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Minjarez MB, Gengoux GW, Paszek K, Liang JA, Ardel CM, Hardan AY, Frazier T. Adherence and Opportunity Frequency as Predictors of Communication Outcomes from Pivotal Response Parent Training. J Autism Dev Disord 2024:10.1007/s10803-024-06447-7. [PMID: 38976103 DOI: 10.1007/s10803-024-06447-7] [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] [Accepted: 06/19/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Access to intervention is a barrier for children with autism. As parent-mediated interventions have emerged to address this need, understanding implementation components contributing to child gains is critically important. Existing literature documents relationships between parent treatment adherence and child progress; however, less is understood about components, such as frequency of learning opportunities, which could also affect child outcomes. METHODS This study is a secondary analysis of data from a randomized controlled trial evaluating Pivotal Response Treatment group parent training (PRTG) compared to psychoeducation. Linear regression and mediational models were employed to identify potential predictors and mediators of outcome. RESULTS PRTG produced large increases in adherence and learning opportunities. In general, greater frequency of learning opportunities and adherence predicted better child outcomes. The best-fitting cross-sectional mediational models indicated at least partial mediational effects, whereby increased learning opportunities mediated the relationship between greater adherence and improved child outcomes. CONCLUSIONS This study provides preliminary evidence of how early gains in adherence may support parents to provide more frequent learning opportunities, which, in turn, yield positive effects on child social communication. Future large-scale research, with greater granularity of measurement, is needed to further understand the temporal relationships between these variables.
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Affiliation(s)
| | - Grace W Gengoux
- Stanford University School of Medicine, Stanford, United States.
- Department of Psychiatry & Behavioral Sciences, Division of Child & Adolescent Psychiatry, 401 Quarry Road, Stanford, CA, 94305-5719, USA.
| | | | | | | | | | - Thomas Frazier
- John Carroll University and SUNY Upstate Medical University, OH, United States
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Sengupta K, Shah H, Ghosh S, Sanghvi D, Mahadik S, Dani A, Deshmukh O, Pacione L, Dixon P, Salomone E, Servili C. World Health Organisation-Caregiver Skills Training (WHO-CST) Program: Feasibility of Delivery by Non-Specialist Providers in Real-world Urban Settings in India. J Autism Dev Disord 2021; 53:1444-1461. [PMID: 34853959 DOI: 10.1007/s10803-021-05367-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
The World Health Organization-Caregiver Skills Training Program, a parent-mediated early intervention facilitated by non-specialist providers piloted in urban India was evaluated using mixed-methods for feasibility and effects on child and caregiver outcomes. Caregivers (n = 22) of children (2-9 years) with social-communication delays participated in a single-group pre-post study. High rates of caregiver attendance, improved caregiver fidelity, and facilitator competency suggested program feasibility. Caregivers voiced acceptability of various intervention-components. The intervention was associated with improved caregiver-reported skills and knowledge (p < 0.00), reduction in stress (p = 0.03), improved child developmental outcomes on communication and social interaction (p < 0.00), and adaptive behaviors (p < 0.00). Challenges about logistics and availability of time were highlighted. Implications of results in resource-poor settings and recommendations for future feasibility trials are discussed.
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Affiliation(s)
- Koyeli Sengupta
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India.
