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: OBJECTIVE This study reports 12-month follow-up data from a r and omized controlled trial of preschool-based social communication treatment for young children with autism . METHOD A total of 61 children ( 48 males ) with autism , 29 to 60 months of age , had earlier been r and omized either to 8 weeks of preschool-based social communication treatment in addition to st and ard preschool program ( n = 34 ) or to st and ard preschool program only ( n = 27 ) . Significant short-term effects on targeted social communication skills have previously been published . Long-term gains in social communication , language and global social functioning and communication were assessed from video-taped preschool teacher-child and mother-child interactions , Early Social Communication Scales , Reynell Developmental Language Scale , and Social Communication Question naire . RESULTS Compared with those in the control group , the treated children achieved significantly larger improvements in joint attention and joint engagement from baseline to 12-month follow-up . However , no effects were detected on language and global ratings of social functioning and communication . The treatment effect on child initiation of joint attention increased with increasing level of sociability at baseline , whereas nonverbal IQ and expressive language had no moderating effect . CONCLUSIONS This study is the first to show that , similar to specialist-delivered treatment , preschool-based treatment may produce small but possibly clinical ly important long-term changes in social communication in young children with autism . The treatment did not affect language and global ratings of social functioning and communication . More studies are needed to better underst and whether treatment effects may be improved by increasing the intensity and duration of the treatment . Clinical trial registration information -- Joint Attention Intervention and Young Children With Autism ; http:// clinical trials.gov/ ; NCT00378157 This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer The current study is a r and omized clinical trial evaluating the efficacy of Focused Playtime Intervention ( FPI ) in a sample of 70 children with Autism Spectrum Disorder . This parent-mediated intervention has previously been shown to significantly increase responsive parental communication ( Siller et al. in J Autism Dev Disord 43:540–555 , 2013a ) . The current analyses focus on children ’s attachment related outcomes . Results revealed that children who were r and omly assigned to FPI showed bigger increases in attachment-related behaviors , compared to children assigned to the control condition . Significant treatment effects of FPI were found for both an observational measure of attachment-related behaviors elicited during a brief separation-reunion episode and a question naire measure evaluating parental perceptions of child attachment . The theoretical and clinical implication s of these findings are discussed Adolescents with ASD face numerous personal and context ual barriers that impede the development of social motivation and core competencies , warranting the need for targeted intervention . A r and omized controlled trial was conducted with 40 adolescents to evaluate the merits of a multi-component socialization intervention that places emphasis on experiential learning . This investigation evaluated the impact of the 20-week START program on the social functioning of adolescents with ASD . Significant Group × Time differences between START and waitlist control groups were found across multiple measures . Secondary analyses of the entire program cohort also yielded significant improvement trends across all measures . These findings may be an important step in identifying optimal strategies to target the complex factors limiting optimal social development in ASD Increased anxiety and stress are frequently found in children with autism spectrum disorder and are associated with social challenges . Recently , we reported changes in social competence following peer-mediated , theatre-based intervention . The purpose of this study was to examine the impact of the intervention on reducing anxiety and stress .  Participants included 30 youth with autism spectrum disorder ( 8–14 years old ) r and omly assigned to the experimental ( 17 ) or waitlist control ( 13 ) group . Pretest adjusted , between-group differences were analyzed for state-anxiety , trait-anxiety , play-based cortisol , and diurnal cortisol . Pearson correlations were conducted between anxiety , cortisol , and group play . Significant pretest-adjusted between-group differences at posttest were observed on trait-anxiety ( F(1 , 27 ) = 9.16 , p = 0.005 ) but not state-anxiety ( F(1 , 27 ) = 0.03 , p = 0.86 ) , showing lower trait-anxiety in the experimental group . There were no between-group differences on cortisol . There was a significant negative correlation between group play and trait-anxiety ( r = −0.362 , p = 0.05 ) . Playground cortisol correlated with group play , for the experimental group ( r = 0.55 , p = 0.03 ) . The theatre-based , peer-mediated intervention not only contributes to improvement in social competence in youth with autism spectrum disorder but also contributes to reductions in trait-anxiety associated with more social interaction with peers . Results suggest that some degree of physiological arousal is essential for social