PLAY Programme d'intervention de consultation de projet à domicile pour les jeunes enfants avec des troubles du spectre autistique: un essai contrôlé randomisé

Traduction: G.M.

J Dev Behav Pediatr. 2014 Oct;35(8):475-85. doi: 10.1097/DBP.0000000000000096.

PLAY Project Home Consultation Intervention Program for Young Children With Autism Spectrum Disorders: A Randomized Controlled Trial 

Solomon R¹, Van Egeren LA, Mahoney G, Quon Huber MS, Zimmerman P.

Author information

• ¹*Ann Arbor Center for Developmental and Behavioral Pediatrics, Ann Arbor, MI; †Community Evaluation and Research Collaborative, Office of University Outreach and Engagement, Michigan State University, East Lansing, MI; ‡Center on Intervention for Children and Families, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH.

Abstract

OBJECTIVE:

To evaluate the effectiveness of the Play and Language for Autistic Youngsters (PLAY) Project Home Consultation model, in combination with usual community services (CS), to improve parent-child interaction, child development, and autism symptomatology in young children with autism spectrum disorders (ASDs) compared with CS only.
Evaluer l'efficacité de Play and Language for Autistic Youngsters  (PLAY), modèle de projet de consultation à domicile, en combinaison avec les services communautaires habituels (CS), pour améliorer l'interaction parent-enfant, le développement de l'enfant, et la symptomatologie de l'autisme chez les jeunes enfants avec des troubles du spectre autistique (TSA) comparée aux seuls CS.  

METHODS:

Children (N = 128) with autism or PDD-NOS (DSM-4 criteria) aged 2 years 8 months to 5 years 11 months and recruited from 5 disability agencies in 4 US states were randomized in two 1-year cohorts. Using videotape and written feedback within a developmental framework, PLAY consultants coached caregivers monthly for 12 months to improve caregiver-child interaction. CS included speech/language and occupational therapy and public education services. Primary outcomes included change in parent-child interactions, language and development, and autism-related diagnostic category/symptoms. Secondary outcomes included parent stress and depression and home consultant fidelity. Data were collected pre- and post-intervention.

RESULTS:

Using intent-to-treat analysis (ITT), large treatment effects were evident for parent and child interactional behaviors on the Maternal and Child Behavior Rating Scales. Child language and developmental quotient did not differ over time by group, although functional development improved significantly. PLAY children improved in diagnostic categories on the Autism Diagnostic Observation Schedule (ADOS). PLAY caregivers' stress did not increase, and depressive symptomatology decreased. Home consultants administered the intervention with fidelity.
En utilisant l'analyse intention de traiter (ITT), de grands effets du traitement étaient évidents pour les comportements d'interaction parents et enfants sur l'échelle d'évaluation du comportement maternel et infantile. Le langage de l'enfant et quotient de développement ne diffèrent pas au fil du temps par groupe, bien que le développement fonctionnel s'améliore de manière significative. Les enfants PLAY s'améliorent dans les catégories de diagnostic de l'Autism Diagnostic Observation Schedule (ADOS). Le stress des soignants PLAY n'a pas augmenté, et la symptomatologie dépressive a diminué. Les consultants à domicile administrent l'intervention avec fidélité. 

CONCLUSIONS:

PLAY intervention demonstrated substantial changes in parent-child interaction without increasing parents' stress/depression. ADOS findings must be interpreted cautiously because results do not align with clinical experience. PLAY offers communities a relatively inexpensive effective intervention for children with ASD and their parents.
L'intervention PLAY montre des changements importants dans l'interaction parent-enfant sans augmenter le stress / la dépression des parents. Les conclusions de l'ADOS doivent être interprétées avec prudence, car les résultats ne sont pas alignés avec l'expérience clinique. PLAY offre aux collectivités une intervention efficace relativement peu coûteuse pour les enfants avec TSA et leurs parents. 

PMID: 25264862