Study protocol of the multi-centre, randomized controlled trial of the Frankfurt Early Intervention Program A-FFIP versus early intervention as usual for toddlers and preschool children with Autism Spectrum Disorder (A-FFIP study)

Abstract

Background: Naturalistic developmental behavioural interventions (NDBI) have been shown to improve autism-specific symptoms in young children with Autism Spectrum Disorder (ASD). NDBI approaches, such as the ASD-specific Frankfurt Early Intervention Program for ASD (A-FFIP), are based on ASD-specific developmental and learning aspects. A-FFIP is a low-intensity, cost-effective intervention which can easily be implemented in the local health care / social welfare system. The aim of the present study is to establish one-year efficacy of the manualised early intervention program A-FFIP in toddlers and preschool children with ASD. It is hypothesized that A-FFIP will result in improved ASD-specific symptoms compared to early intervention as usual (EIAU). Child and family specific secondary outcomes, as well as moderators and mediators of outcome will be explored. Methods/design: A prospective multi-centre, parallel-group, randomized, controlled, phase-III trial comparing A-FFIP versus EIAU. A total of 134 children (A-FFIP: 67, EIAU: 67) aged 2;0–5;6 years meeting criteria for ASD (DSM-5) will be included. The primary outcome is the absolute change of the total score of the Brief Observation of Social Communication Change (BOSCC-AT) between baseline and 12 months after begin of the interventions. The treatment effect will be tested adjusted for relevant covariates applying a mixed model for repeated measures. Secondary outcomes are BOSCC social communication and repetitive behaviour scores, single ASD symptoms, language, cognition, psychopathology, parental well-being and family quality of life. Predictors, moderators and mediating mechanisms will be explored. Discussion: If efficacy of the manualised A-FFIP early intervention is established, the current study has the potential to change clinical practice strongly towards the implementation of cost-effective evidence based early intervention in ASD. Early intervention in ASD requires specialist training, which subsequently needs to be developed or included into current training curricula.