interaction The efficacy of a peer-mediated , theatre-based intervention on social competence  in participants with autism spectrum disorder ( ASD ) was tested . Thirty 8-to-14 year-olds with ASD were r and omly assigned to the treatment ( n = 17 ) or a wait-list control ( n = 13 ) group . Immediately after treatment , group effects were seen on social ability , ( d = .77 ) , communication symptoms ( d = −.86 ) , group play with toys in the company of peers ( d = .77 ) , immediate memory of faces as measured by neuropsychological ( d = .75 ) and ERP methods ( d = .93 ) , delayed memory for faces ( d = .98 ) , and theory of mind ( d = .99 ) . At the 2 month follow-up period , group effects were detected on communication symptoms ( d = .82 ) . The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention This study compared immediate and 4-month outcomes among adolescents with autism spectrum disorder r and omly assigned to the PEERS curriculum ( n = 10 ) , a peer mediated PEERS curriculum ( n = 12 ) , or a delayed treatment control group ( n = 12 ) . Findings suggest a modest advantage in social skills knowledge and social functioning for participants in the peer-mediated PEERS curriculum relative to Traditional PEERS , and gains in social skills knowledge , social functioning , and reductions in loneliness were maintained in one or both treatment groups at a 4-month follow-up . Typically developing peer mentors ( n = 16 ) showed improvements in social skills knowledge and marginal improvements in autism knowledge and loneliness . Future research with a larger sample and objective outcome measures is needed Children with Autism Spectrum Disorder ( ASD ) often experience difficulty participating in everyday home routines , such as bed time or bath time . This r and omized controlled trial examined the efficacy of an interactive , web‐based parenting tutorial for improving children 's engagement in daily routines ( i.e. , proximal outcomes ) as well improving children 's social communication and parenting efficacy and stress ( i.e. , broad outcomes ) . Parents of children with ASD between 18 and 60 months were r and omly assigned to the  Tutorial  group ( n = 52 ) or the  Control group ( n = 52 ) . All parents completed question naires at baseline ( T1 ) , 1 month after T1 ( T2 ; post‐tutorial completion ) , and 2 months after T1 ( T3 ) . Relative to the Control group , parents in the Tutorial group reported significantly higher use of evidence ‐based instructional strategies and higher levels of child engagement during routines at T2 and T3 . In addition , parents in the Tutorial group reported significantly lower parenting stress and higher parenting efficacy at T3 , as well as higher ratings of child social communication at T2 and T3 , compared to the Control group . Parents reported being highly satisfied with both the clinical content and technical aspects of the tutorial . These improvements in both proximal and broad parent‐child outcomes suggest that this tutorial may be a promising and accessible way for empowering some parents and improving parent‐child interactions . Autism Res 2018 , 11 : 667–678 . © 2018 International Society for Autism Research , Wiley Periodicals , OBJECTIVE To determine the effect of the Early Start Denver Model ( ESDM ) for treatment of young children with autism on health care service use and costs . METHOD We used data from a r and omized trial that tested the efficacy of the ESDM , which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents , for 2 years . Parents were interviewed about their children 's service use every 6 months from the onset of the intervention to follow-up ( age 6 years ) . The sample for this study consisted of 39 children with autism who participated in the original r and omized trial at age 18 to 30 months , and were also assessed at age 6 years . Of this sample , 21 children were in the ESDM group , and 18 children were in the community care ( COM ) group . Reported services were categorized and costed by applying unit hourly costs . Annualized service use and costs during the intervention and post intervention for the two study arms were compared . RESULTS During the intervention , children who received the ESDM had average annualized total health-related costs that were higher by about $ 14,000 than those of children who received community-based treatment . The higher cost of ESDM was partially offset during the intervention period because children in the ESDM group used less  applied behavior analysis (ABA)/early intensive behavioral intervention ( EIBI )  and  speech therapy services than children in the comparison group . In the postintervention period , compared with children who had earlier received treatment as usual in community setting s , children in the ESDM group used less ABA/EIBI , occupational/physical therapy , and speech therapy services , result ing in significant cost savings in the amount of about $ 19,000 per year per child . CONCLUSION Costs associated with ESDM treatment were fully offset within a few years after the intervention because of reductions in other service use and associated costs . CLINICAL TRIAL REGISTRATION INFORMATION Early Characteristics of Autism ; http:// clinical trials.gov/ ; NCT0009415 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 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 
    Output:
    
agent
