Embedding interpersonal stigma resistance into the medical curriculum: a focus group study of medical students.

BACKGROUND: Mental-health-related stigma among physicians towards people with mental illnesses remains a barrier to quality care, yet few curricula provide training with a proactive focus to reduce the potential negative impacts of stigma. The aim of our study was to explore medical students' perspectives on what areas of learning should be targeted (where stigma presents) and how they could be supported to prevent the formation of negative attitudes. METHODS: Six focus group discussions were conducted with second, third, and fourth-year postgraduate medical students (n = 34) enrolled at The University of Melbourne Medical School in September - October 2021. Transcripts were analysed using inductive thematic analysis. RESULTS: In terms of where stigma presents, three main themes emerged - (1) through unpreparedness in dealing with patients with mental health conditions, (2) noticing mentors expressing stigma and (3) through the culture of medicine. The primary theme related to 'how best to support students to prevent negative attitudes from forming' was building stigma resistance to reduce the likelihood of perpetuating stigma towards patients with mental health conditions and therefore enhance patient care. The participants suggest six primary techniques to build stigma resistance, including (1) reflection, (2) skills building, (3) patient experiences, (4) examples and exemplars, (5) clinical application and (6) transforming structural barriers. We suggest these techniques combine to form the ReSPECT model for stigma resistance in the curriculum. CONCLUSIONS: The ReSPECT model derived from our research could provide a blueprint for medical educators to integrate stigma resistance throughout the curriculum from year one to better equip medical students with the potential to reduce interpersonal stigma and perhaps self-stigma. Ultimately, building stigma resistance could enhance care towards patients with mental health conditions and hopefully improve patient outcomes.

Does employment status mediate the association between disability status and mental health among young adults? Evidence from the Household, Income and Labour Dynamics in Australia (HILDA) survey.

OBJECTIVE: Young adults with disabilities are less likely to be employed and more likely to have poor mental health than peers without disabilities. Growing evidence shows that social determinants of health may be causally related to mental health outcomes of people with disabilities. We aimed to assess if the disability to mental health association was mediated by employment status among young adults aged 20-35 years. METHODS: Four consecutive years (2016-2019) of data from the Household, Income and Labour Dynamics in Australia survey were used to conduct a causal mediation analysis. We decomposed the total causal effect of disability status on mental health (Short Form-36 Mental Health Inventory-5) into the natural direct effect from disability to mental health and the natural indirect effect representing the pathway through the employment mediator (being employed; being unemployed or wanting to work). RESULTS: 3435 participants (3058 with no disabilities, 377 with disabilities) were included in the analysis. The total causal effect of disability status on mental health was an estimated mean decrease in mental health of 4.84 points (95% CI -7.44 to -2.23). The indirect effect, through employment status, was estimated to be a 0.91-point decline in mental health (95% CI -1.50 to -0.31). CONCLUSIONS: Results suggest disability has an effect on the mental health of young adults; a proportion of this effect appears to operate through employment. The mental health of young adults with disabilities could potentially be improved with interventions to improve employment outcomes among this group, and by supporting individuals with disabilities into suitable employment.

Continuity of temperament subgroup classifications from infancy to toddlerhood in the context of early autism traits.

Our previous cross-sectional investigation (Chetcuti et al., 2020) showed that infants with autism traits could be divided into distinct subgroups based on temperament. This longitudinal study builds on this existing work by exploring the continuity of temperament subgroup classifications and their associations with behavioral/clinical phenotypic features from infancy to toddlerhood. 103 infants (68% male) showing early signs of autism were referred to the study by community healthcare professionals and seen for assessments when aged around 12-months (Time 1), 18-months (Time 2), and 24-months (Time 3). Latent profile analysis revealed inhibited/low positive, active/negative reactive, and sociable/well-regulated subgroups at each timepoint, and a unique reactive/regulated subgroup at Time 3. Cross-tabulations indicated a significant likelihood of children having a recurrent subgroup classification from one timepoint to the next, and no apparent patterns to the movement of children who did change from one subgroup to another over time. Temperament subgroups were associated with concurrent child social-emotional functioning and autism traits, but unrelated to child age, sex, or developmental level. These findings suggest that temperament subgroup classifications might represent a reliable and very early indicator of autism characteristics and social-emotional functioning among infants/toddlers with autism traits.

Predictors of vaccine hesitancy among disability support workers in Australia: A cross-sectional survey.

