Abstract：
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.
OBJECTIVE: Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
OBJECTIVE: Our objective is to evaluate the effectiveness of a medically coordinated care program in a MHCC versus the care in DCH of child psychiatry.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
自闭症谱系障碍（ASD）是不同强度和残疾的神经发育障碍。法国照顾自闭症幼儿的参考健康策略是日托医院（DCH）。由于DCH的名额不足，心理健康咨询中心（MHCC）正在制定医疗协调的护理计划。
目的：我们的目的是评估MHCC与儿童精神病学DCH的医疗协调护理计划的有效性。
方法：非劣效性回顾性研究比较了20名ASD儿童在护理一年后的演变，分为DCH和MHCC两组。在DCHASD组中，这个孩子每周在日间医院接受两个半天的照顾，并接受个人教育。在MHCCASD组中，儿童受益于医疗协调护理计划。通过向父母提供更频繁和更长时间的指导咨询，加强了医疗保健。在这两组中,儿童在私人诊所以相同的速度接受言语治疗和精神运动治疗。使用将CARS-2和VABS-II相关联的复合准则进行比较。参考DCH的自闭症医学协调护理计划的非劣效性在变化之间的差异（DCH组变异-MHCC组变异）进行了测试，非劣效性阈值为每个评分初始值的10％。
结果：我们观察到两组CARS-2的自闭症严重程度降低，VABS-II的社会适应行为中度改善。这种趋势在MHCC组中比在DCH组中更明显，但只有MHCC患者的CARS-2严重程度降低幅度较大才有统计学意义.
结论：由于有必要将两个量表集成到复合标准中，无法保留MHCC的非劣效性。然而,DCH患者和MHCC护理计划患者均有进展.这表明MHCC为患有ASD的儿童提供的护理的相关性，在DCH空间日益缺乏的背景下。通过大量多中心研究继续进行这项研究工作，可以证明MHCC与DCH的协调护理计划的非劣效性。它还允许建立子组，考虑到儿童的初始特征，以便对每种治疗的相关性有更准确的指示。
目的：我们的目的是评估MHCC与儿童精神病学DCH的医疗协调护理计划的有效性。
方法：非劣效性回顾性研究比较了20名ASD儿童在护理一年后的演变，分为DCH和MHCC两组。在DCHASD组中，这个孩子每周在日间医院接受两个半天的照顾，并接受个人教育。在MHCCASD组中，儿童受益于医疗协调护理计划。通过向父母提供更频繁和更长时间的指导咨询，加强了医疗保健。在这两组中,儿童在私人诊所以相同的速度接受言语治疗和精神运动治疗。使用将CARS-2和VABS-II相关联的复合准则进行比较。参考DCH的自闭症医学协调护理计划的非劣效性在变化之间的差异（DCH组变异-MHCC组变异）进行了测试，非劣效性阈值为每个评分初始值的10％。
结果：我们观察到两组CARS-2的自闭症严重程度降低，VABS-II的社会适应行为中度改善。这种趋势在MHCC组中比在DCH组中更明显，但只有MHCC患者的CARS-2严重程度降低幅度较大才有统计学意义.
结论：由于有必要将两个量表集成到复合标准中，无法保留MHCC的非劣效性。然而,DCH患者和MHCC护理计划患者均有进展.这表明MHCC为患有ASD的儿童提供的护理的相关性，在DCH空间日益缺乏的背景下。通过大量多中心研究继续进行这项研究工作，可以证明MHCC与DCH的协调护理计划的非劣效性。它还允许建立子组，考虑到儿童的初始特征，以便对每种治疗的相关性有更准确的指示。
