Whitney Guthrie 等人

Robust evidence supports the efficacy of early autism intervention. Despite broad consensus that earlier intervention leads to better outcomes, evidence for this has been limited to correlational studies. This study examined timing effects of the Early Social Interaction (ESI) model, a parent-implemented intervention, using a complete crossover randomized controlled trial (RCT). Effects of Individual-ESI were compared when initiated at 18 or 27 months of age, and also contrasted with effects of the less intensive Group-ESI as an active control condition. Participants included 82 autistic toddlers who received 9 months of Individual-ESI and 9 months of Group-ESI, with the timing/order randomized. Blinded clinicians completed assessments at baseline (18 months of age), end of Condition 1 (27 months), and end of Condition 2 (36 months). Toddlers randomized to Individual-ESI at 18 months showed greater gains during treatment than those starting Individual-ESI at 27 months in receptive/expressive language, social communication, and daily living skills. This pattern was not observed for Group-ESI, demonstrating that timing effects were specific to Individual-ESI and ruling out maturation effects. This RCT demonstrated that earlier intensive, individualized intervention led to greater improvements, and suggests that even a narrow window of 18 versus 27 months may impact child outcomes.

强有力的证据支持早期自闭症干预的有效性。尽管人们普遍认为早期干预会带来更好的结果，但这方面的证据仅限于相关研究。本研究通过一项完全交叉随机对照试验（RCT），考察了由家长实施干预的早期社会互动（ESI）模式的时间效果。研究比较了个体-ESI 在幼儿 18 个月或 27 个月时启动的效果，并将其与强度较低的群体-ESI 作为积极对照条件的效果进行了对比。研究对象包括 82 名自闭症幼儿，他们分别接受了 9 个月的个体-ESI 和 9 个月的群体-ESI，时间/顺序随机安排。蒙眼临床医生分别在基线（18 个月大）、条件 1 结束（27 个月大）和条件 2 结束（36 个月大）时完成评估。与 27 个月时开始接受个体-ESI 的幼儿相比，18 个月时随机接受个体-ESI 的幼儿在接受/表达语言、社交沟通和日常生活技能方面的进步更大。在群体-ESI 中没有观察到这种模式，这表明时间效应是个体-ESI 所特有的，并排除了成熟效应。这项研究表明，更早的强化、个性化干预能带来更大的改善，并表明即使是 18 个月与 27 个月的狭窄窗口期也可能影响儿童的结果。