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Research Program in Early Detection and Intervention

Program Leader: Giacomo Vivanti, Ph.D.

Faculty: Ashley DeMarchena, Ph.DDiana Robins, Ph.D.Andrea Wieckowski, 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).

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, 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.

Dissemination Efforts:

Regional, national, and international presentations to audiences including scientific, clinical, educational, advocacy groups, and family members, including:

Collaborating with scientists conducting screening and/or treatment research internationally, including:

Local Partnerships to facilitate community-based research, including:

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

Addressing the Unmet Needs of Young Children with ASD and their Working Families in Underserved Communities: A Pilot Randomized Controlled Trial

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

Building a Streamlined Birth Cohort to Study Autism Risk Factors and Biomarkers

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

Extending the Early Start Denver Model to Young Children with Down Syndrome

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

Prevalence and Profile of Treatment Non-Responders in Autism Early Intervention

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

Screening for Autism at Entrance to Elementary School

Studies demonstrate that risk for autism spectrum disorder (ASD) can be detected in many children when pediatric providers use standardized screening during well-child check-ups at 18 and 24 months. However, a number of barriers limit detection in children younger than 4 years, leaving some children undiagnosed before they start school. This project aims to develop a screening questionnaire for parents and teachers, to detect children at risk for ASD between the ages of 4 and 8. The questionnaire will be an upward extension of the toddler screener, the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT-R/F) to school-aged children, the M-CHAT-S, to screen children in early elementary school.

Funded by the Wawa Foundation

Emotional Expressivity in Young Children with and without Autism Spectrum Disorder

From early in life, individuals with Autism Spectrum Disorder (ASD) express emotion differently compared to typically developing peers. These difficulties impact children’s social engagement and personal wellbeing. The study aims to integrate multiple complementary methods to examine young children’s emotional expressivity and its neural and psychophysiological correlates in response to (1) naturalistic probes eliciting specific emotions, and (2) emotion-eliciting videos during a viewing paradigm. The goal for this project is to identify early, foundational manifestations of atypical emotional responses in young children with ASD. Results will shed light on specific challenges experienced by toddlers and preschool children with ASD, highlight the mechanism underlying the challenges, and specify under what conditions are challenges most pronounced, in order to inform key intervention targets in this age group, prior to school entry.

Funded by the Eagles Autism Foundation 

Examining preverbal social learning processes in minimally verbal children with autism

Children with autism who are minimally verbal often show limited response to early intervention. This is partly due to the fact that our knowledge on their learning strengths and needs is insufficient, particularly in the social-cognitive and social-motivational abilities that are foundational to verbal communication. This project addresses this gap in knowledge by examining the preverbal social foundations of verbal communication in minimally verbal children with ASD using the Measurement of Preverbal Social Learning, a novel experimental battery that uses cutting-edge eye-tracking and pupillometry techniques to measure social motivational and social cognitive prerequisites of verbal language.

Funded by the Eagles Autism Foundation