BACKGROUND: Achieving high levels of vaccination among disability support workers (DSWs) is critical to protecting people with disability from COVID-19 and other vaccine-preventable diseases. OBJECTIVE: To identify how demographic factors, risk perceptions of COVID-19 and the COVID-19 vaccine, and views about COVID-19 vaccination are associated with COVID-19 vaccine hesitancy among DSWs. METHODS: Survey of 252 Australian DSWs conducted in March and early April 2021. Participants were classified as vaccine hesitant if they had not been vaccinated and would not have the vaccine when offered it. Logistic regression analysis was used to control for confounders. RESULTS: 52.4% of DSWs were hesitant with females being more likely to be hesitant than males (58.2% female, 38.1% male). Hesitancy was more frequent among DSWs who were not worried about COVID-19 for themselves or their family (adjusted odds ratio (AOR) 1.86, 95% CI 1.0-3.45); did not agree they were at more risk than the rest of the community (AOR 2.29, 95% 1.25-4.20); were concerned about vaccine safety (AOR 22.86, 95% CI 10.59-49.13) and were not confident the vaccine would protect them (AOR 6.06, 95% CI 3.21-11.41) or the clients from COVID-19 (AOR 6.03, 95% CI 3.19-11.41). DSWs who thought vaccination was a personal choice were more likely to be hesitant (82.1%) than those who thought it was a community responsibility (27.6%). CONCLUSIONS: The study shows that increasing vaccination rates among DSWs requires targeted strategies that emphasise the seriousness of the infection; the potential for vaccines to reduce transmission; and vaccine safety and efficacy.

Employment and disability among young Australians and associations with psychological distress during the COVID-19 pandemic.

Background: Emerging global data indicates that the employment status and mental health of young people is being adversely impacted by the COVID-19 pandemic. However, little research has focused on young people with disabilities, despite their lower pre-pandemic employment rates and poorer mental health. We quantified the association between employment status and mental health among young Australians, and tested for effect modification by disability status. Methods: Linear regression analysis of Wave 9 (October-December 2020) of the Longitudinal Study of Australian Children (LSAC) assessing the association between employment status (employed, unemployed) on psychological distress (Kessler-10) and including an interaction term for employment status and disability. Results: The association between employment status and psychological distress differed by disability status. Young adults with disabilities had higher adjusted mean K10 scores indicating greater psychological distress both when they were employed (mean 22.99, 95% CI 21.41, 24.58) and unemployed (mean 29.19, 95% CI 25.36, 33.03) compared to their peers without disabilities (employed mean 18.72, 95% CI 17.75, 19.70; unemployed mean 20.45, 95% CI 18.60, 22.29). Conclusion: Young Australians in general may benefit from additional supports to improve their employment and mental health outcomes. Young people with disabilities may particularly benefit from targeted supports to gain and maintain employment and improve mental health.

The COVID-19 vaccine intentions of Australian disability support workers.

OBJECTIVES: Describe perceptions of COVID-19, COVID-19 vaccines, information sources, and levels and reasons for vaccine hesitancy among disability support workers (DSWs). METHODS: Cross-sectional survey of 252 DSWs from across Australia, between early March and early April 2021. Perceptions of risk of COVID-19; government and media representations; vaccination status (Y/N); vaccine intentions (when offered, delayed vaccinators, vaccine refusers); reasons for hesitancy; confidence in safety and efficacy of vaccine; and information sources. RESULTS: At the time of the survey, fewer than 1% of DSWs had been vaccinated and 17% had been offered vaccination. Of those who had not had the vaccine, 47% said they would get it as soon as it was offered; 19% would not get the vaccine; 12% would have if required; 13% hadn't decided; and 8% would wait until it was available for a while. Reasons for hesitancy included inadequate safety data (70% delayed vaccinators, 79% vaccine refusers), side effects (63% delayed vaccinators, 58% refusers), and distrust in the government (17% delayed vaccinators, 52% refusers). DSWs most trusted sources of information were their own doctor, Chief Medical Officers, and governments. 61% believed that COVID-19 will only stop if most of the community is vaccinated and 53% agreed the chances of them or their clients getting COVID-19 would be reduced if they were vaccinated. CONCLUSIONS: Tailored information is needed to reduce vaccine hesitancy and increase confidence in COVID-19 vaccines among DSWs. The importance of getting vaccinated to prevent COVID-19 among people with disability should be emphasised.

Trajectories of disability throughout early life and labor force status as a young adult: Results from the Longitudinal Study of Australian Children.

