Therapeutic body wraps (TBW) for treatment of severe injurious behaviour in children with autism spectrum disorder (ASD): A 3-month randomized controlled feasibility study

Abstract

IntroductionThe use of therapeutic body wraps (TBW) has been reported in small series or case reports, but has become controversial.ObjectivesThis is a feasibility, multicentre, randomized, controlled, open-label trial with blinded outcome assessment (PROBE design).SettingChildren with autism and severe-injurious behaviours (SIB) were enrolled from 13 specialized clinics.InterventionsDry-sheet TBW (DRY group) vs. wet-sheet TBW (WET group).Primary outcome measures3-month change in the Aberrant Behaviour Checklist irritability score (ABC-irritability) within per-protocol (PP) sample.ResultsFrom January 2008 to January 2015, we recruited 48 children (age range: 5.9 to 9.9 years, 78.1% male). Seven patients (4 in the DRY group, 3 in the WET group) were dropped from the study early and were excluded from PP analysis. At endpoint, ABC-irritability significantly improved in both groups (means (standard deviation) = -11.15 (8.05) in the DRY group and -10.57 (9.29) in the WET group), as did the other ABC scores and the Children Autism Rating scale score. However, there was no significant difference between groups. All but 5 patients were rated as much or very much improved. A repeated-measures analysis confirmed the significant improvement in ABC-irritability scores according to time (p < .0001), with no significant difference between the two groups (group effect: p = .55; interaction time x group: p = .27). Pooling both groups together, the mean 3-month change from baseline in ABC-irritability score was -10.90 (effect size = 1.59, p < .0001).ConclusionsWe found that feasibility was overall satisfactory with a slow recruitment rate and a rather good attrition rate. TBW was a safe complementary therapy in this population. There was no difference between wet and dry TBW at 3 months, and ABC-irritability significantly decreased with both wet and dry sheet TBW. To assess whether TBW may constitute an alternative to medication or behavioural intervention for treating SIB in ASD patients, a larger randomized comparative trial (e.g. TBW vs. antipsychotics) is warranted.Trial registrationClinicalTrials.gov NCT03164746.

Packing : quand des parents témoignent

“…Ces témoignages, très positifs vis-à-vis du packing, ont été recueillis dans un seul hôpital et ne peuvent donc rendre compte des pratiques de packing dans d'autres lieux mais ils complètent les résultats publiés dans des revues scientifiques [4][5][6][7][8] en donnant l'opportunité de connaître le point de vue des parents. Ils permettent de mieux comprendre les raisons de prescription de Ce recueil d'expériences en Seine-Saint-Denis met en évidence une discordance entre les besoins des parents qui subissent au quotidien les conséquences du manque de places et de services publics pour leur enfant, et les revendications des associations les plus visibles, qui réclament la suppression des hôpitaux de jour et qui influencent les politiques publiques [19].…”

“…Mme L. 6 élève seule, avec l'aide de sa mère, son fils unique, Antoine, né en 2011. La grossesse et l'accouchement se sont bien passés.…”

“…Dans quelques services hospitaliers en France, des enveloppements sont utilisés pour traiter la catatonie, l'anorexie ou les automutilations sévères. Cette méthode, appelée « packing », est pratiquée seulement dans certains centres pour des enfants, des adolescents et des adultes présentant des troubles autistiques sévères, de sérieux problèmes de comportement, et quand aucune thérapie n'a réussi à traiter ces symptômes [4][5][6][7][8].…”

“…En dépit des publications scientifiques [4][5][6][7][8] et des témoignages de parents qui insistaient sur les effets bénéfiques du packing sur leur enfant [14][15], l'hostilité envers le packing a augmenté et des associations ont réclamé son interdiction. Dans son discours du 21 avril 2016, Ségolène Neuville, Secrétaire d'État chargée des personnes handicapées et de la lutte contre l'exclusion, a adopté la position de l'ONU qui qualifie le packing d'acte de maltraitance.…”

Compressive Garments in Individuals with Autism and Severe Proprioceptive Dysfunction: A Retrospective Exploratory Case Series

“…Second, practitioners often observe low-functioning patients with autism spontaneously wrapping themselves in sheets [64]. Third, therapeutic procedures aiming to facilitate sensory integration, such as therapeutic body wraps (TBW), have been proposed with encouraging preliminary results [65,66]. However, they remain controversial [67].…”