Effet de la formation des parents vs éducation des parents sur les problèmes de comportement chez les enfants avec des troubles du spectre autistique: un essai clinique randomisé

Traduction: G.M.

JAMA. 2015 Apr 21;313(15):1524-33. doi: 10.1001/jama.2015.3150.

Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: a randomized clinical trial

Bearss K1, Johnson C2, Smith T3, Lecavalier L4, Swiezy N5, Aman M4, McAdam DB3, Butter E6, Stillitano C7, Minshawi N5, Sukhodolsky DG8, Mruzek DW3,Turner K9, Neal T5, Hallett V10, Mulick JA6, Green B1, Handen B11, Deng Y12, Dziura J13, Scahill L1.

Author information

• 1Department of Pediatrics, Marcus Autism Center, Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia.
• 2Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania13Dr Johnson is now with the Department of Clinical and Health Psychology, University of Florida, Gainesville.
• 3Department of Pediatrics, University of Rochester, Rochester, New York.
• 4Departments of Psychology and Psychiatry, Nisonger Center, UCEDD, Ohio State University, Columbus.
• 5Department of Psychiatry, Indiana University, Indianapolis.
• 6Department of Pediatrics, Ohio State University and Nationwide Children's Hospital, Columbus.
• 7Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania.
• 8Child Study Center, Yale University, New Haven, Connecticut.
• 9Division of Education Leadership and Innovation, Mary Lou Fulton Teachers College, Arizona State University, Tempe.
• 10Institute of Psychiatry, Psychology, and Neuroscience, King's College London, Department of Psychology, London, United Kingdom.
• 11Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
• 12School of Public Health, Yale University, New Haven, Connecticut.
• 13Department of Emergency Medicine, Yale University, New Haven, Connecticut.

Abstract

IMPORTANCE:

Disruptive behavior is common in children with autism spectrum disorder. Behavioral interventions are used to treat disruptive behavior but have not been evaluated in large-scale randomized trials.

Le comportement perturbateur est fréquent chez les enfants avec des troubles du spectre autistique. Les interventions comportementales sont utilisées pour traiter les comportements perturbateurs, mais n'ont pas été évaluées dans des essais randomisés à grande échelle.

OBJECTIVE:

To evaluate the efficacy of parent training for children with autism spectrum disorder and disruptive behavior.

Evaluer l'efficacité de la formation des parents pour les enfants avec des troubles du spectre autistique et des comportements perturbateurs.

DESIGN, SETTING, AND PARTICIPANTS:

This 24-week randomized trial compared parent training (n = 89) to parent education (n = 91) at 6 centers (Emory University, Indiana University, Ohio State University, University of Pittsburgh, University of Rochester, Yale University). We screened 267 children; 180 children (aged 3-7 years) with autism spectrum disorder and disruptive behaviors were randomly assigned (86% white, 88% male) between September 2010 and February 2014.

INTERVENTIONS:

Parent training (11 core, 2 optional sessions; 2 telephone boosters; 2 home visits) provided specific strategies to manage disruptive behavior. Parent education (12 core sessions, 1 home visit) provided information about autism but no behavior management strategies.

La formation des parents (11 séances de base, deux séances facultatives; 2 rappels téléphoniques;deux visites à domicile) a fourni des stratégies spécifiques pour gérer les comportements perturbateurs. L'éducation des parents (12 sessions de base, une visite à domicile) ont fourni des informations sur l'autisme, mais pas de stratégies de gestion du comportement.

MAIN OUTCOMES AND MEASURES:

Parents rated disruptive behavior and noncompliance on co-primary outcomes: the Aberrant Behavior Checklist-Irritability subscale (range, 0-45) and the Home Situations Questionnaire-Autism Spectrum Disorder (range, 0-9). On both measures, higher scores indicate greater severity and a 25% reduction indicates clinical improvement. A clinician blind to treatment assignment rated the Improvement scale of the Clinical Global Impression (range, 1-7), a secondary outcome, with a positive response less than 3.

RESULTS:

At week 24, the Aberrant Behavior Checklist-Irritability subscale declined 47.7% in parent training (from 23.7 to 12.4) compared with 31.8% for parent education (23.9 to 16.3) (treatment effect, -3.9; 95% CI, -6.2 to -1.7; P < .001, standardized effect size = 0.62). The Home Situations Questionnaire-Autism Spectrum Disorder declined 55% (from 4.0 to 1.8) compared with 34.2% in parent education (3.8 to 2.5) (treatment effect, -0.7; 95% CI, -1.1 to -0.3; P < .001, standardized effect size = 0.45). Neither measure met the prespecified minimal clinically important difference. The proportions with a positive response on the Clinical Global Impression-Improvement scale were 68.5% for parent training vs 39.6% for parent education (P < .001).

À la semaine 24, al sosu-échelle de l'Aberrant Behavior Checklist-Irritabilité a diminué de 47,7% dans la formation des parents (23,7 à 12,4) contre 31,8% pour l'éducation des parents (23,9 à 16,3) (effet du traitement, -3,9; IC à 95%, -6,2 à - 1,7; P <0,001, la taille d'effet normalisée = 0,62). Le Questionnaire sur les troubles du spectre autistique à domicile a diminué de 55% (de 4,0 à 1,8), comparativement à 34,2% dans l'éducation des parents (3.8 à 2.5) (effet du traitement, -0,7; IC à 95%, -1,1 à -0,3; P <0,001 , la taille d'effet normalisée = 0,45). Aucune mesure n'a rencontré le différence minimale cliniquement importante prédéfinie. Les proportions avec une réponse positive à l'échelle Clinical Global Impression-amélioration ont été de 68,5% pour la formation de parent vs 39,6% pour l'éducation des parents (P <0,001).

CONCLUSIONS AND RELEVANCE:

For children with autism spectrum disorder, a 24-week parent training program was superior to parent education for reducing disruptive behavior on parent-reported outcomes, although the clinical significance of the improvement is unclear. The rate of positive response judged by a blinded clinician was greater for parent training vs parent education.

Pour les enfants avec des troubles du spectre de l'autisme, un programme de formation des parents de 24 semaines a été supérieure à l'éducation des parents pour réduire les comportements perturbateurs sur les résultats déclarées par les parents, bien que la signification clinique de l'amélioration ne soit pas claire. Le taux de réponse positive jugé par un clinicien en aveugle était plus important pour la formation des parents vs éducation des parents.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT01233414.

PMID: 25898050