human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism . These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts ( see Kasari , Freeman , & Paparella , 2001 ) . In this study , we examine the efficacy of targeted interventions of joint attention and symbolic play . METHODS Participants were 58 children with autism aged 3 and 4 years ( 46 boys ) . Children were r and omized to a joint attention intervention , a symbolic play intervention , or control group . Interventions were conducted 30 minutes daily for 5 - 6 weeks . Both structured assessment s of joint attention and play skills and mother-child interactions were collected pre and post intervention by independent assessors . RESULTS Results indicate that both intervention groups improved significantly over the control group on certain behaviors . Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child-initiated joint attention in the mother-child interaction . The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels on both the play assessment and in interaction with their mothers . CONCLUSIONS This r and omized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism . Future studies need to examine the long-term effects of these early interventions on children 's development Abstract The study of mediation of treatment effects , or how treatments work , is important to underst and ing and improving psychological and behavioral treatments , but applications often focus on mediators and outcomes measured at a single time point . Such cross-sectional analyses do not respect the implied temporal ordering that mediation suggests . Clinical trials of treatments often provide repeated measures of outcomes and , increasingly , of mediators as well . Repeated measurements allow the application of various types of longitudinal structural equation mediation models . These provide flexibility in modeling , including the ability to incorporate some types of measurement error and unmeasured confounding that can strengthen the robustness of findings . The usual approach is to identify the most theoretically plausible model and apply that model . In the absence of clear theory , we put forward the option of fitting a few theoretically plausible models , providing a type of sensitivity analysis for the mediation hypothesis . In this tutorial , we outline how to fit several longitudinal mediation models , including  simplex , latent growth  and  latent change models  . This will allow readers to learn about one type of model that is of interest , or about several alternative models , so that they can take this sensitivity approach . We use the Pacing , Grade d Activity , and Cognitive Behavioral Therapy :  A R and omized Evaluation ( PACE ) trial of rehabilitative treatments for chronic fatigue syndrome ( IS RCT N 54285094 ) as a motivating example and describe how to fit and interpret various longitudinal mediation models using simulated data similar to those in the PACE trial . The simulated data set and Mplus code and output are provided This study aim ed to determine if a joint attention intervention would result in greater joint engagement between caregivers and toddlers with autism . The intervention consisted of  24 caregiver-mediated sessions  with follow-up 1 year later . Compared to caregivers and toddlers r and omized to the waitlist control group the immediate treatment ( IT ) group made significant improvements in targeted areas of joint engagement . The IT group demonstrated significant improvements with medium to large effect sizes in their responsiveness to joint attention and their diversity of functional play acts after the intervention with maintenance of these skills 1 year post-intervention . These are among the first r and omized controlled data to suggest that short-term parent-mediated  interventions can have important effects on core impairments in toddlers with autism . Clinical Trials # : NCT00065910 In 2002 , the National Institutes of Health sponsored a meeting concerning method ological challenges of research in psychosocial interventions in Autism Spectrum Disorders . This paper provides a summary of the presentations and the discussion s that occurred during this meeting . Recommendations to federal and private agencies included the need for r and omized clinical trials of comprehensive interventions for autism as the highest , but not the sole priority . Ongoing working groups were proposed to address psychosocial interventions with a focus on relevant statistics , st and ardized documentation and methods of diagnosis , development of outcome measures , establishment of st and ards in research ; and the need for innovative treatment design s , including application of design s from other research areas to the study of interventions in ASD Objective : To evaluate the effectiveness of the Play and Language for Autistic Youngsters ( PLAY ) Project Home Consultation model , in combination with usual community services ( CS ) , to improve parent-child interaction , child development , and autism