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Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial



شناسه مقاله
10.1016/S2215-0366(14)00091-1
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انگلیسی

Title: Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial

Authors: Jonathan Green and Tony Charman and Andrew Pickles and Ming W Wan and Mayada Elsabbagh and Vicky Slonims and Carol Taylor and Janet McNally and Rhonda Booth and Teodora Gliga and Emily J H Jones and Clare Harrop and Rachael Bedford and Mark H Johnson

Journal: The Lancet Psychiatry

Year: 2015

Abstract:

SummaryBackground Risk markers for later autism identified in the first year of life present plausible intervention targets during early development. We aimed to assess the effect of a parent-mediated intervention for infants at high risk of autism on these markers. Methods We did a two-site, two-arm assessor-blinded randomised controlled trial of families with an infant at familial high risk of autism aged 7–۱۰ months, testing the adapted Video Interaction to Promote Positive Parenting (iBASIS-VIPP) versus no intervention. Families were randomly assigned to intervention or no intervention groups using a permuted block approach stratified by centre. Assessors, but not families or therapists, were masked to group assignment. The primary outcome was infant attentiveness to parent. Regression analysis was done on an intention-to-treat basis. This trial is registered with {ISCRTN} Registry, number ISRCTN87373263. Findings We randomly assigned 54 families between April 11, 2011, and Dec 4, 2012 (28 to intervention, 26 to no intervention). Although {CIs} sometimes include the null, point estimates suggest that the intervention increased the primary outcome of infant attentiveness to parent (effect size 0·۲۹, ۹۵% {CI} −۰·۲۶ to 0·۸۶, thus including possibilities ranging from a small negative treatment effect to a strongly positive treatment effect). For secondary outcomes, the intervention reduced autism-risk behaviours (0·۵۰, {CI} −۰·۱۵ to 1·۰۸), increased parental non-directiveness (0·۸۱, ۰·۲۸ to 1·۵۲), improved attention disengagement (0·۴۸, −۰·۰۱ to 1·۰۲), and improved parent-rated infant adaptive function (χ۲[۲] ۱۵·۳۹, p=0·۰۰۰۵). There was a possibility of nil or negative effect in language and responsivity to vowel change (P1: ES–۰·۶۲, {CI} −۲·۴۲ to 0·۳۱; P2: −۰·۲۹, −۱·۵۵ to 0·۷۱). Interpretation With the exception of the response to vowel change, our study showed positive estimates across a wide range of behavioural and brain function risk-markers and developmental outcomes that are consistent with a moderate intervention effect to reduce the risk for later autism. However, the estimates have wide {CIs} that include possible nil or small negative effects. The results are encouraging for development and prevention science, but need larger-scale replication to improve precision. Funding Autistica, Waterloo Foundation, Autism Speaks, and the {UK} Medical Research Council.

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عنوان: مداخله پدر و مادر واسطه در مقابل عدم مداخله برای نوزادان در معرض خطر اوتیسم: موازی، یک سو کور، کارآزمایی تصادفی

نویسندگان: Jonathan Green and Tony Charman and Andrew Pickles and Ming W Wan and Mayada Elsabbagh and Vicky Slonims and Carol Taylor and Janet McNally and Rhonda Booth and Teodora Gliga and Emily J H Jones and Clare Harrop and Rachael Bedford and Mark H Johnson

ژورنال: The Lancet Psychiatry

سال: ۲۰۱۵

چکیده:
تفسیر به غیر از پاسخ به تغییر واکه، مطالعه ما برآورد مثبت در سراسر طیف گسترده ای از ریسک نشانگر رفتاری و عملکرد مغز و نتایج توسعه ای است که با یک اثر مداخله متوسط ​​سازگار است نشان داد برای کاهش خطر ابتلا به اوتیسم بعد با این حال، برآوردهای باید گسترده {کشورهای مستقل مشترک المنافع} که شامل امکان صفر یا کوچک اثرات منفی نتایج تشویق برای توسعه و علم پیشگیری، اما نیاز به تکرار در مقیاس بزرگتر به منظور بهبود دقت بودجه Autistica، بنیاد واترلو، اوتیسم صحبت می کند، و شورای تحقیقات پزشکی {بریتانیا}
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