Neurodevelopmental DisordersERI-SIBSNCT06512649
Early Recognition and Intervention in Siblings at High-risk for Neurodevelopmental Disorder
A study testing Early intervention and Active monitoring in people with Neurodevelopmental Disorders and Autism Spectrum Disorder, run by Fondazione Don Carlo Gnocchi ETS at 1 site in Italy.
Trial summary
H1The primary goal of this intervention study is to learn if very early parent-mediated intervention in children at risk for neurodevelopmental disorders in the first year of life can be implemented in routine care, positively impacting early sensory-motor and socio-communicative developmental trajectories and… Read more about this study
- Who is it for?
- Ages 6 to 8 monthsHealthy volunteers can take part
- Conditions the study is for
- Neurodevelopmental Disorders, Autism Spectrum Disorder
- What is being tested?
- Early intervention and Active monitoring
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 48 participants
- Where
- 1 siteItaly
- Study dates
- 31 May 2023to 31 May 2026
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 6 to 8 months
- All sexes
- Healthy volunteers accepted
- Child
Who may be able to join
- Age at recruitment less than or equal to 8 months.
- Sibling diagnosed with autism spectrum disorder
- Normal neurological examination
Who cannot join
- Focal neurological signs/symptoms or suspicion of genetic-metabolic disorders
- Genetically determined suspected or known conditions in brother/sister
- Significant familial language barrier
Trial locations and contacts
1 site in 1 country.
Italy1 site, 1 recruiting
- Recruiting
Santa Maria Nascente
Milan, 20148
Silvia Annunziata, sannunziata@dongnocchi.it
About this study
H1The primary goal of this intervention study is to learn if very early parent-mediated intervention in children at risk for neurodevelopmental disorders in the first year of life can be implemented in routine care, positively impacting early sensory-motor and socio-communicative developmental trajectories and reducing the developmental gap in children with signs of concern.
H2: It is here postulated that early intervention with active parental involvement can reduce parental stress, as well as improve parental understanding and responsiveness to the child's communication cues.
Read more
H3: An important part of our work will be analysing data about early social and joint attention behaviours in recruited children and comparing them at different time points. The hypothesis is to find early differences between groups at baseline and to detect a change before and after the intervention. For this reason, in our study design, we decided to use technologies to collect data on quantitative measures during play-structured and laboratory sessions to understand changes in developmental trajectories.
H4: Given the potential role of genetic and immunological mechanisms in ASD, one of the study's secondary aims is to investigate the impact of an early intervention programme on epigenetic changes and inflammatory and immune response.
After enrolment and baseline assessments (T0), children will be allocated to the three groups:
- Group 1 - Clinical Monitoring Group (CM): Siblings of TD children subjects with no signs of concern
- Group 2 - Active Monitoring Group (AM): Siblings of ASD children with no signs of concern
- Group 3 - Early Intervention Group (EI): Siblings classified as "with signs of concern" at baseline evaluation.
All children will be re-evaluated after 6 months (T1) and after 12 months (T2).
Read the detailed description
Researchers will contact interested parents to assess eligibility and provide detailed study information. Parents will provide written consent before completing baseline assessments (T0) and based on the scores at the main outcome measures, children will be assigned to the correct group. Infants with no signs of concern and siblings of TD children will be allocated to Group 1 (CM); infants with no signs of concern (scores at the Griffiths-3 and CSBS-ITC in the normal range) and siblings of ASD children will be allocated to Group 2 (AM); infants with General Quotient score below 85 using Griffiths-3 and/or at least one score above the "concern" cutoff using the CSBS-ITC will be allocated to Group 3 (EI). Families allocated to Groups 2 and 3 will start the intervention within one month from the baseline assessment. Families allocated to Group 1 will perform only the evaluations at different time points. Assessments will be conducted at baseline (T0), which will be when the parents give their consent and within the 8 months of life of the child, after 6 months from the start of the intervention (T1) and after 12 months from the start of the intervention (T2).
Technological assessment of social behaviour and joint attention:
- video recording of ESCP through Kinect Azure camera to collect and analyse quantitative data related to joint attention.
The administration of the ECSP-I will be video-recorded through an Azure Kinect camera to extract automatically gaze orientation and quantitatively assess Joint Attention.
- Eye-tracker acquisitions An experimental Eye-Tracker Screening (ETS) protocol for children will also be developed. Specifically, short videos will be used to measure the children's ability to process familiar/unfamiliar faces and to respond to social stimuli, particularly referential gaze. The children's eye movements will be analysed using the eye-tracker (Tobii Pro Fusion) and extracted using the appropriate software.
At recruitment (T0), anamnestic, sociodemographic data and auxological and clinical parameters at birth will be collected.
Biomolecular assessment Saliva samples will be collected using 3 different kits, respectively for DNA or RNA extraction, and for protein detection, through spongy swabs that are inserted into the baby's mouth, leading the saliva collection non-invasive, simple, fast, and most importantly, painless. Saliva samples will be collected from all the probands (at T0, T1 and T2) and from their siblings and parents at T0 to assess parent-to-child genetic transmission in relation to the risk of ASD. If possible, a sample of approximately 40 mL of blood (from the parents) will be collected.
