About the project in English
Verifying the effectiveness of the Early intervention O.T.A. for children with positive screening in the M-CHAT-R.
HISTORY OF METHOD RESEARCH:
Methodology of the early intervention O.T.A. began to emerge in 2010. In the years 2012-2016, the first research of the effectiveness of this method took place at the Faculty of Education of Charles University in Prague. After the results were published the method was further used and developed and the results were still very encouraging.
CURRENT RESEARCH STUDY
The project aims to verify or refute the repeatability of the results by using it by other therapists, also outside the organization Centrum Terapie Autismu where the method was created, so that the method could be used by other professionals and help to reduce the impact of incipient disease on further development of children.
Who is the project for?
- For parents of children who have shown high positivity in the M-CHAT-R or M-CHAT-R/F test and want to get:
- care from top-class clinical speech
therapist, doctor care - leading expert in child
- psychiatry and four-day therapeutic stay of the child and the whole family system including ADOS-2 testing (gold standard tool) by an experienced diagnostician.
- or they want to work exclusively with the O.T.A. (parent training to work with a child)
RESULTS OF THE STUDY
Design Difference in Defferences
A test of the difference between pre-intervention and post-intervention PAS severity values was performed by a paired two-tailed t-test of the ADOS-2 total weighted score and the SA and RSP weighted scores. Normality test of pre and post test was done using S-W test. Table 2 summarizes all significant results.
ADOS-2 weighted mean scores for the intervention group (n=50)
results: green - 1 CATEGORY IMPROVEMENT (16%) , blue - 2 SEVERITY CATEGORY IMPROVEMENT (22%) and the same category of severity ASD
In terms of the impact evaluation, it is crucial that the pre- and post-intervention differences are statistically significant at the 95% significance level for the total weighted score and social aspects. More than a 30% decrease in symptom severity means a big effect. The change in repetitive behavior is not statistically significant. Graph 1 illustrates pre- and post-intervention change for individual study participants for overall CSS and for CSS SA. It shows that the intervention increased variance, mainly towards lower scores. In other words, the majority of participants improved in terms of the symptom severity (some of them very significantly), a smaller proportion remained at the same values, and only a minimum of participants slightly worsened.
Comparison of the Intervention group with the Control group
The results of the study indicate that the intervention has a statistically significant effect on the intervention group. The chance of improvement by one or both categories of severity is 3.6 times greater for children from the intervention group than for children from the control group.
Evaluation of the Effectiveness of the O.T.A. Method by a Child Psychiatrist
50 children of the Intervention group were involved. Children were examined at the entry time and at the end by the independent child psychiatrist prof. MUDr. Ivo Paclt, CSc.
The current subjective well-being (i.e. several months after the intervention) was monitored by using the Emotional Well-Being Index (WHO-5, version 1998). Respondents were asked to answer how they felt in the past two weeks in five different areas. The answer scale is 5 - all the time; 4 - most of the time; 3 - more than half the time; 2 - less than half the time; 1 - occasionally; 0 - never. The raw score ranges from 0 to 25, with 0 being the worst and 25 the best possible quality of life. A score lower than 13 points means low emotional well-being of the respondent and is an indication for depression testing according to the ICD-10. The total average gross score was 16, lower than the critical value (13 points included) was recorded by 8 respondents (29%). This proportion of women at risk of depression is comparable to the results of the female population in the EU (Eurofound, 2017) and can be interpreted as relatively low in the given context.
We retrospectively examined the emotional states induced in mothers by the information that their child might suffer from ASD. Quite understandably, the predominant emotion in the first two weeks was intense sadness, followed by feelings of despair and confusion. Some mothers also felt hopeless and angry at someone/something. On the other hand, communication of the suspicion of a disorder practically did not leave the mothers calm or indifferent. From the point of view of well-being evaluation, it was key to find out what changes have occurred in the lives of mothers since then in terms of experiencing the whole situation and in relation to the child with ASD. Respondents assessed a total of 12 changes in various aspects of their lives using the degree of agreement or disagreement with the given statement. Graphs summarize the results.
Changes since notification of suspected ASD:
Next questions: - My child attend the kindergarden now.
- My worries about my child have decrease.
- My child is significantly more independent, so I can plan my time better.
- I now have space to think about myself during the day.
- I now have more time for my partner, friends, hobbie.
- I am going to work again or I have increased my working hours now.
