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

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

Educational interventions used to improve the cognitive and social development of children and adolescents with autism

“…In addition, it was evidenced that the use of interactive technological devices (applications, virtual games, video modeling, and robots) stimulated the cognitive and social development of the evaluated population (Plavinick, et al, 2015;Yun, et al, 2017;Leão, et al, 2019;Fantasia, et al, 2020;Kostrubieck and Kruck, 2020;Saint-Georges, et al, 2020).…”

An adapted social communication intervention at home and education to promote social communication change in children with severe autism: the PACT-G RCT

“…Results are mixed, with no effects found on autism symptoms, but improvements in social functioning reported in the curriculum-based SCERTS trial 117 and on academic performance in the DS1-EI trial. 116 A briefer social communication classroom-based intervention 118 achieved results somewhat similar to PACT-G.…”

“…The closest in style is a RCT, conducted over 1 year, of an individually delivered social communication and educational attainment-focused intervention (DS1-EI) in specialist autism settings in France (day-care hospitals and medicoeducational institutes). 116 Participants comprised 72 children aged 5-9 years with 'severe' autism and intellectual disability. 116 Children in the intervention group received 10 hours per week of one-to-one instruction with a trained teacher (considerably more than attempted in PACT-G).…”

“…116 Participants comprised 72 children aged 5-9 years with 'severe' autism and intellectual disability. 116 Children in the intervention group received 10 hours per week of one-to-one instruction with a trained teacher (considerably more than attempted in PACT-G). The trial found no significant differences in main clinical outcomes reflecting autism symptoms, but educational attainment was significantly improved for the DS1-EI group and led to more students in the intervention group being included in mainstream classrooms at the 3-year end point.…”

Two-year follow-up of 90 children with autism spectrum disorder receiving intensive developmental play therapy (3i method)

“…In contrast, being categorized as a verbal subject by the ADI-R assessment at the beginning of the 3i intervention was associated with better outcomes concerning CARS and ADI-R interaction and communication subscores (Tables 3 and 4). As it is known that a better intellectual level, or developmental quotient, is a factor of better prognosis [29,44], it is tempting to propose that patients with higher verbal skills should perform better with 3i than those with lower verbal skills. Higher communication skills at the beginning of the 3i intervention may facilitate interaction with adults in the playroom and accelerate the decrease in ASD severity reflected by the CARS score and ADI-R's interaction and communication subscores.…”