Le suivi de 3 ans du premier ECR d'une intervention de communication sociale très précoce pour les nourrissons à risque familial de développement de l'autisme a montré un effet de traitement, qui s'étend 24 mois après la fin de l'intervention, afin de réduire la gravité globale des symptômes prodromaux autistiques et d'améliorer la communication sociale dyadique parents-enfants au cours de cette période
J Child Psychol Psychiatry. 2017 Apr 10. doi: 10.1111/jcpp.12728.
Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years
Green J1,2, Pickles A3,4, Pasco G3,5, Bedford R3, Wan MW6, Elsabbagh M5,7, Slonims V8, Gliga T5, Jones EJ5, Cheung CH5, Charman T3, Johnson MH5; British Autism Study of Infant Siblings (BASIS) Team.
- Social Development Research Group, School of Biological Sciences, University of Manchester, Manchester, UK.
- Royal Manchester Children's Hospital, Manchester, UK.
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- National Institute for Health Research Medical Health Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK.
- Centre for Brain and Cognitive Development, Birkbeck College, London, UK.
- School of Health Sciences, University of Manchester, Manchester, UK.
- Department of Psychiatry, McGill University, West Montréal, QC, Canada.
- Evelina London Children's Hospital and King's College London Neurosciences Centre, London, UK.
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.
© 2017 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
Pre-emptive intervention; autism; autism spectrum disorder; high-risk siblings; parent-mediated intervention; prevention trials
- PMID: 28393350
- DOI: 10.1111/jcpp.12728