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Saint-Georges C, Pagnier M, Ghattassi Z, Hubert-Barthelemy A, Tanet A, Clément MN, Soumille F, Crespin GC, Pellerin H, Cohen D. 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. EClinicalMedicine 2020; 26:100537. [PMID: 33089127 PMCID: PMC7565367 DOI: 10.1016/j.eclinm.2020.100537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Children with autism spectrum disorder (ASD) and intellectual disability (ID) are an understudied population whose school inclusion is challenging. METHODS We assessed the effects of "Developmental and Sequenced one-to-one Educational Intervention" (DS1-EI), a ten-hour-per-week adapted instruction programme for five- to nine-year-old children with ASD and ID treated in outpatient health care institutions. A single-blind multisite randomized controlled trial was conducted to compare DS1-EI given for three years with treatment as usual (TAU)(trial registration numbers: ANSM130282B-31 (April 16, 2013) and ACTRN12616000592448). The primary outcome was the change in the psycho-educational profile (PEP). Secondary variables included the Childhood Autism Rating Scale (CARS), Autism Diagnostic Interview-Revised (ADI-R), Vineland Adaptive Behaviour Scale-II (VABS-II), Children's Global Assessment Scale (CGAS) and annual assessment of educational achievement. Statistical analyses used linear mixed models. FINDINGS Seventy-two participants with severe ASD and ID were recruited. Intention-to-treat and per-protocol analyses showed no significant group*time interaction for the PEP, CARS, ADI-R, VABS-II and CGAS but a significant effect for educational achievement with a better improvement in the DS1-EI group. At the 36-month time point, more DS1-EI children were included in mainstream classrooms. Additional analyses using multivariate models taking into account moderating variables at the baseline (e.g., Developmental Quotient) confirmed that DS1-EI had a significant effect on educational outcomes. INTERPRETATION DS1-EI did not improve communication or social skills in children with ASD and ID compared with TAU. However, DS1-EI enhanced school skills in four domains (language, mathematics, inter modality, and school autonomy) favouring inclusion in mainstream classrooms more than TAU. Providing such adapted instruction is feasible and should be encouraged. FUNDING CNSA; Fondation Bettencourt-Schueller; Fondation EDF.
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Affiliation(s)
- Catherine Saint-Georges
- Institut des Systèmes Intelligents et de Robotiques, Sorbonne Université, 75005, Paris, France
- Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 47 bd de l'Hôpital, 75013 Paris, France
- Hôpital de jour André Boulloche, Association Cerep-Phymentin, 56 rue du Faubourg Poissonnière, 75010 Paris, France
| | - Maryse Pagnier
- Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 47 bd de l'Hôpital, 75013 Paris, France
| | - Zeineb Ghattassi
- Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 47 bd de l'Hôpital, 75013 Paris, France
| | - Annick Hubert-Barthelemy
- Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 47 bd de l'Hôpital, 75013 Paris, France
- Association Programme de Recherche et d'Etudes sur l'Autisme, 7, Square Dunois, 75013 Paris, France
| | - Antoine Tanet
- Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 47 bd de l'Hôpital, 75013 Paris, France
| | - Marie-Noëlle Clément
- Hôpital de jour André Boulloche, Association Cerep-Phymentin, 56 rue du Faubourg Poissonnière, 75010 Paris, France
| | - François Soumille
- Association Régionale pour l'Intégration, 26 rue Saint Sébastien, 13006 Marseille, France
| | - Graciela C. Crespin
- Association Programme de Recherche et d'Etudes sur l'Autisme, 7, Square Dunois, 75013 Paris, France
| | - Hugues Pellerin
- Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 47 bd de l'Hôpital, 75013 Paris, France
| | - David Cohen
- Institut des Systèmes Intelligents et de Robotiques, Sorbonne Université, 75005, Paris, France
- Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 47 bd de l'Hôpital, 75013 Paris, France
- Corresponding author at: Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 47 bd de l'Hôpital, 75013 Paris, France.