OBJECTIVES: Young people with disabilities have poorer labor force outcomes than their peers without disabilities. These understandings, however, are largely based on research assessing disability at one time point only, an approach that potentially obscures variation in disability over time. We aimed to identify trajectories of disability during childhood/adolescence and assess associations between trajectory membership and labor force status in young adulthood. METHODS: We conducted group-based trajectory modeling of disability status information from six waves [waves 2-7 (age 4/5 to 16/17 years)] of the Longitudinal Study of Australian Children. The trajectories were used to predict labor force participation (employed, unemployed, not in the labor force) at wave 8 (18/19 years), adjusted for confounders. RESULTS: We identified four trajectory groups of the prevalence of disability: low (75.5% of cohort), low increasing (9.7%), high decreasing (10.9%), and consistently high (3.9%). Individuals in the low increasing trajectory were nearly three times as likely to be unemployed at age 18/19 years compared to individuals in the low trajectory [risk ratio (RR) 2.96, 95% confidence interval (CI) 1.94-4.53]. Individuals in the consistently high trajectory had a greater RR of not being in the labor force at age 18/19 years compared to individuals in the low group (reference) (RR 3.65, 95% CI 2.21-6.02). CONCLUSIONS: Results suggest that prolonged and increasing experiences of disability among young Australians may be differentially associated with future labor force outcomes. Additional support to prepare young people for the labor force should focus on individuals who consistently or increasingly report a disability.

Australia's Disability Employment Services Program: Participant Perspectives on Factors Influencing Access to Work.

Disability employment programs play a key role in supporting people with disability to overcome barriers to finding and maintaining work. Despite significant investment, ongoing reforms to Australia's Disability Employment Services (DES) are yet to lead to improved outcomes. This paper presents findings from the Improving Disability Employment Study (IDES): a two-wave survey of 197 DES participants that aims to understand their perspectives on factors that influence access to paid work. Analysis of employment status by type of barrier indicates many respondents experience multiple barriers across vocational (lack of qualifications), non-vocational (inaccessible transport) and structural (limited availability of jobs, insufficient resourcing) domains. The odds of gaining work decreased as the number of barriers across all domains increased with each unit of barrier reported (OR 1.22, 95% CI 1.07, 1.38). Unemployed respondents wanted more support from employment programs to navigate the welfare system and suggest suitable work, whereas employed respondents wanted support to maintain work, indicating the need to better tailor service provision according to the needs of job-seekers. Combined with our findings from the participant perspective, improving understanding of these relationships through in-depth analysis and reporting of DES program data would provide better evidence to support current DES reform and improve models of service delivery.

Effect of Preemptive Intervention on Developmental Outcomes Among Infants Showing Early Signs of Autism: A Randomized Clinical Trial of Outcomes to Diagnosis.

Importance: Intervention for individuals with autism spectrum disorder (ASD) typically commences after diagnosis. No trial of an intervention administered to infants before diagnosis has shown an effect on diagnostic outcomes to date. Objective: To determine the efficacy of a preemptive intervention for ASD beginning during the prodromal period. Design, Setting, and Participants: This 2-site, single rater-blinded randomized clinical trial of a preemptive intervention vs usual care was conducted at 2 Australian research centers (Perth, Melbourne). Community sampling was used to recruit 104 infants aged 9 to 14 months showing early behaviors associated with later ASD, as measured by the Social Attention and Communication Surveillance-Revised. Recruitment occurred from June 9, 2016, to March 30, 2018. Final follow-up data were collected on April 15, 2020. Interventions: Infants were randomized on a 1:1 ratio to receive either a preemptive intervention plus usual care or usual care only over a 5-month period. The preemptive intervention group received a 10-session social communication intervention, iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP). Usual care comprised services delivered by community clinicians. Main Outcomes and Measures: Infants were assessed at baseline (approximate age, 12 months), treatment end point (approximate age, 18 months), age 2 years, and age 3 years. Primary outcome was the combined blinded measure of ASD behavior severity (the Autism Observation Scale for Infants and the Autism Diagnostic Observation Schedule, second edition) across the 4 assessment points. Secondary outcomes were an independent blinded clinical ASD diagnosis at age 3 years and measures of child development. Analyses were preregistered and comprised 1-tailed tests with an α level of .05. Results: Of 171 infants assessed for eligibility, 104 were randomized; 50 infants (mean [SD] chronological age, 12.40 [1.93] months; 38 boys [76.0%]) received the iBASIS-VIPP preemptive intervention plus usual care (1 infant was excluded after randomization), and 53 infants (mean [SD] age, 12.38 [2.02] months; 32 boys [60.4%]) received usual care only. A total of 89 participants (45 in the iBASIS-VIPP group and 44 in the usual care group) were reassessed at age 3 years. The iBASIS-VIPP intervention led to a reduction in ASD symptom severity (area between curves, -5.53; 95% CI, -∞ to -0.28; P = .04). Reduced odds of ASD classification at age 3 years was found in the iBASIS-VIPP group (3 of 45 participants [6.7%]) vs the usual care group (9 of 44 participants [20.5%]; odds ratio, 0.18; 95% CI, 0-0.68; P = .02). Number needed to treat to reduce ASD classification was 7.2 participants. Improvements in caregiver responsiveness and language outcomes were also observed in the iBASIS-VIPP group. Conclusions and Relevance: Receipt of a preemptive intervention for ASD from age 9 months among a sample of infants showing early signs of ASD led to reduced ASD symptom severity across early childhood and reduced the odds of an ASD diagnosis at age 3 years. Trial Registration: http://anzctr.org.au identifier: ACTRN12616000819426.