symptomatology in young children with autism spectrum disorders ( ASDs ) compared with CS only . Methods : Children ( N = 128 ) with autism or PDD-NOS ( DSM-4 criteria ) aged 2 years 8 months to 5 years 11 months and recruited from 5 disability agencies in 4 US states were r and omized in two 1-year cohorts . Using videotape and written feedback within a developmental framework , PLAY consultants coached caregivers monthly for 12 months to improve caregiver-child interaction . CS included speech/ language and occupational therapy and public education services . Primary outcomes included change in parent-child interactions , language and development , and autism-related diagnostic category/symptoms . Secondary outcomes included parent stress and depression and home consultant fidelity . Data were collected pre- and post-intervention . Results : Using intent-to-treat analysis ( ITT ) , large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales . Child language and developmental quotient did not differ over time by group , although functional development improved significantly . PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule ( ADOS ) . PLAY caregivers ' stress did not increase , and depressive symptomatology decreased . Home consultants administered the intervention with fidelity . Conclusions : PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parents ' stress/depression . ADOS findings must be interpreted cautiously because results do not align with clinical experience . PLAY offers communities a relatively inexpensive effective intervention for children with ASD and their parents Abstract ‘ Everyday memory ’ is conceptualised as memory within the context of day-to-day life and , despite its functional relevance , has been little studied in individuals with autism spectrum disorders ( ASDs ) . In the first study of its kind , 94 adolescents with an ASD and 55 without an ASD completed measures of everyday memory  from the Rivermead Behavioural Memory Test ( RBMT ) and a st and ard word recall task ( Children ’s Auditory Verbal Learning Test-2 : CAVLT-2 ) . The ASD group showed significant impairments on the RBMT  , including in prospect i ve memory , alongside impaired performance on the CAVLT-2 . Social and communication ability was significantly associated with prospect i ve remembering in an everyday memory context but not with the CAVLT-2 . The complex nature of everyday memory and its relevance to ASD is discussed Cognitive processing in autism has been characterized by a difficulty with the abstract ion of information across multiple stimuli or situations and subsequent generalization to new stimuli or situations . This apparent difficulty leads to the suggestion that prototype formation , a process of creating a mental summary representation of multiple experienced stimuli that go together in a category , may be impaired in autism . Adults with high functioning autism and a typically developing comparison group matched on age and IQ completed a r and om dot pattern categorization task .  Participants with autism demonstrated intact prototype formation in all four ways it was operationally defined , and this performance was not significantly different from that of control participants . However , participants with autism  categorized dot patterns that were more highly distorted from the category prototypes less accurately than did control participants . These findings suggest , at least within the constraints of the r and om dot pattern task , that although prototype formation may not be impaired in autism , difficulties may exist with the generalization of what has been learned about a category to novel stimuli , particularly as they become less similar to the category 's prototype Summary Background Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children . We therefore investigated the efficacy of such an intervention in a larger trial . Methods Children with core autism ( aged 2 years to 4 years and 11 months ) were r and omly assigned in a one-to-one ratio to a parent-mediated communication-focused ( Preschool Autism Communication Trial [ PACT ] ) intervention or treatment as usual at three specialist centres in the UK . Those assigned to PACT were also given treatment as usual . R and omisation was by use of minimisation of probability in the marginal distribution of treatment centre , age ( ≤42 months or > 42 months ) , and autism severity ( Autism Diagnostic Observation Schedule-Generic [ ADOS-G ] algorithm score 12–17 or 18–24 ) . Primary outcome was severity of autism symptoms ( a total score of social communication algorithm items from ADOS-G , higher score indicating greater severity ) at 13 months . Complementary secondary outcomes were measures of parent-child interaction , child language , and adaptive functioning in school . Analysis was by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N58133827 . Results 152 children were recruited . 