Suivi qualitatif de l’évolution de 120 enfants porteurs de troubles du spectre autistique pris en charge par la méthode des 3i

International audienceAimThe 3i intervention is a developmental play-therapy method that considers that children with Autism Spectrum disorders (ASD) present an altered developmental process. It aims to help the child progress along a natural developmental path. Each developmental deficit is dealt with successively, with full attention to the specific sensory characteristics of each child. The method is based on Intensive Individual Interaction (the 3Is) of the child with adults. The 3i intervention is managed by the parents and selected care-givers, 5 to 6 hours per day, 7 days per week, to favor constant stimulation of the child. A key characteristic of the 3i method is the intervention of numerous selected care-givers, each contributing their preferred way of playing with the child and their enthusiasm. These selected care-givers are mostly non-professionals in the field of ASD. They undergo preliminary screening and receive initial training before interacting with the child in the playroom. They subsequently participate each month in a group session with the other participants, together with the parents, under the supervision of a trained psychologist.GoalThe main objective of this retrospective study was to assess the development of communication and social skills among children diagnosed with autism spectrum disorders (ASD), treated with the 3i method for 2 years.Methods120 subjects who pursued the 3i method for 24 months were included in this study, on the basis of their individual files kept by the psychologist, who conducted the monthly meeting with professionals during the implementation of the 3i method. The psychologist rated six indicators (Imitation, Gaze Quality, Social and Emotional Regulation, Verbal Expression, Non-Verbal Expression and Verbal Comprehension) from 1 to 3 (1: not acquired; 2: partially acquired and 3: competence acquired). Thus a developmental acquisition stage or score was allocated to each patient at the beginning of 3i Method and 24 months later.ResultsFor each indicator, the statistical analysis showed that the group of patients significantly increased their skills over the 24 months of the 3i method. On average, the patients reached a higher level of skills in four of the six skill areas. There was a relatively greater increase in the skills relating to imitation and non-verbal communication.DiscussionBeyond the limitations arising from the retrospective nature of the study, which used a non-standardized assessment scale, these results are consistent with a previous prospective study on 20 subjects using international standardized instruments. These results suggest that disabilities related to autism spectrum disorders decrease as a result of a 3i intervention, enabling better daily-life interaction with parents and as a second step better integration in school with peers.ConclusionThis method could reduce the intensity of the autistic syndrome and improve the ability of ASD children to interact with their environment.ObjectifL’objectif de cette étude rétrospective est de décrire l’évolution des compétences en communication et relation d’un groupe d’enfants porteurs de trouble du spectre autistique et traités par la méthode des 3i pendant 2 ans.MéthodeCent-vingt dossiers d’enfants ayant poursuivi cette méthode pendant 24 mois ont été inclus dans cette étude. Un score de 1 à 3 dans une échelle d’acquisition de compétences (1 : non acquise, 2 : partiellement acquise, 3 : acquise) a été attribué à chaque sujet pour chacun des six indicateurs choisis (Imitation, Qualité du regard, Régulation sociale et émotionnelle, Expression verbale, Expression non verbale et Compréhension verbale). Les scores initiaux sont comparés aux scores finaux après 24 mois de méthode 3i.RésultatsL’analyse statistique montre que pour chaque indicateur le groupe de patients a significativement progressé au cours des 24 mois de méthode 3i. En moyenne, les sujets acquièrent un stade supérieur dans 4 domaines de compétences sur 6. La progression est plus grande dans les domaines de l’imitation et de la communication non verbale.DiscussionMalgré les limites liées au caractère rétrospectif de l’étude et à une grille d’évaluation non standardisée, les résultats sont cohérents avec une précédente étude prospective sur 20 sujets avec des outils internationaux. Ce résultat suggère que les handicaps liés aux troubles du spectre autistique diminuent au cours de la prise en charge 3i.ConclusionCelle-ci pourrait permettre de réduire l’intensité du syndrome autistique et d’améliorer les capacités d’interaction avec l’environnement