Research Program in Early Detection and Intervention
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).
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, Interim Director of the A.J. Drexel Autism Institute, 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. Current studies are examining the optimal ages for universal screening, connecting the dots between primary care detection of ASD, intensive evidence-based early intervention, and outcomes as children prepare to enter kindergarten, and degree to which screening is implemented as intended in community programs.
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, that has been published in multiple languages, including Chinese. 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. Current projects include eye tracking investigations of profiles of social learning and responsiveness to different interventions, factors that facilitate adaptation of intervention strategies in community settings, and strategies to support communication in minimally verbal children.
Regional, national, and international presentations to audiences including scientific, clinical, educational, advocacy groups, and family members, including:
- University of Guam Center for Excellence in Developmental Disabilities Education, Guam
- Federal University of Minas Gerais, Belo Horizonte, Brazil
- Hospital of St. John of God, Institute of Neurology, Linz, Austria
- Autismi, Rimini, Italy
- Bar Ilan University, Tel Aviv, Israel
- Early Childhood Development International Summit Forum, Guangzhou, China
- University of Salamanca, Salamanca, Spain
- La Trobe University, Melbourne, Australia
- University of Trento, Italy
- Stella Maris Scientific Institute, Pisa, Italy
- Italian National Institute of Health, Rome, Italy
Collaborating with scientists conducting screening and/or treatment research internationally, including:
Local Partnerships to facilitate community-based research, including:
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.
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
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
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
This project examines the impact of delivering an evidence-based intervention for children with ASD in community childcare settings. Through this study we will examine whether the Group Early Start Denver Model (GESDM) program is experienced as acceptable and feasible by key stakeholders; we will test preliminary effectiveness of the GESDM program by examining whether children enrolled in the program experience superior benefits compared to children on a waitlist; and will assessing the impact of the GESDM program on parent workforce participation.
Funded by the Eagles Autism Foundation
The goal of this project is to identify early emerging biomarkers of Autism
Specific Aims. We will estimate participation, enrollment uptake, and retention rates for pregnant women at Virtua Health System recruited via a multimodal approach
We look to demonstrate feasibility/utility of delivery biosampling (cord blood, cord tissue, placental biopsy, and meconium) performed by Virtua birth hospital staff integrated with routine clinical practice. And, we will compare markers of early social behaviors potentially relevant to ASD derived from Computer Vision Analysis of mobile-device-captured video with those derived from standard laboratory-based eye tracking measurement.
Funded by the New Jersey Governor’s Council for Medical Research and Treatment of Autism
This supplement to the R01 grant ‘Connecting the Dots’examines the impact of Early Start Denver Model, and early intervention model designed for children with ASD, on the outcomes of children with Down Syndrome. We will examine whether children with Down Syndrome show greater gains from receiving the ESDM intervention compared to a treatment as usual comparison group and will test whether the gains in the Down Syndrome group randomized to ESDM are comparable to those observed in a subset of children with ASD treated with ESDM in the parent study and whether comorbid ASD symptoms in the DS group are associated with the response to ESDM.
Funded by the NIH and NIMH
The goal of this project is to examine secondary child-level data from early intervention trials in ASD to examine the prevalence and profile of children with ASD who show a suboptimal response to intervention.
Our aims are to determine the prevalence of children who remain minimally verbal despite receiving evidence-supported early intervention targeting spoken language, to characterize empirically derived profiles of ‘minimal-responders’ in the language domain through the analysis of variables that distinguish treated minimally verbal children who show language improvements from those who continue to be minimally verbal after treatment and, to identify potential mechanisms of child minimal intervention response by testing predictions from social, cognitive and motor accounts of language impairment in ASD.
Funded by the NIH, NIDCD
This project examines the accuracy with which screening protocols are deployed in community agencies, and the utility in identifying children in need of ASD-specific evaluation and treatment. We will look to assess the procedural fidelity of implementation of screening in an early intervention community setting. Barriers to implementation will be examined by investigating whether errors and omissions are systematic or random. Additionally, we will look to measure the proximal outcomes of screening in the early intervention setting.
Funded by the NIH, NIDCD