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Extending the Parent-Delivered Early Start Denver Model to Young Children with Fragile X Syndrome

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Abstract

This is the first study to evaluate an autism intervention model, the parent-delivered Early Start Denver Model (P-ESDM), for young children with fragile X syndrome (FXS), a known genetic disorder associated with autism spectrum disorder. Four parent–child dyads participated in a low-intensity, parent coaching model of the P-ESDM to evaluate initial efficacy and acceptability. Parents improved in P-ESDM fidelity, implemented intervention goals to increase child learning, and found the experience moderately to highly acceptable. Visual examination and Baseline Corrected Tau effect sizes revealed mixed results across child measures. Findings suggest a potential therapeutic opportunity in need of larger, well-controlled studies of P-ESDM and other interventions for families of young children with FXS who face limited empirically-supported intervention options.

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References

  • Bailey, D. B. Jr., Hatton, D. D., Mesibov, G., Ament, N., & Skinner, M. (2000). Early development, temperament, and functional impairment in autism and fragile X syndrome. Journal of Autism and Developmental Disorders, 30(1), 49–59.

    Article  PubMed  Google Scholar 

  • Bailey, D. B. Jr., Hatton, D. D., Skinner, M., & Mesibov, G. (2001). Autistic behavior, FMR1 protein, and developmental trajectories in young males with FXS. Journal of Autism and Developmental Disorders, 31(2), 165–174.

    Article  PubMed  Google Scholar 

  • Bailey, D. B. Jr., Raspa, M., Bishop, E., Mitra, D., Martin, S., Wheeler, A., & Sacco, P. (2012). Health and economic consequences of fragile X syndrome for caregivers. Journal of Developmental and Behavioral Pediatrics, 33(9), 705–712.

    Article  PubMed  Google Scholar 

  • Bailey, D. B. Jr., Raspa, M., Olmsted, M., & Holiday, D. B. (2008). Co-occurring conditions associated with FMR1 gene variations: Findings from a national parent survey. American Journal of Medical Genetics, 146(16), 2060–2069.

    Article  Google Scholar 

  • Bailey, D. B., Skinner, D., & Sparkman, K. L. (2003). Discovering fragile X syndrome: Family experiences and perceptions. Pediatrics, 111(2), 407–416.

    Article  PubMed  Google Scholar 

  • Baranek, G., Watson, L. R., Turner-Brown, L., Field, S. H., Crais, E. R., Wakeford, L., … Reznick, J. S. (2015). Preliminary efficacy of Adapted Responsive Teaching for infants at risk of autism spectrum disorder in a community sample. Autism Research and Treatment. https://doi.org/10.1155/2015/386951.

  • Boyle, L., & Kaufmann, W. E. (2010). The behavioral phenotype of FMR1 mutations. American Journal of Medical Genetics, 154C(4), 469–476.

    Article  PubMed  Google Scholar 

  • Bradshaw, J., Steiner, A. M., Gengoux, G., & Koegel, L. K. (2015). Feasibility and effectiveness of very early intervention for infants at-risk for autism spectrum disorder: A systematic review. Journal of Autism and Developmental Disorders, 45(3), 778–794.

    Article  PubMed  Google Scholar 

  • Carter, A. S., Messinger, D. S., Stone, W. L., Celimi, S., Nahmias, A. S., & Yoder, P. (2011). A randomized controlled trial of Hanen’s ‘More Than Words’ in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry, 52(7), 741–752.

    Article  PubMed  Google Scholar 

  • Chevreul, K., Berg Brigham, K., Brunn, M., des Portes, V., Serrano-Aguilar, P., Linertova, R., … Cavazza, M. (2015). Fragile X syndrome: Economic burden and health-related quality of life of patients and caregivers in France. Journal of Intellectual Disabilities Research, 59(12), 1108–1120.

    Article  Google Scholar 

  • Cordeiro, L., Ballinger, E., Hagerman, R., & Hessl, D. (2011). Clinical assessment of DSM-IV anxiety disorders in fragile X syndrome: Prevalence and characterization. Journal of Neurodevelopmental Disorders, 3(1), 57–67.