Biological samples from family quartet will be collected as follow:
- In all the enrolled children, their older siblings and parents, genetic analysis will be conducted by a Next-Generation Sequencing (NGS) gene-targeted panel approach to analyse genes involved in synaptogenesis and immunogenetic regulation.
- Epigenetic analysis of the miRNome in saliva collected from all enrolled children at all time-points will be performed by NGS. Epigenetic analysis will allow to define a panel of microRNAs that can differentiate between ASD children and children with typical development.
- Analysis of inflammatory cytokines and neurotrophic factors using an automated immunoassay system (ELLA, Biotech) will be performed in probands at T0, T1 and T2. Parents will also be characterized for cytokine and lymphocyte subset at T0.
Correlations between clinical parameters and all biological variables (genetic, epigenetic, inflammatory) will be performed to correlate molecular biomarkers with neurodevelopmental changes in follow-up and pre-post intervention.
Sample size
Since the importance of ECSP-I in this project, as behavioural outcome measures as a tool for reaching quantitative data through technology, we calculate the sample size to detect an association between the ECSP-I score and the groups (1, 2 and 3) at each time point. The calculation was performed based on preliminary data (not already published) from the Italian Version of ESCP (ECSP-I). Assuming a standard deviation of 0.56 for the ECSP-I scale and a significance level α= 0. 01, obtained by applying the Bonferroni correction for multiple comparisons, performed in pairs between groups, to the type I error, we obtained a sample size of 14 subjects per group to detect a difference of 0.8 between the means of each group using a 2-tailed Student's t-test for independent samples, with a power of 80%. Assuming a drop-out rate of 10%, the required sample size increases to 16 subjects per group, that is 48 subjects in total.
Statistical analysis
Analysis (using STATA or SPSS 28.00) will follow standard methods for trials using comparisons between the three groups. First, a study of the maturation trajectories of the infants will be carried out, with a description of the pre-post intervention changes in the tests carried out. Secondly, quantitative evaluations of joint attention data and molecular markers will be performed, detected, and described through mean and standard deviation in case of Gaussian distribution of variables, or median and interquartile range in case of non-Gaussian distribution. The normality of distributions will be assessed by applying the Shapiro-Wilk test. For categorical variables, absolute frequencies and percentages will be reported. Genetic analysis of intra-familial allelic inheritance will be conducted by AFBAC (Affected Family-Based Controls) and TDT (Transmission Disequilibrium Test) . The immunological parameters obtained from the groups of ASD children and children with typical development will be analysed using a nonparametric Mann-Whitney test that will allow to identification of specific immunological biomarkers of ASD-associated neuroinflammation. Moreover, clinical parameters will be correlated with immunological biomarkers characteristic of ASD children. Finally, epigenetic analysis will allow us to define a panel of microRNAs that can differentiate between ASD children and children with typical development. Using computer algorithms, the potential targets, pathways, and biological functions deregulated by this group of miRNAs will be analysed. These data will also be analysed concerning the clinical parameters evaluated in the study and both the genetic and inflammatory characterization of the subjects studied.
- Being tested
- Early intervention, Active monitoring
- Medical subject headings
- Neurodevelopmental Disorders, Autism Spectrum Disorder
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Early interventionBehavioural
90-minute parent-coaching session once a week for 6 months with an expert developmental therapist, supported by a child neuropsychiatrist or psychologist. A parent will always be present and actively involved in the intervention. The intervention is individualized and tailored to each child's needs and identifies with caregivers the ways to embody objectives in daily life.
Active monitoringBehavioural
90-minute session once a month for 6 months. Sessions will be performed by an expert developmental therapist, supported by a child neuropsychiatrist or psychologist. A parent will always be present and actively involved in the intervention.
| Study group | Role | What they receive |
|---|---|---|
| Early Intervention Group | Experimental | ASD and typical siblings with Signs of concern Receives: Behavioral: Early intervention |
| Clinical Monitoring Group | No intervention | Typical siblings with no signs of concern Children allocated to this arm will undergo to re-assessment at T1 and T2 |
| Active monitoring Group | Experimental | ASD siblings, no signs of concern Receives: Behavioral: Active monitoring |
What is being measured
The primary outcome is the main question the study is designed to answer.
Griffiths Scales of Child Development, 3rd Edition (Griffiths-3)
Griffiths-3 is the gold standard to provide an overall measure of a child's development (0-6 years); it permits the definition of an individual profile of strengths and needs of the child across five areas: foundations of learning, language and communication, eye and hand coordination, personal-social-emotional, gross motor
UNIT OF MEASURE: Developmental quotients (range 20-150, normality 85-115)
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Communication and Symbolic Behaviour Scales - Infant-Toddler Checklist (CSBS-IT-C)
is a tool for developmental screening, designed to measure 7 language predictors in children 6 to 24 months of age. The questions of the checklist may be presented in an interview format with adequate explanations to clarify what is being asked. It takes about 5 to 10 minutes to complete and permits the detection of signs of concern for ASD in infants and toddlers
UNIT OF MEASURE: weighted score, number: range 3-17; no concern > 7
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Early Social Communication Scale (Échelle de la Communication Sociale Précoce, Italian adaptation, ECSP-I)
the ECSP-I is a structured assessment designed to provide measures of individual differences in nonverbal communication skills in children from 3 to 30 months of age. The administration requires 15-20 min involving the presentation of approximately 23 standardised situations which provide opportunities for social communication. The ECSP-I demonstrates strong reliability and both construct and discriminant validity
Unit of measure: number. Optimal and average level (mean, range 1-4).
