A New Model of Therapy Mediated by Parents for Children with Autism and Pervasive Developmental Disorder

Background:  The social impairment, communicative, attentive and play skills shared reduce opportunities for children with Autism and Pervasive Developmental Disorder (PDD) to take advantage of natural experiences of everyday interaction. The development of socio-communicative skills in PDD was, in fact, the key objective of years of research from which they originated many types of therapeutic intervention. Our contribution concerns a model of Therapy Mediated by Parents (TMG) experienced at the outset, at the UOC Neuropsychiatry Bambino Gesù Children's Hospital in Rome. This model aims to enhance mutual communication and social interaction in a setting starring children and their parents. These become mediators of the proposed therapy in the clinical setting, proposing it to the child in his daily environment.
Objectives:  The aim of this pilot study is to test the efficacy of a Therapy model Mediated by Parents in increasing the communication skills of children with PDD, compared to usual rehabilitation treatments.

Methods: A randomized controlled trial involving 26 children (20 boys and 6 girls; M age = 4.55 years; SD =  ± 1.03) who met criteria for PDD and their parents participated in the study. All children followed a psychoeducational therapy by less than 1 year. For the sperimental group was added the TMG. 

Both groups were administered the following tests at T0 and T1.

• ADOS (Lord et al 2000)
• ADI-R (Lord et al 1994)
• GDMS - ER (Griffith,2006)  
• Vineland (Sparrow, Balboni, Pedrabissi, 2001)
• PVB Primo Vocabolario del Bambino (Caselli, Casadio, 1995)
• PSI Parent Stress Index ( Abidin, 1995)
• CBLC Child Beavior Checklist (Achenbach, 2001)

To encode the intervention and make it repeatable, we created a detailed manual of TMG . To this end, meetings have been provided training for therapists before treatment and after the feedback meetings and interim post TMG treatment in order to standardize the structure of the manual.
The treatment consists of 6 monthly meetings as follows:
1. Psychoeducation and focus attention on the interest of the child
2. Posture to encourage interaction
3. Using simple language and appropriate
4. Reinforcement of communication
5. Promotion of the child's
6. Route calculation and verification key points
Each session lasts 50 minutes di TMG in the first part
is devoted to role playing exercises focused on the theme of the meeting and the last part is delivered to the parents a memorandum with the key points of the session and a homework to be done at home under discussion at the next.

Results: The comparison between the two groups after treatment showed a significant difference in the scale of communication dell'ADOS for the group that followed the TMG.

Conclusions:  

A first analysis of data shows a statistically significant difference between the experimental group and control groups in the area of communication, both measured A) on a scale with dell'ADOS  and B) on  the percentage of children who become verbal (definited as: use of more than 5 words ). Overall, the other parameters analyzed did not differ significantly the two groups. In order to further verify the effectiveness of the treatment we propose to increase the sample, systematically measure and carry out follow up at 6 months and a year