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Tanet A, Hubert-Barthelemy A, Clément MN, Soumille F, Crespin GC, Pellerin H, Allaert FA, Cohen D, Saint-Georges C. 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. BMC Pediatr 2020; 20:263. [PMID: 32471387 PMCID: PMC7260851 DOI: 10.1186/s12887-020-02156-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 05/20/2020] [Indexed: 12/27/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusions 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. Trial registration ANSM130282B-31 (April 16, 2013) and ACTRN12616000592448. Registered 6 May 2016, retrospectively registered, http://www.anzctr.org.au/
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Affiliation(s)
- Antoine Tanet
- Institut des Systèmes Intelligents et de Robotiques, Sorbonne Université, 75005, Paris, France.,Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 75013, Paris, France
| | - Annick Hubert-Barthelemy
- Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 75013, Paris, France.,Association Programme de Recherche et d'Etudes sur l'Autisme, 7, square Dunois, 75013, Paris, France
| | - Marie-Noëlle Clément
- Hôpital de jour André Boulloche, association Cerep-Phymentin, 56 rue du Faubourg Poissonnière, 75010, Paris, France
| | - François Soumille
- Association Régionale pour l'Intégration, 26 rue Saint Sébastien, 13006, Marseille, France
| | - Graciela C Crespin
- Association Programme de Recherche et d'Etudes sur l'Autisme, 7, square Dunois, 75013, Paris, France
| | - Hugues Pellerin
- Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 75013, Paris, France
| | - François-André Allaert
- CEN Biotech, Parc Mazen-Sully, Zone des biotechnologies, Impasse Françoise Dolto, 21000, Dijon, France
| | - David Cohen
- Institut des Systèmes Intelligents et de Robotiques, Sorbonne Université, 75005, Paris, France. .,Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 75013, Paris, France.
| | - Catherine Saint-Georges
- Institut des Systèmes Intelligents et de Robotiques, Sorbonne Université, 75005, Paris, France.,Département de Psychiatrie de l'Enfant et de l'Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Sorbonne Université, 75013, Paris, France.,Hôpital de jour André Boulloche, association Cerep-Phymentin, 56 rue du Faubourg Poissonnière, 75010, Paris, France
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Tilmont Pittala E, Saint-Georges-Chaumet Y, Favrot C, Tanet A, Cohen D, Saint-Georges C. Clinical outcomes of interactive, intensive and individual (3i) play therapy for children with ASD: a two-year follow-up study. BMC Pediatr 2018; 18:165. [PMID: 29753322 PMCID: PMC5948870 DOI: 10.1186/s12887-018-1126-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 04/30/2018] [Indexed: 12/27/2022] Open
Abstract
Background 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. Methods 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). Results 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). Conclusion 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. Trial registration 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. Electronic supplementary material The online version of this article (10.1186/s12887-018-1126-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Claire Favrot
- Regional Psychiatric Center for Child and Adolescent with Deafness, 1st intersecteur, 64 rue de la glacière, 75013, Paris, France
| | - Antoine Tanet
- Department of Child and Adolescent Psychiatry, Hôpital de la Pitie-Salpêtriere, University Pierre and Marie Curie, 75013, Paris, France.,Institut des Systèmes Intelligents et de Robotiques, CNRS UMR 7222, Université Pierre et Marie Curie, Paris, France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Hôpital de la Pitie-Salpêtriere, University Pierre and Marie Curie, 75013, Paris, France.,Institut des Systèmes Intelligents et de Robotiques, CNRS UMR 7222, Université Pierre et Marie Curie, Paris, France
| | - Catherine Saint-Georges
- Department of Child and Adolescent Psychiatry, Hôpital de la Pitie-Salpêtriere, University Pierre and Marie Curie, 75013, Paris, France. .,Institut des Systèmes Intelligents et de Robotiques, CNRS UMR 7222, Université Pierre et Marie Curie, Paris, France.
