114 Chapter 6 emptive intervention called BEAR (Blended E-health for children at eArly Risk). The BEARintervention, designed by Dietz and Oosterling (2019) and with input from experts from the Dutch national expertise network for autism in young children, is a pre-emptive, homebased, parent-mediated intervention suitable for infants and toddlers aged approximately 12-30/36 months who show a neurodevelopmental vulnerability (e.g. concerns regarding social communication, contact, flexible behavior and/or play). Without the need of an ASD diagnosis, BEAR is intended to be more acceptable and well-received by parents with relatively minor concerns or who are somewhat hesitant about seeking help or pursuing a diagnostic assessment. The intervention is delivered by a first-line healthcare professional and (ideally) supervised by a specialized mental healthcare professional. For a more comprehensive description of the SCOPE project and its three components, we refer to our previous published protocol paper (Snijder et al., 2022). The current study evaluates outcomes at short-term and after six-months follow-up of BEAR. Pre-emptive interventions such as BEAR are often grounded in evidence-based naturalistic developmental behavioral intervention principles (NDBI’s) and parent-mediated (Bruinsma et al., 2020; Wan, Green & Scott, 2018). Previous studies suggest that early interventions based on a comparable theoretical framework may produce both short-term and long-term outcomes on child development, family functioning, societal outcomes and cost-effectiveness (Fuller & Kaiser, 2020; Horlin et al. 2014; Pickles et al., 2016;Tinelli et al., 2023). However, findings regarding the effectiveness of pre-emptive interventions are mixed. Recent systematic reviews and meta-analyses have found that while parent-mediated interventions led to improved parental strategies and parental engagement, this did not directly translate into shortterm improvements in child developmental outcomes such as reducing ASD symptoms or enhancing cognitive or expressive language abilities (Hamptom & Rodgriquez, 2022; Law et al., 2022). These findings are supported by another recent systematic review and metaanalysis (McGlade et al., 2023) that found limited effects of pre-emptive interventions on child (neuro)developmental outcomes with exception of the iBASIS-Video Interaction to Promote Positive Parenting intervention (iBasis-VIPP; Green, Wan, Guiraud et al; BASIS Team, 2013). Specifically, two randomized controlled trials (RCTs) suggested that preemptive interventions like iBASIS-VIPP have the potential to reduce ASD symptom severity and decrease the likelihood of an ASD diagnosis in early childhood, elicit a positive change in sensitive parental responses, improve parent-child interaction, and improve the child’s development (Green et al., 2015, 2017; Whitehouse et al., 2019, 2021). In summary, these collective findings suggest that promoting parental sensitivity and responsiveness should remain pivotal objectives and that pre-emptive interventions for infants and toddlers at increased likelihood for ASD may yet hold promise. However, research on the effects of pre-emptive interventions remains necessary, not only to document the short-term effects but also to examine their long-term implications.
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