Connecting the Dots: An RCT Integrating Standardized ASD Screening, High-Quality Treatment, and Long-Term Outcomes

连接点：整合标准化 ASD 筛查、高质量治疗和长期结果的随机对照试验

• 批准号: 10205984
• 负责人: Diana L Robins
• 金额: $ 221.38万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-07 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10205984
• 关键词: 2 year old; 4 year old; Academy; Address; Advisory Committees; Affect; Age; Age of Onset; American; Attitude; Behavior Therapy; Belief; California; Child; Childhood; Clinical; Cognition; Communities; Conflict (Psychology); Connecticut; Control Groups; Coupled; Data; Detection; Development; Diagnosis; Diagnostic; Early Diagnosis; Early Intervention; Early identification; Early treatment; Educational Intervention; Eligibility Determination; Enrollment; Ethics; Evaluation; Geographic Locations; Goals; Guidelines; Happiness; Health Services Accessibility; Heterogeneity; Institutes; Intervention; Knowledge; Literature; Longevity; Measures; Medical; Methods; Monitor; Outcome; Outcome Measure; Parent-Child Relations; Parents; Pediatrics; Personal Satisfaction; Physicians; Positioning Attribute; Preventive service; Process; Productivity; Publishing; Randomized; Randomized Controlled Trials; Readiness; Recommendation; Research; Risk; Sampling; Science Policy; Screening procedure; Severities; Site; Social Functioning; Socioeconomic Status; Standardization; Stress; Symptoms; System; Testing; Toddler; Training; Universities; Work; autism spectrum disorder; autistic children; base; cognitive ability; cognitive function; disability; early onset; early screening; empowerment; evidence base; experience; experimental group; improved; improved outcome; individuals with autism spectrum disorder; intervention effect; kindergarten; primary outcome; satisfaction; screening; screening guidelines; secondary outcome; service delivery; social engagement; social reciprocity; societal costs; targeted treatment; treatment as usual; treatment response; trial design; visual tracking

A growing body of evidence demonstrates that younger age of onset for ASD treatment improves outcomes. Universal toddler screening for autism spectrum disorder (ASD) has been shown to lower the age of ASD diagnosis by two years compared to the national median; this in turn lowers the age of access to ASD-specific treatment. Yet on February 17, 2016, the US Preventive Services Task Force (USPSTF) published a final statement on autism screening in JAMA, in which they found insufficient evidence to recommend universal ASD screening. One of the primary gaps they identified was a lack of randomized controlled trials (RCTs) in which children detected through screening received treatment for ASD, with their outcomes compared to those of children not screened. The current proposal aims to fill this gap, connecting the dots between the screening and treatment literatures, and demonstrating that standardized, high-fidelity, universal screening lowers the age of diagnosis and treatment onset, leading to improved short- and long-term outcomes. The intervention in this RCT is supported deployment of such screening, with immediate evaluation of at-risk children, compared to a control group receiving usual care approaches to early detection of ASD, namely physician surveillance and/or unstandardized screening. In a sample of 8,000 toddlers enrolled through participating pediatric practices near Drexel University, the University of Connecticut, and the University of California Davis MIND Institute, we expect that cognitive functioning and ASD symptom severity will show greater improvements in the experimental group, in which most children will be detected at 18 m screening, compared to the control group, in which children are expected to be detected significantly later. In both groups, missed ASD cases will be detected through screening at 48 m. Across both groups, all children identified as at risk for ASD will receive a diagnostic evaluation, and all children diagnosed with ASD will be enrolled in one year of manualized early intensive behavioral treatment (EIBI). In addition to the primary outcome measures of cognition and symptom severity, exploratory outcomes will include group differences in adaptive functioning, kindergarten readiness, and social reciprocity as measured by experimental eye tracking and parent-child interaction ratings. We also will examine the impact of the screening intervention on physician attitudes and on parent empowerment and stress. Finally, we will examine potential moderators of group differences, to determine whether initial symptom severity, cognitive ability, or SES affects the expected superior response to treatment in the experimental group. Our Autism Centers of Excellence Network is uniquely positioned to carry out this study; our prior work demonstrates our extensive experience and productivity in the field of early screening and treatment in ASD. This study will be the first RCT of toddler ASD screening, and will use rigorous methods that have provided evidence for universal screening protocols in other medical fields. This study will have a significant impact on science, policy, and practice. By demonstrating that universal early screening leads to earlier treatment and better outcomes, this project will provide evidence for the benefits of universal ASD screening, including better social and cognitive functioning, mitigating lifespan disability, reducing societal costs, and improving personal well-being and productivity of individuals with ASD.

