A Tool for Setting Therapeutic Goals by the Multidisciplinary Team for the Preschool Age Child with ASD

Background: The clinical profile of children with ASD varies considerably at the early stages of development. A variety of specific deficits may be observed e.g. feeding difficulties, motor and verbal dyspraxia, sensory integration deficits, perceptual deficits etc, therefore the need for multidisciplinary observation and assessment  is necessary for setting realistic therapeutic targets. In 2007 the interdisciplinary team of the Day Centre developed a behavior observation tool (EDALFA) which provides a clinical profile of the child’s level of function and detailed targets for intervention.  

Objectives: To test the validity of EDALFA in relation to VINELAND questionnaire filled by the parents, and to examine the usefulness of the tool in the clinical application over the years.

Methods: EDALFA consists of a developmental scale based on eight international scales and systematic review of the recent literature. It includes the following observation measures: motor development (gross and fine movements), cognitive development, speech and language development (comprehension and expression), psychosocial development (emotions-social skills), everyday skills (feeding, dressing, and toilet training), play, and a new one other(joined attention, imitation, stereotypes). In every one of those functions, at each age level (1 month to 6 years) skills ranging from 0 to 9 are described, which the typically developing child is expected to master.

Upon admission to the program three therapists (behavior, speech, occupational) observe systematically the child on a sufficient number of sessions and jointly complete the EDALFA protocol, which shows the developmental profile of the child compared to the typically developing child. A diagram of the child’s functional profile is drawn, and the targets (skills not mastered) to be addressed in therapy emerge.

The sample consisted of thirty children (30) (2yrs. to 5yrs 11 months. average: 3yrs 9 months.) diagnosed with ASD (DSM-V). For each one of them the VINELAND questionnaire was filled by the parents and EDALFA was completed by the team.  A correlation analysis was made between measures shared by the two assessment tools. 

The usefulness of EDALFA was tested using reassessments of the child’s progress, which are carried out routinely at regular intervals to set new targets. The profiles of the child over time were compared with his clinical progress in order to find out whether the measures concurred.  

Results: The correlation between EDALFA and VINELAND  was statistically significant  (r ranged from 0,61 to 0,84 in seven measures). The observed changes in the EDALFA profiles over the years of treatment corresponded strongly with the clinical progress of the child. Furthermore, the close cooperation of the different professionals sensitized the therapists to the holistic approach of the child with ASD. The therapeutic targets were shared with the parents and teachers contributing further to the child`s progress.

Conclusions: EDALFA in practice showed satisfactory usefulness in identifying non developed skills and setting hierarchical targets for the interdisciplinary team, the parents and teachers.