早期丹佛模式中干预获益的概率

Probability of Intervention Benefit in the Early Start Denver Model.

作者信息

Sterrett Kyle, Rogers Sally J, Estes Annette, Lord Catherine, Kim So Hyun

机构信息

Department of Pediatrics, University of Minnesota, Minneapolis, USA.

MIND Institute, University of California, Davis, Davis, USA.

出版信息

J Autism Dev Disord. 2025 Sep 1. doi: 10.1007/s10803-025-07031-3.

Abstract

Early intervention has the potential to improve the outcomes of children with autism. As more evidence-based early intervention approaches become available, data generated from studies testing their efficacy provide the unique opportunity to examine whether specific interventions differentially benefit children based on their demographic and behavioral characteristics. In this study, we retrospectively applied a probability-of-intervention-benefit framework to data from a randomized controlled trial comparing the outcomes of children with autism receiving community intervention as usual to those receiving the Early Start Denver Model (ESDM) delivered by university-based clinicians. Data from 85 children, randomized to one of the two intervention groups were analyzed. The primary outcome was the Brief Observation of Social Communication Change, a video coded measure of autism related social communication and repetitive behaviors. Children were classified as making reliable change or not on this outcome based on their reliable change index. 73% of children in the ESDM group and 57% in the community group made reliable improvements over the 24 months of intervention. The probability of intervention benefit in the community group depended on children's baseline characteristics. Those with more significant cognitive delays and greater autism severity were less likely to make reliable change in the community group, but not the ESDM group. Overall, the data highlight the variability of change that individual children make in early interventions, the role of various factors contributing to change, and finally, the importance of analyzing change at both the group and the individual levels.

摘要

早期干预有可能改善自闭症儿童的预后。随着越来越多基于证据的早期干预方法出现,对其疗效进行测试的研究所产生的数据提供了独特的机会,来检验特定干预措施是否会根据儿童的人口统计学和行为特征而产生不同的益处。在本研究中,我们回顾性地将干预获益概率框架应用于一项随机对照试验的数据,该试验比较了接受常规社区干预的自闭症儿童与接受由大学临床医生提供的早期丹佛模式(ESDM)的儿童的预后。对随机分配到两个干预组之一的85名儿童的数据进行了分析。主要结局是《社会沟通变化简要观察》,这是一种对自闭症相关社会沟通和重复行为进行视频编码的测量方法。根据可靠变化指数,将儿童在该结局上分为有可靠变化或无可靠变化。在24个月的干预期间,ESDM组73%的儿童和社区组57%的儿童有可靠改善。社区组的干预获益概率取决于儿童的基线特征。在社区组中,认知延迟更显著且自闭症严重程度更高的儿童不太可能有可靠变化,但在ESDM组并非如此。总体而言,数据凸显了个体儿童在早期干预中变化的可变性、促成变化的各种因素的作用,以及最后,在组水平和个体水平上分析变化的重要性。

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