Neurodevelopmental Outcomes of Extremely Preterm Infants Fed Donor Milk or Preterm Infant Formula: A Randomized Clinical Trial.

Importance: Maternal milk feeding of extremely preterm infants during the birth hospitalization has been associated with better neurodevelopmental outcomes compared with preterm formula. For infants receiving no or minimal maternal milk, it is unknown whether donor human milk conveys similar neurodevelopmental advantages vs preterm formula. Objective: To determine if nutrient-fortified, pasteurized donor human milk improves neurodevelopmental outcomes at 22 to 26 months' corrected age compared with preterm infant formula among extremely preterm infants who received minimal maternal milk. Design, Setting, and Participants: Double-blind, randomized clinical trial conducted at 15 US academic medical centers within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants younger than 29 weeks 0 days' gestation or with a birth weight of less than 1000 g were enrolled between September 2012 and March 2019. Intervention: Preterm formula or donor human milk feeding from randomization to 120 days of age, death, or hospital discharge. Main Outcomes and Measures: The primary outcome was the Bayley Scales of Infant and Toddler Development (BSID) cognitive score measured at 22 to 26 months' corrected age; a score of 54 (score range, 54-155; a score of ≥85 indicates no neurodevelopmental delay) was assigned to infants who died between randomization and 22 to 26 months' corrected age. The 24 secondary outcomes included BSID language and motor scores, in-hospital growth, necrotizing enterocolitis, and death. Results: Of 1965 eligible infants, 483 were randomized (239 in the donor milk group and 244 in the preterm formula group); the median gestational age was 26 weeks (IQR, 25-27 weeks), the median birth weight was 840 g (IQR, 676-986 g), and 52% were female. The birthing parent's race was self-reported as Black for 52% (247/478), White for 43% (206/478), and other for 5% (25/478). There were 54 infants who died prior to follow-up; 88% (376/429) of survivors were assessed at 22 to 26 months' corrected age. The adjusted mean BSID cognitive score was 80.7 (SD, 17.4) for the donor milk group vs 81.1 (SD, 16.7) for the preterm formula group (adjusted mean difference, -0.77 [95% CI, -3.93 to 2.39], which was not significant); the adjusted mean BSID language and motor scores also did not differ. Mortality (death prior to follow-up) was 13% (29/231) in the donor milk group vs 11% (25/233) in the preterm formula group (adjusted risk difference, -1% [95% CI, -4% to 2%]). Necrotizing enterocolitis occurred in 4.2% of infants (10/239) in the donor milk group vs 9.0% of infants (22/244) in the preterm formula group (adjusted risk difference, -5% [95% CI, -9% to -2%]). Weight gain was slower in the donor milk group (22.3 g/kg/d [95% CI, 21.3 to 23.3 g/kg/d]) compared with the preterm formula group (24.6 g/kg/d [95% CI, 23.6 to 25.6 g/kg/d]). Conclusions and Relevance: Among extremely preterm neonates fed minimal maternal milk, neurodevelopmental outcomes at 22 to 26 months' corrected age did not differ between infants fed donor milk or preterm formula. Trial Registration: ClinicalTrials.gov Identifier: NCT01534481.

Thinking Small to Think Big: Modular Approach for Autism Programming in Schools (MAAPS).

To date there are no evidence-based comprehensive interventions for use in school settings. There are numerous barriers to delivery of high-quality interventions in schools that have limited the transfer of research-based interventions to school settings. Modular Approach to Autism Programing for Schools (MAAPS) is a framework for implementation of evidence-based interventions in school settings that is designed to address these barriers. The development and initial evaluation of MAAPS was conducted using an implementation-science framework and results indicate that MAAPS is aligned with needs and resources available in schools, that it had excellent social validity, and that there is good evidence that MAAPS is effective for addressing core and associated features of autism in educational settings.

A method to establish stimulus control and compliance with instructions.

We evaluated a unique procedure to establish compliance with instructions in four young children diagnosed with autism spectrum disorder (ASD) who had low levels of compliance. Our procedure included methods to establish a novel therapist as a source of positive reinforcement, reliably evoke orienting responses to the therapist, increase the number of exposures to instruction-compliance-reinforcer contingencies, and minimize the number of exposures to instruction-noncompliance-no reinforcer contingencies. We further alternated between instructions with a high probability of compliance (high-p instructions) with instructions that had a prior low probability of compliance (low-p instructions) as soon as low-p instructions lost stimulus control. The intervention is discussed in relation to the conditions necessary for the development of stimulus control and as an example of a variation of translational research.

Evaluation of multiple schedules with naturally occurring and therapist-arranged discriminative stimuli following functional communication training.

Many studies have shown that (a) functional communication training (FCT) is effective for reducing problem behavior, and (b) multiple schedules can facilitate reinforcer schedule thinning during FCT. Most studies tha have used multiple schedules with FCT have included therapist-arranged stimuli (e.g., colored cards) as the discriminative stimuli (S(D) s), but recently, researchers have evaluated similar multiple-schedule training procedures with naturally occurring S(D) s (e.g., overt therapist behavior). The purposes of the current study were to compare the effects of arranged and naturally occurring S(D) s directly during (a) acquisition of discriminated functional communication responses (FCRs) and (b) generalization of discriminated FCRs when we introduced the multiple schedules in novel contexts in which the naturally occurring stimuli were either relatively easy or difficult to discriminate. Results showed that (a) 2 of 3 participants acquired discriminated responding of the FCR more rapidly with arranged than with naturally occurring stimuli, (b) 2 of 3 participants showed resurgence of problem behavior , and (c) 2 of 3 participants showed greater generalization of discriminated responding to novel contexts with arranged stimuli than with naturally occurring stimuli. We discuss these results relative to the conditions under which naturally occurring and arranged S(D) s may promote rapid and generalized treatment gains.