77 were assigned to PACT ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=25 ] ) ; and 75 to treatment as usual ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=23 ] ) . At the 13-month endpoint , the severity of symptoms was reduced by 3·9 points ( SD 4·7 ) on the ADOS-G algorithm in the group assigned to PACT , and 2·9 ( 3·9 ) in the group assigned to treatment as usual , representing a between-group effect size of −0·24 ( 95 % CI −0·59 to 0·11 ) , after adjustment for centre , sex , socioeconomic status , age , and verbal and non-verbal abilities . Treatment effect was positive for parental synchronous response to child ( 1·22 , 0·85 to 1·59 ) , child initiations with parent ( 0·41 , 0·08 to 0·74 ) , and for parent-child shared attention ( 0·33 , −0·02 to 0·68 ) . Effects on directly assessed language and adaptive functioning in school were small . Interpretation On the basis of our findings , we can not recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms ; however , a clear benefit was noted for parent-child dyadic social communication . Funding UK Medical Research Council , and UK Department for Children , Schools and Families OBJECTIVES : To compare 2 short-term , community caregiver training interventions for preschool-aged children with Autism Spectrum Disorder who had low re sources . Low re source was defined by the US Department of Housing and Urban Development low-income index or 1 “ indicator , ” ( eg , Medicaid eligibility ) . Child outcomes focused on joint engagement , joint attention , and play . METHODS : Participants included 112 families of a child who had Autism Spectrum Disorder who met criteria for being low-re source d and who were r and omly assigned to 1 of 2 3-month interventions , group caregiver education or individualized caregiver-mediated intervention ( CMM ) .  Children were assessed for social communication skills pre- and post-treatment , and followed up at 3 months . RESULTS : All children improved in joint engagement and initiating joint attention , with significantly greater improvement by the CMM group . Outcomes on play skills were mixed , with improvement of symbolic play for the CMM group and no change in functional play skills . Joint engagement maintained over time for the CMM group , and initiating joint attention maintained for both groups over time . CONCLUSIONS : This study is among the first r and omized trials comparing 2 active interventions with a large sample of low-re source d families . Results suggest improvements in core autism deficits of joint engagement , joint attention , and symbolic play with relatively brief , caregiver-mediated interventions , but additional support is necessary to maintain and generalize these gains over time BACKGROUND Behavioral interventions are commonplace in the treatment of autism spectrum disorders , yet relatively little is known about how and why these interventions work . This study tests the relationship between isolated core components of a packaged social communication intervention and the primary outcome , joint engagement , to better underst and how the intervention is affecting change in individuals . METHODS A total of 86 toddlers and their parents were enrolled in the study and r and omized to one of two treatments , the joint attention , symbolic play , engagement , and regulation ( JASPER ) parent-mediated intervention or a psychoeducational intervention . Measures regarding the parent 's use of intervention strategies were collected before and after the 10-week intervention . Additional measures of child and parent joint engagement were also collected . RESULTS A significant effect of treatment was found for all four of the core strategies of the intervention , favoring a larger increase in the JASPER condition . A hierarchical linear regression revealed several individual predictors of joint engagement , including parent-rated buy-in , interventionist-rated parent involvement , and parental use of strategies . To complement the hierarchical analysis , we also tested the potential mediating effect the strategies may have on the relationship between treatment and joint engagement . Results showed that the strategy of mirrored pacing mediated the relationship between treatment and joint engagement in the positive direction . CONCLUSIONS These results strongly suggest that the mirrored pacing strategy is an active ingredient of the JASPER treatment OBJECTIVE Previous research has demonstrated that peer rejection is a significant part of the clinical presentation of many children with attention-deficit hyperactivity disorder ( ADHD ) . Outcome studies of treatment interventions have typically failed to show generalization of treatment gains to the home and classroom . This has been especially true 
    Output:
    
agent
