Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
J Am Acad Child Adolesc Psychiatry. 2019 Sep;58(9):846-848. doi: 10.1016/j.jaac.2019.03.004. Epub 2019 Mar 7.
Despite a slow start, the past 15 years has seen an unprecedented increase in the number and quality of randomized controlled trials (RCTs) being conducted in the early autism field. This is welcome, because many young children with autism struggle to communicate and interact with others, restricting their opportunities to learn and develop, and impacting on their parents who can find their child's behavior perplexing and challenging to manage. However, as with so many areas of clinical science, with progress come challenges. Rogers et al. report on a multi-site RCT of the Early Start Denver Model (ESDM), an intensive, naturalistic developmental-behavioural intervention program. The original small-scale (n = 48) ESDM study found improvements in IQ and adaptive behavior (on both measures largely in the language/communication domains) and a marginal improvement in diagnostic classification but no differences on continuous measures of autism severity. The study is highly cited and has been influential as a key part of the evidence for proponents arguing for the effectiveness of comprehensive early intervention programs.
尽管起步缓慢，但过去 15 年中，早期自闭症领域开展的随机对照试验（RCT）的数量和质量都出现了前所未有的增长。这是令人欢迎的，因为许多患有自闭症的幼儿在沟通和与他人互动方面存在困难，限制了他们学习和发展的机会，并影响到他们的父母，他们可能会觉得孩子的行为令人困惑，难以管理。然而，就像临床科学的许多领域一样，随着进展也会出现挑战。Rogers 等人报告了一项早期丹佛模式（ESDM）的多中心 RCT，这是一种密集的、自然的发展行为干预计划。最初的小规模（n=48）ESDM 研究发现智商和适应行为（在这两个方面，语言/交流领域都有很大程度的提高）有所改善，诊断分类略有改善，但自闭症严重程度的连续测量没有差异。这项研究被高度引用，并作为支持全面早期干预计划有效性的证据的重要组成部分产生了影响。