    Article  PubMed  Google Scholar 

  • Dawson, G., Jones, E. J., Merkle, K., Venema, K., Lowy, R., Faja, S., … Webb S. J. (2012). Early behavioral intervention is associated with normalized brain activity in young children with autism. Journal of the American Academy of Child and Adolescent Psychiatry, 51(11), 1150–1159.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., … Varley, J. (2010). Randomized controlled trial of the Early Start Denver Model: A developmental behavioral intervention for toddlers with autism: Effects on IQ, adaptive behavior, and autism diagnosis. Pediatrics, 125(1), e17–e23.

    Article  PubMed  Google Scholar 

  • Drew, A., Baird, G., Baron-Cohen, S., Cox, A., Slonims, V., Wheelwright, S., … Charman, T. (2002). A pilot randomized controlled trial of a parent training intervention for preschool children with autism: Preliminary findings and methodological challenges. European Child and Adolescent Psychiatry, 11(6), 266–272.

    Article  PubMed  Google Scholar 

  • Edgington, E. S. (1996). Randomized single-subject experimental designs. Behavior Research and Therapy, 34(7), 567–574.

    Article  Google Scholar 

  • Estes, A., Vismara, L., Mercado, C., Fitzpatrick, A., Elder, L., Greenson, J., … Dawson, G. (2014). The impact of parent-delivered intervention on parents of very young children with autism. Journal of Autism and Developmental Disorders, 44(2), 353–365.

    Article  PubMed  PubMed Central  Google Scholar 

  • Farzin, F., & Koldewyn, K. (2014). Fragile X syndrome and autism. In V. B. Patel, V. R. Preedy & C. R. Martin (Eds.), Comprehensive guide to autism (pp. 2743–2754). New York: Springer.

    Google Scholar 

  • Farzin, F., Perry, H., Hessl, D., Loesch, D., Cohen, J., Bacalman, S., … Hagerman, R. (2006). Autism spectrum disorders and attention-deficit/hyperactivity disorder in boys with the fragile X permutation. Journal of Developmental Behavioral Pediatrics, 27(2 suppl), S137–S144.

    Article  PubMed  Google Scholar 

  • Fenson, L., Marchman, V. A., Thal, D., Dale, P. S., Bates, E., & Reznick, J. S. (2007). The MacArthur-Bates communicative development inventories: Level III: User’s guide and technical manual (2nd ed.). Baltimore: Brookes Publishing Co.

    Google Scholar 

  • Green, J., Charman, T., Pickles, A., Wan, M. W., Elsabbagh, M., Slonims, V., … Johnson, M. H. (2015). Parent-mediated intervention versus no intervention for infants at high risk of autism: A parallel, single-blind, randomized trial. The Lancet Psychiatry, 2(2), 133–140.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hagerman, R. J., Berry-Kravis, E., Kaufmann, W. E., Ono, M. Y., Tartaglia, N., Lachiewicz, A., … Tranfaglia, M. (2009). Advances in the treatment of fragile X syndrome. Pediatrics, 123(1), 378–390.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hagerman, R. J., Rivera, S. M., & Hagerman, P. J. (2008). The fragile X family of disorders: A model for autism and targeted treatments. Current Pediatric Reviews, 4(1), 40–52.

    Article  Google Scholar 

  • Hall, S. S. (2009). Treatments for fragile X syndrome: A closer look at the data. Developmental Disabilities Research Reviews, 15(4), 353–360.

    Article  PubMed  PubMed Central  Google Scholar 

  • Harris, S. L., & Handleman, J. S. (2000). Age and IQ at intake as predictors of placement for young children with autism: A four to six-year follow-up. Journal of Autism and Developmental and Disorders, 30(2), 137–142.