Caregiver Psychological Distress Predicts Temperament and Social-Emotional Outcomes in Infants with Autism Traits.

Child temperament and caregiver psychological distress have been independently associated with social-emotional difficulties among individuals with autism. However, the interrelationship among these risk factors has rarely been investigated. We explored the reciprocal interplay between child temperament (surgency, negative affectivity, and self-regulation) and caregiver psychological distress in the development of child internalizing and externalizing symptoms, in a cohort of 103 infants showing early autism traits. Caregivers completed questionnaires when children were aged around 12-months (Time 1 [T1]), 18-months (Time 2 [T2]), and 24-months (Time 3 [T3]). Cross-lagged path models revealed a significant pathway from T1 caregiver psychological distress through lower T2 child self-regulation to subsequently greater T3 child internalizing symptoms. No such caregiver-driven pathway was evident through T2 child negative affectivity or in the prediction of T3 child externalizing symptoms. Further, no support was found for temperament-driven pathways through caregiver psychological distress to child social-emotional difficulties. Child surgency was mostly unrelated to caregiver psychological distress and social-emotional difficulties. These findings implicate the need to support the mental health of caregivers with an infant with autism traits in order to enhance the emotion regulation and social-emotional development of their infants.

Suicide in welfare support workers: a retrospective mortality study in Australia 2001-2016.

OBJECTIVES: Employees working in the welfare and healthcare industry have poorer mental health than other occupational groups; however, there has been little examination of suicide among this group. In this study, we examined suicide rates among welfare support workers and compared them to other occupations in Australia. METHODS: We used data from the National Coroners Information System to obtain suicide deaths between the years 2001 and 2016. Using the Australian standard population from 2001 and Census data from 2006, 2011 and 2016, we calculated age-standardised suicide rates and rate ratios to compare suicide rates across different occupational groups. RESULTS: Overall, the age-standardised suicide rate of welfare support workers was 8.6 per 100 000 people. The gender-stratified results show that male welfare support workers have a high suicide rate (23.8 per 100 000 people) which is similar to male social workers and nurses (25.4 per 100 000). After adjusting for age and year of death, both males (rate ratio 1.48, 95% CI 1.23 to 1.78) and female welfare support workers (rate ratio 1.49, 95% CI 1.20 to 1.86) have higher suicide rate ratios compared with the reference group (excluding occupations from the comparison groups). CONCLUSION: The age-standardised suicide rates of male welfare support workers are comparable to occupations which have been identified as high-risk occupations for suicide. Both female and male welfare support workers are at elevated risk of suicide compared with other occupations. Further research is required to understand the drivers of the elevated risk in this group.

Diet quality and mental health problems in late childhood.

