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1.
J Autism Dev Disord ; 49(2): 632-646, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-30203308

RESUMEN

Short-term low intensity parent implemented intervention studies for toddlers with autism spectrum disorder (ASD) have found it difficult to demonstrate significantly improved developmental scores or autism severity compared to community treatment. We conducted a randomized comparative intent-to-treat study of a parent implemented intervention to (1) test the effects of an enhanced version on parent and child learning, and (2) evaluate the sensitivity to change of proximal versus distal measures of child behavior. We randomized 45 children with ASD, 12-30 months of age, into one of two versions of parent-implemented Early Start Denver Model (P-ESDM), the basic model, in which we delivered 1.5 h of clinic-based parent coaching weekly, and an enhanced version that contained three additions: motivational interviewing, multimodal learning tools, and a weekly 1.5-h home visit. We delivered the intervention for 12 weeks and measured child and parent change frequently in multiple settings. We found a time-by-group interaction: parents in the enhanced group demonstrated significantly greater gains in interaction skills than did parents in the non-enhanced group. Both interventions were associated with significant developmental acceleration; however, child outcomes did not differ by group. We found a significant relationship between degree of change in parental interaction skill and rate of children's improvement on our proximal measure. Parents in both groups reported satisfaction with the intervention. These findings suggest that parent skills improved more in the enhanced group than the comparison group. Children in the two groups showed similar improvements. Rate of individual parent learning was associated with greater individual child progress on a measure quite proximal to the treatment, though not on standardized assessments.


Asunto(s)
Trastorno Autístico/terapia , Desarrollo Infantil , Intervención Educativa Precoz/métodos , Intervención Médica Temprana/métodos , Tutoría/métodos , Padres , Preescolar , Femenino , Humanos , Lactante , Masculino
2.
Monogr Soc Res Child Dev ; 64(1): 1-114, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-10412222

RESUMEN

The aims of this longitudinal study were: (1) to assess the continuity and change in diagnosis, intelligence, and language skills in children with autism, Down syndrome, and other developmental delays, (2) to specify the deficits in social competence and language skills in these children, and (3) to identify precursors in the preschool period of gains in language skills and of peer engagement in the mid-school years. The initial sample consisted of 70 children with autism, 93 children with Down syndrome, 59 children with developmental delays, and 108 typically developing children, with the first three groups of children studied when they were between 2 and 6 years of age. At follow-up, 51 children with autism, 71 children with Down syndrome, and 33 children with developmental delays were assessed at mean ages around 10-13 years. The long-term follow-up showed little change in the diagnosis of autism but sizeable improvements in intellectual and language abilities within the autistic group, a pattern that was not seen in the children with Down syndrome. Unique deficits in joint attention, some forms of representational play, responsiveness to the emotions of others, and initiation of peer engagement were identified in the autistic children, whereas the children with Down syndrome seemed to have a specific deficit only in language. Joint attention skills were concurrently associated with language abilities in all groups and predicted long-term gains in expressive language for the children with autism. Children with autism, regardless of their level of functioning, were less socially engaged with classmates than the other developmentally disabled children because they infrequently initiated and accepted play bids, not because they were rebuffed by peers. Early nonverbal communication and play skills were predictors of the frequency of initiations of peer play for the children with Down syndrome as well as the extent of peer engagement of the children with autism. These results suggest that improvements in early communication and play skills may have long-term consequences for later language and social competence in these groups of children.


Asunto(s)
Trastorno Autístico/psicología , Discapacidades del Desarrollo/psicología , Síndrome de Down/psicología , Relaciones Interpersonales , Ajuste Social , Adolescente , Análisis de Varianza , Trastorno Autístico/diagnóstico , Trastorno Autístico/rehabilitación , Estudios de Casos y Controles , Niño , Preescolar , Discapacidades del Desarrollo/diagnóstico , Discapacidades del Desarrollo/rehabilitación , Diagnóstico Diferencial , Progresión de la Enfermedad , Síndrome de Down/diagnóstico , Síndrome de Down/rehabilitación , Emoción Expresada , Femenino , Humanos , Inteligencia , Desarrollo del Lenguaje , Trastornos del Lenguaje/diagnóstico , Trastornos del Lenguaje/rehabilitación , Estudios Longitudinales , Masculino , Grupo Paritario , Pronóstico , Reproducibilidad de los Resultados , Conducta Social , Trastorno de la Conducta Social/diagnóstico , Trastorno de la Conducta Social/rehabilitación , Percepción Social
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