    Article  Google Scholar 

  • Hatton, D. D., Sideris, J., Skinner, M., Mankowski, J., Bailey, D. B. Jr., Roberts, J. E., & Mirrett, P. (2006). Autistic behavior in children with FXS: Prevalence, stability, and the impact of FMRP. American Journal of Medical Genetics, 140(17), 1804–1813.

    Article  Google Scholar 

  • Hernandez, R. N., Feinberg, R. L., Vaurio, R., Passanante, N. M., Thompson, R. E., & Kaufmann, W. E. (2009). Autism spectrum disorder in FXS: A longitudinal evaluation. American Journal of Medical Genetics, 149(6), 1125–1137.

    Article  Google Scholar 

  • Hersen, M., & Barlow, D. H. (1976). Single case experimental designs: Strategies for studying behavior change. New York: Pergamon.

    Google Scholar 

  • Hersh, J. H., & Saul, R. A. (2011). Committee on Genetics. Health supervision for children with fragile X syndrome. Pediatrics, 127(5), 994–1006.

    Article  PubMed  Google Scholar 

  • Hessl, D., Glaser, B., Dyer-Friedman, J., Blasey, C., Hastie, T., Gunnar, M., & Reiss, A. L. (2002). Cortisol and behavior in fragile X syndrome. Psychoneuroendocrinology, 27(7), 855–872.

    Article  PubMed  Google Scholar 

  • Hessl, D., Glaser, B., Dyer-Friedman, J., & Reiss, A. L. (2006). Social behavior and cortisol reactivity in children with fragile X syndrome. Journal of Child Psychology and Psychiatry, 47(6), 602–610.

    Article  PubMed  Google Scholar 

  • Hohenberger, A. (2011). The role of affect and emotion in language development. In D. Gokcay & G. Yildirim (Eds.), Affective computing and interaction: Psychological, cognitive and neuroscientific perspectives (pp. 208–243). Hershey: IGI Global.

    Chapter  Google Scholar 

  • Kasari, C., Gulsrud, A. C., Wong, C., Kwon, S., & Locke, J. (2010). Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 40(9), 1045–1056.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kasari, C., Sigman, M., Mundy, P., & Yirmiya, N. (1990). Affective sharing in the context of joint attention interactions. Journal of Autism and Developmental Disorders, 20(1), 87–100.

    Article  PubMed  Google Scholar 

  • Kasari, C., Siller, M., Huynh, L. N., Shih, W., Swanson, M., Hellemann, G. S., & Sugar, C. A. (2014). Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism. Infant Behavior and Development, 37(4), 711–721.

    Article  PubMed  Google Scholar 

  • Kau, A. S., Tierney, E., Bukelis, I., Stump, M., Kates, W., Trescher, W., & Kaufmann, W. E. (2004). Social behavior profile in young males with FXS: Characteristics and specificity. American Journal of Medical Genetics, 126A(1), 9–17.

    Article  PubMed  Google Scholar 

  • Lord, C., Luyster, R., Gotham, K., & Guthrie, W. (2012). Autism diagnostic observation schedule, second edition (ADOS-2) manual (part II): Toddler module. Torrance: Western Psychological Services.

    Google Scholar 

  • Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., Bishop, S. L. … Guthrie, W. (2002). Autism diagnostic observation schedule, second edition (ADOS-2): The manual. Los Angeles: Western Psychological Services.

    Google Scholar 

  • Lord, C., Wagner, A., Rogers, S., Szatmari, P., Aman, M., Charman, T., … Yoder, P. (2005). Challenges in evaluating psychosocial interventions for Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 35(6), 695–708.

    Article  PubMed  Google Scholar 

  • Lozano, R., Azarang, A., Wilaisakditipakorn, T., & Hagerman, R. J. (2016). Fragile X syndrome: A review of clinical management. Intractable Rare Disorders Research, 5(3), 145–157.

    Article  Google Scholar 

  • Markovic, J., Anderson, A. K., & Todd, R. M. (2014). Tuning to the significant: Neural and genetic processes underlying affective enhancement of visual perception and memory. Behavioral Brain Research, 259(1), 229–241.