CONCLUSION Non-specialist mediated interventions for autism spectrum disorder demonstrate effectiveness across a range of outcomes for children with autism and their caregivers
***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: OBJECTIVE This study reports 12-month follow-up data from a r and omized controlled trial of preschool-based social communication treatment for young children with autism . METHOD A total of 61 children ( 48 males ) with autism , 29 to 60 months of age , had earlier been r and omized either to 8 weeks of preschool-based social communication treatment in addition to st and ard preschool program ( n = 34 ) or to st and ard preschool program only ( n = 27 ) . Significant short-term effects on targeted social communication skills have previously been published . Long-term gains in social communication , language and global social functioning and communication were assessed from video-taped preschool teacher-child and mother-child interactions , Early Social Communication Scales , Reynell Developmental Language Scale , and Social Communication Question naire . RESULTS Compared with those in the control group , the treated children achieved significantly larger improvements in joint attention and joint engagement from baseline to 12-month follow-up . However , no effects were detected on language and global ratings of social functioning and communication . The treatment effect on child initiation of joint attention increased with increasing level of sociability at baseline , whereas nonverbal IQ and expressive language had no moderating effect . CONCLUSIONS This study is the first to show that , similar to specialist-delivered treatment , preschool-based treatment may produce small but possibly clinical ly important long-term changes in social communication in young children with autism . The treatment did not affect language and global ratings of social functioning and communication . More studies are needed to better underst and whether treatment effects may be improved by increasing the intensity and duration of the treatment . Clinical trial registration information -- Joint Attention Intervention and Young Children With Autism ; http:// clinical trials.gov/ ; NCT00378157 This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer The current study is a r and omized clinical trial evaluating the efficacy of Focused Playtime Intervention ( FPI ) in a sample of 70 children with Autism Spectrum Disorder . This parent-mediated intervention has previously been shown to significantly increase responsive parental communication ( Siller et al. in J Autism Dev Disord 43:540–555 , 2013a ) . The current analyses focus on children ’s attachment related outcomes . Results revealed that children who were r and omly assigned to FPI showed bigger increases in attachment-related behaviors , compared to children assigned to the control condition . Significant treatment effects of FPI were found for both an observational measure of attachment-related behaviors elicited during a brief separation-reunion episode and a question naire measure evaluating parental perceptions of child attachment . The theoretical and clinical implication s of these findings are discussed Adolescents with ASD face numerous personal and context ual barriers that impede the development of social motivation and core competencies , warranting the need for targeted intervention . A r and omized controlled trial was conducted with 40 adolescents to evaluate the merits of a multi-component socialization intervention that places emphasis on experiential learning . This investigation evaluated the impact of the 20-week START program on the social functioning of adolescents with ASD . Significant Group × Time differences between START and waitlist control groups were found across multiple measures . Secondary analyses of the entire program cohort also yielded significant improvement trends across all measures . These findings may be an important step in identifying optimal strategies to target the complex factors limiting optimal social development in ASD Increased anxiety and stress are frequently found in children with autism spectrum disorder and are associated with social challenges . Recently , we reported changes in social competence following peer-mediated , theatre-based intervention . The purpose of this study was to examine the impact of the intervention on reducing anxiety and stress .  Participants included 30 youth with autism spectrum disorder ( 8–14 years old ) r and omly assigned to the experimental ( 17 ) or waitlist control ( 13 ) group . Pretest adjusted , between-group differences were analyzed for state-anxiety , trait-anxiety , play-based cortisol , and diurnal cortisol . Pearson correlations were conducted between anxiety , cortisol , and group play . Significant pretest-adjusted between-group differences at posttest were observed on trait-anxiety ( F(1 , 27 ) = 9.16 , p = 0.005 ) but not state-anxiety ( F(1 , 27 ) = 0.03 , p = 0.86 ) , showing lower trait-anxiety in the experimental group . There were no between-group differences on cortisol . There was a significant negative correlation between group play and trait-anxiety ( r = −0.362 , p = 0.05 ) . Playground cortisol correlated with group play , for the experimental group ( r = 0.55 , p = 0.03 ) . The theatre-based , peer-mediated intervention not only contributes to improvement in social competence in youth with autism spectrum disorder but also contributes to reductions in trait-anxiety associated with more social interaction with