Objectives: There is evidence that diet quality is associated with mental health problems in adults and adolescents. Yet the extent to which overall diet quality (not individual nutrients or dietary patterns) may be associated with mental health problems in pre-adolescent children, a common time for first onset of symptoms, remains unclear. This study examined associations between overall diet quality, using a brief measure, and mental health problems during late childhood, in a large community sample. Methods: Participants were 787 eight and nine-year-old children taking part in the Childhood to Adolescence Transition Study. Parents reported on their child's mental health problems using the Strengths and Difficulties Questionnaire and on their child's diet quality, using a six-item screening tool. Results: Regression analyses were conducted, adjusting for child age, sex, body mass index, and family socioeconomic status. Overall diet quality was significantly associated with children's mental health before (beta = -0.11, 95% CI -0.18 to -0.04, p = 0.004) and after adjustments for age, sex, body mass index and family socioeconomic status (beta = -0.10, 95% CI -0.18 to -0.03, p = 0.007). Conclusion: Concordant with previous literature, results indicate that better overall diet quality is related to more positive mental health in pre-adolescent children. Additionally, these results support the utility and efficacy of a brief (six-item) parent-report questionnaire as an indicator of overall diet quality.

Performance of the Autism Observation Scale for Infants with community-ascertained infants showing early signs of autism.

LAY ABSTRACT: We investigated whether a commonly used research assessment - the Autism Observation Scale for Infants (AOSI) - accurately measures autism behaviours among infants showing early signs of autism identified within the community. The AOSI is often included in studies tracking the development of infants at increased likelihood of autism, such as the infant siblings of diagnosed children. However, the suitability of this measure has not previously been tested with community-referred infants. We administered the AOSI with infants when aged 9 to 14 months and again 6 months later. Our researchers - independent of the AOSI development team and newly trained on this measure - were able to administer the brief interactive assessment and score it accurately. The infants' AOSI scores were linked to their scores on other established and validated clinical assessments, particularly at the second visit when average age was 18 months. Stronger correspondence of AOSI and other scores at this second visit suggests early autism behaviours are better established and more consistent by 18 months of age, even though these infants showed clear enough signs of possible autism to prompt referral to our study around 12 months of age. However, the moderate association of AOSI scores over time suggests that, like infant siblings - who mostly do not develop autism - community-identified infants showing early signs may also have variable developmental pathways in early life.

Does disability modify the relationship between labour force status and psychological distress among young people?

OBJECTIVE: To examine the association between labour force status, including young people who were unemployed and having problems looking for work, and psychological distress one year later. We then assessed whether this association is modified by disability status. METHODS: We used three waves of cohort data from the Longitudinal Surveys of Australian Youth. We fitted logistic regression models to account for confounders of the relationship between labour force status (employed, not in the labour force, unemployed and having problems looking for work) at age 21 years and psychological distress at age 22 years. We then estimated whether this association was modified by disability status at age 21 years. RESULTS: Being unemployed and having problems looking for work at age 21 years was associated with odds of psychological distress that were 2.48 (95% CI 1.95 to 3.14) times higher than employment. There was little evidence for additive effect measure modification of this association by disability status (2.52, 95% CI -1.21 to 6.25). CONCLUSIONS: Young people who were unemployed and having problems looking for work had increased odds of poor mental health. Interventions should focus on addressing the difficulties young people report when looking for work, with a particular focus on supporting those young people facing additional barriers to employment such as young people with disabilities.

'I'm proud of how far I've come. I'm just ready to work': mental health recovery narratives within the context of Australia's Disability Employment Services.

BACKGROUND: Employment is recognised as facilitating the personal and clinical recovery of people with psychosocial disability. Yet this group continue to experience considerable barriers to work, and, constitute a significant proportion of individuals engaged with Disability Employment Services (DES). Recognition of the role of recovery-oriented practice within DES remains limited, despite these approaches being widely promoted as best-practice within the field of mental health. METHODS: The Improving Disability Employment Study (IDES) aims to gather evidence on factors influencing employment outcomes for Australians with disability. Descriptive analysis and linear regression of IDES survey data from 369 DES participants, alongside narrative analysis of data collected through 56 in-depth interviews with 30 DES participants with psychosocial disability, allowed us to explore factors influencing mental health, well-being and personal recovery within the context of DES. RESULTS: Psychosocial disability was reported as the main disability by 48% of IDES respondents. These individuals had significantly lower scores on measures of mental health and well-being (44.9, 48.4 respectively, p ≤ 0.01), compared with respondents with other disability types (52.2, 54.3 p ≤ 0.01). Within this group, individuals currently employed had higher mental health and well-being scores than those not employed (47.5 vs 36.9, 55.5 vs 45.4 respectively, p ≤ 0.01). Building on these findings, our qualitative analysis identified five personal recovery narratives: 1) Recovery in spite of DES; 2) DES as a key actor in recovery; 3) DES playing a supporting role in fluctuating journeys of recovery; 4) Recovery undermined by DES; and, 5) Just surviving regardless of DES. Narratives were strongly influenced by participants' mental health and employment status, alongside the relationship with their DES worker, and, participants' perspectives on the effectiveness of services provided. CONCLUSION: These findings re-iterate the importance of work in supporting the mental health and well-being of people with psychosocial disability. Alongside access to secure and meaningful work, personal recovery was facilitated within the context of DES when frontline workers utilised approaches that align with recovery-orientated practices. However, these approaches were not consistently applied. Given the number of people with psychosocial disability moving through DES, encouraging greater consideration of recovery-oriented practice within DES and investment in building the capacity of frontline staff to utilise such practice is warranted.

