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Randomized Controlled Trial
. 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

Jonathan Green  1   2 , Andrew Pickles  3   4 , Greg Pasco  3   5 , Rachael Bedford  3 , Ming Wai Wan  6 , Mayada Elsabbagh  5   7 , Vicky Slonims  8 , Teea Gliga  5 , Emily Jones  5 , Celeste Cheung  5 , Tony Charman  3 , Mark Johnson  5 ; British Autism Study of Infant Siblings (BASIS) Team
Collaborators, Affiliations
Randomized Controlled Trial

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

Jonathan Green et al. J Child Psychol Psychiatry. 2017 Dec.

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.

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Figures

Figure 1
Figure 1
Intervention in the British Autism Study of Infant Siblings CONSORT participant flow diagram. *The same family [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Time profile of treatment effects on autism symptoms and caregiver–child interaction (‘area’ = area between curves estimation; see text). The effect size difference is shown by holding TAU as zero. (A) Primary Outcome, Autism Prodromal Symptoms. (The negative effect size reflects a reduction in symptom severity in iBASIS‐VIPP relative to TAU). (B) Parental Dyadic Social Interaction. (C) Child Dyadic Social Interaction
Figure 3
Figure 3
Time profile of effects on Mullen language and Vineland communication and social scores (area = area between curves estimation; see text)
See this image and copyright information in PMC

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