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

Abstract

BackgroundThere has been increasing interest in the potential for pre‐emptive interventions in the prodrome of autism, but little investigation as to their effect.MethodsA 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.ResultsEffect 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.ConclusionsFollow‐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.

Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders

“…The gains in language, social, play, cognitive, and adaptive functioning, sometimes substantial, associated with some interventions, is very encouraging, and can have sustained effects (e.g. Green et al, 2017; Landa & Kalb, 2012). However, identification of positive treatment effects in the literature does not imply that EI should be limited to the early childhood period.…”

“…Non-significant negative treatment effects were identified for child receptive language and P100 in an evoked response potential task. Infant follow-up at 1- and 2-years (Green et al, 2017) identified beneficial treatment effects on reduced severity of ASD symptoms and increased levels of child social engagement with parents in the VIPP group, from baseline to 39 months of age. The negative treatment effects identified in the VIPP group at the end of the intervention period were not sustained; there were no group differences in language performance at either follow-up visit.…”

“…Provide parents with booster sessions to support ongoing use and adaptation of intervention strategies after coaching support ends (Carter et al, 2011; Green et al, 2017). …”

Anxiety Disorders and Obsessive-Compulsive Disorder in Individuals with Autism Spectrum Disorder

“…In the past decade, advances in the understanding and early identification of ASD promoted a shift from reactive to preventative efforts in the treatment of core ASD symptoms [30, 88, 89]. This approach capitalizes on the opportunity to target symptoms of ASD during early sensitive periods when neurodevelopmental trajectories can be advantageously altered [90].…”

Childhood autism: The good, the bad and the ugly

“…The final assessment was the longitudinal outcomes up to the age of 3 years. They recruited a high-risk group of infants with a familial risk of autism 6 . This very first randomized controlled trial of a very early social communication intervention for infants at familial risk of developing autism and followed up for 3 years has shown a treatment effect, extending to 24 months after the intervention ended, to reduce the overall severity of autism prodromal symptoms and enhance parent-child social communication over this period.…”