Kaufman Assessment Battery for Children–Second Edition

A developmental and sequenced one-to-one educational intervention (DS1-EI) for autism spectrum disorder and intellectual disability: A three-year randomized, single-blind controlled trial.

The outcomes of psycho-educational interventions for Autism Spectrum Disorders (ASDs) comorbid with severe to moderate intellectual disability (ID) are insufficiently documented. In this prospective study, we examined a developmental individual, interactive and intensive approach, called the ‘3i method’, which is based on play therapy. Twenty DSM-IV-TR ASD subjects (mean chronological age 63.8 ± 37.8 months; mean developmental age 19.5 ± 6.6 months) were included and followed the 3i method for 24 months. Developmental and behavioural skills were assessed at baseline and after 24 months using the VABS, PEP-R and Nadel Imitation scale. Autism severity was evaluated using the Child Autism Rating Scale (CARS) and the Autism Diagnostic Interview (ADI-R). After 2 years of the 3i method, our 3 primary outcome variables significantly increased (VABS developmental age of socialization increased by 83%, age of communication by 34%, and Nadel Imitation score by 53%). Almost all VABS and PEP-R domains significantly improved. Additionally, increases in the VABS socialization score were positively correlated with the total number of treatment hours and CARS score; all ADI-R areas significantly decreased; and diagnoses had changed in 47.5% of the subjects (37% for PDD-NOS and even 10.5% for ID without PDD). Children who followed the 3i method for 2 years had significantly improved behavioural and developmental skills and showed a clear decrease in autism severity. These results suggest that the 3i method may be useful for autistic children by improving their daily interactions with their social environment. was retrospectively registered on May 20th, 2014 by the French Agency for drug and health (ANSM) under number ID-RCB 2014-A00542–45, reference: B148558–31.

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Clinical outcomes of interactive, intensive and individual (3i) play therapy for children with ASD: a two-year follow-up study

Children with autism spectrum disorder (ASD) and moderate to severe intellectual disability (ID) face many challenges. There is little evidence-based research into educational settings for children with ID and ASD and in France. Little is known about how this unserved population could benefit from intervention and education. This study assessed the feasibility and efficacy of a new intervention model using an individualized educational approach. We conducted a randomized, single-blind controlled trial to assess a novel intervention: the “Developmental and Sequenced One-to-One Intervention (DS1-EI)”. In DS1-EI, trained teachers worked one-to-one with each child in a small classroom setting, offering 10 h per week of the intervention. The focus was on encouraging spontaneous communication, promoting skills through play with peers, supporting positive interactions, and developmental and sequenced learning. We enrolled 5- to 9-year-old children with ASD and ID across 11 French child care institutions for children with co-occurring ASD and ID. Participants were matched in dyads by developmental quotient and randomized to the treatment-as-usual (TAU) group or the DS1-EI group. Independent raters blindly assessed the primary variables: The Childhood Autism Rating scale (CARS) and the Psychoeducational Profile, third edition (PEP-3). The secondary variables included the Vineland Adaptive Behavior Scale II (VABS-II) and the Clinical Global Assessment Scale (CGAS). Here we perform interim analyses at 24 months. At baseline, 72 participants were randomized. Nine patients (5 in the DS1-EI group and 4 in the TAU group) dropped out of the study. Using linear mixed models, both intent-to-treat (ITT) and per-protocol (PP) analyses at the 12-, 18- and 24-month outcomes showed no significant group nor group-by-time interaction effects. However, we found significant improvements in most primary and secondary variables over time in both groups. The study did not show that DS1-EI was superior to TAU in treating children with ASD and ID over 24 months. However, the low dropout rate shows that DS1-EI is feasible, and well accepted. As the study is still ongoing, we need to wait for data at 36 months to ensure whether DS1-EI could be recommended. ANSM130282B-31 (April 16, 2013) and ACTRN12616000592448
 . Registered 6 May 2016, retrospectively registered, http://www.anzctr.org.au/

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Developmental and Sequenced One-To-One Educational Intervention (DS1-EI) for Autism Spectrum Disorder and Intellectual Disability: A Two-Year Interim Report of a Randomized Single-Blind Multicenter Controlled Trial

Enabling functional communication is critical for accessibility in school and society for all pupils. This systematic review analyzed the results of educational studies on developing communication ...

Educational Approaches to Improve Communication Skills of Learners with Autism Spectrum Disorder and Comorbid Intellectual Disability: An Integrative Systematic Review

Introduction: Individuals with Autism Spectrum Disorder (ASD) who also exhibit severe to moderate ranges of intellectual disability (ID) still face many challenges (i.e. less evidence-based trials, less inclusion in school with peers). Methods: We implemented a novel model called the “Developmental and Sequenced One-to-One Educational Intervention” (DS1-EI) in 5-9-year-old children with co-occurring ASD and ID. The treatment protocol was adapted for school implementation by designing it using an educational agenda. The intervention was based on intensity, regular assessments, updating objectives, encouraging spontaneous communication, promoting skills through play with peers, supporting positive behaviours, providing supervision, capitalizing on teachers’ unique skills, and providing developmental and sequenced learning. Developmental learning implies that the focus of training is what is close to the developmental expectations given a child’s development in a specific domain. Sequenced learning means that the teacher changes the learning activities every 10-15 minutes to maintain the child’s attention in the context of an anticipated time agenda. We selected 11 French institutions in which we implemented the model in small classrooms. Each institution recruited participants per dyads matched by age, sex and developmental quotient. Patients from each dyad were then randomized to a DS1-EI group or a Treatment as usual (TAU) group for 36 months. The primary variables – the Childhood Autism Rating scale (CARS) and the psychoeducational profile (PEP-3) – will be blindly assessed by independent raters at the 18-month and 36-month follow-up. Discussion and baseline description: We enrolled 75 participants: 38 were randomized to the DS1-EI and 37 to the TAU groups. At enrolment, we found no significant differences in participants’ characteristics between groups. As expected, exposure to school was the only significant difference (9.4 (±4.1) h/week in the DS1-EI group versus 3.4 (±4.5) h/week in the TAU group, Student’s t-test, t=5.83, p<.001). Ethics and dissemination: The protocol was authorized by the competent national regulatory authority [Agence nationale de securite du medicament et des produits de sante (ANSM)] and approved by the local Ethics Committee (Comite de Protection des Personnes) at the University Hospital Saint-Antoine (May 7, 2013). The findings will be disseminated through peer-reviewed journals.

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Hélène Petiton

Papers

A Developmental and Sequenced One-to-One Educational Intervention for Autism Spectrum Disorder: A Randomized Single-Blind Controlled Trial