Devescovi Raffaella, Monasta Lorenzo, Mancini Alice, Bin Maura, Vellante Valerio, Carrozzi Marco, Colombi Costanza
Division of Child Neurology and Psychiatry, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
Clinical Epidemiology and Public Health Research Unit, Institute for Maternal and Child Health - IRCCS "Burlo Garofolo", Trieste, Italy.
Neuropsychiatr Dis Treat. 2016 Jun 14;12:1379-84. doi: 10.2147/NDT.S106850. eCollection 2016.
Early diagnosis combined with an early intervention program, such as the Early Start Denver Model (ESDM), can positively influence the early natural history of autism spectrum disorders. This study evaluated the effectiveness of an early ESDM-inspired intervention, in a small group of toddlers, delivered at low intensity by the Italian Public Health System.
Twenty-one toddlers at risk for autism spectrum disorders, aged 20-36 months, received 3 hours/wk of one-to-one ESDM-inspired intervention by trained therapists, combined with parents' and teachers' active engagement in ecological implementation of treatment. The mean duration of treatment was 15 months. Cognitive and communication skills, as well as severity of autism symptoms, were assessed by using standardized measures at pre-intervention (Time 0 [T0]; mean age =27 months) and post-intervention (Time 1 [T1]; mean age =42 months).
Children made statistically significant improvements in the language and cognitive domains, as demonstrated by a series of nonparametric Wilcoxon tests for paired data. Regarding severity of autism symptoms, younger age at diagnosis was positively associated with greater improvement at post-assessment.
Our results are consistent with the literature that underlines the importance of early diagnosis and early intervention, since prompt diagnosis can reduce the severity of autism symptoms and improve cognitive and language skills in younger children. Particularly in toddlers, it seems that an intervention model based on the ESDM principles, involving the active engagement of parents and nursery school teachers, may be effective even when the individual treatment is delivered at low intensity. Furthermore, our study supports the adaptation and the positive impact of the ESDM entirely sustained by the Italian Public Health System.
早期诊断与早期干预计划（如早期丹佛模式[ESDM]）相结合，可对自闭症谱系障碍的早期自然病程产生积极影响。本研究评估了意大利公共卫生系统以低强度为一小群幼儿提供的受ESDM启发的早期干预的有效性。
21名年龄在20 - 36个月的有自闭症谱系障碍风险的幼儿，接受了由训练有素的治疗师提供的每周3小时的一对一受ESDM启发的干预，并结合家长和教师在治疗的生态实施中的积极参与。治疗的平均持续时间为15个月。在干预前（时间0 [T0]；平均年龄 = 27个月）和干预后（时间1 [T1]；平均年龄 = 42个月），使用标准化测量方法评估认知和沟通技能以及自闭症症状的严重程度。
通过一系列配对数据的非参数威尔科克森检验表明，儿童在语言和认知领域有统计学上的显著改善。关于自闭症症状的严重程度，诊断时年龄较小与评估后改善程度较大呈正相关。
我们的结果与强调早期诊断和早期干预重要性的文献一致，因为及时诊断可以降低自闭症症状的严重程度，并提高年幼儿童的认知和语言技能。特别是在幼儿中，基于ESDM原则的干预模式，即使个体治疗以低强度进行，似乎也可能有效，因为它涉及家长和幼儿园教师的积极参与。此外，我们的研究支持了由意大利公共卫生系统完全支持的ESDM的适应性和积极影响。
