Blanc Romuald, Latinus Marianne, Guidotti Marco, Adrien Jean-Louis, Roux Sylvie, Dansart Pascale, Barthélémy Catherine, Rambault Aude, Bonnet-Brilhault Frédérique, Malvy Joëlle
Exac-T, Centre Universitaire de Pédopsychiatrie, CHRU de Tours, Tours, France.
Université de Paris, Laboratoire de Psychopathologie et Processus de Santé, Boulogne Billancourt, France.
Front Pediatr. 2021 Dec 15;9:785762. doi: 10.3389/fped.2021.785762. eCollection 2021.
Early intervention programs positively affect key behaviors for children with autism spectrum disorder (ASD). However, most of these programs do not target children with severe autistic symptomatology associated with intellectual disability (ID). This study aimed to investigate the psychological and clinical outcomes of children with severe autism and ID enrolled in the Tailored and Inclusive Program for Autism-Tours (TIPA-T). The first step of the TIPA-T is the Exchange and Development Therapy (EDT): an individual neurofunctional intervention consisting of one-to-one exchanges between a child and a therapist taking place in a pared-down environment. It aims to rehabilitate psychophysiological abilities at the roots of social communication through structured sequences of "social play." Cognitive and socio-emotional skills and general development were evaluated with the Social Cognitive Evaluation Battery scale and the Brunet-Lézine Scale-Revised, respectively, before and after 9 months of intervention in 32 children with ASD and ID. Autistic symptomatology was evaluated with the Behavior Summarized Evaluation-Revised scale at five time-points in a subset of 14 children, both in individual and group settings. Statistically significant post-intervention improvements were found in cognitive and socio-emotional skills. All but one child showed improvements in at least one social domain, and 78% of children gained one level in at least four social domains. Twenty-nine children improved in cognitive domains, with 66% of children improving in at least three cognitive domains. Autistic symptomatology evaluated in one-to-one settings significantly decreased with therapy; this reduction was observed in more than 85% of children. In group settings, autistic symptomatology also decreased in more than 60% of children. Global developmental age significantly increased by 3.8 months. The TIPA-T, including EDT in particular, improves socio-emotional skills of most children with ASD and reduces autistic symptomatology, yet with heterogeneous outcomes profiles, in line with the strong heterogeneity of profiles observed in ASD. At the group level, this study highlights the benefits of the TIPA-T for children with severe autism and associated ID. Assessment of autistic core symptoms showed an improvement of social interaction, both in one-to-one and group evaluations, demonstrating the generalizability of the skills learned during the EDT.
早期干预项目对自闭症谱系障碍(ASD)儿童的关键行为有积极影响。然而,这些项目大多并未针对伴有智力残疾(ID)且有严重自闭症症状的儿童。本研究旨在调查参加自闭症定制与融合项目——探索之旅(TIPA-T)的重度自闭症和ID儿童的心理和临床结局。TIPA-T的第一步是交流与发展疗法(EDT):一种个体神经功能干预,由儿童与治疗师在精简环境中进行一对一交流组成。它旨在通过“社交游戏”的结构化序列,恢复社会交往根源处的心理生理能力。在对32名患有ASD和ID的儿童进行9个月干预前后,分别使用社会认知评估量表和修订后的布鲁内-勒津量表评估认知和社会情感技能以及总体发育情况。在14名儿童的子集中,在五个时间点使用修订后的行为总结评估量表在个体和小组环境中评估自闭症症状。干预后在认知和社会情感技能方面发现了具有统计学意义的改善。除一名儿童外,所有儿童在至少一个社会领域都有改善,78%的儿童在至少四个社会领域提升了一个等级。29名儿童在认知领域有所改善,66%的儿童在至少三个认知领域有所改善。在一对一环境中评估的自闭症症状通过治疗显著减轻;超过85%的儿童出现了这种减轻情况。在小组环境中,超过60%的儿童自闭症症状也有所减轻。总体发育年龄显著增加了3.8个月。TIPA-T,特别是包括EDT,改善了大多数ASD儿童的社会情感技能并减轻了自闭症症状,但结果存在异质性,这与在ASD中观察到的强烈异质性特征一致。在群体层面,本研究突出了TIPA-T对重度自闭症及相关ID儿童的益处。对自闭症核心症状的评估显示,在一对一和小组评估中社会互动均有改善,证明了在EDT期间所学技能的可推广性。