Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind,
Jonathan Green1, Tony Charman2, Andrew Pickles3
1Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK.
Insights
A parent-mediated intervention for infants at high risk of autism showed promising results, improving infant attentiveness and reducing autism-risk behaviors. Larger studies are needed to confirm these findings for early autism prevention.
Area of Science:
- Developmental Psychology
- Clinical Psychology
- Neuroscience
Background:
- Early identification of autism risk markers in infancy is crucial for timely intervention.
- Parent-mediated interventions offer a promising avenue for supporting infants at high risk for autism spectrum disorder (ASD).
- Assessing the impact of such interventions on early developmental markers is key to prevention science.
Purpose of the Study:
- To evaluate the effectiveness of a parent-mediated intervention (iBASIS-VIPP) in infants at high risk for autism.
- To assess the intervention's impact on early behavioral and neurodevelopmental risk markers for autism.
- To determine if the intervention influences infant attentiveness to parents and other developmental outcomes.
Main Methods:
- A two-site, assessor-blinded randomized controlled trial was conducted with families of infants aged 7-10 months at familial high risk for autism.
- Participants were randomized to receive the adapted Video Interaction to Promote Positive Parenting (iBASIS-VIPP) or a control group (no intervention).
- The primary outcome was infant attentiveness to parent, with secondary outcomes including autism-risk behaviors, parental non-directiveness, and adaptive function.
Main Results:
- The intervention demonstrated a positive effect on infant attentiveness to parent (effect size 0.29), though confidence intervals included the null.
- Secondary outcomes showed significant improvements: reduced autism-risk behaviors (ES 0.50), increased parental non-directiveness (ES 0.81), and improved infant adaptive function.
- Some areas, like language and responsivity to vowel change, showed potential for nil or negative effects, indicating varied intervention impact.
Conclusions:
- The iBASIS-VIPP intervention shows encouraging, moderate effects in reducing autism risk markers and improving developmental outcomes in high-risk infants.
- While results are promising for autism prevention science, wide confidence intervals necessitate larger-scale studies to enhance precision.
- The findings support the potential of parent-mediated early interventions for infants at risk of developing autism spectrum disorder.
Background:
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 7-10 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 0.29, 95% CI -0.26 to 0.86, 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 (0.50, CI -0.15 to 1.08), increased parental non-directiveness (0.81, 0.28 to 1.52), improved attention disengagement (0.48, -0.01 to 1.02), and improved parent-rated infant adaptive function (χ(2)[2] 15.39, p=0.0005). There was a possibility of nil or negative effect in language and responsivity to vowel change (P1: ES-0.62, CI -2.42 to 0.31; P2: -0.29, -1.55 to 0.71).
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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