Groupe Hospitalo-Universitaire Pitié-Salpêtrière, Institut des pathologies du Développement de l'Enfant et de l'AdoLescent (IDEAL), APHP. SU, Paris, France.
Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7222, Institut des Systèmes Intelligents et Robotiques, Sorbonne Université, Paris, France.
PLoS One. 2022 Oct 6;17(10):e0272693. doi: 10.1371/journal.pone.0272693. eCollection 2022.
The prevalence of autism-spectrum disorder (ASD) has been shown to be higher in migrant families, but it is also a challenge for health care professionals to offer adequate services to families that face multiple challenges. In the context of the EPIGRAM study (a French prospective, multisite, longitudinal observational study implementing integrative care practices (ICPs) for children with ASD), we aimed to assess the impact of migration on children with ASD.
89 children with ASD aged 3 to 6 years old (92% males) were recruited and followed up for 12 months. The children were clinically assessed using several instruments. At baseline, children had severe autism on average on the Children Autism Rating Scale (CARS, mean = 44; SD = 6.51) and moderate autism on the PsychoEducational profile-3-R (PEP-3-R) maladaptive behavior category (mean = 30; SD = 29.89). Thirty percent of the families had a low socio-economic status, and 56% were first-generation immigrants. For all clinical variables, children of immigrant parents had more severe autism and developmental delays at baseline. A linear mixed model established an improvement in all clinical characteristics over the 12 months of the study. This trend may be attributed to ICPs or any naturally occurring event during that period. Families shared this positive view over time. However, the improvements were slower for two clinical dimensions of the PEP-3-R in children from migrant families. For the inappropriate behavior category, the time effect diminished by an average of 0.83 percentile/month for children whose parents were migrants vs. children whose parents were non-migrants. Similarly, for verbal behavior characteristics, the time effect diminished by an average of 1.32 percentile/month for children whose parents were migrants vs. children whose parents were non-migrants.
Despite an overall positive improvement, we found that migration is associated baseline severity and progress over time in children with ASD. There is an urgent need to target the migrant population with specific research and understand the avenues that carry such higher severity.
Study registration on clinicaltrials.gov under the number NCT02154828.
自闭症谱系障碍（ASD）的患病率在移民家庭中较高，但对于医疗保健专业人员来说，为面临多种挑战的家庭提供足够的服务也是一项挑战。在 EPIGRAM 研究（一项法国前瞻性、多地点、纵向观察研究，实施自闭症儿童综合护理实践（ICPs））的背景下，我们旨在评估移民对 ASD 儿童的影响。
招募了 89 名 3 至 6 岁（92%为男性）的 ASD 儿童，并对其进行了 12 个月的随访。使用几种工具对儿童进行了临床评估。在基线时，儿童自闭症评定量表（CARS）的平均评分为 44（标准差=6.51），精神教育概况-3-R（PEP-3-R）适应行为障碍的平均评分为 30（标准差=29.89）。30%的家庭社会经济地位较低，56%是第一代移民。对于所有临床变量，移民父母的孩子在基线时自闭症和发育迟缓更严重。线性混合模型确定了所有临床特征在研究的 12 个月内都有所改善。这种趋势可能归因于 ICP 或在此期间发生的任何自然事件。家庭随着时间的推移分享了这种积极的观点。然而，对于来自移民家庭的儿童，PEP-3-R 的两个临床维度的改善速度较慢。对于不当行为类别，父母为移民的儿童的时间效应平均每月减少 0.83 个百分点，而非移民的儿童则为 0.83 个百分点。同样，对于言语行为特征，父母为移民的儿童的时间效应平均每月减少 1.32 个百分点，而非移民的儿童则为 1.32 个百分点。
尽管整体上有积极的改善，但我们发现，在 ASD 儿童中，移民与基线严重程度和随时间的进展有关。迫切需要针对移民人口开展特定研究，并了解导致这种更高严重程度的途径。
在 clinicaltrials.gov 上注册，注册号为 NCT02154828。
