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Research Program in Early Detection and Intervention

Program Leader:  Diana Robins, Ph.D.

Program Overview

The goal of the Early Detection and Intervention (EDI) program is to advance a comprehensive research agenda aimed at promoting optimal outcomes for children with ASD through early detection and intervention efforts. Our research approach bridges knowledge across different fields, including public health, psychology, education and policy, in order to provide cohesive and comprehensive answers to the complex challenge of evaluating and implementing successful and detection and intervention programs in the community. A critical framework that informs our research program is the notion that outcomes of children with ASD are shaped by the interplay of child factors (e.g., learning strengths and weaknesses, severity of symptoms, and additional challenges such as anxiety), program factors (e.g., the adoption of evidence-based detection and intervention strategies) and context factors (e.g., community and family-level resources devoted to the implementation of effective programs).

Focus on

Therefore, we focus on three fundamental questions: (1) How do child factors contribute to our ability to modify outcomes through early detection and intervention? (2) How do factors related to specific detection and intervention programs affect our ability to modify outcomes? And (3) How do factors related to the implementation context affect our ability to modify outcomes through early detection and intervention?

Early Detection: Dr. Diana Robins spearheaded recent advances in toddler screening for ASD using the Modified Checklist for Autism in Toddlers (M-CHAT), and its revision, the M-CHAT-R with Follow-Up (M-CHAT-R/F). Evidence indicates that if a standardized screening protocol is implemented during pediatric well-child care visits at 18 and 24 months, including immediate referral of children who demonstrate risk for ASD, the average age of diagnosis can be reduced by two years compared to the national median. In addition, more than three times as many toddlers were flagged for possible ASD risk based on the M-CHAT-R/F compared to the healthcare provider’s surveillance, suggesting that the use of a standardized screening tool is essential to promote early detection for the greatest number of children. The M-CHAT-R/F is a brief, cost-effective, parent-report survey that can be integrated into a variety of settings in order to reach as many toddlers as possible.

Early Intervention: The EDI program at the A.J. Drexel Autism Institute aims to better link early detection with early intervention research, and to investigate how early intervention programs can be optimized and adapted to fit the needs and resources of children, family, and implementation contexts. Dr. Giacomo Vivanti is the author of “Implementing the Group-Based Early Start Denver Model for Preschoolers with Autism”, a manualized intervention focused on the adaptation of evidence-based strategies across public healthcare and educational settings. Additionally, his research focuses on understanding “what works for whom, and why” in ASD early intervention, and factors related to individual differences in intervention response. Understanding modifiable factors associated with optimal versus suboptimal outcomes holds the potential to optimize current interventions and develop new ones, thus mitigating the burden associated with ASD symptoms and reducing care costs.

Addressing additional challenges of children with ASD: Individuals with ASD are at risk for a range of comorbid psychiatric disorders; among of the most common are anxiety disorders. Dr. Connor Kerns studies how co-occurring anxiety impacts detection and treatment for individuals with ASD. She also has launched a new area of research investigating what is perceived as traumatic to individuals with ASD and how they express symptoms of trauma, with the understanding that these may differ from those without ASD.

Announcements

  • Work from the Early Detection and Intervention team was included in the Interagency Autism Coordinating Committee's 2017 Summary of Advances in Autism Research. Dr. Diana Robins's work, published in Autism last year, focused on the influence of race on parent reporting of concerns about autism.
  • The Early Detection and Intervention Research Program is currently accepting applications for a full-time postdoctoral fellowship. For more details and to apply, go to https://www.drexeljobs.com and search for requisition #8772 or keyword: autism.