| | - Henal Shah
- Department of Psychiatry, T. N. Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Subharati Ghosh
- Research Insights and Innovation, Population Health and Safety, SEIU 775 Benefits Group, Seattle, USA
| | - Disha Sanghvi
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India
| | - Sanchita Mahadik
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India
| | - Allauki Dani
- Department of Psychiatry, T. N. Medical College & BYL Nair Ch. Hospital, Mumbai, India
| | - Oshin Deshmukh
- Autism Intervention Services, Ummeed Child Development Center, Ground Floor, Mantri Pride, 1-B, 1/62 N.M. Joshi Marg, Subhash Nagar, Near Chinchpokli Station, Lower Parel, Mumbai, 400011, India
| | - Laura Pacione
- Division of Child and Youth Mental Health, Department of Psychiatry, University of Toronto, Toronto, Canada.,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Pamela Dixon
- Autism Speaks, 1060 State Rd, Princeton, NJ, USA
| | - Erica Salomone
- Department of Psychology, University of Milan-Bicocca, Milan, Italy.,Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | | | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Leadbitter K, Macdonald W, Taylor C, Buckle KL. Parent perceptions of participation in a parent-mediated communication-focussed intervention with their young child with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2129-2141. [PMID: 32667223 PMCID: PMC7539598 DOI: 10.1177/1362361320936394] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Paediatric Autism Communication Therapy is a parent-mediated, video-aided, communication-focussed intervention for young children with autism spectrum disorder. It has been shown in a UK randomised controlled trial to lead to improvements in parent–child communication and family quality of life, together with a sustained reduction in child autism symptom severity. This qualitative study examined parental perceptions of their participation in Paediatric Autism Communication Therapy within the context of the randomised controlled trial. Semi-structured interviews were carried out with 18 parents within 12 months of completion of the therapy. The thematic analysis provides insights into parents’ hopes, expectations, and learning processes when working with Paediatric Autism Communication Therapy therapists and carrying out daily practice in the home. Parents reported positive changes in their interaction and relationship with their child and improvements to their child’s communication and interaction. Some also highlighted poignant realisations and emotional challenges associated with taking part in this post-diagnostic therapy. Practical difficulties were also emphasised. Implications for the clinical practice of parent-mediated interventions with young children with autism spectrum disorder are discussed.
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Kitzerow J, Teufel K, Jensen K, Wilker C, Freitag CM. Case-control study of the low intensive autism-specific early behavioral intervention A-FFIP: Outcome after one year. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 48:103-112. [PMID: 30971173 DOI: 10.1024/1422-4917/a000661] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Abstracts: Objective: In current international research, early intervention in children with autism-spectrum disorder (ASD) focuses on naturalistic developmental behavioral interventions (NDBI). The manualized Frankfurt Early Intervention Program for preschool-aged children with ASD (A-FFIP) implements NDBI principles within a low-intensity approach of 2 h intervention/week. The present case-control study established effect sizes of change in autistic symptoms, comorbid behavioral problems as well as IQ after one year. Methodology: An intervention group (N = 20; age: 3.4-7.9 years) and a treatment-as-usual control group (N = 20; age: 3.2-7.3 years) of children with ASD were matched for developmental and chronological age. The outcome measures used were the ADOS severity score, the Child Behavior Checklist, and cognitive development. Results: After one year, the A-FFIP group showed a trend towards greater improvement in autistic symptoms (η2 = .087 [95 %-CI: .000-.159]) and significantly greater improvements in cognitive development (η2 = .206 [CI: .012-.252]) and global psychopathology (η2 = .144 [CI: .001-.205]) compared to the control group. Conclusion: The efficacy of A-FFIP should be established in a larger, sufficiently powered, randomized controlled study.
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Affiliation(s)
- Janina Kitzerow
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Karoline Teufel
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Katrin Jensen
- Institute of Medical Biometry and Informatics, University of Heidelberg, Germany
| | - Christian Wilker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Autism Research and Intervention Center of Excellence Frankfurt, Goethe University Frankfurt am Main, Germany
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Review of interventions for the management of anxiety symptoms in children with ASD. Neurosci Biobehav Rev 2018; 95:449-463. [DOI: 10.1016/j.neubiorev.2018.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 10/07/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022]
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Locke J, Shih W, Kang-Yi CD, Caramanico J, Shingledecker T, Gibson J, Frederick L, Mandell DS. The impact of implementation support on the use of a social engagement intervention for children with autism in public schools. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:834-845. [PMID: 29998740 DOI: 10.1177/1362361318787802] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Several interventions have demonstrated efficacy in improving social outcomes for children with autism; however, few have been successfully implemented in schools. This study compared two implementation strategies to improve the use of a social engagement intervention for children with autism in public schools. In total, 31 children with autism in grades K-5 and 28 school personnel participated in a randomized controlled trial. Schools were randomized to (1) training in Remaking Recess, a social engagement intervention, or (2) training in Remaking Recess with implementation support. Linear regression with random effects was used to test the intervention effects on implementation fidelity and social outcomes (peer engagement, social network inclusion, and friendship nominations). In both groups, implementation fidelity improved after training but remained low. Children in the Remaking Recess with implementation support condition had significantly higher social network inclusion and received more friendship nominations than children in the Remaking Recess-only condition (p = 0.03). Children in both groups experienced reduced solitary engagement (p < 0.001) and increased joint engagement (p < 0.001). The results suggest that implementation supports may have an effect on outcomes above and beyond the intervention, and that further research is needed into the active intervention mechanisms.