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Satisfaction Survey
Parents of children in Groups 2 and 3 will also be asked to anonymously complete a satisfaction survey (created ad hoc for this project) immediately after the intervention to assess their satisfaction with the services provided. The questionnaire takes 5 minutes to complete.
unit of measure: likert scale, range 0-5
Measured: T1 (T0 + 6 months)
Secondary outcomes (13)
Vineland Adaptive Behaviour Scales-II - Second Edition (Vineland-II)
This assessment measures personal and social adaptation skills in everyday-life. It is applicable to children from birth through 18 years, 11 months. Standardization included national samples of children with and without disabilities.
The scales yield normative standard scores (M = 100; SD = 15) that indicate level of adaptive functioning
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Questionnaire Sensory Profile - Second Edition (SP-2)
The SP-2 is a norm-referenced collection of five parent- and teacher-report questionnaires that assess sensory processing in children about everyday sensory events; for this study, the age-appropriate version was used, that is the Toddler Module (from 7 to 35 months); Unit of measure: items are rated on a 5-point Likert scale from 5 (almost always) to 1 (almost never). Point are scored as Standard Deviation through automatized scoring provided by the editor
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
McArthur-Bates questionnaire, child's first vocabulary (PVB) - gestures and words
The PVB assesses major features of communicative development, including words' comprehension and production, use of gesture, and first sentences' comprehension. The PVB/words and gestures form is a checklist filled by the parents'. The questionnaire is validated on an Italian sample, and it allows to calculate quotients related to the different subareas investigated
Unit of measure: centile according to age (range 5-95) and quotients (number)
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Infant Behavior Questionnaire-Revised (IBQ-R) and Early Childhood Behavior Questionnaire (ECBQ)
The IBQ-R (3-12 months) and ECBQ (18-36 months) are parent-report questionnaires for the assessing of temperament in infancy and later childhood; items are rated on a 7-point scale (from 1 that is 1 never to 7 that is always) (Cozzi et al., 2013; Gartstein \& Rothbart, 2003)
Measured: T0 (recruitment); T2 (T0 + 12 months)
Autism Diagnostic Observation Schedule, Second Edition (ADOS-2)
The ADOS-2 is a semi structured, standardized assessment of communication social interaction, play/imaginative use of materials and restricted/repetitive patterns of interest to assess the presence of ASD symptoms. The administration involves direct observations using hierarchical manualized procedures and progressive prompts. Every behaviour/symptom is assessed using a likert scale (0-3) and coded on an algorithm based on DSM-5 diagnostic criteria. We will use Toddler Module, for 12 to 30 months-aged children, or the Module 2 if language in sentences is present.
We will consider the total score (unit of measure number, range 0-28), social affect score (unit of measure number, range 0-20), and restricted and repetitive behaviours score (unit of measure number, range 0-8).
Measured: T2 (T0 + 12 months)
Autism Diagnostic Interview-Revised (ADI-R)
The ADI-R is a semi-structured interview conducted by a trained researcher or psychologist with the child's parents or other caregivers, based on DSM-IV criteria. The ADI-R focuses on the developmental history of the child and on the actual description given by the parents.
Every behaviour/symptom is assessed using a likert scale (0-3) and coded on an algorithm. We will use algorithms specifically developed for toddlers, that give a clinical cutoff and a rate of risk for ASD.
unit of measure: number
Measured: T2 (T0 + 12 months)
Parent interactions with children: Checklist of Observations Linked to Outcomes (PICCOLO)
this is an observational measure in which a parent-child interaction is video recorded and trained observers code-specific parenting behaviours known to predict children's early social, cognitive, and language development. Specifically, the PICCOLO examines four domains of parenting behaviours, including affection, responsiveness, encouragement, and teaching. The PICCOLO demonstrates strong reliability and both construct and predictive validity.
Each domain is scored on a 0-2 likert scale.
Unit of measure: number, range 0-14 for each subscale
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Questionnaire Parent Stress Index - Short Form (PSI-SF)
It is a questionnaire completed by the parents, composed by thirty-six items are divided into three domains: Parental Distress (PD), Parent-Child Dysfunctional Interaction (P-CDI), and Difficult Child (DC), which combine to form a Total Stress scale.
UNIT of MEASURE: centiles, number. Range 1-99
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Kinect
video recording of ESCP through Kinect Azure camera to collect and analyse quantitative data to estimate the gaze orientation.
- time spent by the child looking at the therapist
- joint attention lenght, (the time during which the child and the therapist simultaneously focus on the same object or each other).
