Herbrecht Evelyn, Lazari Olga, Notter Marianne, Kievit Esther, Schmeck Klaus, Spiegel René
Child and Adolescent Psychiatry, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.
Front Psychiatry. 2020 Jul 14;11:687. doi: 10.3389/fpsyt.2020.00687. eCollection 2020.
Comprehensive behaviorally or developmentally based early intervention programs have been shown to be effective in improving cognitive, social communicative, and adaptive skills of children with autism spectrum disorder (ASD). Besides the definition of relevant outcome predictors, the question of whether early intensive intervention positively changes core autism symptoms in children, as well as their long-term outcome, is an important issue for current research. The primary objective of the current study was to examine whether symptomatic and behavioral changes in children up to 4.5 years with ASD were sustained one and two years after an initial 18 days of intensive FIAS (Frühintervention bei autistischen Störungen) intervention.
We analyzed the data of 32 young children with moderately severe to severe ASD who had been treated at the FIAS center between January 2011 and July 2017 and who had completed their 2-year follow-up in summer 2019.
ADOS total scores decreased significantly from baseline to the 1-year follow-up and from baseline to the 2-year follow-up (p < 0.01), with the most prominent change being from baseline to 2-year follow-up. The DD-C-GAS, a global scale used to assess four areas of everyday functioning, showed highly significant improvements on all subdomains. We found mostly significant correlations between results on both rating instruments at all time points, yet mostly no meaningful correlation between their changes over time. There was a close and statistically significant relationship between parents' treatment adherence and ADOS scores, indicating that the better parents' treatment adherence, the lower the children scored on the ADOS at 1- and 2-year follow-up. Overall, improvement on both scales was virtually independent of age and autism symptom severity at baseline, suggesting that older (>43 months) and more severely affected children (ADOS total score >20) may benefit from the FIAS intervention to the same extent as younger children do.
The results of the study indicate that the FIAS approach of providing an initial highly intensive 18-day intervention period, followed by 2 years of less intensive follow-up care had an impact on the core autism symptoms as well as the adaptive functioning of children with ASD.
基于行为或发育的综合早期干预项目已被证明能有效提高自闭症谱系障碍（ASD）儿童的认知、社交沟通和适应技能。除了确定相关的结果预测因素外，早期强化干预是否能积极改变儿童的核心自闭症症状及其长期结果，是当前研究的一个重要问题。本研究的主要目的是检验4.5岁以下患有ASD的儿童在最初18天的强化FIAS（自闭症障碍早期干预）干预后的1年和2年，其症状和行为变化是否持续存在。
我们分析了2011年1月至2017年7月在FIAS中心接受治疗并于2019年夏天完成2年随访的32名中重度至重度ASD幼儿的数据。
从基线到1年随访以及从基线到2年随访，ADOS总分均显著下降（p<0.01），最显著的变化是从基线到2年随访。DD-C-GAS是一种用于评估日常功能四个领域的综合量表，在所有子领域均显示出高度显著的改善。我们发现，在所有时间点，两种评定工具的结果之间大多存在显著相关性，但它们随时间的变化之间大多没有有意义的相关性。父母的治疗依从性与ADOS评分之间存在密切且具有统计学意义的关系，这表明父母的治疗依从性越好，孩子在1年和2年随访时ADOS的得分越低。总体而言，两个量表的改善实际上与基线时的年龄和自闭症症状严重程度无关，这表明年龄较大（>43个月）和受影响更严重的儿童（ADOS总分>20）可能与年龄较小的儿童一样从FIAS干预中获益。
研究结果表明，FIAS方法提供了一个为期18天的初始高强度干预期，随后是2年的低强度后续护理，对ASD儿童的核心自闭症症状以及适应功能产生了影响。
