Groupe Hospitalo-Universitaire Pitié-Salpêtrière, 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.
Centre Nantais de Parentalité, 1 rue Marmontel, Centre Hospitalo-Universitaire, 44000 Nantes, France.
Res Dev Disabil. 2024 Apr;147:104688. doi: 10.1016/j.ridd.2024.104688. Epub 2024 Mar 2.
Prognostic factors from naturalistic treatment studies of children with Autism Spectrum Disorder (ASD) remain largely unknown. We aimed to identify baseline and treatment-related prognostic predictors at 1-year follow-up after Integrative Care Practices (ICPs).
Eighty-nine preschool children with severe ASD were given ICP combining nine therapeutic workshops based on children's needs. Participants were assessed at baseline and during 12 months follow-up with the Psycho-educational Profile-3-R, Children Autism Rating Scale, Parental Global Impression, and the Autistic Behaviors Scale. We assessed prognostic predictors using multivariable regression models and explored treatment ingredients influencing outcome using Classification and Regression Trees (CART).
Multivariable models showed that being a child from first generation immigrant parents predicted increased maladaptive behaviors, whereas play activities had an opposite effect; severity of ASD symptoms and impaired cognitive functions predicted worse autism severity at follow-up; and lower play activities predicted worse parent impression. Regarding treatment effects, more emotion/behavioral interventions predicted better outcomes, and more communication interventions predicted lower autism severity, whereas more education and cognitive interventions had an opposite effect. CART confirmed that more hours of intervention in the emotion/behavioral domain helped classifying cases with better outcomes. More parental support was associated with decreased maladaptive behaviors. Sensorimotor and education interventions also significantly contributed to classifying cases according to outcomes but defined subgroups with opposite prognosis.
Children who exhibited the best prognosis following ICPs had less autism severity, better cognition, and non-immigrant parents at baseline. Emotion/behavior interventions appeared key across all outcomes and should be promoted.
自闭症谱系障碍（ASD）患儿的自然治疗研究预后因素在很大程度上尚不清楚。我们旨在确定综合护理实践（ICPs）后 1 年随访时的基线和治疗相关预后预测因素。
89 名患有严重 ASD 的学龄前儿童接受了结合了基于儿童需求的九个治疗性工作坊的 ICP。参与者在基线和 12 个月的随访中接受了心理教育概况-3-R、儿童自闭症评定量表、父母总体印象和自闭症行为量表的评估。我们使用多变量回归模型评估预后预测因素，并使用分类回归树（CART）探索影响结果的治疗成分。
多变量模型显示，第一代移民父母的孩子表现出更多的适应不良行为，而游戏活动则有相反的效果；自闭症症状的严重程度和认知功能受损预测随访时自闭症严重程度更差；而较低的游戏活动则预测父母的印象更差。关于治疗效果，更多的情绪/行为干预预测更好的结果，更多的沟通干预预测自闭症严重程度较低，而更多的教育和认知干预则有相反的效果。CART 证实，情绪/行为领域的干预时间增加有助于更好的结果分类。更多的父母支持与减少适应不良行为有关。感觉运动和教育干预也显著有助于根据结果对病例进行分类，但定义了预后相反的亚组。
在 ICP 后表现出最佳预后的儿童在基线时具有较低的自闭症严重程度、更好的认知和非移民父母。情绪/行为干预似乎在所有结果中都是关键的，应该得到推广。