peers . Results suggest that some degree of physiological arousal is essential for social interaction The efficacy of a peer-mediated , theatre-based intervention on social competence  in participants with autism spectrum disorder ( ASD ) was tested . Thirty 8-to-14 year-olds with ASD were r and omly assigned to the treatment ( n = 17 ) or a wait-list control ( n = 13 ) group . Immediately after treatment , group effects were seen on social ability , ( d = .77 ) , communication symptoms ( d = −.86 ) , group play with toys in the company of peers ( d = .77 ) , immediate memory of faces as measured by neuropsychological ( d = .75 ) and ERP methods ( d = .93 ) , delayed memory for faces ( d = .98 ) , and theory of mind ( d = .99 ) . At the 2 month follow-up period , group effects were detected on communication symptoms ( d = .82 ) . The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention This study compared immediate and 4-month outcomes among adolescents with autism spectrum disorder r and omly assigned to the PEERS curriculum ( n = 10 ) , a peer mediated PEERS curriculum ( n = 12 ) , or a delayed treatment control group ( n = 12 ) . Findings suggest a modest advantage in social skills knowledge and social functioning for participants in the peer-mediated PEERS curriculum relative to Traditional PEERS , and gains in social skills knowledge , social functioning , and reductions in loneliness were maintained in one or both treatment groups at a 4-month follow-up . Typically developing peer mentors ( n = 16 ) showed improvements in social skills knowledge and marginal improvements in autism knowledge and loneliness . Future research with a larger sample and objective outcome measures is needed Children with Autism Spectrum Disorder ( ASD ) often experience difficulty participating in everyday home routines , such as bed time or bath time . This r and omized controlled trial examined the efficacy of an interactive , web‐based parenting tutorial for improving children 's engagement in daily routines ( i.e. , proximal outcomes ) as well improving children 's social communication and parenting efficacy and stress ( i.e. , broad outcomes ) . Parents of children with ASD between 18 and 60 months were r and omly assigned to the  Tutorial  group ( n = 52 ) or the  Control group ( n = 52 ) . All parents completed question naires at baseline ( T1 ) , 1 month after T1 ( T2 ; post‐tutorial completion ) , and 2 months after T1 ( T3 ) . Relative to the Control group , parents in the Tutorial group reported significantly higher use of evidence ‐based instructional strategies and higher levels of child engagement during routines at T2 and T3 . In addition , parents in the Tutorial group reported significantly lower parenting stress and higher parenting efficacy at T3 , as well as higher ratings of child social communication at T2 and T3 , compared to the Control group . Parents reported being highly satisfied with both the clinical content and technical aspects of the tutorial . These improvements in both proximal and broad parent‐child outcomes suggest that this tutorial may be a promising and accessible way for empowering some parents and improving parent‐child interactions . Autism Res 2018 , 11 : 667–678 . © 2018 International Society for Autism Research , Wiley Periodicals , OBJECTIVE To determine the effect of the Early Start Denver Model ( ESDM ) for treatment of young children with autism on health care service use and costs . METHOD We used data from a r and omized trial that tested the efficacy of the ESDM , which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents , for 2 years . Parents were interviewed about their children 's service use every 6 months from the onset of the intervention to follow-up ( age 6 years ) . The sample for this study consisted of 39 children with autism who participated in the original r and omized trial at age 18 to 30 months , and were also assessed at age 6 years . Of this sample , 21 children were in the ESDM group , and 18 children were in the community care ( COM ) group . Reported services were categorized and costed by applying unit hourly costs . Annualized service use and costs during the intervention and post intervention for the two study arms were compared . RESULTS During the intervention , children who received the ESDM had average annualized total health-related costs that were higher by about $ 14,000 than those of children who received community-based treatment . The higher cost of ESDM was partially offset during the intervention period because children in the ESDM group used less  applied behavior analysis (ABA)/early intensive behavioral intervention ( EIBI )  and  speech therapy services than children in the comparison group . In the postintervention period , compared with children who had earlier received treatment as usual in community setting s , children in the ESDM group used less ABA/EIBI , occupational/physical therapy , and speech therapy services , result ing in significant cost savings in the amount of about $ 19,000 per year per child . CONCLUSION Costs associated with ESDM treatment were fully offset within a few years after the intervention because of reductions in other service use and associated costs . CLINICAL TRIAL REGISTRATION INFORMATION Early Characteristics of Autism ; http:// clinical trials.gov/ ; NCT0009415 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 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 
    Output:
    