Da: "[email protected]" <[email protected]> A: [email protected] Inviato: Martedì 21 Maggio 2013 21:37 Oggetto: [autismo-biologia] Outcomes negli adulti - Ricerche, articoli Buonasera, pur comprendendo la complessità e i criteri di rigore statistico e scientifico necessari, che molto probabilmente rendono la domanda poco pertinente, vi chiedo se esistono studi e ricerche recenti che mettano in relazione le terapie di intervento educativo precoci con gli outcomes negli adulti. Grazie Saluti AM Nel 2011 è stato pubblicato un importante lavoro che, nell’ambito della rassegna critica della letteratura sulle terapie dello spettro autistico pubblicata nella decade 2000 - 2010, si pone il problema posto da Armando Warren Z, Veenstra-VanderWeele J, Stone W, Bruzek JL, Nahmias AS, Foss-Feig JH, Jerome RN, Krishnaswami S, Sathe NA, Glasser AM, Surawicz T, McPheeters ML. Therapies for Children With Autism Spectrum Disorders. Comparative Effectiveness Review No. 26. (Prepared by the Vanderbilt Evidence-based PracticeCenter under Contract No. 290-2007-10065-I.) AHRQ Publication No. 11-EHC029-EF. Rockville, MD: Agency for Healthcare Research and Quality. April 2011. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm. Più che risposte il lavoro evidenzia le molte domande a cui ora non si puo’ dare risposta. Il follw up, quando c’è, è di pochi mesi o pochi anni e la migliore qualità di vita in età adulta di chi è stato trattato precocemente con gli approcci più evidence based per ora resta un auspicio, ma non una realtà documentata. Dal lavoro citato copio alcuni stralci While controlled trials seem to be increasing, much research is observational, generally with small sample sizes, limited followup, and limited discussion of the durability of treatment gains once active therapy ends This sustained level of impairment, along with a lack of longer-term outcomes data, makes it difficult to assess whether treatment-related changes can modify long-term functional and developmentally appropriate adaptive independence. Duration of treatment and followup was generally short Few studies provided data on long-term outcomes after cessation of treatment. Future studies should extend the followup period and assess the degree to which outcomes are durable Among children ages 2-12 with ASDs, what are the short and long-term effects of available behavioral, educational, family, medical, allied health, or CAM treatment approaches? Specifically, KQ1a. What are the effects on core symptoms (e.g., social deficits, communication deficits and repetitive behaviors), in the short term (≤6 months)? KQ1b. What are the effects on commonly associated symptoms (e.g., motor, sensory, medical, mood/anxiety, irritability, and hyperactivity) in the short term (≤6 months)? KQ1c.. What are the longer-term effects (>6 months) on core symptoms (e.g., social deficits, communication deficits and repetitive behaviors)? KQ1d. What are the longer-term effects (>6 months) on commonly associated symptoms (e.g., motor, sensory, medical, mood/anxiety, irritability, and hyperactivity)? KQ4. What is the evidence that effects measured at the end of the treatment phase predict long-term functional outcomes? 4. Were followup measures of outcome conducted to assess maintenance of skills at least 3 months after the end of treatment? Unfortunately, there have been to date very few well-controlled trials and those conducted have used small samples…… and different outcome measurements over different periods of time (weeks to years). Longer term functional outcomes are the goal for autism interventions In terms of followup for assessing durability of effects, most studies report on outcomes collected immediately post-treatment or within 3 months of treatment (76 percent of studies in the behavioral literature, 86 percent in the medical literature). Additional research is needed on the degree to which changes observed during treatment translate to functional outcomes over time should treatment be discontinued. Duration of treatment and follow up was generally short, with few studies providing data on long-term outcomes after cessation of treatment. Future studies should extend the follow up period and assess the degree to which outcomes are durable. Daniela MC