    Article  Google Scholar 

  • McDuffie, A., Banasik, A., Bullard, L., Nelson, S., Tempero-Feigles, R., Hagerman, R., & Abbeduto, L. (2018). Distance delivery of a spoken language intervention for school-aged and adolescent boys with fragile X syndrome. Developmental Neurorehabilitation, 21(1), 48–63.

    Article  PubMed  Google Scholar 

  • McDuffie, A., Machalicek, W., Bullard, L., Nelson, S., Mello, M., Tempero-Feigles, R., … Abbeduto, L. (2016a). A spoken language intervention for school-aged boys with fragile X syndrome. American Journal of Intellectual Developmental Disabilities, 121(3), 236–265.

    Article  Google Scholar 

  • McDuffie, A., Oakes, A., Machalicek, W., Ma, M., Bullard, L., Nelson, S., & Abbeduto, L. (2016b). Early language intervention using distance video-teleconferencing: A pilot study of young boys with fragile X syndrome and their mothers. American Journal of Speech-Language Pathology, 25(1), 46–66.

    Article  PubMed  Google Scholar 

  • Messinger, D. S., Fogel, A., & Dickenson, K. L. (2001). All smiles are positive, but some smiles are more positive than others. Developmental Psychology, 37(5), 642.

    Article  PubMed  Google Scholar 

  • Miller, L. J., McIntosh, D. N., McGrath, J., Shyu, V., Lampe, M., Taylor, A. K., … Hagerman, R. J. (1999). Electrodermal responses to sensory stimuli in individuals with fragile X syndrome: A preliminary report. American Journal of Medical Genetics, 83(4), 268–279.

    Article  PubMed  Google Scholar 

  • Moeschler, J. B., & Shevell, M. (2014). Committee on genetics. Comprehensive evaluation of the child with intellectual disability or global developmental delays. Pediatrics, 134(3), e903–e918.

    Article  PubMed  Google Scholar 

  • Moskowitz, L. J., & Jones, E. A. (2015). Uncovering the evidence for behavioral interventions for individuals with fragile X syndrome: A systematic review. Research on Developmental Disabilities, 38, 223–241.

    Article  Google Scholar 

  • Mullen, E. M. (1995). Mullen scales of early learning. Circle Pines: American Guidance.

    Google Scholar 

  • Reiss, A. L., & Hall, S. S. (2007). Fragile X syndrome: Assessment and treatment implications. Child and Adolescent Psychiatrics Clinics of North America, 16(3), 663–675.

    Article  Google Scholar 

  • Roberts, J. E., Weisenfeld, L. A., Hatton, D. D., Heath, M., & Kaufmann, W. E. (2007). Social approach and autistic behavior in children with FXS. Journal of Autism and Developmental Disorders, 37(9), 1748–1760.

    Article  PubMed  Google Scholar 

  • Rogers, S., Wehner, E., & Hagerman, R. (2001). The behavioral phenotype in fragile X: Symptoms of autism in very young children with FXS, idiopathic autism, and other developmental disorders. Journal of Developmental and Behavioral Pediatrics, 22(6), 409–417.

    Article  PubMed  Google Scholar 

  • Rogers, S. J., & Dawson, G. (2010). Early Start Denver Model for young children with autism: Promoting language, learning, and engagement. New York: Guilford Press.

    Google Scholar 

  • Rogers, S. J., Dawson, G., & Vismara, L. A. (2012a). An early start for your child with autism: Using everyday activities to help kids connect, communicate, and learn. New York: Guilford Press.

    Google Scholar 

  • Rogers, S. J., Estes, A., Lord, C., Vismara, L., Winter, J., Fitzpatrick, A., … Dawson, G. (2012b). Effects of a brief Early Start Denver model (ESDM)-based parent intervention on toddlers at risk for autism spectrum disorders: A randomized controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 51(10), 1052–1065.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rogers, S. J., Estes, A., Vismara, L. A., Munson, J., Zierhut, C., Greenson, J., … Talbott, M. (2018). Enhancing low-intensity coaching in parent implemented Early Start Denver Model intervention for early autism: A randomized comparison treatment trial. Journal of Autism and Developmental Disorders, 1–15.