PROJECT TERMS AND CONDITIONS:
- High-risk of ASD (M-CHAT-R or /F ≥7)
- Children in the age of 18-36 months when entering the intervention.
- Limited capacity to the project criteria. After completing the number of 100 children and their families, recruitment ended.
Brief description of the research design
The project included 100 children and their families,
children with positive screening in M-CHAT-R. 163 families applied for entry, some did not enter, some left the project. Finally 100 children were included in the evaluation for various reasons.
At the beginning of the project, the child psychiatrist examined the child with the ADOS-2 scale, and this test was repeated after two years. The results of the intervention group were compared with the results of the control group.
The children were examined at the entry time and at the end by another independent child psychiatris, this results will be published separately.
Families were evaluated by a questionnaire which measures parental satisfaction and stress at the beginning and end of the project. The parent's questionnaire will be evaluated.
The first families enter the project in February 2019.
2019-2021 Families and children of control group (n=50) were in
the care of a child psychiatrist, clinical speech therapist and common social early care of children with autism (community care). And families of 50 toddlers in the intervention group were under the Early Intervention O.T.A., including 10 therapeutic meetings within 2 years.
2021-2022 Project evaluation and publication of research results.
Characteristics of a child with positive screening in M-CHAT-R or M-CHAT-R/F.
- In the case of a positive screening in the M-CHAT-R or M-CHAT-R/F questionnaire, it is very likely that it may be a childhood developmental disorder, some neurodevelopmental disorder.
- These disorders may, in isolated cases, gradually disappear and no longer affect the development of the child. However, in most cases, the parent needs professional assistance to stimulate the child's skills necessary for his / her healthy development. The common, intuitive upbringing is not sufficient in this case.
- Neurodevelopmental disorders also include autism spectrum disorders. On the contrary, the development with the age of the child deviates from the healthy development more clearly, is uneven and the symptom is deepening. It cannot be cured, but it can be successfully influenced by the influence of the external environment - educational procedures - to modify the manifestations.
- However, at the early age, a well-targeted intervention can stimulate skills that belong to a healthy child's development and force the brain to "rewrite" its original settings (epigenetics), strengthen the child's healthy development, and optimally achieve full integration and healthy development.
Early intervention O.T.A.
High intensity of the therapeutic action is needed to stimulate the healthy reactivity in a vulnerable child. It cannot be achieved outside the child's family. Therefore, O.T.A. - like Vojta's method - aims to train parents who become the child's main therapists.
The intervention is not focused on working with a child and training him, but on optimizing the child's external environment through his primary educators. The aim is to stimulate a child's healthy development. In its very nature, O.T.A. is suitable for the positive development of every child, as it is based on the healthy development.
Conditions of Successful Early Intervention O.T.A.
- A parent fully engaged in therapeutic work, willing to train his / her own educational skills to achieve a positive change in the child development.
- The parent should be able to minimize his or her child's demands at the beginning, and then gradually increase them and demand their fulfilment without damaging the child's regret.
- Fulfilment of the intervention plan, which looks simple, but in practice initially entails a demanding work and an effort to change mainly on the part of us educators (the work of parents is quite demanding and the first unchangeable successes come in months).
- Measure and record the behaviour into the recording sheet according to an updated intervention plan.
- The early intervention O.T.A. showed worse results in children who worked not only under the guidance of their parents but also under the regular activity of a specialized therapist. Better results are repeatedly reported by children who are only therapeutically guided by their parents under the supervision of a therapist and the child's therapy is added at a maximum of 4-5 hours over two years.
Who is involved in the project
Early intervention O.T.A. is provided by O.T.A. and VTI therapist in Center of Autism Therapy.
Video trainers trained in O.T.A. Outside the Center of Autism Therapy.
Society for Primary Pediatric Care (OSPDL)
prof. MUDr. Ivo Paclt, CSc. - child and adolescent psychiatrist
MUDr. Ryšánková - child and adolescent psychiatrist and diagnostician (NAUTIS z.s., Canadian Medical, s.r.o.)
Private Clinic Logo, Brno (children's psychiatrist and clinical psychologist)
Mgr. Přemysl Mikoláš - psychologist and psychotherapist
Mgr. Anna Vozková - psychologist
Mgr. Martin Nekola, Ph.D., Mgr. Markéte Nekolová - evaluation.
The project is run by the Autism Therapy Center.