent broader autism phenotype and offspring communication, and have reported that autistic-like traits in parents are related to offspring communication difficulties and autism severity. However, past research has focused on studying such associations in childhood and we know very little about them in infancy. With accumulating evidence that interventions administered during infancy may be most effective in reducing ASD symptoms, it is imperative to examine whether relationships between parent autistic-like traits and child communication appear even earlier during this critical period of life. METHOD This longitudinal study collected data from infant siblings of autistic children (N = 32) and infants with no family history of autism (N = 45) to explore how autistic-like traits in parents related to child developmental outcomes during infancy. RESULTS Parental communication difficulties and autistic-like traits were found to be associated with a range of child behaviours in the first two years of life, including social-emotional difficulties at 6 and 24 months, lower communication and emerging cognition at 24 months, and increased autistic behaviours at 24 months. CONCLUSIONS Based on the results, it appears that some of the difficulties seen in parents are relayed to children genetically. These findings contribute to ASD research concerning early communication development in children and heritability of ASD traits and may have important implications in monitoring child development. Furthermore, since the current study found a significant association between autistic traits in parents and child social-emotional behaviour as early as 6 months of age, it provides evidence of the value of assessing interventions that target infancy.
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Johnson MH, Charman T, Pickles A, Jones EJH. Annual Research Review: Anterior Modifiers in the Emergence of Neurodevelopmental Disorders (AMEND)-a systems neuroscience approach to common developmental disorders. J Child Psychol Psychiatry 2021; 62:610-630. [PMID: 33432656 PMCID: PMC8609429 DOI: 10.1111/jcpp.13372] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 02/06/2023]
Abstract
We present the Anterior Modifiers in the Emergence of Neurodevelopmental Disorders (AMEND) framework, designed to reframe the field of prospective studies of neurodevelopmental disorders. In AMEND we propose conceptual, statistical and methodological approaches to separating markers of early-stage perturbations from later developmental modifiers. We describe the evidence for, and features of, these interacting components before outlining analytical approaches to studying how different profiles of early perturbations and later modifiers interact to produce phenotypic outcomes. We suggest this approach could both advance our theoretical understanding and clinical approach to the emergence of developmental psychopathology in early childhood.
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Affiliation(s)
- Mark H. Johnson
- Centre for Brain and Cognitive DevelopmentDepartment of Psychological SciencesBirkbeck, University of LondonLondonUK
- Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Tony Charman
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Andrew Pickles
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Emily J. H. Jones
- Centre for Brain and Cognitive DevelopmentDepartment of Psychological SciencesBirkbeck, University of LondonLondonUK
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Holmes H, Sawer F, Clark M. Autism spectrum disorders and epilepsy in children: A commentary on the occurrence of autism in epilepsy; how it can present differently and the challenges associated with diagnosis. Epilepsy Behav 2021; 117:107813. [PMID: 33642176 DOI: 10.1016/j.yebeh.2021.107813] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/17/2021] [Accepted: 01/20/2021] [Indexed: 01/02/2023]
Abstract
Autism occurs more frequently in epilepsy, but is often not diagnosed. This could be due to a focus on medical issues, or because it presents differently from classic autism in its timing, phenotype, fluctuating profiles, and high level of comorbidity. Without a diagnosis, these children miss out on interventions that could modify outcome and their families and local teams will struggle to understand and support them. They also become a hidden group that does not participate in or benefit from research. This paper examined the issues and challenges of diagnosing autism in a population with a high-risk of epilepsy, drawing on more than 20 years' experience of a specialist multi-disciplinary Developmental Epilepsy Clinic (DEC).
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Affiliation(s)
- Harriet Holmes
- Developmental Epilepsy Clinic, Great Ormond Street Hospital, London WC1N3JH, UK
| | - Francesca Sawer
- Developmental Epilepsy Clinic, Great Ormond Street Hospital, London WC1N3JH, UK
| | - Maria Clark
- Developmental Epilepsy Clinic, Great Ormond Street Hospital, London WC1N3JH, UK.