Unit of measure: absolute time values (seconds) and a relative measurement in relation to the total session duration (percentage)).
To date, there are no normative data available in the literature for these specific metrics.
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Eye-tracker
An experimental Eye-Tracker Screening (ETS) protocol will be implemented using the Tobii Pro Fusion 120Hz to analyze children's eye movement patterns. The indices that will be used include Total Fixation Duration (TFD) and Time to First Fixation (TFF).
TFD will measure children's general attention to specific areas, such as faces and objects (i.e. target and distractor).TFF will assess children's ability to follow the gaze of the familiar or unfamiliar faces towards the target, thereby verifying their response to referential gaze (i.e., the gaze-following mechanism).
Both indices, TFD and TFF, will be measured in milliseconds.
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Laboratory- genetic analysis
genetic analysis will be conducted by a Next-Generation Sequencing (NGS) gene-targeted panel approach to analyse genes involved in synaptogenesis and immunogenetic regulation.
Gene association will be reported as genotypes and alleles NUMBER and percentages
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Laboratory- epigenetic analysis
Epigenetic analysis of the miRNome by NGS. Epigenetic analysis will allow to define a panel of microRNAs that can differentiate between ASD children and children with typical development.
MiRNA concentrations will be reported as COPIES/NANOGRAMS of extracted RNA
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Laboratory- inflammatory cytokines and neurotrophic factors
Analysis of inflammatory cytokines and neurotrophic factors using an automated immunoassay system (ELLA, Biotech).
Cytokine and neurotrophic factors concentration measured in saliva and plasma samples will be reported as PICOGRAMS/ML.
Results calculations will be based on standard curves and internal controls provided by commercial kits
Measured: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Jul 2024
- Study start31 May 2023
- Primary completion31 May 2026 (estimated)
- Study completion31 May 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (19)Papers the sponsor has linked to this study.
- Other trials for Neurodevelopmental DisordersStudies of the same condition, open and under way.
- More trials run by Fondazione Don Carlo Gnocchi ETSThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 48 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Fondazione Don Carlo Gnocchi ETS
- Sponsor type
- University, hospital or other
- Collaborators
- University of Milano Bicocca, Politecnico di Milano, Catholic University of the Sacred Heart, University of Turin, Italy
- Responsible party
- Sponsor
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06512649
- Sponsor's protocol ID
- 94-7
- Acronym
- ERI-SIBS
- Status last verified
- May 2024
- First submitted
- 3 Jun 2024
- Last updated
- 22 Jul 2024
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Publications
Armitano-Lago C, Willoughby D, Kiefer AW. A SWOT Analysis of Portable and Low-Cost Markerless Motion Capture Systems to Assess Lower-Limb Musculoskeletal Kinematics in Sport. Front Sports Act Living. 2022 Jan 25;3:809898. doi: 10.3389/fspor.2021.809898. eCollection 2021.
PubMed 35146425Baroncelli L, Braschi C, Spolidoro M, Begenisic T, Sale A, Maffei L. Nurturing brain plasticity: impact of environmental enrichment. Cell Death Differ. 2010 Jul;17(7):1092-103. doi: 10.1038/cdd.2009.193. Epub 2009 Dec 18.
PubMed 20019745Bertram J, Kruger T, Rohling HM, Jelusic A, Mansow-Model S, Schniepp R, Wuehr M, Otte K. Accuracy and repeatability of the Microsoft Azure Kinect for clinical measurement of motor function. PLoS One. 2023 Jan 26;18(1):e0279697. doi: 10.1371/journal.pone.0279697. eCollection 2023.
PubMed 36701322Colombi C, Chericoni N, Bargagna S, Costanzo V, Devescovi R, Lecciso F, Pierotti C, Prosperi M, Contaldo A. Case report: Preemptive intervention for an infant with early signs of autism spectrum disorder during the first year of life. Front Psychiatry. 2023 May 3;14:1105253. doi: 10.3389/fpsyt.2023.1105253. eCollection 2023.
PubMed 37205979Di Giovanni D, Enea R, Di Micco V, Benvenuto A, Curatolo P, Emberti Gialloreti L. Using Machine Learning to Explore Shared Genetic Pathways and Possible Endophenotypes in Autism Spectrum Disorder. Genes (Basel). 2023 Jan 25;14(2):313. doi: 10.3390/genes14020313.
PubMed 36833240Elsabbagh M, Bedford R, Senju A, Charman T, Pickles A, Johnson MH; BASIS Team. What you see is what you get: contextual modulation of face scanning in typical and atypical development. Soc Cogn Affect Neurosci. 2014 Apr;9(4):538-43. doi: 10.1093/scan/nst012. Epub 2013 Feb 5.
PubMed 23386743Green J, Charman T, Pickles A, Wan MW, Elsabbagh M, Slonims V, Taylor C, McNally J, Booth R, Gliga T, Jones EJ, Harrop C, Bedford R, Johnson MH; BASIS team. Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial. Lancet Psychiatry. 2015 Feb;2(2):133-40. doi: 10.1016/S2215-0366(14)00091-1. Epub 2015 Jan 28.