  • Rogers, S. J., Hepburn, S., & Wehner, E. (2003b). Parent reports of sensory symptoms in toddlers with autism and those with other developmental disorders. Journal of Autism and Developmental Disorders, 33(6), 631–642.

    Article  PubMed  Google Scholar 

  • Rogers, S. J., Hepburn, S. L., Stackhouse, T., & Wehner, E. (2003a). Imitation performance in toddlers with autism and those with other developmental disorders. Journal of Child Psychology and Psychiatry, 44(5), 763–781.

    Article  PubMed  Google Scholar 

  • Rogers, S. J., & Vismara, L. A. (2013). P-ESDM parent coaching fidelity measure. Unpublished document.

  • Rogers, S. J., Vismara, L. A., Wagner, A. L., McCormick, C., Young, G., & Ozonoff, S. (2014). Autism treatment in the first year of life: A pilot study of Infant Start, a parent-implemented intervention for symptomatic infants. Journal of Autism and Developmental Disorders, 44(12), 2981–2995.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sameroff, A. J., & Chandler, M. J. (1975). Reproductive risk and the continuum of caretaking casualty. Review of Child Development Research, 21(4), 187–244.

    Google Scholar 

  • Schertz, H. H., Odom, S. L., Baggett, K. M., & Sideris, J. H. (2013). Effects of joint attention mediated learning for toddlers with autism spectrum disorders: An initial randomized controlled study. Early Childhood Research Quarterly, 28(2), 249–258.

    Article  Google Scholar 

  • Schreibman, L., Dawson, G., Stahmer, A. C., Landa, R., Rogers, S. J., McGee, G. G., … Halladay, A. (2015). Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(8), 2411–2428.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sigman, M., Ruskin, E., Arbeile, S., Corona, R., Dissanayake, C., Espinosa, M., … Zierhut, C. (1999). Continuity and change in the social competence of children with autism, down syndrome, and developmental delays. Monographs of the Society for Research in Child Development, 64(1), 1.114..

    Article  PubMed  Google Scholar 

  • Sparrow, S. S., Cicchetti, D. V., & Balla, D. A. (2005). Vineland adaptive behavior scales (2nd edn.). Shoreview: AGS Publishing.

    Google Scholar 

  • Statham, H., Ponder, M., Richards, M., Hallowell, N., & Raymond, F. L. (2011). A family perspective of the value of a diagnosis for intellectual disability: Experiences from a genetic research study. British Journal of Learning Disabilities, 39(1), 46–56.

    Google Scholar 

  • Talisa, V. B., Boyle, L., Crafa, D., & Kaufmann, W. E. (2014). Autism and anxiety in males with fragile X syndrome: An exploratory analysis of neurobehavioral profiles from a parent survey. American Journal of Medical Genetics, 164(5), 1198–1203.

    Article  Google Scholar 

  • Tarlow, K. R. (2016). Baseline Corrected Tau Caluculator. Available from https://ktarlow.com/status/tau.

  • Tarlow, K. R. (2017). An improved rank correlation effect size statistic for single-case designs: Baseline Corrected Tau. Behavioral Modification, 41(4), 427–467.

    Article  Google Scholar 

  • Trepal, H., Haberstroh, S., Duffey, T., & Evans, M. (2007). Considerations and strategies for teaching online counseling skills: Establishing relationships in cyberspace. Counselor & Education, 46, 266–279.

    Article  Google Scholar 

  • Vismara, L. A., McCormick, C., Monlux, K., Nadhan, A., & Young, G. S. (2016). Telehealth parent training in the Early Start Denver Model: Results from a randomized controlled study. Focus on Autism and Other Developmental Disabilities, 33(2), 67–79.

