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J Child Psychol Psychiatry. 2017 Dec;58(12):1330-1340. doi: 10.1111/jcpp.12728. Epub 2017 Apr 10.

Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years.

Author information

1
Social Development Research Group, School of Biological Sciences, University of Manchester, Manchester, UK.
2
Royal Manchester Children's Hospital, Manchester, UK.
3
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
4
National Institute for Health Research Medical Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
5
Centre for Brain and Cognitive Development, Birkbeck College, London, UK.
6
School of Health Sciences, University of Manchester, Manchester, UK.
7
Department of Psychiatry, McGill University, West Montréal, QC, Canada.
8
Evelina London Children's Hospital and King's College London Neurosciences Centre, London, UK.

Abstract

BACKGROUND:

There has been increasing interest in the potential for pre-emptive interventions in the prodrome of autism, but little investigation as to their effect.

METHODS:

A two-site, two-arm assessor-blinded randomised controlled trial (RCT) of a 12-session parent-mediated social communication intervention delivered between 9 and 14 months of age (Intervention in the British Autism Study of Infant Siblings-Video Interaction for Promoting Positive Parenting), against no intervention. Fifty-four infants (28 intervention, 26 nonintervention) at familial risk of autism but not otherwise selected for developmental atypicality were assessed at 9-month baseline, 15-month treatment endpoint, and 27- and 39-month follow-up.

PRIMARY OUTCOME:

severity of autism prodromal symptoms, blind-rated on Autism Observation Schedule for Infants or Autism Diagnostic Observation Schedule 2nd Edition across the four assessment points.

SECONDARY OUTCOMES:

blind-rated parent-child interaction and child language; nonblind parent-rated communication and socialisation. Prespecified intention-to-treat analysis combined estimates from repeated measures within correlated regressions to estimate the overall effect of the infancy intervention over time.

RESULTS:

Effect estimates in favour of intervention on autism prodromal symptoms, maximal at 27 months, had confidence intervals (CIs) at each separate time point including the null, but showed a significant overall effect over the course of the intervention and follow-up period (effect size [ES] = 0.32; 95% CI 0.04, 0.60; p = .026). Effects on proximal intervention targets of parent nondirectiveness/synchrony (ES = 0.33; CI 0.04, 0.63; p = .013) and child attentiveness/communication initiation (ES = 0.36; 95% CI 0.04, 0.68; p = .015) showed similar results. There was no effect on categorical diagnostic outcome or formal language measures.

CONCLUSIONS:

Follow-up to 3 years of the first RCT of a very early social communication intervention for infants at familial risk of developing autism has shown a treatment effect, extending 24 months after intervention end, to reduce the overall severity of autism prodromal symptoms and enhance parent-child dyadic social communication over this period. We highlight the value of extended follow-up and repeat assessment for early intervention trials.

KEYWORDS:

Pre-emptive intervention; autism; autism spectrum disorder; high-risk siblings; parent-mediated intervention; prevention trials

PMID:
28393350
PMCID:
PMC5724485
DOI:
10.1111/jcpp.12728
[Indexed for MEDLINE]
Free PMC Article

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