Effect of ESDM and PCIT-A in Autism Spectrum Disorder

NCT ID: NCT04722783

Last Updated: 2024-12-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

24 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-14

Study Completion Date

2024-10-21

Brief Summary

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Children with ASD often show disruptive behaviors. However, interventions that were specifically designed to improve these symptoms have not been sufficiently investigated, especially in children with level 1 to level 3 ASD. PCIT has large effects on externalizing behavior problems in children with disruptive behavior disorders. Recently PCIT was adapted for children with autism spectrum disorder (PCIT-A). ESDM is an evidence-based treatment for ASD but has not been investigated in combination with PCIT-A.

As primary aims, the investigators assess a) the effect of PCIT-A on disruptive behavior and b) the effect of ESDM on autism symptoms in toddlers and preschool children with ASD level 1 to 3. As secondary aims, the investigators evaluate a) the maintenance of the effect of PCIT-A one year after the end of intervention and b) the effect of both interventions on secondary outcomes (developmental level, intelligence, adaptive behavior, and parenting stress), c) the combined intervention effect of PCIT-A and ESDM depending on intervention overlap periods.

Detailed Description

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Autism spectrum disorder (ASD) is a life-long neurodevelopmental disorder with recognizable symptoms often beginning between one and two years of age and an estimated prevalence of about 0.6%. Both social communication deficits, and restrictive and repetitive behavior depict the core symptoms of ASD.

ESDM is an evidence-based treatment for ASD. A recent meta-analysis comprising 12 studies show favorable effects of ESDM on cognition and language with a moderate effect size, in contrast to control groups. ESDM showed to become cost-efficient within a few years after treatment as a result of less use of other health care services in the years following the intervention.

Children with ASD often show disruptive behaviors such as angry outbursts, irritability, aggressive and oppositional behaviors. However, interventions that were specifically designed to improve these symptoms have not been sufficiently investigated, especially in children with level 1 to level 3 ASD. PCIT has large effects on externalizing behavior problems in children with disruptive behavior disorders. Recently, PCIT was adapted for children with autism spectrum disorder (PCIT-A).

As primary aims of the so-called TAFF (Tagesklinik für Autismus und Frühförderung \[Day Clinic for Autism and Early Intervention\]) pilot study, the investigators assess a) the effect of PCIT-A on disruptive behavior and b) the effect of ESDM on autism symptoms in toddlers and preschool children with ASD level 1 to 3. As secondary aims, the investigators evaluate a) the maintenance of the effect of PCIT-A one year after the end of intervention and b) the effect of both interventions on secondary outcomes (developmental level, intelligence, adaptive behavior, and parenting stress), c) the combined intervention effect of PCIT-A and ESDM depending on intervention overlap periods.

Conditions

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Autism Spectrum Disorder

Keywords

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Parent-Child Interaction Therapy Early Start Denver Model Autism Spectrum Disorder Disruptive behavior Autism Symptoms Toddlers Preschool children

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

This is a pilot, practical clinical trial with a single-blind, mixed randomized and non-randomized controlled factorial design within a monocentric setup
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The DPICS rating - as part of the primary outcome - is the only measure that is masked

Study Groups

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ESDM and PCIT-A

Participants in this arm receive 2 years ESDM and after 4 months PCIT-A for 8 months (see Study Protocol, Figure 2).

Group Type EXPERIMENTAL

Parent-Child-Interaction Therapy adapted for children with autism spectrum disorder (PCIT-A)

Intervention Type BEHAVIORAL

PCIT is a behavioral family therapy approach emphasizing the integration of traditional child play therapy techniques within a behavioral framework of parent-child therapy and was developed by Eyberg (1988). It is based on attachment theory, social learning theory, and parenting styles theory. Recently, the intervention was adapted to children with ASD by our team (McNeil, Quetsch, \& Anderson, 2019). PCIT-A will last about 8 months, 1 day per week, 60min per day (see Study Protocol, Fig. 2).

Early Start Denver Model (ESDM) intervention

Intervention Type BEHAVIORAL

ESDM intervention provides intensive teaching by trained therapists and parents during natural play and relationship-focused daily routines. It is evidence-based and uses principles of developmental psychology and applied behavior analysis. It was designed for toddlers and preschoolers with autism spectrum disorder by Rogers and Dawson (2010). The first intensive part of ESDM intervention (20h per week) will last 40 weeks of intervention within a period of 12 months. It includes 2 days per week for 6h a day clinic therapy, and 5 days per week for 1h homework tasks, and 2 days per week for 1.5h an early special needs education at home. After the first 12 months, children receive the second lower intensity part of ESDM (7 hours per week). It includes 1 days every two weeks 1h day clinic therapy, and 5 days per week for 1h homework tasks, and 1 days per week for 1.5h an early special needs education at home (see Study Protocol, Fig. 2).

ESDM and active control for PCIT-A

Participants in this arm receive 2 years ESDM and after 4 months 1h-ESDM as active control instead of 1h-PCIT-A for 8 months

Group Type EXPERIMENTAL

Early Start Denver Model (ESDM) intervention

Intervention Type BEHAVIORAL

ESDM intervention provides intensive teaching by trained therapists and parents during natural play and relationship-focused daily routines. It is evidence-based and uses principles of developmental psychology and applied behavior analysis. It was designed for toddlers and preschoolers with autism spectrum disorder by Rogers and Dawson (2010). The first intensive part of ESDM intervention (20h per week) will last 40 weeks of intervention within a period of 12 months. It includes 2 days per week for 6h a day clinic therapy, and 5 days per week for 1h homework tasks, and 2 days per week for 1.5h an early special needs education at home. After the first 12 months, children receive the second lower intensity part of ESDM (7 hours per week). It includes 1 days every two weeks 1h day clinic therapy, and 5 days per week for 1h homework tasks, and 1 days per week for 1.5h an early special needs education at home (see Study Protocol, Fig. 2).

