Evaluation of a medically coordinated care program in the management of autism.

This study looked at 20 children with autism receiving care through two different programs in France. One group attended a day hospital twice weekly, while the other received coordinated medical care with more frequent doctor visits and parent support. Both groups also had speech and movement therapy. After a year, children in both programs improved, with those in the coordinated care program showing slightly better results in reducing autism symptoms.

This suggests coordinated care could be a good option when day hospital spaces aren't available.

This French retrospective study compared two autism care models for 20 children with ASD: day care hospital (DCH) providing structured care two half-days weekly versus medically coordinated care programs through mental health consultation centers (MHCC) with enhanced medical consultations and parent guidance. Both groups received private speech and psychomotor therapy. After one year, both groups showed reduced autism severity (CARS-2) and improved adaptive behavior (VABS-II), with MHCC showing greater CARS-2 improvement that was statistically significant. However, the composite outcome criterion did not demonstrate non-inferiority of MHCC compared to DCH.

Results suggest MHCC programs may offer viable alternative care when DCH capacity is limited, though larger studies are needed.

Medically coordinated care programs with enhanced parent guidance may provide effective autism intervention when traditional day hospital capacity is limited. Both models demonstrated clinical improvements, suggesting flexibility in service delivery approaches. Larger controlled studies needed to establish definitive equivalence and identify which children benefit most from each approach.

Very small sample size (20 children), retrospective design, single-center study, and inability to demonstrate statistical non-inferiority on composite outcomes. Study acknowledges need for multicenter research with larger numbers and consideration of baseline child characteristics.

Autism spectrum disorders (ASD) are neurodevelopmental disorders of varying intensity and disability. The reference health strategy in France for the care of young children with autism is day care hospital (DCH). As the number of places in DCH is insufficient, medically coordinated care programs by the mental health consultation centers (MHCC) are being developed in response. Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry.

Non-inferiority retrospective study comparing the evolution after one year of care of 20 ASD children divided into two groups DCH and MHCC. In the DCH ASD group, the child is taken care of two half-days a week in a day hospital with individual educational care. In the MHCC ASD group, the child benefits from a medically coordinated care program. The medical care is reinforced by more frequent and longer consultations with guidance offered to parents.

In both groups, the child receives speech therapy and psychomotor therapy in private practice at the same rate. Comparison is made using a composite criterion associating CARS-2 and VABS-II. Non-inferiority of the medically coordinated care program in autism in reference to DCH was tested on the difference between the changes (DCH group variation - MHCC group variation) with a non-inferiority threshold of 10% of the initial value of each score. We observed a reduction in autism severity at the CARS-2 and a moderate improvement in socio-adaptive behavior at the VABS-II in both groups.

This trend was even more pronounced in the MHCC group than in the DCH group, but only the greater reduction in CARS-2 severity in the MHCC was statistically significant. As it is necessary to integrate the two scales into the composite criterion, it is not possible to retain the non-inferiority of the MHCC with care program. However, both those children followed in DCH and those in the MHCC care program progress. This shows the relevance of the care offered at the MHCC for children suffering from ASD, in the context of a growing lack of space in DCH.

The continuation of this research work through multicenter studies with larger numbers could demonstrate the non-inferiority of coordinated care programs in the MHCC versus DCH. It would also allow subgroups to be set up, taking into account the initial characteristics of the children in order to have more precise indications concerning the relevance of each treatment.