ASD is a very complex and lifelong disorder. Patients' functioning is influenced by multiple factors, including treatments, inclusion and life contexts. Nonetheless, outcome measures are still point-specific and highly fragmented, rarely considering global or multidimensional functioning, development or long-term modifications, especially in the real world. The present study considers ongoing real-life treatments in three different NHS settings, in line with the Italian Guidelines. Two age classes will be considered, 0-5 and 6-11, adding new outcome tools pre-post intervention to those already used, to evaluate quality of life, global functioning, multidimensional needs and strengths and shared decision making. Correlations between the different outcome tools will be explored, and possible clusters will be investigated. Acceptability of the outcome tools for the operators, patients and families, as well as usefulness and sustainability in daily practice, will also be evaluated.
ASD diagnosis according to the criteria shared by the regional NFA network
Age under 12
Consent from the person holding parental responsibility for health choices
Subjects aged 12 years or older at the time of enrollment
No consent from the person holding parental responsibility for health choices
Children diagnosed with ASD enrolled in one of the intervention programs in line with the national guidelines, within the partner institutions or other NPIA/rehabilitation services for developmental age of the Lombardy Region are eligible. The overall expected sample is 400 male and female children, under 12 years of age, 200 children aged 0-5 years at T0 and 200 children aged 6-11 years at T0.
Cohort
Prospective
DD-CGAS (Wagner et al. 2007)
Other interventionThe DD-CGAS is a clinician-completed scale that provides a global rating of the child's functioning. The score refers to the subject's typical functioning during a specified period of time, usually the week prior to the assessment. It is a global assessment based on all available sources of information and all domains of functioning, including self-sufficiency, communication, social behavior, and academic/school functioning. The score should not be influenced by the specific diagnosis, the perceived cause of dysfunction (e.g., cognitive or physical limitation, environmental constraints, behavioral disturbance), or the type and severity of symptoms. The DD-CGAS is a dimensional scale with scores ranging from 1 to 100, with 1 representing the greatest impairment in functioning and 100 representing the best functioning. Each decile (e.g., 1-10, 11-20) has a specific description. The instrument has excellent replicability between raters and temporal stability.
Pediatric Quality of Life Inventory (PedsQL).
Other interventionThe PedsQL is designed for children and adolescents between the ages of 2 and 18 years and takes approximately 5 minutes to complete. It is administered as a self-report instrument or via proxy interview. The proxy interview version corresponds to the age of the child (e.g., 2-4 years, 5-7 years, 8-12 years, and 13-18 years). The PedsQL consists of 23 items that assess 4 broad scales, including: physical functioning, emotional functioning, social functioning, and academic functioning. Items are rated using a 5-point Likert scale (0 = never; 4 = almost always), with the total score calculated as the sum of all items considered. PedsQL item scores are inverted and linearly transformed to a 0 to 100 scale, with higher scores indicating a better perception of health-related quality of life. It is important to note that the PedsQL has been validated in children with autism, including parents of children with autism (Vasilopoulou et al. 2016; Perry, N. et al. 2024).
Child and Adolescent Needs and Strengths (CANS) (Lyons 2022)
Other interventionThe Child and Adolescent Needs and Strengths scale (CANS) (Lyons 2022) is an open source tool widely used to assess the needs and strengths of children, adolescents, and their families, in clinical, educational and social services settings. It is organized into multiple domains that cover various aspects of a child's life. Common domains include life functioning, behavioral/emotional needs, risk behaviors, strengths, caregiver needs and strengths. Additional modules as trauma can be used.The tool uses a scoring system that reflects the level of need or strength in each area. Typically, needs are rated on a scale from 0 to 3, where 0: No evidence of problems; 1: Watchful waiting, preventive action needed; 2: Action or intervention is required; 3: Immediate or intensive action required. Strengths are rated similarly, with higher scores reflecting greater need for action to support the development of each specific strength.
Specific clusters of CANS items that differentiate the profiles of needs and strengths of users at T0.
The primary objective of the study is to identify specific clusters of CANS items that differentiate the profiles of needs and strengths of users at T0.
Correlations between CANS assessment and participants' global functioning (DD-CGAS)
The outcome measure TAI measured with CANS and expressed as the sum of the actionable items (see section "Groups and Intervention") will be correlated will be correlated with outcome measure quality of life, measured with DD-CGAS expressed as 1-100 score con 1 che rappresenta la maggiore compromissione del funzionamento e 100 il miglior funzionamento
Correlations between CANS assessment and participants' quality of life (PEDSQL)
The outcome measure TAI measured with CANS and expressed as the sum of the actionable items (see section "Groups and Intervention") will be correlated will be correlated with outcome measure quality of life, measured with DD-CGAS expressed as 0-100 score with higher scores on the PedsQL indicating better perceptions of health-related quality of life.
Evaluation of changes in children's needs over time based on CANS actionable items.
Differences between T0 and T1 TAI measeured with CANS and expressed as the sum of the actionable items (see section "Groups and Interventions") will be evaluated using a paired sample t test.
Evaluation of changes in children's Quality of Life over time.
Differences between T0 and T1 PedsQL scores (range 0-100, where 0 represents the lowest quality of life and 100 represents the highest quality of life ) will be evaluated using a paired sample t test.
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Antonella Costantino
Lead sponsor
Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
Sponsor institution
IRCCS Eugenio Medea
Collaborator
Azienda Socio Sanitaria Territoriale della Valle Olona
Collaborator