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Pijl MK, Buitelaar JK, de Korte MW, Rommelse NN, Oosterling IJ. Sustainability of an early detection program for autism spectrum disorder over the course of 8 years. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2017; 22:1018-1024. [PMID: 29068245 PMCID: PMC6196591 DOI: 10.1177/1362361317717977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The importance of early detection of autism spectrum disorder followed by early intervention is increasingly recognized. This quasi-experimental study evaluated the long-term effects of a program for the early detection of autism spectrum disorder (consisting of training of professionals and use of a referral protocol and screening instrument), to determine whether the positive effects on the age at referral were sustained after the program ended while controlling for overall changes in the number of referrals. Before, during, and after the program, the proportion of children referred before 3 years (versus 3–6 years) of age was calculated for children subsequently diagnosed with autism spectrum disorder (N = 513) or another, non-autism spectrum disorder, condition (N = 722). The odds of being referred before 3 years of age was higher in children with autism spectrum disorder than in children with another condition during the program than before (3.1, 95% confidence interval: 1.2–7.6) or after (1.7, 95% confidence interval: 1.0–3.0) the program but was not different before versus after the program. Thus, although the program led to earlier referral of children with autism spectrum disorder, after correction for other referrals, the effect was not sustained after the program ended. This study highlights the importance of continued investment in the early detection of autism spectrum disorder.
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Affiliation(s)
- Mirjam Kj Pijl
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
| | - Jan K Buitelaar
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
| | - Manon Wp de Korte
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
| | - Nanda Nj Rommelse
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
| | - Iris J Oosterling
- 1 Karakter Child and Adolescent Psychiatry University Centre, The Netherlands.,2 Radboud University Medical Centre, Nijmegen
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Autism in Southeast Europe: A Survey of Caregivers of Children with Autism Spectrum Disorders. J Autism Dev Disord 2017; 47:2314-2325. [DOI: 10.1007/s10803-017-3145-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Touzet S, Occelli P, Schröder C, Manificat S, Gicquel L, Stanciu R, Schaer M, Oreve MJ, Speranza M, Denis A, Zelmar A, Falissard B, Georgieff N, Bahrami S, Geoffray MM. Impact of the Early Start Denver Model on the cognitive level of children with autism spectrum disorder: study protocol for a randomised controlled trial using a two-stage Zelen design. BMJ Open 2017; 7:e014730. [PMID: 28348195 PMCID: PMC5372147 DOI: 10.1136/bmjopen-2016-014730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Early intervention for autism spectrum disorder (ASD) in the European French-speaking countries is heterogeneous and poorly evaluated to date. Early intervention units applying the Early Start Denver Model (ESDM) for toddlers and young children with ASD have been created in France and Belgium to improve this situation. It is essential to evaluate this intervention for the political decision-making process regarding ASD interventions in European French-speaking countries. We will evaluate the effectiveness of 12 hours per week ESDM intervention on the cognitive level of children with ASD, over a 2-year period. METHODS AND ANALYSIS The study will be a multicentre, randomised controlled trial, using a two-stage Zelen design. Children aged 15-36 months, diagnosed with ASD and with a developmental quotient (DQ) of 30 or above on the Mullen Scale of Early Learning (MSEL) will be included. We will use a stratified minimisation randomisation at a ratio 1:2 in favour of the control group. The sample size required is 180 children (120 in the control and 60 in the intervention group). The experimental group will receive 12 hours per week ESDM by trained therapists 10 hours per week in the centre and 2 hours in the toddlers' natural environment (alternatively by the therapist and the parent). The control group will receive care available in the community. The primary outcome will be the change in cognitive level measured with the DQ of the MSEL scored at 2 years. Secondary outcomes will include change in autism symptoms, behavioural adaptation, communicative and productive language level, sensory profile and parents' quality of life. The primary analysis will use the intention-to-treat principle. An economic evaluation will be performed. DISSEMINATION Findings from the study will be disseminated through peer reviewed publications and meetings. TRIAL REGISTRATION NUMBER NCT02608333 (clinicaltrials.gov); Pre-results.