PubMed 26359749Green J, Pickles A, Pasco G, Bedford R, Wan MW, Elsabbagh M, Slonims V, Gliga T, Jones E, Cheung C, Charman T, Johnson M; British Autism Study of Infant Siblings (BASIS) Team. Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years. J Child Psychol Psychiatry. 2017 Dec;58(12):1330-1340. doi: 10.1111/jcpp.12728. Epub 2017 Apr 10.
PubMed 28393350Guzzetta A, Baldini S, Bancale A, Baroncelli L, Ciucci F, Ghirri P, Putignano E, Sale A, Viegi A, Berardi N, Boldrini A, Cioni G, Maffei L. Massage accelerates brain development and the maturation of visual function. J Neurosci. 2009 May 6;29(18):6042-51. doi: 10.1523/JNEUROSCI.5548-08.2009.
PubMed 19420271Huguet G, Benabou M, Bourgeron T. The Genetics of Autism Spectrum Disorders. 2016 Apr 5. In: Sassone-Corsi P, Christen Y, editors. A Time for Metabolism and Hormones [Internet]. Cham (CH): Springer; 2016. Available from http://www.ncbi.nlm.nih.gov/books/NBK453174/
PubMed 28892342Kong X, Liu J, Chien T, Batalden M, Hirsh DA. A Systematic Network of Autism Primary Care Services (SYNAPSE): A Model of Coproduction for the Management of Autism Spectrum Disorder. J Autism Dev Disord. 2020 May;50(5):1847-1853. doi: 10.1007/s10803-019-03922-4.
PubMed 30790194Lord C, Brugha TS, Charman T, Cusack J, Dumas G, Frazier T, Jones EJH, Jones RM, Pickles A, State MW, Taylor JL, Veenstra-VanderWeele J. Autism spectrum disorder. Nat Rev Dis Primers. 2020 Jan 16;6(1):5. doi: 10.1038/s41572-019-0138-4.
PubMed 31949163Luyster RJ, Wagner JB, Vogel-Farley V, Tager-Flusberg H, Nelson CA 3rd. Neural correlates of familiar and unfamiliar face processing in infants at risk for autism spectrum disorders. Brain Topogr. 2011 Oct;24(3-4):220-8. doi: 10.1007/s10548-011-0176-z. Epub 2011 Mar 26.
PubMed 21442325Maenner MJ, Warren Z, Williams AR, Amoakohene E, Bakian AV, Bilder DA, Durkin MS, Fitzgerald RT, Furnier SM, Hughes MM, Ladd-Acosta CM, McArthur D, Pas ET, Salinas A, Vehorn A, Williams S, Esler A, Grzybowski A, Hall-Lande J, Nguyen RHN, Pierce K, Zahorodny W, Hudson A, Hallas L, Mancilla KC, Patrick M, Shenouda J, Sidwell K, DiRienzo M, Gutierrez J, Spivey MH, Lopez M, Pettygrove S, Schwenk YD, Washington A, Shaw KA. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2020. MMWR Surveill Summ. 2023 Mar 24;72(2):1-14. doi: 10.15585/mmwr.ss7202a1.
PubMed 36952288Rutherford MD, Walsh JA, Lee V. Brief Report: Infants Developing with ASD Show a Unique Developmental Pattern of Facial Feature Scanning. J Autism Dev Disord. 2015 Aug;45(8):2618-23. doi: 10.1007/s10803-015-2396-7.
PubMed 25703032
Study at a glance
From the registry record, last updated by the sponsor on 22 Jul 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Early Recognition and Intervention in Siblings at High-risk for Neurodevelopmental Disorder
- ClinicalTrials.gov ID
- NCT06512649
- Acronym / sponsor ID
- ERI-SIBS / 94-7
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 48 participants (estimated)
- Lead sponsor
- Fondazione Don Carlo Gnocchi ETSUniversity, hospital or other
- Collaborators
- University of Milano Bicocca, Politecnico di Milano, Catholic University of the Sacred Heart, University of Turin, Italy
- Study start
- 31 May 2023 (actual)
- Primary completion
- 31 May 2026 (estimated)
- Study completion
- 31 May 2026 (estimated)
- First posted
- 22 Jul 2024 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
H1The primary goal of this intervention study is to learn if very early parent-mediated intervention in children at risk for neurodevelopmental disorders in the first year of life can be implemented in routine care, positively impacting early sensory-motor and socio-communicative developmental trajectories and reducing the developmental gap in children with signs of concern.
H2: It is here postulated that early intervention with active parental involvement can reduce parental stress, as well as improve parental understanding and responsiveness to the child's communication cues.
H3: An important part of our work will be analysing data about early social and joint attention behaviours in recruited children and comparing them at different time points. The hypothesis is to find early differences between groups at baseline and to detect a change before and after the intervention. For this reason, in our study design, we decided to use technologies to collect data on quantitative measures during play-structured and laboratory sessions to understand changes in developmental trajectories.
