Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial

IF 7.6 1区医学 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet Regional Health: Western Pacific Pub Date : 2024-08-16 DOI:10.1016/j.lanwpc.2024.101173

Hannah Waddington , Phoebe Jordan , Matthew Hammond , Jessica Tupou , Lee Patrick , Ella Macaskill , Georgia Davies , Sarah Pillar , Larah van der Meer , Andrew J.O. Whitehouse

{"title":"Low-intensity parent- and clinician-delivered support for young autistic children in Aotearoa New Zealand: a randomised controlled trial","authors":"Hannah Waddington , Phoebe Jordan , Matthew Hammond , Jessica Tupou , Lee Patrick , Ella Macaskill , Georgia Davies , Sarah Pillar , Larah van der Meer , Andrew J.O. Whitehouse","doi":"10.1016/j.lanwpc.2024.101173","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children.</p></div><div><h3>Methods</h3><p>This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2–3 h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1–4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529.</p></div><div><h3>Findings</h3><p>From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43) = 21.47, p < 0.0001, η<sub>p</sub><sup>2</sup> = 0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support.</p></div><div><h3>Interpretation</h3><p>A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited.</p></div><div><h3>Funding</h3><p>Emerging Researcher First Grant from the <span>Health Research Council of New Zealand</span>.</p></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6000,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666606524001676/pdfft?md5=396053697bdb50c4b8934f9924913e49&pid=1-s2.0-S2666606524001676-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Lancet Regional Health: Western Pacific","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666606524001676","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Aotearoa New Zealand does not provide publicly-funded intensive autism support. While parent-mediated supports are promising, children and families may also benefit from direct clinician support. We tested the efficacy of a low-intensity programme involving parent- and clinician-delivered support for autistic children.

Methods

This single-blind, two-arm randomised controlled trial assessed outcomes of a six-month low-intensity parent- and clinician-delivered support (2–3 h per week) based on the Early Start Denver Model compared to a control group who received monthly support calls and assistance with referrals. Children aged 1–4.5 years who were autistic or showing signs of autism and their parents were randomised to the low-intensity or control group by a blinded statistician using the Urn minimisation method. Assessments were conducted at baseline and immediately following the support period (24-weeks post-baseline). The primary outcome was child engagement during an interaction with their parent. The trial was pre-registered with ANZCTR: U1111-1260-2529.

Findings

From March 2021 to May 2023, 56 families were randomised to either the low-intensity or control group. Following drop-outs, 21 families in the low-intensity group and 24 in the control group were included in analysis. There was large and significantly greater improvement in children's engagement in the low-intensity group compared to the control group (F (1, 43) = 21.47, p < 0.0001, η_p² = 0.33). There was one recorded adverse event unrelated to the support and two adverse effects related to the support.

Interpretation

A low-intensity parent- and clinician-delivered support can improve engagement between an autistic child and their parent during play. Low-intensity supports may be beneficial in areas where access to clinical autism supports is limited.

Funding

Emerging Researcher First Grant from the Health Research Council of New Zealand.

查看原文本刊更多论文

新西兰奥特亚罗瓦地区由家长和临床医生为自闭症儿童提供的低强度支持：随机对照试验

背景新西兰没有提供由政府资助的自闭症强化支持。虽然由家长提供的支持很有前景，但儿童和家庭也可从临床医生的直接支持中受益。我们测试了一项由家长和临床医生共同为自闭症儿童提供支持的低强度计划的有效性。方法这项单盲双臂随机对照试验评估了家长和临床医生共同提供的为期 6 个月的低强度支持（每周 2-3 小时）的结果，该支持以早期开始丹佛模式为基础，对照组则每月接受支持电话和转介协助。年龄在 1-4.5 岁的自闭症儿童或有自闭症迹象的儿童及其家长被随机分配到低强度组或对照组。评估在基线和支持期结束后（基线后 24 周）立即进行。主要结果是儿童在与父母互动时的参与度。研究结果从 2021 年 3 月到 2023 年 5 月，56 个家庭被随机分配到低强度组或对照组。在退出后，低强度组中的 21 个家庭和对照组中的 24 个家庭被纳入分析。与对照组相比，低强度组儿童参与度的提高幅度较大且明显（F (1, 43) = 21.47, p < 0.0001, ηp2 = 0.33）。有一项记录的不良事件与支持无关，两项不良反应与支持有关。在临床自闭症支持服务有限的地区，低强度支持服务可能是有益的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

The Lancet Regional Health: Western Pacific Medicine-Pediatrics, Perinatology and Child Health

CiteScore

8.80

自引率

2.80%

发文量

305

审稿时长

11 weeks

期刊介绍： The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.