Panerai et al., 2009

Study DescriptionInterventionInclusion/Exclusion
Criteria/Population
Baseline MeasuresOutcomes
Author:
Panerai et al., 2009
Country:
Italy
Practice setting:
Research center
Intervention setting:
Residential, clinic, and/or school
Enrollment period:
NR
Funding:
NR
Author industry relationship disclosures:
NR
Design:
Prospective cohort study
Intervention:
TEACCH in a residential center vs. TEACCH at home and at mainstream schools after a parent psychoeducational training vs. inclusive education in mainstream schools (i.e., treatment as usual, nonspecific program)
Duration: 3 years in setting
TEACHH residential – In residence education with regular intervals home and no additional school involvement
TEACCH home based – Attended mainstream classes with support teacher; psychoeducational training of parents for 4 weeks, then repeated 2 week stays on 6 month basis
Assessments:
CARS, LAP-R, PEP-R, VABS
Groups:
G1: TEACCH in a residential center
G2: TEACCH parent training
G3: inclusive education in mainstream school (no protocol)
Provider:
G1: Educators with support of the management team (a psychologist, educational coordinator, neurologist, and doctor specializing in normal and special education)
Inclusion criteria:
  • Attending primary school
  • Evaluated for at least a 3-year period
  • Assessment included PEP-R
  • Diagnosed with autistic disorder and mental retardation
Exclusion criteria:
  • See inclusion criteria
Age, years ± SD:
G1: 9.66 ± 2.31
G2: 8.66 ± 2.01
G3: 9.09 ± 2.07
Mental age, months ± SD:
G1: 20.63 ± 9.52
G2: 23.69 ± 10.5
G3: 20.4 ± 6.93
Gender, n (%):
Male: 34 (100)
Female: 0
Race/ethnicity:
NR
SES:
Maternal education: NR
Household income: NR
Diagnostic approach:
In Study
Diagnostic tool/method:
DSM-IV, CARS, ADI-R
Diagnostic category, n (%):
Autism: 34 (100)
PDD-NOS: 0
Aspergers: 0
Other characteristics:
Severe Mental Retardation n (%): 34 (100)
CARS score, mean ± SD:
G1: 45.75 ± 5.23
G2: 42.42 ± 2.41
G3: 42.9 ± NR
Overall ratings:*
PEP-R composite score, mean ± SD:
G1: 43.36 ± 24.36
G2: 54.15 ± 26.46
G3: 46.4 ± 21.9
G1/G2/G3: P = NS
VABS composite scale, mean ± SD:
G1: 100.72 ± 42.92
G2: 109.69 ± 33.83
G3: 94.8 ± 27.89
G1/G2/G3: P = NS
Social skills:
VABS socialization score, mean ± SD:
G1: 16.1 ± 11.6
G2: 16.23 ± 7.45
G3: 16 ± 5.29
G1/G2/G3: P = NS
Communication/language:
VABS communication score, mean ± SD:
G1: 15.9 ± 14.9
G2: 19.46 ± 11.24
G3: 18.1 ± 10.48
G1/G2/G3: P = NS
Problem behavior:
VABS maladaptive behaviors score, mean ± SD:
G1: 16.18 ± 7.33
G2: 17.92 ± 6.57
G3: 18.5 ± 7.38
G1/G2/G3: P = NS
Adaptive behavior:
VABS daily living score, mean ± SD:
G1: 33.1 ± 12.9
G2: 31.92 ± 11.62
G3: 27.8 ± 11.14
G1/G2/G3: P = NS
Motor skills:
PEP-R fine motor score, mean ± SD:
G1: 8.54 ± 4.18
G2: 9.61 ± 3.69
G3: 9.3 ± 3.8
G1/G2/G3: P = NS
Overall ratings:
PEP-R composite score, 3 years, mean ± SD:
G1: 57.45 ± 29.76
G2: 69.54 ± 22.54
G3: 49 ± 25.24
G1/BL: P = 0.02
G2/BL: P = 0.022
G3/BL: P = NS
G1/G2/G3: P = 0.009
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = 0.001