Current projects

Connecting the dots, An RCT integrating standardized ASD screening, high- quality treatment, and long-term outcomes

Connecting the dots

Autism spectrum disorder is defined by impaired social engagement and social communication, and repetitive, restricted, or stereotyped behaviors and interests. The average age of diagnosis in the US is after the fourth birthday. However, children who start ASD-specific early intervention have better outcomes than children start later. The current study will address a gap identified by the US Prevention Services Task Force, namely that children detected through screening respond positively to early intervention. This Autism Centers of Excellence (ACE) network study, which is a collaboration across Drexel University, University of Connecticut, and University of California, Davis, will directly relate early detection strategies to early intervention, and measure the impact of age of intervention onset on outcomes when children are entering kindergarten. Local pediatric providers will be randomized to provide either usual care, or to an experimental condition in which autism early detection strategies are enhanced through the addition of specific procedures. Across all sites, 8,000 children will be recruited through their participating pediatric practice. Qualifying children will receive up to one year of early intensive behavioral intervention, after getting an ASD diagnosis. Primary outcome measures will include children’s cognitive functioning and ASD symptom severity, which will be measured at multiple time points. We predict that our study will inform early detection strategies which will result in improving children’s social and cognitive functioning, mitigating lifespan disability, and improving personal well-being and productivity of individuals with ASD.

Funded by the National Institute of Mental Health, 1R01MH115715-01.

Improving Child-Treatment Fit in Autism Early Intervention

The Improving Child-Treatment Fit in Autism Early Intervention Study focuses on the question of “what works for whom”. There are several Early Interventions approaches for children with ASD that demonstrated powerful effects in improving cognitive and social outcomes. Intervention response however is variable, and the factors associated with positive versus suboptimal treatment outcomes remain unknown. Hence the issue of which intervention should be chosen for an individual child remains a common dilemma. As children with ASD vary in their learning abilities and preferences, and different intervention programs vary in their teaching procedures, it is plausible that suboptimal treatment outcomes occur when there is a poor fit between child learning profile and treatment teaching procedures. However, there is currently no established protocol to match children to the program from which they are more likely to benefit from. The “Improving Child-Treatment Fit” project addresses this gap in knowledge by testing a novel child-treatment fit algorithm based on the eye-tracking technology, which measures eye movements and changes in pupil size to determine attentional and emotional responses to stimuli. This technology will be used for the first time to obtain a fine-grained characterization of how children respond attentionally and emotionally to different teaching styles, so that children can be matched to teaching programs that are congruent with their learning preferences and abilities. This approach has the potential to increase the likelihood of enrolling children in programs from which they will benefit the most, thus increasing the cost-effectiveness of already existing support options, promoting the overall rate of optimal treatment outcomes, mitigating later adult disability, reducing societal costs and improving personal wellbeing and productivity of individuals with ASD.

Funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) R21HD090344

Early Detection Project

The ongoing goals of the Early Detection Project include examining the optimal schedule for routine ASD screening, better integrating of screening with surveillance and other strategies to detect ASD, and broadening the scope of screening beyond pediatric primary care. The study builds on the seminal M-CHAT work (e.g., Robins et al., 2001; Chlebowski et al., 2013; Robins et al., 2014). This study will investigate three key questions: (1) What is the best age to initiate screening? (2) Can physician screening and surveillance improve after brief, focused training? (3) What are the factors associated with disparity in effective ASD screening and surveillance at the child/family level and at the physician/practice level? The proposed study will answer key remaining questions about early ASD screening, thereby impacting the early health monitoring of children across the nation, and helping ensure that the promise of early ASD detection can become a reality.

Funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) R01HD039961

Mobilizing Community Systems

It is vitally important to connect all aspects of care for children with ASD, from the initial screening at their primary care physician or other community setting, to the early intervention system mandated by the Individuals with Disabilities education Act (IDEA) Part C. By integrating different levels of care, we expect to reduce disparities and better serve children with ASD and other developmental delays. This study is a collaboration among 4 universities and involves: primary care training in ASD, universal screening using the Smart Early Screening for Autism and Communication Disorders (Smart ESAC), tracking of referrals and their uptake, and early intervention training, which are all supported by a web-based platform. The principal investigators, Drs. Amy Wetherby, Ami Klin, Craig Newschaffer, and Catherine Lord, are seasoned senior autism researchers on early detection, diagnosis, early treatment, and large-scale multisite longitudinal research.  Working together with a team of additional key investigators, consultants, and collaborators, they bring unique expertise related to family engagement, early intervention systems, and health disparities.

Funded by National Institute of Mental Health (NIMH) R01MH104423