H4: Given the potential role of genetic and immunological mechanisms in ASD, one of the study's secondary aims is to investigate the impact of an early intervention programme on epigenetic changes and inflammatory and immune response.
After enrolment and baseline assessments (T0), children will be allocated to the three groups:
- Group 1 - Clinical Monitoring Group (CM): Siblings of TD children subjects with no signs of concern
- Group 2 - Active Monitoring Group (AM): Siblings of ASD children with no signs of concern
- Group 3 - Early Intervention Group (EI): Siblings classified as "with signs of concern" at baseline evaluation.
All children will be re-evaluated after 6 months (T1) and after 12 months (T2).
Detailed description
Researchers will contact interested parents to assess eligibility and provide detailed study information. Parents will provide written consent before completing baseline assessments (T0) and based on the scores at the main outcome measures, children will be assigned to the correct group. Infants with no signs of concern and siblings of TD children will be allocated to Group 1 (CM); infants with no signs of concern (scores at the Griffiths-3 and CSBS-ITC in the normal range) and siblings of ASD children will be allocated to Group 2 (AM); infants with General Quotient score below 85 using Griffiths-3 and/or at least one score above the "concern" cutoff using the CSBS-ITC will be allocated to Group 3 (EI). Families allocated to Groups 2 and 3 will start the intervention within one month from the baseline assessment. Families allocated to Group 1 will perform only the evaluations at different time points. Assessments will be conducted at baseline (T0), which will be when the parents give their consent and within the 8 months of life of the child, after 6 months from the start of the intervention (T1) and after 12 months from the start of the intervention (T2).
Technological assessment of social behaviour and joint attention:
- video recording of ESCP through Kinect Azure camera to collect and analyse quantitative data related to joint attention.
The administration of the ECSP-I will be video-recorded through an Azure Kinect camera to extract automatically gaze orientation and quantitatively assess Joint Attention.
- Eye-tracker acquisitions An experimental Eye-Tracker Screening (ETS) protocol for children will also be developed. Specifically, short videos will be used to measure the children's ability to process familiar/unfamiliar faces and to respond to social stimuli, particularly referential gaze. The children's eye movements will be analysed using the eye-tracker (Tobii Pro Fusion) and extracted using the appropriate software.
At recruitment (T0), anamnestic, sociodemographic data and auxological and clinical parameters at birth will be collected.
Biomolecular assessment Saliva samples will be collected using 3 different kits, respectively for DNA or RNA extraction, and for protein detection, through spongy swabs that are inserted into the baby's mouth, leading the saliva collection non-invasive, simple, fast, and most importantly, painless. Saliva samples will be collected from all the probands (at T0, T1 and T2) and from their siblings and parents at T0 to assess parent-to-child genetic transmission in relation to the risk of ASD. If possible, a sample of approximately 40 mL of blood (from the parents) will be collected.
Biological samples from family quartet will be collected as follow:
- In all the enrolled children, their older siblings and parents, genetic analysis will be conducted by a Next-Generation Sequencing (NGS) gene-targeted panel approach to analyse genes involved in synaptogenesis and immunogenetic regulation.
- Epigenetic analysis of the miRNome in saliva collected from all enrolled children at all time-points will be performed by NGS. Epigenetic analysis will allow to define a panel of microRNAs that can differentiate between ASD children and children with typical development.
- Analysis of inflammatory cytokines and neurotrophic factors using an automated immunoassay system (ELLA, Biotech) will be performed in probands at T0, T1 and T2. Parents will also be characterized for cytokine and lymphocyte subset at T0.
Correlations between clinical parameters and all biological variables (genetic, epigenetic, inflammatory) will be performed to correlate molecular biomarkers with neurodevelopmental changes in follow-up and pre-post intervention.
Sample size
Since the importance of ECSP-I in this project, as behavioural outcome measures as a tool for reaching quantitative data through technology, we calculate the sample size to detect an association between the ECSP-I score and the groups (1, 2 and 3) at each time point. The calculation was performed based on preliminary data (not already published) from the Italian Version of ESCP (ECSP-I). Assuming a standard deviation of 0.56 for the ECSP-I scale and a significance level α= 0. 01, obtained by applying the Bonferroni correction for multiple comparisons, performed in pairs between groups, to the type I error, we obtained a sample size of 14 subjects per group to detect a difference of 0.8 between the means of each group using a 2-tailed Student's t-test for independent samples, with a power of 80%. Assuming a drop-out rate of 10%, the required sample size increases to 16 subjects per group, that is 48 subjects in total.