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Lim YH, Licari M, Spittle AJ, Watkins RE, Zwicker JG, Downs J, Finlay-Jones A. Early Motor Function of Children With Autism Spectrum Disorder: A Systematic Review. Pediatrics 2021; 147:peds.2020-011270. [PMID: 33510035 DOI: 10.1542/peds.2020-011270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Early motor impairments have been reported in children with neurodevelopmental disorders (NDD), but it is not clear if early detection of motor impairments can identify children at risk for NDD or how early such impairments might be detected. OBJECTIVE To characterize early motor function in children later diagnosed with NDD relative to typically developing children or normative data. DATA SOURCES The Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, PsycINFO, and Scopus electronic databases were searched. STUDY SELECTION Eligible studies were required to include an examination of motor function in children (0-24 months) with later diagnosis of NDD by using standardized assessment tools. DATA EXTRACTION Data were extracted by 4 independent researchers. The quality of the studies was assessed by using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields checklist. RESULTS Twenty-five studies were included in this review; in most of the studies, the authors examined children with later autism spectrum disorder (ASD). Early motor impairments were detected in children later diagnosed with ASD. The meta-analysis results indicated that differences in fine, gross, and generalized motor functions between the later ASD and typically developing groups increased with age. Motor function across different NDD groups was found to be mixed. LIMITATIONS Results may not be applicable to children with different types of NDD not reported in this review. CONCLUSIONS Early motor impairments are evident in children later diagnosed with ASD. More research is needed to ascertain the clinical utility of motor impairment detection as an early transdiagnostic marker of NDD risk.
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Affiliation(s)
- Yi Huey Lim
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Melissa Licari
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Jill G Zwicker
- British Columbia Children's Hospital Research Institute and.,Sunny Hill Health Center, British Columbia Children's Hospital, Vancouver, Canada.,Departments of Occupational Science and Occupational Therapy and.,Pediatrics, The University of British Columbia, Vancouver, Canada
| | - Jenny Downs
- Telethon Kids Institute, Nedlands, Western Australia, Australia.,The University of Western Australia, Perth, Western Australia, Australia.,Schools of Physiotherapy and Exercise Science and
| | - Amy Finlay-Jones
- Telethon Kids Institute, Nedlands, Western Australia, Australia; .,Psychology, Curtin University, Bentley, Western Australia, Australia
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Bernie C, Williams K, Graham F, May T. Coaching While Waiting for Autism Spectrum Disorder Assessment: Protocol of a Pilot Feasibility Study for a Randomized Controlled Trial on Occupational Performance Coaching and Service Navigation Support. JMIR Res Protoc 2021; 10:e20011. [PMID: 33410761 PMCID: PMC7819777 DOI: 10.2196/20011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In Australia, the average time between a first concern of autism spectrum disorder (ASD) and diagnosis is over 2 years. After referral for assessment, families often wait 6-12 months before their appointment. This can be a time of uncertainty and stress for families. For some families, other forms of assistance are not accessible and thus timely intervention opportunities are missed. There is little evidence about how to provide the best support for children or caregivers while on assessment waiting lists. OBJECTIVE The aim of this study is to determine whether use of a coaching intervention called Occupational Performance Coaching (OPC) combined with service navigation support is feasible for families waiting for ASD assessment, as a crucial first step in planning a randomized controlled trial. METHODS A pilot and feasibility study will be conducted using recommended constructs and associated measures, which will be reported using CONSORT (Consolidated Standards or Reporting Trials) guidance. Participants will be child and caregiver dyads or triads, recruited within 4 months of their child (aged 1-7 years) being referred to one of two services for an ASD assessment in Victoria, Australia. A blinded randomization procedure will be used to allocate participants to one of three trial arms: (1) coaching and support intervention delivered face to face, (2) coaching and support intervention via videoconference, and (3) usual care. Descriptive statistics will be used to describe the sample characteristics of parents and children, inclusive of service access at baseline and follow up. Recruitment rates will be reported, and retention rates will be evaluated against a predicted rate of 70%-80% in each intervention arm. Goal attainment, using the Canadian Occupational Performance Measure, will indicate preliminary evidence for efficacy within the intervention arms, with an increase of 2 or more points on a 10-point performance and satisfaction scale considered clinically significant. RESULTS The study was approved by The Royal Children's Hospital Research Ethics and Governance Department in September 2018. As of October 2020, 16 families have been recruited to the study. Data analysis is ongoing and results are expected to be published in 2021. CONCLUSIONS Study findings will support planning for a future randomized controlled trial to assess the efficacy of OPC and service navigation support for caregivers of children awaiting ASD assessment. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12620000164998; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378793&isReview=true. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/20011.
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Affiliation(s)
- Charmaine Bernie
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Allied Health, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Katrina Williams
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Developmental Paediatrics, Monash Children's Hospital, Melbourne, Australia
- The Murdoch Children's Research Institute, Melbourne, Australia
| | - Fiona Graham
- Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Tamara May
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- The Murdoch Children's Research Institute, Melbourne, Australia
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