    Article  Google Scholar 

  • Vismara, L. A., McCormick, C., Young, G. S., Nadhan, A., & Monlux, K. (2013). Preliminary findings of a telehealth approach to parent training in autism. Journal of Autism and Developmental Disorders, 43(12), 2953–2969.

    Article  PubMed  Google Scholar 

  • Vivanti, G., & Dissanayake, C. (2016). Outcome for children receiving the Early Start Denver Model before and after 48 months. Journal of Autism and Developmental Disorders, 46(2), 2441–2449.

    Article  PubMed  Google Scholar 

  • Vivanti, G., Dissanayake, C., Zierhut, C., & Rogers, S. J. (2013). Brief Report: Predictors of Outcomes in the Early Start Denver Model delivered in a group setting. Journal of Autism and Developmental Disorders, 43(7), 1717–1724.

    Article  PubMed  Google Scholar 

  • Wallace, K. S., & Rogers, S. J. (2010). Intervening in infancy: Implications for autism spectrum disorders. Journal of Child Psychology and Psychiatry, 51(12), 1300–1320.

    Article  PubMed  Google Scholar 

  • Wetherby, A. M., Guthrie, W., Woods, J., Schatschneider, C., Holland, R. D., Morgan, L., & Lord, C. (2014). Parent-implemented social intervention for toddlers with autism: An RCT. Pediatrics, 134(6), 1084–1093.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wheeler, A. C., Mussey, J., Villagomez, A., Bishop, E., Raspa, M., Edwards, A., … Bailey, D. B. Jr. (2015). DSM-5 changes and the prevalence of parent-reported autism spectrum symptoms in Fragile X syndrome. Journal of Autism and Developmental Disorders, 45(3), 816–829.

    Article  PubMed  Google Scholar 

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Acknowledgments

We gratefully acknowledge the families who participated in this study, as well as Melanie Rothfuss and Patrick Hugunin for their work involved with behavioral coding and the manuscript.

Funding

This study was funded by the MIND Institute and the National Fragile X Foundation (NFXF) awarded to Laurie A. Vismara and David Hessl.

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Authors and Affiliations

  1. MIND Institute, University of California Davis Medical Center, 2825 50th Street, Sacramento, CA, 95817, USA

    Laurie A. Vismara, Rebecca Shields & David Hessl

  2. Human Development and Family Studies, Purdue University, Fowler Memorial House, Rm. 202 1200 W. State Street, West Lafayette, IN, 47907-2055, USA

    Carolyn E. B. McCormick

  3. Department of Psychiatry and Behavioral Sciences, University of California Davis Medical Center, 2230 Stockton Blvd., Sacramento, CA, 95817, USA

    Rebecca Shields & David Hessl

Authors
  1. Laurie A. Vismara
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  2. Carolyn E. B. McCormick
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  4. David Hessl
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Contributions

LAV designed and implemented the study, co-assisted in the analyses of data, wrote the bulk of the manuscript, and addressed the reviewers’ comments and revisions made to the manuscript. CEBM conducted the statistical analyses, lead the analysis of the data, wrote the results section of the manuscript, and responded with revisions to the statistical analyses, data, and results section of the manuscript. RS participated in the coding of data. DH provided clinical guidance on the implementation of the study, developed and made changes per reviewers’ requests to the figures representing the data, and assisted with manuscript development and revisions to the manuscript addressing the reviewers’ comments.

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Correspondence to Laurie A. Vismara.

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Conflict of interest

Potential conflicts of interest for Laurie A. Vismara involve royalties from publications and honoraria received from lectures related to the parent-delivered Early Start Denver Model. David Hessl serves on the Scientific Advisory Board and the Clinical Trials Committee of the NFXF.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from parents or legal guardians of all individual participants for whom identifying information is included in this article. No adverse effects of the study occurred.

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Vismara, L.A., McCormick, C.E.B., Shields, R. et al. Extending the Parent-Delivered Early Start Denver Model to Young Children with Fragile X Syndrome. J Autism Dev Disord 49, 1250–1266 (2019). https://doi.org/10.1007/s10803-018-3833-1

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