Statistical analysis
Analysis (using STATA or SPSS 28.00) will follow standard methods for trials using comparisons between the three groups. First, a study of the maturation trajectories of the infants will be carried out, with a description of the pre-post intervention changes in the tests carried out. Secondly, quantitative evaluations of joint attention data and molecular markers will be performed, detected, and described through mean and standard deviation in case of Gaussian distribution of variables, or median and interquartile range in case of non-Gaussian distribution. The normality of distributions will be assessed by applying the Shapiro-Wilk test. For categorical variables, absolute frequencies and percentages will be reported. Genetic analysis of intra-familial allelic inheritance will be conducted by AFBAC (Affected Family-Based Controls) and TDT (Transmission Disequilibrium Test) . The immunological parameters obtained from the groups of ASD children and children with typical development will be analysed using a nonparametric Mann-Whitney test that will allow to identification of specific immunological biomarkers of ASD-associated neuroinflammation. Moreover, clinical parameters will be correlated with immunological biomarkers characteristic of ASD children. Finally, epigenetic analysis will allow us to define a panel of microRNAs that can differentiate between ASD children and children with typical development. Using computer algorithms, the potential targets, pathways, and biological functions deregulated by this group of miRNAs will be analysed. These data will also be analysed concerning the clinical parameters evaluated in the study and both the genetic and inflammatory characterization of the subjects studied.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Early Intervention Group | Experimental | Behavioral: Early interventionASD and typical siblings with Signs of concern |
| Clinical Monitoring Group | No intervention | –Typical siblings with no signs of concern Children allocated to this arm will undergo to re-assessment at T1 and T2 |
| Active monitoring Group | Experimental | Behavioral: Active monitoringASD siblings, no signs of concern |
Who may qualify
- Ages
- 6 to 8 months
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child
Key inclusion criteria (3 listed)
- Age at recruitment less than or equal to 8 months.
- Sibling diagnosed with autism spectrum disorder
- Normal neurological examination
Key exclusion criteria (3 listed)
- Focal neurological signs/symptoms or suspicion of genetic-metabolic disorders
- Genetically determined suspected or known conditions in brother/sister
- Significant familial language barrier
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Early intervention90-minute parent-coaching session once a week for 6 months with an expert developmental therapist, supported by a child neuropsychiatrist or psychologist. A parent will always be present and actively involved in the intervention. The intervention is individualized and tailored to each child's needs and identifies with caregivers the ways to embody objectives in daily life. | Behavioural | Early Intervention Group |
| Active monitoring90-minute session once a month for 6 months. Sessions will be performed by an expert developmental therapist, supported by a child neuropsychiatrist or psychologist. A parent will always be present and actively involved in the intervention. | Behavioural | Active monitoring Group |
Primary outcome
Griffiths Scales of Child Development, 3rd Edition (Griffiths-3)
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Griffiths-3 is the gold standard to provide an overall measure of a child's development (0-6 years); it permits the definition of an individual profile of strengths and needs of the child across five areas: foundations of learning, language and communication, eye and hand coordination, personal-social-emotional, gross motor UNIT OF MEASURE: Developmental quotients (range 20-150, normality 85-115)
Communication and Symbolic Behaviour Scales - Infant-Toddler Checklist (CSBS-IT-C)
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
is a tool for developmental screening, designed to measure 7 language predictors in children 6 to 24 months of age. The questions of the checklist may be presented in an interview format with adequate explanations to clarify what is being asked. It takes about 5 to 10 minutes to complete and permits the detection of signs of concern for ASD in infants and toddlers UNIT OF MEASURE: weighted score, number: range 3-17; no concern > 7
Early Social Communication Scale (Échelle de la Communication Sociale Précoce, Italian adaptation, ECSP-I)
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
the ECSP-I is a structured assessment designed to provide measures of individual differences in nonverbal communication skills in children from 3 to 30 months of age. The administration requires 15-20 min involving the presentation of approximately 23 standardised situations which provide opportunities for social communication. The ECSP-I demonstrates strong reliability and both construct and discriminant validity Unit of measure: number. Optimal and average level (mean, range 1-4).
Satisfaction Survey
Time frame: T1 (T0 + 6 months)
Parents of children in Groups 2 and 3 will also be asked to anonymously complete a satisfaction survey (created ad hoc for this project) immediately after the intervention to assess their satisfaction with the services provided. The questionnaire takes 5 minutes to complete. unit of measure: likert scale, range 0-5
13 secondary outcomes
Vineland Adaptive Behaviour Scales-II - Second Edition (Vineland-II)
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Questionnaire Sensory Profile - Second Edition (SP-2)
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
McArthur-Bates questionnaire, child's first vocabulary (PVB) - gestures and words
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Infant Behavior Questionnaire-Revised (IBQ-R) and Early Childhood Behavior Questionnaire (ECBQ)
Time frame: T0 (recruitment); T2 (T0 + 12 months)
Autism Diagnostic Observation Schedule, Second Edition (ADOS-2)
Time frame: T2 (T0 + 12 months)
Autism Diagnostic Interview-Revised (ADI-R)
Time frame: T2 (T0 + 12 months)
Parent interactions with children: Checklist of Observations Linked to Outcomes (PICCOLO)
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Questionnaire Parent Stress Index - Short Form (PSI-SF)
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Kinect
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Eye-tracker
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Laboratory- genetic analysis
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Laboratory- epigenetic analysis
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Laboratory- inflammatory cytokines and neurotrophic factors
Time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 Jul 2024.
- Background: PubMed 35146425Armitano-Lago C, Willoughby D, Kiefer AW. A SWOT Analysis of Portable and Low-Cost Markerless Motion Capture Systems to Assess Lower-Limb Musculoskeletal Kinematics in Sport. Front Sports Act Living. 2022 Jan 25;3:809898. doi: 10.3389/fspor.2021.809898. eCollection 2021.
