The Stability of ASD Symptoms after One Year of Applied Behaviour Analysis

Background:

To establish a diagnosis of certainty at younger ages implies certain uncertainties, especially when such a heterogeneous disorder as Autistic Spectrum Disorder is involved, all the more so as the clinical aspect is complicated with characteristic elements of ADHD. In the process of development, the symptoms may change - some manifestations become more obvious, others pass in the secondary plane. Behaviour therapy improves the characteristic deficits of the comorbidity between Autism Spectrum Disorder and ADHD (based on theoretical hypotheses and clinical observations).

Objectives:

This paper aims to analyse the evolution of children diagnosed with Autism Spectrum Disorder (ASD) comorbid with ADHD type symptoms involved in an Applied Behaviour Analysis program with the identification of potential evolutionary models.

Methods:

We conducted an observational study on a group of 52 subjects (2-5 years old) diagnosed with Autism Spectrum Disorder (according to DSM IV-TR diagnostic criteria) comorbid with ADHD-specific symptoms, without significant comorbid disorders (psychiatric and somatic). Each of the subjects included in the clinical group followed a psychotherapist-conducted applied behaviour analysis program for one year, which was structured as such: 2 hours / day, 5 days / week. To standardize behaviour intervention among subjects, supervision of the intervention programs was performed by the same psychologist for all subjects.

Data collection involves a longitudinal direction by assessing the main symptomatology domains of ASD (using ADOS scores) and ADHD (using ADHD - RSboth at moment of inclusion in the study (T0) and after one year of applied behaviour analysis program (T1).

Results:

In our group, after one year of applied behaviour analysis (T1), only 27% of children still met the DSM IV-TR criteria for Autism (compared to 63% at T0), 50% meet criteria for PDD-NOS (compared to 35% at T0) and 23% of children no longer met the diagnostic criteria for Autism Spectrum Disorder. In other words, after therapy, the evolution was favourable for a significant number of children, with the diminishing and even disappearance of the clinical elements suggestive for ASD.

The favourable evolution of ASD symptoms after 1 year of therapy also results from the statistically significant differences between ADOS scores averages from T0 and T1 moments. Differences are established both in the total ADOS-C+Is domain and separately in each of the two domains. Also, there are statistically significant positive correlations between T0 and T1 scores. The average total score difference between the two moments is 2.44±2.72.

The results of the study show that 71% of the subjects had a favourable evolution of the ADOS-C+Is score, whereas only 32% of the subjects had a favourable evolution of total ADHD-RS score.

Conclusions:

Applied behaviour analysis significantly improves the ASD-specific symptomatology among children with ASD-ADHD polymorphic clinical features.

Behaviour therapy improves ADHD-specific symptomatology among children with polymorphic ASD-ADHD clinical features, but the observed differences are smaller than those highlighted for ASD symptomatology. The most frequent evolutionary pattern after one year of behaviour therapy is represented by the association between a favourable evolution of ADOS-G score and a stagnation of ADHD-RS scores.