CLINICAL PHENOTYPE: TREATMENT RESPONSE CORE

临床表型：治疗反应核心

• 批准号: 7681647
• 负责人: LAURA E SCHREIBMAN
• 金额: $ 20万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7681647
• 关键词: 2 year old; Age; Appendix; Area; Arts; Autistic Disorder; Behavior Therapy; Behavioral; Bioinformatics; Biologic Characteristic; Biological Factors; Biometry; Brain; Characteristics; Child; Clinical; Cognitive; Communities; Data; Development; Educational Curriculum; Educational process of instructing; Effectiveness; Ensure; Evidence based treatment; Floor; Foundations; Funding; Gene Expression; Goals; Human Resources; Intervention; Language; Learning; Length; Methods; Outcome; Outcome Measure; Parenting Education; Participant; Pattern; Population; Rate; Research; Risk; Severities; Social Behavior; Speed; Structure; Symptoms; Time; Toddler; Training; Treatment Protocols; Treatment outcome; Variant; Work; autism spectrum disorder; base; clinical phenotype; cognitive function; genetic profiling; indexing; joint attention; programs; quality assurance; response; social

Research has shown that despite significant rigor and intensity, some children with an autism spectrum disorder fail to make significant gains in response to behavioral treatment (e.g., Sherer & Schreibman, 2005). The behavioral characteristics of children who excel versus those that do not are not well understood. The biological characteristics of such treatment responders and nonresponders are completely unknown. In order to determine what behavioral and biological factors predict treatment responsiveness, consistency regarding various aspects of treatment must be provided. For all children the type of treatment, age at which treatment is administered, and length of treatment must be consistent. Therefore, a Treatment Core (TxC) has been established to implement an evidence-based treatment for toddlers with autism participating in the ACE projects. A specific, manualized treatment, the STAR Program (see Appendix A), has been chosen as the foundation for the treatment. This curriculum incorporates evidence-based behavioral methods, including discrete trial teaching, pivotal response training, and teaching within functional routines, that are of documented effectiveness. This curriculum will be adapted to accommodate 2-year-old children and to include additional social goals and developmental strategies. Recently, a developmental, social-pragmatic intervention that incorporates both developmental and naturalistic behavioral strategies has been examined as a parent education adjunct to the STAR curriculum. This program incorporates early developmental strategies such as Responsive Teaching and Floor Time/DIR, which encourage joint attention, social responsiveness, and engagement in children with autism. We believe, and preliminary data agree, that this combination of curricula and strategies will provide an effective and consistent treatment for children with autism. Overall, the Treatment Core (TxC), has two main goals: The first is to provide state-of-the art behavioral treatment to all participants who meet provisional criteria for autism at 2 years. In order to meet this goal, the TxC will ensure consistent application of treatment practices by training all study personnel in treatment protocol to mastery level. Additionally, the TxC will ensure fidelity of implementation of the treatment protocol throughout the funding period. The second goal is to provide a quantitative index of level of response to treatment for each at-risk toddler for use in predictive analyses in Projects 1-4. As such, the TxC will collect data throughout treatment to assess learning rate and speed of progress in each curriculum area. Finally, the TxC will establish an overall response-to-treatment profile for each study toddler in the domains of symptom severity, cognitive, language, and social behavior. These profiles will be used by each project as well as the Integrated Biostatistics and Bioinformatic Analysis Core to determine the profiles of treatment responders and nonresponders.

研究表明，尽管非常严格和强度，一些患有自闭症谱系的儿童 行为治疗未能取得显着效果（例如，Sherer & Schreibman， 2005）。表现优秀的孩子与表现不佳的孩子的行为特征并不相同 明白了。此类治疗反应者和无反应者的生物学特征完全不同 未知。为了确定哪些行为和生物因素可以预测治疗反应， 必须提供治疗各方面的一致性。对于所有儿童的治疗类型， 进行治疗的年龄和治疗时间必须一致。因此，治疗 Core (TxC) 的成立是为了对患有自闭症的幼儿实施循证治疗 参与 ACE 项目。一种具体的、手动的治疗，即 STAR 计划（参见附录 A）， 已被选为治疗的基础。该课程包含基于证据的 行为方法，包括离散试验教学、关键反应训练和内部教学 具有记录有效性的功能例程。本课程将进行调整以适应 2 岁儿童并包括额外的社会目标和发展策略。最近，一个 发展的、社会实用的干预，结合了发展和自然主义 行为策略已被视为 STAR 课程的家长教育辅助手段。这 计划结合了早期发展策略，例如响应式教学和Floor Time/DIR， 鼓励自闭症儿童的共同关注、社会反应和参与。我们 我们相信，并且初步数据也同意，这种课程和策略的结合将提供有效的 以及对自闭症儿童的持续治疗。 总体而言，治疗核心 (TxC) 有两个主要目标：第一个是提供最先进的行为治疗 对所有 2 岁时符合自闭症临时标准的参与者进行治疗。为了实现这一目标， TxC 将通过对所有研究人员进行治疗培训来确保治疗实践的一致应用 协议达到掌握水平。此外，TxC 将确保治疗实施的保真度 整个资助期间的协议。第二个目标是提供一个量化的水平指标。 每个高危幼儿对治疗的反应，用于项目 1-4 的预测分析。因此， TxC 将在整个治疗过程中收集数据，以评估每个课程的学习率和进展速度 区域。最后，TxC 将为每个研究幼儿建立一个总体治疗反应概况 症状严重程度、认知、语言和社会行为等领域。这些配置文件将被每个人使用 项目以及综合生物统计学和生物信息学分析核心，以确定 治疗有反应者和无反应者。