VABS composite score, 3 years, mean ± SD:
G1: 127.81 ± 45.07
G2: 155.23 ± 39.89
G3: 109.6 ± 33.52
G1/BL: P = 0.02
G2/BL: P = 0.02
G3/BL: P = NS
Composite score with motor skills:
G1/G2/G3: P = NS
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = NS
Composite score w/o motor skills:
G1/G2/G3: P = 0.038
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = 0.01
Social skills:
VABS socialization score, 3 years, mean ± SD:
G1: 25.5 ± 12.2
G2: 27.46 ± 10.89
G3: 16 ± 6.14
G1/BL: P = 0.02
G2/BL: P = 0.018
G3/BL: P = NS
G2: Support teacher, specific generalist team (psychologist, doctor specializing in normal and special education, educator-coordinator, educator, social worker, psycho-motor and speech therapists), and parent
G3: Support teacher and general education teachers
Measure of treatment fidelity reported:
No
Co-interventions held stable during treatment:
NR
Concomitant therapies, n:
G1: NR
G2: NR
G3: Outpatient treatments (including psychomotor therapy and speech therapy): NR
N at enrollment:
G1: 11
G2: 13
G3: 10
N at follow-up:
G1: 11
G2: 13
G3: 10
ADI-R score, mean ± SD:
Communication:
G1: 15.18 ± 2.79
G2: 14.15 ± 2.76
G3: 13.6 ± 2.01
Social impairment:
G1: 27.45 ± 2.8
G2: 24.92 ± 4.54
G3: 26.4 ± 2.55
Repetitive behavior:
G1: 7.09 ± 2.43
G2: 7.2 ± 2.65
G3: 6.6 ± 1.78
LAP-R developmental age, months ± SD:
Language and literacy:
G1: 19.55 ± 9.76
G2: 20.82 ± 8.59
G3: 18.7 ± 6.78
Emotional and social skills:
G1: 22.55 ± 9.44
G2: 22.15 ± 6.96
G3: 20.6 ± 6.29
Pre-writing:
G1: 22.36 ± 14.47
G2: 26.77 ± 12.79
G3: 26.4 ± 16.11
Self help skills:
G1: 29.64 ± 13.9
G2: 31.08 ± 17.69
G3: 27.5 ± 9.08
PEP-R gross motor score, mean ± SD:
G1: 11.45 ± 3.14
G2: 13.23 ± 4.64
G3: 13.4 ± 4.03
G1/G2/G3: P = NS
PEP-R eye-hand coordination score, mean ± SD:
G1: 4.82 ± 2.89
G2: 5.54 ± 3.53
G3: 4.6 ± 2.95
G1/G2/G3: P = NS
VABS motor skills score, mean ± SD:
G1: 37.5 ± 7.79
G2: 42.15 ± 10.94
G3: 33.9 ± 8.99
G1/G2/G3: P = NS
Educational/cognitive/academic attainment:
PEP-R develop- mental age, months ± SD:
G1: 20.64 ± 9.52
G2: 23.69 ± 10.55
G3: 20.04 ± 6.93
G1/G2/G3: P = NS
PEP-R cognitive performances score, mean ± SD:
G1: 4.82 ± 5.47
G2: 7.61 ± 6.2
G3: 6.5 ± 6.04
G1/G2/G3: P = NS
PEP-R cognitive verbal performances score ± SD:
G1: 2.09 ± 4.99
G2: 2.85 ± 4.08
G3: 0.6 ± 0.07
G1/G2/G3: P = NS
Additional:
PEP-R imitation score, mean ± SD:
G1: 3.45 ± 4.86
G2: 5.77 ± 4.81
G3: 4.1 ± 3.69
G1/G2/G3: P = NS
Total score:
G1/G2/G3: P = 0.009
G1/G2: P = NS
G1/G3: P = 0.017
G2/G3: P = 0.006
Interpersonal relationships:
G1/G2/G3: P = 0.017
G1/G2: P = NS
G1/G3: P = 0.035
G2/G3: P = 0.008
Communication/language:
VABS communication score, 3 years, mean ± SD:
G1: 22.1 ± 16.5
G2: 28.92 ± 16.43
G3: 21.4 ± 11.01
G1/BL: P = 0.05
G2/BL: P = 0.02
G3/BL: P = NS
G1/G2/G3: P = NS
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = NS
Problem behavior:
VABS maladaptive behaviors score, 3 years, mean ± SD:
G1: 12.27 ± 7.04
G2: 17.23 ± 7.35
G3: 24.1 ± 9.69
G1/BL: P = 0.02
G2/BL: P = 0.02
G3/BL: P = NS
