#VisualAbstract: Early iBASIS–Video Interaction to Promote Positive Parenting therapy reduced autism spectrum disorder symptom severity and diagnosis rate

1. The use of iBASIS–Video Interaction to Promote Positive Parenting (iBASIS-VIPP) led to fewer and less drastic autism spectrum disorder (ASD) symptoms in children and a lower rate of diagnosis of ASD.
2. The number needed to treat with iBASIS-VIPP was 7.2 participants to reduce ASD diagnosis.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Autism spectrum disorder (ASD) is a neurodevelopmental disorder affecting communication. The iBASIS–Video Interaction to Promote Positive Parenting (iBASIS-VIPP) is a potential intervention that aims to improve caregiver interaction styles to support children with ASD early in life. Previous studies were underpowered or were of insufficient duration of follow-up to determine if iBASIS-VIPP improved ASD diagnosis rates. This study looks at the longitudinal (24 months) odds of ASD symptom severity and rate of diagnosis after iBASIS-VIPP. Infants who displayed 3 of 5 ASD behaviours on screening were randomized to 10 iBASIS-VIPP sessions for 5 months and community care or community care only (control), stratified by site, age, sex, and number of ASD behaviours. ASD severity was assessed at baseline, treatment end-point (6 months), 12 months, and 24 months for ASD severity and diagnosis. How the parent interacted with the child and the child’s development were categorized. The iBASIS-VIPP infants had reduced ASD symptom severity at 12 and 24 months, met fewer ASD criteria, and had a lower chance of being diagnosed with ASD compared to the control group. The number needed to treat was 7.2 participants to reduce a single ASD diagnosis. While caregiver sensitivity was improved after iBASIS-VIPP therapy, this effect was no longer detectable at 24 months. Most functional developmental behaviours were similar between the iBASIS-VIPP and control group. A strength of the study is its long follow-up time, which is necessary to detect the previously theorized delayed ASD peak severity of iBASIS-VIPP. The statistics were performed conservatively and still demonstrated significance. One potential limitation of this study was that more participants in the control group received community therapy than in the iBASIS-VIPP with community therapy group at all time-points, but this should have biased results to be more conservative estimates of the true effect.

Click to read the study in JAMA Pediatrics

Relevant Reading: Video-feedback Intervention to promote Positive Parenting adapted to Autism (VIPP-AUTI): A randomized controlled trial

In-Depth [randomized controlled trial]: This 2-site, single blinded randomized clinical trial enrolled infants between 9 and 15 months if they displayed some ASD behavioural screenings on the Social Attention and Communication Surveillance–Revised (SACS-R) checklist. Infants with comorbid neurologic or developmental disorders were excluded. Participants were randomized to an iBASIS-VIPP group or a control group. 10 iBASIS-VIPP sessions were delivered to families by a therapist over 5 months. Infants were assessed at baseline, treatment end-point (6 months), 12 months, and 24 months for ASD severity by direct observation using the Autism Observation Scale for Infants (AOSI) and the Autism Diagnostic Observation Schedule (ADOS), where higher scores indicate more severe ASD behaviours. A clinician assessed the participants for ASD diagnosis using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The Manchester Assessment of Caregiver-Infant Interaction (MACI) classified a 6-minute parent-infant play session. The 45 infants and caregivers in the iBASIS-VIPP group were comparable on baseline characteristics to the 44 in the control group (age = 12.40±1.93 months vs 12.38±2.02 months; 76.0% vs 60.4% male). There were no adverse effects identified from iBASIS-VIPP and most participants adhered to the protocol. Infants in the iBASIS-VIPP group had reduced ASD symptom severity compared to the control group at 12-months, which persisted until the 24-month assessment (area between curves (ABC) = −5.53; 95%CI = −∞-−0.28; P = 0.04). The iBASIS-VIPP group had a lower odds ratio compared to the control group of meeting the DSM-5 deficits in social-emotional reciprocity (0.35, 95%CI = 0-0.82, P = 0.02), the “stereotyped or repetitive movements” criteria (0.29, 95% CI = 0-0.73, P = 0.02), or the unusual sensory interest criterion (0.13, 95% CI = 0-0.53, P = 0.02) for ASD. Odds of ASD diagnosis were lower in the iBASIS-VIPP group than the control group (6.7% vs 20.5%, 0.18, 95% CI = 0-0.68, P = 0.02). The number needed to treat to reduce an ASD diagnosis was 7.2 participants. The MACI caregiver sensitivity scale was improved at 12 months, but attenuated by 24 months (ABC = 5.02, 95% CI = 0.02-∞).

Image: PD

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