The findings did not support the widely reported generalisation ' difficulties ' associated with autism .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Delays and deficits in joint attention and symbolic play constitute two important developmental problems in young children with autism . These areas of deficit have been well studied in autism but have rarely been the focus of treatment efforts ( see Kasari , Freeman , & Paparella , 2001 ) . In this study , we examine the efficacy of targeted interventions of joint attention and symbolic play . METHODS Participants were 58 children with autism aged 3 and 4 years ( 46 boys ) . Children were r and omized to a joint attention intervention , a symbolic play intervention , or control group . Interventions were conducted 30 minutes daily for 5 - 6 weeks . Both structured assessment s of joint attention and play skills and mother-child interactions were collected pre and post intervention by independent assessors . RESULTS Results indicate that both intervention groups improved significantly over the control group on certain behaviors . Children in the joint attention intervention initiated significantly more showing and responsiveness to joint attention on the structured joint attention assessment and more child-initiated joint attention in the mother-child interaction . The children in the play group showed more diverse types of symbolic play in interaction with their mothers and higher play levels on both the play assessment and in interaction with their mothers . CONCLUSIONS This r and omized controlled trial provides promising data on the specificity and generalizability of joint attention and play interventions for young children with autism . Future studies need to examine the long-term effects of these early interventions on children 's development Abstract The study of mediation of treatment effects , or how treatments work , is important to underst and ing and improving psychological and behavioral treatments , but applications often focus on mediators and outcomes measured at a single time point . Such cross-sectional analyses do not respect the implied temporal ordering that mediation suggests . Clinical trials of treatments often provide repeated measures of outcomes and , increasingly , of mediators as well . Repeated measurements allow the application of various types of longitudinal structural equation mediation models . These provide flexibility in modeling , including the ability to incorporate some types of measurement error and unmeasured confounding that can strengthen the robustness of findings . The usual approach is to identify the most theoretically plausible model and apply that model . In the absence of clear theory , we put forward the option of fitting a few theoretically plausible models , providing a type of sensitivity analysis for the mediation hypothesis . In this tutorial , we outline how to fit several longitudinal mediation models , including  simplex , latent growth  and  latent change models  . This will allow readers to learn about one type of model that is of interest , or about several alternative models , so that they can take this sensitivity approach . We use the Pacing , Grade d Activity , and Cognitive Behavioral Therapy :  A R and omized Evaluation ( PACE ) trial of rehabilitative treatments for chronic fatigue syndrome ( IS RCT N 54285094 ) as a motivating example and describe how to fit and interpret various longitudinal mediation models using simulated data similar to those in the PACE trial . The simulated data set and Mplus code and output are provided This study aim ed to determine if a joint attention intervention would result in greater joint engagement between caregivers and toddlers with autism . The intervention consisted of  24 caregiver-mediated sessions  with follow-up 1 year later . Compared to caregivers and toddlers r and omized to the waitlist control group the immediate treatment ( IT ) group made significant improvements in targeted areas of joint engagement . The IT group demonstrated significant improvements with medium to large effect sizes in their responsiveness to joint attention and their diversity of functional play acts after the intervention with maintenance of these skills 1 year post-intervention . These are among the first r and omized controlled data to suggest that short-term parent-mediated  interventions can have important effects on core impairments in toddlers with autism . Clinical Trials # : NCT00065910 In 2002 , the National Institutes of Health sponsored a meeting concerning method ological challenges of research in psychosocial interventions in Autism Spectrum Disorders . This paper provides a summary of the presentations and the discussion s that occurred during this meeting . Recommendations to federal and private agencies included the need for r and omized clinical trials of comprehensive interventions for autism as the highest , but not the sole priority . Ongoing working groups were proposed to address psychosocial interventions with a focus on relevant statistics , st and ardized documentation and methods of diagnosis , development of outcome measures , establishment of st and ards in research ; and the need for innovative treatment design s , including application of design s from other research areas to the study of interventions in ASD Objective : To evaluate the effectiveness of the Play