Prognostic factors from naturalistic treatment studies of children with Autism Spectrum Disorder (ASD) remain largely unknown. We aimed to identify baseline and treatment-related prognostic predictors at 1-year follow-up after Integrative Care Practices (ICPs). Eighty-nine preschool children with severe ASD were given ICP combining nine therapeutic workshops based on children’s needs. Participants were assessed at baseline and during 12 months follow-up with the Psycho-educational Profile-3-R, Children Autism Rating Scale, Parental Global Impression, and the Autistic Behaviors Scale. We assessed prognostic predictors using multivariable regression models and explored treatment ingredients influencing outcome using Classification and Regression Trees (CART). Multivariable models showed that being a child from first generation immigrant parents predicted increased maladaptive behaviors, whereas play activities had an opposite effect; severity of ASD symptoms and impaired cognitive functions predicted worse autism severity at follow-up; and lower play activities predicted worse parent impression. Regarding treatment effects, more emotion/behavioral interventions predicted better outcomes, and more communication interventions predicted lower autism severity, whereas more education and cognitive interventions had an opposite effect. CART confirmed that more hours of intervention in the emotion/behavioral domain helped classifying cases with better outcomes. More parental support was associated with decreased maladaptive behaviors. Sensorimotor and education interventions also significantly contributed to classifying cases according to outcomes but defined subgroups with opposite prognosis. Children who exhibited the best prognosis following ICPs had less autism severity, better cognition, and non-immigrant parents at baseline. Emotion/behavior interventions appeared key across all outcomes and should be promoted.

中文翻译：

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促进自闭症谱系障碍治疗中的情绪和行为干预：来自 EPIGRAM 的证据，一项自然主义、前瞻性和纵向研究

自闭症谱系障碍 (ASD) 儿童自然治疗研究的预后因素仍然很大程度上未知。我们的目的是在综合护理实践 (ICP) 后 1 年随访中确定基线和治疗相关的预后预测因素。 89 名患有严重 ASD 的学龄前儿童接受了 ICP，根据儿童的需要结合了九个治疗研讨会。参与者在基线和 12 个月的随访期间接受了心理教育概况-3-R、儿童自闭症评定量表、家长总体印象和自闭症行为量表的评估。我们使用多变量回归模型评估预后预测因子，并使用分类和回归树 (CART) 探索影响结果的治疗成分。多变量模型表明，作为第一代移民父母的孩子，适应不良行为会增加，而游戏活动则具有相反的效果；自闭症谱系障碍症状的严重程度和认知功能受损预示着随访时自闭症的严重程度会更严重；游戏活动减少预示着家长印象较差。关于治疗效果，更多的情绪/行为干预预示着更好的结果，更多的沟通干预预示着较低的自闭症严重程度，而更多的教育和认知干预则产生相反的效果。 CART 证实，在情绪/行为领域进行更多时间的干预有助于对病例进行分类，获得更好的结果。更多的父母支持与适应不良行为的减少有关。感觉运动和教育干预也显着有助于根据结果对病例进行分类，但定义的亚组具有相反的预后。 ICPs 后表现出最佳预后的儿童自闭症严重程度较低，认知能力较好，并且基线时父母为非移民。情绪/行为干预似乎对所有结果都很关键，应该得到推广。