Pre-emptive intervention versus treatment as usual for infants showing early behavioural risk signs of autism spectrum disorder: a single-blind, randomised controlled trial.

BACKGROUND: Great interest exists in the potential efficacy of prediagnostic interventions within the autism spectrum disorder prodrome, but available evidence relates to children at high familial risk. We aimed to test the efficacy of a pre-emptive intervention designed for infants showing early behavioural signs of autism spectrum disorder. METHODS: In this single-blind, randomised controlled trial done at two specialist centres in Australia, infants aged 9-14 months were enrolled if they were showing at least three early behavioural signs of autism spectrum disorder on the Social Attention and Communication Surveillance-Revised (SACS-R) 12-month checklist. Infants were randomly assigned (1:1) to receive a parent-mediated video-aided intervention (iBASIS-VIPP) or treatment as usual. Group allocation was done by minimisation, stratified by site, sex, age, and the number of SACS-R risk behaviours. Assessments were done at baseline (before treatment allocation) and at the 6 month endpoint. The primary outcome was Autism Observation Scale for Infants (AOSI), which measures early behavioural signs associated with autism spectrum disorder. Secondary outcomes were a range of infant and caregiver outcomes measured by Manchester Assessment of Caregiver-Infant interaction (MACI), Mullen Scales of Early Learning (MSEL), Vineland Adaptive Behaviour Scales, 2nd edition (VABS-2), MacArthur-Bates Communicative Development Inventory (MCDI), and Parenting Sense of Competence (PSOC) scale. This trial is registered with Australian New Zealand Clinical Trials Registry, number ANZCTR12616000819426. FINDINGS: Between June 9, 2016, and March 30, 2018, 103 infants were randomly assigned, 50 to the iBASIS-VIPP group and 53 to the treatment-as-usual group. After the intervention, we observed no significant differences between groups on early autism spectrum disorder behavioural signs measured by the AOSI (difference estimate -0·74, 95% CI -2·47 to 0·98). We also observed no significant differences on secondary outcomes measuring caregiver non-directiveness (0·16, -0·33 to 0·65), caregiver sensitive responding (0·24, -0·15 to 0·63), and infant attentiveness (-0·19, -0·63 to 0·25) during parent-child interactions (MACI), as well as on researcher-administered measures of receptive (1·30, -0·48 to 3·08) and expressive language (0·54, -0·73 to 1·80), visual reception (0·31, -0·77 to 1·40), and fine motor skills (0·55, -0·32 to 1·41) using the MSEL. Compared with the treatment-as-usual group, the iBASIS-VIPP group had lower infant positive affect (-0·69, -1·27 to -0·10) on the MACI, but higher caregiver-reported receptive (37·17, 95% CI 10·59 to 63·75) and expressive vocabulary count (incidence rate ratio 2·31, 95% CI 1·22 to 4·33) on MCDI, and functional language use (difference estimate 6·43, 95% CI 1·06 to 11·81) on VABS. There were no significant group differences on caregiver-reported measures of MCDI infant gesture use (3·22, -0·60 to 7·04) and VABS social behaviour (3·28, -1·43 to 7·99). We observed no significant differences between groups on self-reported levels of parenting satisfaction (difference estimate 0·21, 95% CI -0·09 to 0·52), interest (-0·23, -0·62 to 0·16) and efficacy (-0·08, -0·38 to 0·22) on PSOC. INTERPRETATION: A pre-emptive intervention for the autism spectrum disorder prodrome had no immediate treatment effect on early autism spectrum disorder symptoms, the quality of parent-child interactions, or researcher-administered measures of developmental skills. However, we found a positive effect on parent-rated infant communication skills. Ongoing follow-up of this infant cohort will assess longer-term developmental effects. FUNDING: Western Australia Children's Research Fund, Autism Cooperative Research Centre, La Trobe University, and Angela Wright Bennett Foundation.