1-hour ESDM

Intervention Type BEHAVIORAL

The active control group for PCIT-A stays in the ESDM day clinic therapy for the 12 hours per week while the PCIT-A group will receive 11 hours of ESDM day clinic therapy and 1 hour PCIT-A per week (see Study Protocol, Fig. 2).

PCIT-A and active control for ESDM

Participants receive after 4 month PCIT-A for 8 months and early special needs education as an active control for ESDM.

Group Type EXPERIMENTAL

Parent-Child-Interaction Therapy adapted for children with autism spectrum disorder (PCIT-A)

Intervention Type BEHAVIORAL

PCIT is a behavioral family therapy approach emphasizing the integration of traditional child play therapy techniques within a behavioral framework of parent-child therapy and was developed by Eyberg (1988). It is based on attachment theory, social learning theory, and parenting styles theory. Recently, the intervention was adapted to children with ASD by our team (McNeil, Quetsch, \& Anderson, 2019). PCIT-A will last about 8 months, 1 day per week, 60min per day (see Study Protocol, Fig. 2).

Early special needs education (ESNE)

Intervention Type BEHAVIORAL

The wait-list control group will receive early special needs education. It consists of a 90-minute visit at participants' homes once a week by an employee educated in early special needs education. As soon as space in ESDM is available children will receive the ESDM intervention (stepped-wedge design, see Study Protocol, Fig. 2).

Active control for ESDM and PCIT-A

Participants receive early special needs education as an active control for ESDM and PCIT-A.

Group Type ACTIVE_COMPARATOR

Early special needs education (ESNE)

Intervention Type BEHAVIORAL

The wait-list control group will receive early special needs education. It consists of a 90-minute visit at participants' homes once a week by an employee educated in early special needs education. As soon as space in ESDM is available children will receive the ESDM intervention (stepped-wedge design, see Study Protocol, Fig. 2).

Interventions

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Parent-Child-Interaction Therapy adapted for children with autism spectrum disorder (PCIT-A)

PCIT is a behavioral family therapy approach emphasizing the integration of traditional child play therapy techniques within a behavioral framework of parent-child therapy and was developed by Eyberg (1988). It is based on attachment theory, social learning theory, and parenting styles theory. Recently, the intervention was adapted to children with ASD by our team (McNeil, Quetsch, \& Anderson, 2019). PCIT-A will last about 8 months, 1 day per week, 60min per day (see Study Protocol, Fig. 2).

Intervention Type BEHAVIORAL

Early Start Denver Model (ESDM) intervention

ESDM intervention provides intensive teaching by trained therapists and parents during natural play and relationship-focused daily routines. It is evidence-based and uses principles of developmental psychology and applied behavior analysis. It was designed for toddlers and preschoolers with autism spectrum disorder by Rogers and Dawson (2010). The first intensive part of ESDM intervention (20h per week) will last 40 weeks of intervention within a period of 12 months. It includes 2 days per week for 6h a day clinic therapy, and 5 days per week for 1h homework tasks, and 2 days per week for 1.5h an early special needs education at home. After the first 12 months, children receive the second lower intensity part of ESDM (7 hours per week). It includes 1 days every two weeks 1h day clinic therapy, and 5 days per week for 1h homework tasks, and 1 days per week for 1.5h an early special needs education at home (see Study Protocol, Fig. 2).

Intervention Type BEHAVIORAL

1-hour ESDM

The active control group for PCIT-A stays in the ESDM day clinic therapy for the 12 hours per week while the PCIT-A group will receive 11 hours of ESDM day clinic therapy and 1 hour PCIT-A per week (see Study Protocol, Fig. 2).

Intervention Type BEHAVIORAL

Early special needs education (ESNE)

The wait-list control group will receive early special needs education. It consists of a 90-minute visit at participants' homes once a week by an employee educated in early special needs education. As soon as space in ESDM is available children will receive the ESDM intervention (stepped-wedge design, see Study Protocol, Fig. 2).

Intervention Type BEHAVIORAL

Other Intervention Names

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Intervention I Intervention II Active control for Intervention I Active control for Intervention II

Eligibility Criteria

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Inclusion Criteria

* ASD level 1 to 3
* Time commitment of at least one parent (including homework and traveling time)
* Willingness of one parent to be the study informant over the whole study period

Exclusion Criteria

* Insufficient German language skills of both parents to participate in the intervention
* Severe hearing or visual impairment
* Attention deficit hyperactivity disorder
* Epilepsy
* Rett syndrome
* Other rare, severe neurological disorders that interfere with therapy
Minimum Eligible Age

24 Months

Maximum Eligible Age

59 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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West Virginia University

OTHER

Sponsor Role collaborator

University of Arkansas

OTHER

Sponsor Role collaborator

Bruno Rhiner

OTHER

Sponsor Role lead

Responsible Party

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Bruno Rhiner

Head of Child and Adolescent Psychiatry

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Bruno Rhiner, Dr med

Role: PRINCIPAL_INVESTIGATOR

Psychiatric Services of Thurgovia

Locations

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Psychiatric Services of Thurgovia

Münsterlingen, Thurgau, Switzerland

Site Status

Countries

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Switzerland

Other Identifiers

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2020-02787 (EKOS 20/223)

Identifier Type: OTHER

Identifier Source: secondary_id

Protocol_PDT_010_TAFF

Identifier Type: -

Identifier Source: org_study_id