and Language for Autistic Youngsters ( PLAY ) Project Home Consultation model , in combination with usual community services ( CS ) , to improve parent-child interaction , child development , and autism symptomatology in young children with autism spectrum disorders ( ASDs ) compared with CS only . Methods : Children ( N = 128 ) with autism or PDD-NOS ( DSM-4 criteria ) aged 2 years 8 months to 5 years 11 months and recruited from 5 disability agencies in 4 US states were r and omized in two 1-year cohorts . Using videotape and written feedback within a developmental framework , PLAY consultants coached caregivers monthly for 12 months to improve caregiver-child interaction . CS included speech/ language and occupational therapy and public education services . Primary outcomes included change in parent-child interactions , language and development , and autism-related diagnostic category/symptoms . Secondary outcomes included parent stress and depression and home consultant fidelity . Data were collected pre- and post-intervention . Results : Using intent-to-treat analysis ( ITT ) , large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales . Child language and developmental quotient did not differ over time by group , although functional development improved significantly . PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule ( ADOS ) . PLAY caregivers ' stress did not increase , and depressive symptomatology decreased . Home consultants administered the intervention with fidelity . Conclusions : PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parents ' stress/depression . ADOS findings must be interpreted cautiously because results do not align with clinical experience . PLAY offers communities a relatively inexpensive effective intervention for children with ASD and their parents Abstract ‘ Everyday memory ’ is conceptualised as memory within the context of day-to-day life and , despite its functional relevance , has been little studied in individuals with autism spectrum disorders ( ASDs ) . In the first study of its kind , 94 adolescents with an ASD and 55 without an ASD completed measures of everyday memory  from the Rivermead Behavioural Memory Test ( RBMT ) and a st and ard word recall task ( Children ’s Auditory Verbal Learning Test-2 : CAVLT-2 ) . The ASD group showed significant impairments on the RBMT  , including in prospect i ve memory , alongside impaired performance on the CAVLT-2 . Social and communication ability was significantly associated with prospect i ve remembering in an everyday memory context but not with the CAVLT-2 . The complex nature of everyday memory and its relevance to ASD is discussed Cognitive processing in autism has been characterized by a difficulty with the abstract ion of information across multiple stimuli or situations and subsequent generalization to new stimuli or situations . This apparent difficulty leads to the suggestion that prototype formation , a process of creating a mental summary representation of multiple experienced stimuli that go together in a category , may be impaired in autism . Adults with high functioning autism and a typically developing comparison group matched on age and IQ completed a r and om dot pattern categorization task .  Participants with autism demonstrated intact prototype formation in all four ways it was operationally defined , and this performance was not significantly different from that of control participants . However , participants with autism  categorized dot patterns that were more highly distorted from the category prototypes less accurately than did control participants . These findings suggest , at least within the constraints of the r and om dot pattern task , that although prototype formation may not be impaired in autism , difficulties may exist with the generalization of what has been learned about a category to novel stimuli , particularly as they become less similar to the category 's prototype Summary Background Results of small trials suggest that early interventions for social communication are effective for the treatment of autism in children . We therefore investigated the efficacy of such an intervention in a larger trial . Methods Children with core autism ( aged 2 years to 4 years and 11 months ) were r and omly assigned in a one-to-one ratio to a parent-mediated communication-focused ( Preschool Autism Communication Trial [ PACT ] ) intervention or treatment as usual at three specialist centres in the UK . Those assigned to PACT were also given treatment as usual . R and omisation was by use of minimisation of probability in the marginal distribution of treatment centre , age ( ≤42 months or > 42 months ) , and autism severity ( Autism Diagnostic Observation Schedule-Generic [ ADOS-G ] algorithm score 12–17 or 18–24 ) . Primary outcome was severity of autism symptoms ( a total score of social communication algorithm items from ADOS-G , higher score indicating greater severity ) at 13 months . Complementary secondary outcomes were measures of parent-child interaction , child language , and adaptive functioning in school . Analysis was by intention to treat . This study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N58133827 . Results 152 children were recruited . 