- Background: PubMed 20019745Baroncelli L, Braschi C, Spolidoro M, Begenisic T, Sale A, Maffei L. Nurturing brain plasticity: impact of environmental enrichment. Cell Death Differ. 2010 Jul;17(7):1092-103. doi: 10.1038/cdd.2009.193. Epub 2009 Dec 18.
- Background: PubMed 36701322Bertram J, Kruger T, Rohling HM, Jelusic A, Mansow-Model S, Schniepp R, Wuehr M, Otte K. Accuracy and repeatability of the Microsoft Azure Kinect for clinical measurement of motor function. PLoS One. 2023 Jan 26;18(1):e0279697. doi: 10.1371/journal.pone.0279697. eCollection 2023.
- Background: PubMed 37205979Colombi C, Chericoni N, Bargagna S, Costanzo V, Devescovi R, Lecciso F, Pierotti C, Prosperi M, Contaldo A. Case report: Preemptive intervention for an infant with early signs of autism spectrum disorder during the first year of life. Front Psychiatry. 2023 May 3;14:1105253. doi: 10.3389/fpsyt.2023.1105253. eCollection 2023.
- Background: PubMed 36833240Di Giovanni D, Enea R, Di Micco V, Benvenuto A, Curatolo P, Emberti Gialloreti L. Using Machine Learning to Explore Shared Genetic Pathways and Possible Endophenotypes in Autism Spectrum Disorder. Genes (Basel). 2023 Jan 25;14(2):313. doi: 10.3390/genes14020313.
- Background: PubMed 23386743Elsabbagh M, Bedford R, Senju A, Charman T, Pickles A, Johnson MH; BASIS Team. What you see is what you get: contextual modulation of face scanning in typical and atypical development. Soc Cogn Affect Neurosci. 2014 Apr;9(4):538-43. doi: 10.1093/scan/nst012. Epub 2013 Feb 5.
- Background: PubMed 26359749Green J, Charman T, Pickles A, Wan MW, Elsabbagh M, Slonims V, Taylor C, McNally J, Booth R, Gliga T, Jones EJ, Harrop C, Bedford R, Johnson MH; BASIS team. Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial. Lancet Psychiatry. 2015 Feb;2(2):133-40. doi: 10.1016/S2215-0366(14)00091-1. Epub 2015 Jan 28.
- Background: PubMed 28393350Green J, Pickles A, Pasco G, Bedford R, Wan MW, Elsabbagh M, Slonims V, Gliga T, Jones E, Cheung C, Charman T, Johnson M; British Autism Study of Infant Siblings (BASIS) Team. Randomised trial of a parent-mediated intervention for infants at high risk for autism: longitudinal outcomes to age 3 years. J Child Psychol Psychiatry. 2017 Dec;58(12):1330-1340. doi: 10.1111/jcpp.12728. Epub 2017 Apr 10.
- Background: PubMed 19420271Guzzetta A, Baldini S, Bancale A, Baroncelli L, Ciucci F, Ghirri P, Putignano E, Sale A, Viegi A, Berardi N, Boldrini A, Cioni G, Maffei L. Massage accelerates brain development and the maturation of visual function. J Neurosci. 2009 May 6;29(18):6042-51. doi: 10.1523/JNEUROSCI.5548-08.2009.
- Background: PubMed 28892342Huguet G, Benabou M, Bourgeron T. The Genetics of Autism Spectrum Disorders. 2016 Apr 5. In: Sassone-Corsi P, Christen Y, editors. A Time for Metabolism and Hormones [Internet]. Cham (CH): Springer; 2016. Available from http://www.ncbi.nlm.nih.gov/books/NBK453174/
- Background: PubMed 30790194Kong X, Liu J, Chien T, Batalden M, Hirsh DA. A Systematic Network of Autism Primary Care Services (SYNAPSE): A Model of Coproduction for the Management of Autism Spectrum Disorder. J Autism Dev Disord. 2020 May;50(5):1847-1853. doi: 10.1007/s10803-019-03922-4.
- Background: PubMed 31949163Lord C, Brugha TS, Charman T, Cusack J, Dumas G, Frazier T, Jones EJH, Jones RM, Pickles A, State MW, Taylor JL, Veenstra-VanderWeele J. Autism spectrum disorder. Nat Rev Dis Primers. 2020 Jan 16;6(1):5. doi: 10.1038/s41572-019-0138-4.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Early intervention and Active monitoring in people with Neurodevelopmental Disorders and Autism Spectrum Disorder, run by Fondazione Don Carlo Gnocchi ETS at 1 site in Italy.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 22 Jul 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Italy. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Chiara Fanciullacci (0039055 7393653, ctu@dongnocchi.it), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Griffiths Scales of Child Development, 3rd Edition (Griffiths-3) (time frame: T0 (recruitment), T1 (T0 + 6 months); T2 (T0 + 12 months)). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT06512649, which also lists 19 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jul 2024.