Treatment As Usual (TAU) for Preschoolers with Autism: Insight from the Artificial Neural Networks Analyses

Background: In Italy TAU is composed of specific treatments performed by child neuropsychiatric services (CNS) and of school inclusion with individual support teacher. The Artificial Neural Networks have never been used in order to study the effects of treatment. Auto-CM is a special kind of Artificial Neural Network able to find out consistent trends and associations among variables creating a semantic connectivity map. The matrix of connections, visualized through minimum spanning tree filter takes into account non linear associations among variables and captures connection schemes among clusters.  

Objectives: The main aim is to use Auto-CM, a specific Artificial Neural Networks, in order to evaluate the natural relationships among outcome measure in a group preschoolers with autism engaged in a treatment as usual (TAU).  

Methods: 61 preschoolers with ASD aged between 24 and 48 months were recruited at different centers in Italy. They were evaluated by blind researchers at baseline and after six months using ADOS-G, Griffiths Mental Developmental scales, and Vineland Adaptive Behavior scales. Parents filled out MacArthur Inventory, Social Communication Questionnaire, and Child Behavior Check List. All children were referred to community providers for available interventions.

Results: At endpoint, most of the children were still classified as having an ADOS-G classification of ASD. However, 21 (34.2%) passed from Autism to Autism Spectrum and 3 (4.2%) from Autism Spectrum to Non-Spectrum. Treatment effects were obtained for cognitive functioning, language, adaptive behavior, and child behavior, without differences between developmental-oriented and behavioral-oriented interventions. Parent involvement was a mediator for the best clinical outcome. Baseline low impairments of communication, language comprehension, and gesture were predictors of positive outcome. On the other hand Auto-CM system showed complex relationships between studied outcome variables.

Conclusions: Treatment as usual, composed of individual therapy plus school supported inclusion, may be an effective intervention in ASD. Better initial levels of communication in the child and parent involvement during treatment have an important role on positive outcome.