77 were assigned to PACT ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=25 ] ) ; and 75 to treatment as usual ( London [ n=26 ] , Manchester [ n=26 ] , and Newcastle [ n=23 ] ) . At the 13-month endpoint , the severity of symptoms was reduced by 3·9 points ( SD 4·7 ) on the ADOS-G algorithm in the group assigned to PACT , and 2·9 ( 3·9 ) in the group assigned to treatment as usual , representing a between-group effect size of −0·24 ( 95 % CI −0·59 to 0·11 ) , after adjustment for centre , sex , socioeconomic status , age , and verbal and non-verbal abilities . Treatment effect was positive for parental synchronous response to child ( 1·22 , 0·85 to 1·59 ) , child initiations with parent ( 0·41 , 0·08 to 0·74 ) , and for parent-child shared attention ( 0·33 , −0·02 to 0·68 ) . Effects on directly assessed language and adaptive functioning in school were small . Interpretation On the basis of our findings , we can not recommend the addition of the PACT intervention to treatment as usual for the reduction of autism symptoms ; however , a clear benefit was noted for parent-child dyadic social communication . Funding UK Medical Research Council , and UK Department for Children , Schools and Families OBJECTIVES : To compare 2 short-term , community caregiver training interventions for preschool-aged children with Autism Spectrum Disorder who had low re sources . Low re source was defined by the US Department of Housing and Urban Development low-income index or 1 “ indicator , ” ( eg , Medicaid eligibility ) . Child outcomes focused on joint engagement , joint attention , and play . METHODS : Participants included 112 families of a child who had Autism Spectrum Disorder who met criteria for being low-re source d and who were r and omly assigned to 1 of 2 3-month interventions , group caregiver education or individualized caregiver-mediated intervention ( CMM ) .  Children were assessed for social communication skills pre- and post-treatment , and followed up at 3 months . RESULTS : All children improved in joint engagement and initiating joint attention , with significantly greater improvement by the CMM group . Outcomes on play skills were mixed , with improvement of symbolic play for the CMM group and no change in functional play skills . Joint engagement maintained over time for the CMM group , and initiating joint attention maintained for both groups over time . CONCLUSIONS : This study is among the first r and omized trials comparing 2 active interventions with a large sample of low-re source d families . Results suggest improvements in core autism deficits of joint engagement , joint attention , and symbolic play with relatively brief , caregiver-mediated interventions , but additional support is necessary to maintain and generalize these gains over time BACKGROUND Behavioral interventions are commonplace in the treatment of autism spectrum disorders , yet relatively little is known about how and why these interventions work . This study tests the relationship between isolated core components of a packaged social communication intervention and the primary outcome , joint engagement , to better underst and how the intervention is affecting change in individuals . METHODS A total of 86 toddlers and their parents were enrolled in the study and r and omized to one of two treatments , the joint attention , symbolic play , engagement , and regulation ( JASPER ) parent-mediated intervention or a psychoeducational intervention . Measures regarding the parent 's use of intervention strategies were collected before and after the 10-week intervention . Additional measures of child and parent joint engagement were also collected . RESULTS A significant effect of treatment was found for all four of the core strategies of the intervention , favoring a larger increase in the JASPER condition . A hierarchical linear regression revealed several individual predictors of joint engagement , including parent-rated buy-in , interventionist-rated parent involvement , and parental use of strategies . To complement the hierarchical analysis , we also tested the potential mediating effect the strategies may have on the relationship between treatment and joint engagement . Results showed that the strategy of mirrored pacing mediated the relationship between treatment and joint engagement in the positive direction . CONCLUSIONS These results strongly suggest that the mirrored pacing strategy is an active ingredient of the JASPER treatment OBJECTIVE Previous research has demonstrated that peer rejection is a significant part of the clinical presentation of many children with attention-deficit hyperactivity disorder ( ADHD ) . Outcome studies of treatment interventions have typically failed to show generalization of treatment gains to the home and classroom . This has been especially true 
    Output:
    