Interventions non pharmacologiques pour les enfants autistes : une revue parapluie
Titre original en anglais : Non-pharmacological interventions for autistic children: An umbrella review
Trembath, D., Varcin, K. J., Waddington, H., Sulek, R., Bent, C. A., Ashburner, J., Eapen, V., Goodall, E., Hudry, K., Roberts, J., Silove, N., & Whitehouse, A. (2022). Non-pharmacological interventions for autistic children: An umbrella review. Autism, 27(2), 275-295. https://doi.org/10.1177/13623613221119368
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Résumé
L'étendue des interventions non pharmacologiques disponibles pour les enfants autistes, dont les preuves d'efficacité variables sont résumées dans de multiples revues systématiques, crée des difficultés pour les parents, les praticiens et les décideurs politiques lorsqu'ils cherchent à s'orienter parmi les données probantes de la recherche. Dans cet article, nous présentons les résultats d'une revue parapluie de 58 revues systématiques portant sur des interventions non pharmacologiques destinées aux enfants autistes (âgés de 0 à 12 ans). Des effets thérapeutiques positifs ont été identifiés pour les interventions comportementales, les interventions développementales, les interventions comportementales développementales naturalistes, les interventions fondées sur la technologie et la thérapie cognitivo-comportementale, pour plusieurs résultats concernant l'enfant et la famille. Les effets positifs de certaines pratiques au sein des interventions fondées sur les sens et des interventions « autres » étaient limités à certains résultats concernant l'enfant et la famille. Des effets d'intervention à la fois incohérents et nuls ont été observés, selon les résultats, pour le traitement et l'éducation des enfants autistes et présentant des troubles de la communication associés, ainsi que pour les interventions assistées par les animaux. L'influence possible des caractéristiques de l'enfant (âge chronologique, caractéristiques centrales de l'autisme et compétences associées) et des modalités de mise en oeuvre (intervenant, mode, format et quantité) sur les effets des interventions a rarement été examinée et, lorsqu'elle était rapportée, était incohérente. Vingt-sept revues systématiques (47 %) ont été évaluées comme étant de qualité « élevée ». Peu de revues systématiques ont examiné la participation des enfants et leur qualité de vie, ou les effets indésirables. Les résultats soulignent la nécessité d'une prise de décision individualisée fondée sur les données probantes lors de la sélection d'interventions pour les enfants autistes. Résumé grand public Que sait-on déjà sur ce sujet ? La mise en oeuvre d'interventions fondées sur les données probantes constitue une partie importante du parcours clinique de nombreux enfants autistes et de leurs familles. Toutefois, les parents, les praticiens et les décideurs politiques rencontrent des difficultés à prendre des décisions éclairées par les données probantes, en raison de la grande variété d'interventions disponibles et de l'ensemble vaste, et souvent incohérent, de données probantes concernant leur efficacité. Qu'apporte cet article ? Il s'agit d'une revue parapluie exhaustive, également appelée « revue de revues », qui a examiné l'éventail des interventions disponibles, les données probantes relatives à leur efficacité, ainsi que la question de savoir si les effets étaient influencés par des facteurs liés aux enfants eux-mêmes (par exemple, l'âge chronologique, les caractéristiques centrales de l'autisme et les compétences associées) ou aux modalités de mise en oeuvre des interventions (par qui et dans quel contexte, format, mode et quantité). Des données probantes indiquaient des effets thérapeutiques positifs pour certaines interventions, mais pas toutes. Aucune intervention unique n'avait un effet positif sur tous les résultats d'intérêt concernant l'enfant et la famille. L'influence des caractéristiques de l'enfant et des modalités de mise en oeuvre sur les effets n'était pas claire. Implications pour la pratique, la recherche et les politiques Les résultats fournissent aux parents, aux praticiens et aux décideurs politiques une synthèse des données probantes de la recherche afin d'éclairer la prise de décision et soulignent l'importance d'approches individualisées en l'absence de données probantes claires et cohérentes. Les résultats soulignent également la nécessité d'améliorer la cohérence et l'exhaustivité de la communication des études de recherche, afin que les mêmes questions puissent recevoir des réponses plus complètes à l'avenir.
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