在对自闭症幼儿进行 JASPER 干预的 RCT 中,干预前的照护者策略可降低照护者的忠诚度和维持度

JCPP advances Pub Date : 2024-05-10 DOI:10.1002/jcv2.12247
Wendy Shih, A. Gulsrud, Connie Kasari
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摘要

由照护者协助进行的干预在照护自闭症幼儿的人员中越来越受欢迎。向照顾者传授培养高危自闭症儿童或确诊自闭症儿童社交沟通技能的具体技巧,有可能减轻他们对孩子成长的担忧。此外,与社区提供者所能提供的服务相比,它还能提供更深入的早期干预。本研究旨在探讨护理人员在参与以护理人员为中介的干预之前所采用的策略与护理人员对干预的忠诚度之间的相关性,以及干预在随访期间的持续性和儿童的成果。本研究是对一项随机对照试验的二次分析,该试验对联合注意、象征性游戏、参与和调节(JASPER)和心理教育干预(PEI)进行了比较,结果显示,JASPER干预显著提高了儿童的社会交往能力。86名患有自闭症的儿童(平均年龄31.5个月)及其主要照顾者参加了这项两组随机试验,以评估JASPER与PEI的效果。结果表明,与 PEI 的照顾者相比,JASPER 干预的照顾者在 JASPER 整体策略和单个领域策略(环境、提示、沟通、镜像步调)方面从基线到退出期间取得了更大的进步(P's < 0.01)。虽然在随访时,两组的整体策略和子领域策略都出现了一定程度的退步,但与 PEI 组相比,JASPER 干预方案中的照护者保持了更多的整体策略,尤其是沟通策略和镜像步调策略(P's < 0.05)。此外,基线照顾者策略调节了从退出到随访期间儿童联合注意力技能的治疗效果(p = 0.002),其中基线照顾者策略使用率高的 JASPER 组合在退出后继续提高了联合注意力技能,而所有其他儿童则没有提高。
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Caregiver strategies before intervention moderate caregiver fidelity and maintenance in RCT of JASPER intervention with autistic toddlers
Interventions facilitated by caregivers have gained popularity among those caring for young children with autism. Instructing caregivers on specific techniques to foster social communication skills in their at‐risk or diagnosed autistic children has the potential to alleviate concerns about their children's development. Moreover, it can offer a more intensive early intervention compared to what community providers alone can deliver. This study seeks to explore the correlation between caregiver strategies employed prior to participating in a caregiver‐mediated intervention and the caregiver's fidelity to the intervention, as well as its sustainability during the follow‐up period and child outcomes. This study constitutes a secondary analysis of a randomized controlled trial that compared the joint attention, symbolic play, engagement, and regulation (JASPER) and Psychoeducational Education Intervention (PEI), revealing significant advancements in children's social communication skills with the JASPER intervention.Eighty‐six children (average age 31.5 months) with ASD and their primary caregivers enrolled in the two armed randomized trial evaluating the effect of JASPER versus PEI. Generalized linear mixed models were used to model the longitudinal trajectories of the outcomes.Results indicated that caregivers in the JASPER intervention made more gains in overall JASPER strategies and individual domain strategies (environment, prompt, communication, mirrored pacing) compared to the caregivers in PEI (p's < 0.01) from baseline to exit. While both groups regressed some in overall and subdomain strategies at follow‐up, caregivers in the JASPER intervention maintained more overall, and specifically in communication, and mirrored pacing strategies compared to PEI group (p's < 0.05). Further, baseline caregiver strategies moderated the treatment effect of child's joint attention skills from exit to follow‐up (p = 0.002), where JASPER dyads with high caregiver strategy use at baseline continued to improve in JA skills post exit, whereas all other children did not.In summary, understanding caregiver style of interaction before intervention on caregiver fidelity and maintenance from exit to follow up and child progress is important to improving intervention uptake and child outcomes.
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Issue Information Implementing open science and reproducible research practices in mental health research through registered reports Special educational needs provision and academic outcomes for children with teacher reported language difficulties at school entry Examining the association of neighborhood conditions on attention‐deficit/hyperactivity disorder symptoms in autistic youth using the child opportunity index 2.0 The trajectory of anxiety symptoms during the transition from childhood to young adulthood is predicted by IQ and sex, but not polygenic risk scores
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