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Affiliation(s)
- Sandrine Touzet
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Pauline Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Carmen Schröder
- Department of Child and Adolescent Psychiatry, Hopitaux universitaires de Strasbourg, Strasbourg F-67000, France
- CNRS UPR 3212—Team 9, Strasbourg University, Strasbourg F-67000, France
| | | | - Ludovic Gicquel
- Pôle Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier Spécialisé Henri Laborit, Saint Benoît F-86280, France
- Child and Adolescent Psychiatry Department, Unité de Recherche Clinique, Université de Poitiers, Poitiers F-86000, France
| | - Razvana Stanciu
- Hôpital Universitaire des Enfants Reine Fabiola, Université Libre de Bruxelles, Bruxelles 1020, Belgium
| | - Marie Schaer
- Office Médico-Pédagogique, University of Geneva, Geneva, Switzerland
| | - Marie-Joelle Oreve
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Le Chesnay F-78150, France
| | - Mario Speranza
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Le Chesnay F-78150, France
- EA 4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Versailles F-78000, France
| | - Angelique Denis
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Amelie Zelmar
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon F-69003, France
- Laboratoire Health Services and Performance Research, EA 7425 HESPER, Université de Lyon, Lyon F-69008France
| | - Bruno Falissard
- Université Paris-Sud, CESP, INSERM, UVSQ, Université Paris-Saclay, U1178, Maison de Solenn, Paris cedex 14, France
- Department of Public Health, AP-HP, Hôpital Paul Brousse, Villejuif F-94800, France
| | - Nicolas Georgieff
- Department of child and adolescent psychiatry, Centre Hospitalier le Vinatiers, Bron F-69500, France
- Université de Lyon, Lyon F-69008, France
| | - Stephane Bahrami
- EA 4047 HANDIReSP, Université de Versailles Saint-Quentin-en-Yvelines, Versailles F-78000, France
- CIC 1429, INSERM, AP-HP, Hôpital Raymond-Poincare, Garches F-92380, France
| | - Marie-Maude Geoffray
- Department of child and adolescent psychiatry, Centre Hospitalier le Vinatiers, Bron F-69500, France
- Université de Lyon, Lyon F-69008, France
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Salomone E, Charman T, McConachie H, Warreyn P. Child's verbal ability and gender are associated with age at diagnosis in a sample of young children with ASD in Europe. Child Care Health Dev 2016; 42:141-5. [PMID: 26016520 DOI: 10.1111/cch.12261] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Autism spectrum disorder can in some cases be reliably diagnosed by age 2 years, but in community settings, the mean age at diagnosis is often considerably higher. Later diagnosis has been found to be associated with lower symptom severity, lower parental socioeconomic status and fewer parental concerns. Gender differences in age at diagnosis have been examined, with mixed evidence. METHODS We examined the association of child's verbal ability and gender, and parental education, with age at diagnosis in a large sample of young children with autism spectrum disorder in 18 European countries (n = 1410). RESULTS There was considerable variation in age at diagnosis across countries. Children with better communication skills were diagnosed significantly later than non-verbal and minimally verbal children. There was also a significant interaction of gender with verbal ability on age at diagnosis, in that female children with complex phrase speech were diagnosed later than male children with the same level of verbal ability. CONCLUSIONS Our findings highlight the need to implement public awareness initiatives and training for professionals to promote early detection and, consequently, early intervention for autism spectrum disorder in Europe.
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Affiliation(s)
- E Salomone
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, UK
| | - T Charman
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, UK
| | - H McConachie
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - P Warreyn
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
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