Expérimentation de la prise en charge Early start Denver model (ESDM) : les effets sur le développement de 4 jeunes enfants avec troubles du spectre de l’autisme

Abstract

IntroductionThe Early start Denver model (ESDM) is today recommended by the High authority of health for very young children with disorders of autism spectrum disorders (ASD). Different studies highlight the effectiveness of the method on different areas of development. The ESDM is an intensive method, it recommends at least 20hours of individual intervention per week. This method is still little used in France, the structures do not have enough human resources, equipment and premises are not suitable, the overall cost is too high. Faced with this problem, our research examines whether there may be a significant impact of the ESDM method on child development even if it is less intensive. MethodWe proposed four older ASD children of 27 to 35 months to have 4 hours of ESDM with a therapist and 3 hours with their parents for a year. All the children had a developmental assessment in using the PEP-3 (receptive and expressive language, verbal and preverbal cognition, imitation, gross motor and fine motor), the Vineland and ADOS 2, at the beginning of the ESDM therapy and 1 year after. ResultsThe development profile at the time of inclusion shows great difficulties in language (receptive and expressive) and imitation. After a year of ESDM therapy, development profile shows a more homogeneous trajectory. For some children, there is little change in expressive language. Conversely, the statistical results indicate significant increases in three areas of development: receptive language, the hand-eye imitation and verbal cognition and preverbal. Children have acquired pointing and the object and activity demand have increased in quantity and quality. Instrumental and conventional gestures have also been widely used. In the imitation domain, children have more reproduce object manipulations, they also invest in gestural imitation of songs and social routines. In the cognition area, sorting and categorization activities have quickly developed. Children are more attentive to the material during their handling, and objects are more used in line with their function. Although this group of children could benefit only from 7 hours ESDM intervention per week, their developmental trajectory have been impacted and improved. It also lead to a more homogeneous development and a stabilization of their skills. ConclusionThese positive results with less intensity could be interesting for structures or professionals who have fewer resources. Moreover, the foundations of this method: social communication, social motivation, positive affect and mutual sharing can stimulate the acquisitions and experimentations which are necessary to child development. Finally, these preliminary results are encouraging and lead us to consider the renewal of our study on a larger sample.