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Xavier J, Bourvis N, Tanet A, Ramos T, Perisse D, Marey I, Cohen D, Consoli A. Bipolar Disorder Type 1 in a 17-Year-Old Girl with Wolfram Syndrome. J Child Adolesc Psychopharmacol 2016; 26:750-755. [PMID: 27045389 DOI: 10.1089/cap.2015.0241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Wolfram syndrome (WS, MIM 222300) is a rare autosomal, recessive neurodegenerative disorder associated with mutations in WFS1, a gene that has been associated with bipolar disorder (BD). WS, characterized by the association of juvenile-onset diabetes mellitus (DM) and bilateral progressive optic atrophy (BPOA), encompasses several other clinical features, including cognitive impairments and psychiatric disorders. Detailed data on the psychiatric phenotype are still scarce, and how WS relates to BD is still unknown. METHOD A 17-year-old girl with WS was hospitalized for early-onset BD. A multidisciplinary and developmental assessment was carried out to control mood symptoms and address how BD could be related to WS. RESULTS Besides DM and BPOA, the patient had several risk factors for BD/mood disorders as follows: (1) a history of abuse and maltreatment; (2) a history of specific language disorder and borderline intelligence associated with academic failure; and (3) a comorbid hypothyroidism. Treatment encompassed all aspects of the adolescent's conditions, such as the use of mood stabilizers, addressing psychosocial and scholastic problems, and treating hypothyroid dysfunction. CONCLUSION Given the complexity of WS, this case suggests that the possible association between WS and BD should not only be merely limited to a possible statistical association with WFS1 polymorphism but also to developmental, cognitive, and endocrine risk factors for BD.
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Affiliation(s)
- Jean Xavier
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière, Paris, France
| | - Nadège Bourvis
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière, Paris, France
| | - Antoine Tanet
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière, Paris, France
| | - Tatiana Ramos
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière, Paris, France
| | - Didier Perisse
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière, Paris, France
| | - Isabelle Marey
- 3 Department of Genetics, Centre de Référence Déficience Intellectuelle de Causes Rares , Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière, Paris, France
| | - David Cohen
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière, Paris, France .,2 Institut des Systèmes Intelligents et Robotiques (ISIR), CNRS UMR 7222, Université Pierre et Marie Curie , Paris, France
| | - Angèle Consoli
- 1 Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie , Assistance Publique-Hôpitaux de Paris, GH Pitié-Salpêtrière, Paris, France
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Tanet A, Hubert-Barthelemy A, Crespin GC, Bodeau N, Cohen D, Saint-Georges C. A Developmental and Sequenced One-to-One Educational Intervention for Autism Spectrum Disorder: A Randomized Single-Blind Controlled Trial. Front Pediatr 2016; 4:99. [PMID: 27725927 PMCID: PMC5035746 DOI: 10.3389/fped.2016.00099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/05/2016] [Indexed: 12/27/2022] Open
Abstract
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- to 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 behaviors, 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 min 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 enrollment, 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 vs. 3.4 (±4.5) h/week in the TAU group, Student's t-test, t = 5.83, p < 0.001]. ETHICS AND DISSEMINATION The protocol was authorized by the competent national regulatory authority (Agence nationale de sécurité du médicament et des produits de santé) and approved by the local Ethics Committee (Comité de Protection des Personnes) at the University Hospital Saint-Antoine (May 7, 2013). The findings will be disseminated through peer-reviewed journals and national and international conferences. TRIAL REGISTRATION NUMBERS ANSM130282B-31 (April 16 2013) and ACTRN12616000592448 (May 6 2016).
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Affiliation(s)
- Antoine Tanet
- Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France
- Departement de Psychiatrie de l’Enfant et de l’Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie, Paris, France
- Croix Rouge Française, Paris, France
| | | | | | - Nicolas Bodeau
- Departement de Psychiatrie de l’Enfant et de l’Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie, Paris, France
| | - David Cohen
- Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France
- Departement de Psychiatrie de l’Enfant et de l’Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie, Paris, France
| | - Catherine Saint-Georges
- Institut des Systèmes Intelligents et de Robotiques, Université Pierre et Marie Curie, Paris, France
- Departement de Psychiatrie de l’Enfant et de l’Adolescent, APHP, Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie, Paris, France
- Hôpital de jour Centre André Boulloche, Paris, France
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