G1/G2/G3: P = 0.038
G1/G2: P = NS
G1/G3: P = 0.032
G2/G3: P = 0.044
PEP-R perception score, mean ± SD:
G1: 8 ± 2.76
G2: 9.54 ± 2.47
G3: 7.9 ± 3.66
G1/G2/G3: P = NS
Adaptive behavior:
VABS daily living skills score, 3 years, mean ± SD:
G1: 42.2 ± 14
G2: 44.85 ± 10.95
G3: 31 ± 12.9
G1/BL: P = 0.02
G2/BL: P = 0.02
G3/BL: P = NS
Total:
G1/G2/G3: P = 0.033
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = 0.009
Personal:
G1/G2/G3: P = 0.049
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = 0.022
Motor skills:
PEP-R fine motor score, 3 years, mean ± SD:
G1: 9.82 ± 4.17
G2: 11.46 ± 2.44
G3: 9.3 ± 3.9
G1/BL: P = NS
G2/BL: P = 0.024
G3/BL: P = NS
G1/G2/G3: P = NS
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = NS
PEP-R gross motor score, 3 years, mean ± SD:
G1: 14.1 ± 4.66
G2: 15.8 ± 3.24
G3: 13.8 ± 4.49
G1/BL: P < 0.05
G2/BL: P = 0.018
G3/BL: P = NS
G1/G2/G3: P = 0.031
G1/G2: P = NS
G1/G3: P = 0.026
G2/G3: P = 0.032
PEP-R eye-hand coordination score, 3 years, mean ± SD:
G1: 6.09 ± 3.11
G2: 7.85 ± 2.82
G3: 5.9 ± 4.77
G1/BL: P = 0.02
G2/BL: P = 0.018
G3/BL: P = NS
G1/G2/G3: P = NS
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = NS
VABS motor skills score, 3 years, mean ± SD:
G1: 42.1 ± 6.41
G2: 54.08 ± 13.9
G3: 39.4 ± 11.28
G1/BL: P = 0.02
G2/BL: P = 0.02
G3/BL: P = NS
G1/G2/G3: P = NS
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = NS
Educational/cognitive/academic attainment:
PEP-R developmental age, 3 years, months ± SD:
G1: 25.82 ± 12.03
G2: 29.15 ± 10.01
G3: 21.5 ± 8.36
G1/BL: P = 0.02
G2/BL: P = 0.022
G3/BL: P = NS
G1/G2/G3: P = 0.005
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = 0.005
PEP-R cognitive verbal performances score, 3 years, mean ± SD:
G1: 3.91 ± 5.72
G2: 4 ± 5.07
G3: 1 ± 1.63
G1/BL: P = NS
G2/BL: P = NS
G3/BL: P = NS
G1/G2/G3: P = 0.006
G1/G2: P = NS
G1/G3: P = 0.034
G2/G3: P = 0.002
PEP-R cognitive performances score, 3 years, mean ± SD:
G1: 8.09 ± 6.59
G2: 10.46 ± 5.62
G3: 5.9 ± 6.04
G1/BL: P = 0.032
G2/BL: P = 0.018
G3/BL: P = NS
G1/G2/G3: P = NS
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = NS
Additional:
PEP-R imitation score, 3 years, mean ± SD:
G1: 5.9 ± 6.12
G2: 8.69 ± 4.4
G3: 4.3 ± 4.14
G1/BL: P < 0.05
G2/BL: P = 0.018
G3/BL: P = NS
G1/G2/G3: P = 0.013
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = 0.004
PEP-R perception score, 3 years, mean ± SD:
G1: 9.54 ± 3.17
G2: 11.31 ± 1.75
G3: 8.8 ± 3.85
G1/BL: P = NS
G2/BL: P = 0.02
G3/BL: P < 0.05
G1/G2/G3: P = NS
G1/G2: P = NS
G1/G3: P = NS
G2/G3: P = NS
Harms:
NR
Modifiers:
NR

1 child in G1 was placed on a different mood stabilizer and 2 children in G2 received higher doses of medicine for attentional difficulties; data on changes in therapy not available for 13 participants.

From: Appendix C, Evidence Tables

Cover of Therapies for Children With Autism Spectrum Disorders
Therapies for Children With Autism Spectrum Disorders.
Comparative Effectiveness Reviews, No. 26.
Warren Z, Veenstra-VanderWeele J, Stone W, et al.

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