Personalized, Responsive Intervention Sequences for Minimally Verbal Children with Autism (PRISM)

针对语言能力极低的自闭症儿童的个性化、响应式干预序列 (PRISM)

• 批准号: 9925806
• 负责人: CONNIE L. KASARI
• 金额: $ 64.4万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-05 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925806
• 关键词: 4 year old; Address; Age; Area; Child; Child Language; Classification; Communication; Consensus; Disease; Early Intervention; Educational workshop; Elements; Exhibits; Exposure to; Goals; Heterogeneity; Individual; Intervention; Intervention Studies; Joints; Knowledge; Language; Measures; Mediating; Mediator of activation protein; National Institute of Mental Health; Nursery Schools; Oregon; Outcome; Participant; Play; Population; Preschool Child; Probability; Regulation; Research; Risk; School-Age Population; Site; Specific qualifier value; Speech; Strategic Planning; Terminology; Testing; Time; Training; United States National Institutes of Health; adaptive intervention; aged; applied behavior analysis; autism spectrum disorder; autistic children; base; community setting; design; evidence base; follow-up; improved; joint attention; language outcome; personalized intervention; phrases; primary outcome; research study; response; secondary outcome; skills; social; social communication impairment; standard of care; therapy design

PROJECT ABSTRACT Many 3-4 year olds with autism spectrum disorder (ASD) who are `preverbal' (30-50%) do not go on to develop socially related words and phrases by age 5-6 years and are reclassified as `minimally verbal', never moving past 20 functional, non-echoed words, even with exposure to evidence-based early interventions. Despite significant research of children older than 5 who are already classified as minimally verbal, little research has attempted to optimize intervention for limited language preschool children who may be more likely to develop language with appropriate, targeted, and personalized intervention approaches. Therefore, a major gap in our knowledge remains on how to place these children with ASD on a path to becoming verbal by school age, thus reducing the numbers of minimally verbal children. A key challenge in this population is that one size does not fit all: there is vast heterogeneity in presentation and response to intervention. To capitalize on this heterogeneity, it will be necessary to use an individually tailored, sequential approach to intervention whereby treatment is adapted over time based on how the child responds. The overarching goal of the proposed multi-site project is to maximize language outcomes for preschoolers at risk for maintaining `minimally verbal' status by developing a two-stage, 20-week “adaptive intervention” (an intervention that incorporates a replicable sequence of treatment decision rules to guide clinicians on when and how to alter an intervention). This study addresses key questions in designing an adaptive intervention, including how best to intervene with children responding slowly to initial intervention, which of four pre-specified adaptive interventions is best, which moderators are important to designing a more individually tailored adaptive intervention, and better understanding the mechanism by which the adaptive interventions may exhibit their effects. Specifically, the primary aim tests the effect of intensifying stage 1 singular interventions versus changing intervention by systematically combining and enhancing treatment modules. The stage 1 interventions include a commonly recommended approach based on applied behavior analysis (discrete trial training) and an evidence-based early intervention that specifically addresses the social communication impairment in ASD, JASPER (Joint Attention Symbolic Play Engagement & Regulation). The primary outcome is spontaneous communicative utterances, and secondary outcomes include joint engagement, receptive language, and presence of word combinations. Our secondary and exploratory aims include moderator and mediator tests, and longitudinal outcome at age 5-6 years. Child participants include 140 4-year-olds with ASD and limited language (<20 functional words) across 3 sites (U Oregon, Rochester, and UCLA). This study has the potential to dramatically improve communication outcomes for children with ASD, and addresses a high priority need of the Interagency Autism Coordinating Council and NIH.

项目摘要 许多3-4岁的患有自闭症谱系障碍（ASD）的年龄较大（30-50％）不继续 在5-6岁时开发与社会相关的单词和短语，并将其重新分类为“最低言语”， 即使早期暴露于证据 干预措施。尽管对5岁以上的儿童进行了大量研究，但他们已经被归类为最少 口头，很少的研究试图优化有限语言学龄前儿童的干预措施 可能更有可能通过适当，有针对性和个性化干预来发展语言 方法。因此，我们所知的主要差距仍然存在于如何将这些儿童放在ASD上 按学龄化成为口头的途径，从而减少了最低言语的孩子的数量。钥匙 在这个人群中的挑战是，一种规模并不适合全部：演讲中存在巨大的异质性和 对干预的反应。要利用这种异质性，有必要单独使用 量身定制的，顺序的干预方法，根据孩子的方式，将治疗随着时间的流逝而进行调整 回应。拟议的多站点项目的总体目标是使语言成果最大化 学龄前儿童有可能通过开发一个为期20周的“自适应”来维持“最小口头”状态的风险 干预”（这种干预措施结合了可复制的治疗决策规则以指导 临床医生何时以及如何改变干预措施）。这项研究解决了设计一个关键问题 适应性干预，包括如何最好地干预儿童对初始干预的缓慢响应， 最好的四个预先指定的自适应干预措施中的哪个是哪个，哪个主持人对于设计一个很重要 更独立地定制自适应干预措施，并更好地理解该机制 自适应干预措施可能会表现出其作用。具体而言，主要目的测试了加强的效果 第1阶段的奇异干预措施与通过系统结合和增强而改变干预措施 治疗模块。第1阶段干预措施包括基于 应用行为分析（离散试验培训）和基于证据的早期干预措施 解决ASD，Jasper的社会交流障碍（联合注意象征性游戏 参与与法规）。主要结果是赞助商传说的话语，以及 次要结果包括联合参与，接受语言和单词组合的存在。 我们的次要和探索目的包括主持人和调解器测试，以及年龄的纵向结果 5 - 6年。儿童参与者包括140个40岁的ASD和有限语言（<20个功能单词） 在3个地点（U俄勒冈州，罗切斯特和加州大学洛杉矶分校）。这项研究有可能显着改善 ASD儿童的沟通成果，并满足了机构间的高优先级需求 自闭症协调理事会和NIH。