越来越多的证据表明，年轻的ASD治疗年龄改善了预后。环球小孩 自闭症谱系障碍（ASD）的筛查已显示与与 国家中位数；反过来，这降低了获得ASD特异性治疗的年龄。然而，在2016年2月17日，美国 预防服务工作队（USPSTF）发表了有关JAMA自闭症筛查的最终声明，他们发现 不足以推荐通用ASD筛查的证据。他们确定的主要差距之一是缺乏 随机对照试验（RCT），其中通过筛查检测到的儿童接受了ASD的治疗 与未筛选的儿童相比，结果的结果。当前的建议旨在填补这一空白，连接点 在筛查和治疗文献之间，并证明了标准化的高保真性，通用 筛查降低了诊断和治疗开始的年龄，从而改善了短期和长期结局。这 对此类RCT进行干预得到了这种筛查的部署，并立即对处于危险的儿童进行评估。 对对照组接受常规护理方法来早期检测ASD，即医师监视和/或 非标准的筛选。在Drexel附近的参与儿科实践中注册的8,000个幼儿样本中 大学，康涅狄格大学和加利福尼亚大学戴维斯大学思维学院，我们希望认知 功能和ASD症状的严重程度将显示出大多数儿童的实验组的进步 与对照组相比，将在18 m筛查时检测到，其中预计将显着检测到儿童 之后。在这两组中，将通过48 m的筛查检测到错过的ASD病例。在两组中，所有孩子都确定 由于ASD的风险将接受诊断评估，所有被诊断为ASD的儿童将在一年的一年中注册 手动化了早期强化行为治疗（EIBI）。除了认知和 症状严重程度，探索性结果将包括自适应功能的群体差异，幼儿园准备就绪和 通过实验性眼动追踪和亲子互动等级来衡量的社会互惠。我们还将检查 筛查干预对医师态度以及父母赋权和压力的影响。最后，我们将检查 群体差异的潜在主持人，以确定最初的症状严重程度，认知能力或SES是否会影响 预期在实验组中对治疗的反应卓越。我们的自闭症卓越中心网络是独特的 有能力进行这项研究；我们先前的工作证明了我们在早期领域的丰富经验和生产力 ASD的筛查和治疗。这项研究将是蹒跚学步的ASD筛查的第一个RCT，并将使用严格的方法 这为其他医疗领域的普遍筛查方案提供了证据。这项研究将产生重大影响 关于科学，政策和实践。通过证明普遍的早期筛查会导致早期治疗和更好 结果，该项目将为普遍ASD筛查的好处提供证据，包括更好的社交和 认知功能，减轻寿命残疾，降低社会成本以及改善个人福祉和 患有ASD的个体的生产力。

项目成果

Does Treatment Fidelity of the Early Start Denver Model Impact Skill Acquisition in Young Children with Autism?

• DOI: 10.1007/s10803-021-05371-4
• 发表时间: 2021-12
• 期刊: Journal of Autism and Developmental Disorders
• 影响因子: 3.9
• 作者: Ashley Zitter;Hezekiah Rinn;Ž. Szapuová;Vanessa M Avila-Pons;Kirsty L Coulter;Aubyn C. Stahmer;D. Robins;G. Vivanti

Connecting the Dots: a cluster-randomized clinical trial integrating standardized autism spectrum disorders screening, high-quality treatment, and long-term outcomes.

• DOI: 10.1186/s13063-021-05286-6
• 发表时间: 2021-05-02
• 期刊: Trials
• 影响因子: 2.5
• 作者: McClure LA;Lee NL;Sand K;Vivanti G;Fein D;Stahmer A;Robins DL
• 通讯作者: Robins DL

The Toddler Autism Symptom Inventory: Use in diagnostic evaluations of toddlers.

幼儿自闭症症状量表：用于幼儿的诊断评估。

• DOI: 10.1177/13623613211021699
• 发表时间: 2021-11
• 期刊: Autism : the international journal of research and practice
• 作者: Coulter KL;Barton ML;Boorstein H;Cordeaux C;Dumont-Mathieu T;Haisley L;Herlihy L;Jashar DT;Robins DL;Stone WL;Fein DA
• 通讯作者: Fein DA

The first five minutes: Initial impressions during autism spectrum disorder diagnostic evaluations in young children.

• DOI: 10.1002/aur.2536
• 发表时间: 2021-09
• 期刊: Autism research : official journal of the International Society for Autism Research
• 作者: Wieckowski AT;de Marchena A;Algur Y;Nichols L;Fernandes S;Thomas RP;McClure LA;Dufek S;Fein D;Adamson LB;Stahmer A;Robins DL
• 通讯作者: Robins DL

Initial diagnostic impressions of trainees during autism evaluations: High specificity but low sensitivity.

受训者在自闭症评估过程中的初步诊断印象：特异性高，但敏感性低。

• DOI: 10.1002/aur.2933
• 发表时间: 2023
• 期刊: Autism research : official journal of the International Society for Autism Research
• 作者: deMarchena,Ashley;Wieckowski,AndreaTrubanova;Algur,Yasemin;Williams,LashaeN;Fernandes,Sherira;Thomas,RebeccaP;McClure,LeslieA;Dufek,Sarah;Fein,Deborah;Stahmer,AubynC;Robins,DianaL
• 通讯作者: Robins,DianaL