TOWARDS AN ECLECTIC APPROACH IN AUTISM SPECTRUM DISORDER (ASD)-SMARTS (SEQUENTIAL MULTIPLE ASSIGNMENT RANDOMIZED TRIALS-SMARTS)

Abstract

"The need for evidence-based therapy is a reality in contemporary therapeutic approaches. The most studied approach in autism spectrum disorder (ASD) is the ABA therapy (Applied Behavioral Analysis), among other 27 validated programs Hume & al. (2021) and Steinbrenner & al. (2020). Even if ABA is well known and strongly scientifically studied, in almost 30% of the cases it does not lead to developing the desired verbal communication abilities ((National Institute on Deafness and Other Communication Disorders, 2010; Kasari, Sturm, Shih, 2018). In this context, speech and language therapy can be an alternative to this approach, its use being combined with the usage of different other psychological and psycho-pedagogical techniques and programs for enhancing children and families with the target abilities. This mixture of therapies, known as eclectic approach is often compared with ABA approach and criticized due to its lack of scientific proof. In order to ensure the evidence based approach we propose the implementation of SMARTs (Sequential Multiple Assignment Randomized Trials-SMARTs). The SMARTs approach offers the possibility both to collect measurable data based on the established goals and to tailor possible intervention programs adjusting the approach to participants’ needs. In our research the SMARTs structure include: a sequence of decisions (it applies if participants do not respond positively to the intervention and it is used at each three months’ reevaluation stage), a set of intervention decisions (in this research SLT is combined with kineto-therapy, oral-motor myofunctional therapy, psych-pedagogical programs and programs for sensory integration), elements/factors that indicate change in the established approach (it refers to factors that prove that the intervention program needs to be changed, in our research these are: regression and a plateau in speech and language development acquisition longer than one month) and a sequence of decision rules able to link the other sequences (these decision rules are based on the evaluation and reevaluation results and on reaching or not the established goals in speech and language development area). Participants in the research are 9 children with severe ASD (N=9), with ages between 6-9 years’ old. The starting point of our SMARTs approach implementation was a comprehensive general assessment of speech and language development based on ISD (Integrated Scale of Development), MLU (Mean Length of Utterance) and SIR (Scale for Intelligibility Rate). The intervention period was January 2021-december 2021. Results demonstrated relevant gains in speech and language development of 6-9 months (based on ISD) and of 3 points based on SIR (from 2 level-just of words intelligible, till 5 level-all words intelligible). Very poor results were obtained at the MLU level, due to the fact that grammar approach is difficult to implement. In conclusion we can underline the fact that SMARTs can be a reliable way in individualizing and in collecting scientific proof about speech and language development in ASD context, based on eclectic intervention programs. Further research will be developed in order to tailor the morphological and syntactical aspect in speech and language development."