Early intensive behavioral intervention (EIBI) is currently the most studied and most practiced intervention for children with autism spectrum disorder. There has been increasing evidence supporting the use of EIBI, but there have been limited evaluations of the effectiveness of EIBI intensity. The current study addressed this gap using data obtained from St.Amant Autism Program and comparing children receiving an average of 22 and 30 hours per week for a period of one year. Significant main effects of time were found for standardized measures of cognitive functioning, adaptive functioning, and autism severity. Future research should aim to address this research question with a larger sample size and a low-intensity control group. / May 2016

The research literature has repeatedly emphasized the importance of parent involvement and parent training in the early intervention of young children with autism spectrum disorder (ASD). In fact, parent mediated Early Intensive Behavioral Intervention (EIBI) programs have become a popular method of treatment in recent years. Studies examining these programs have demonstrated that a number of variables may significantly impact the outcomes of EIBI. Moreover, an examination of the psychotherapy literature underscores the importance of a strong parent-therapist alliance as a correlate of positive processes and outcomes in child therapy; while there is very little research examining the working alliance as a factor in parent consultation.The purpose of the present study was to examine the relationship between the working alliance and the consultation process in parent-mediated EIBI for young children with ASD. Forty-four parents of children with an ASD, who were also conducting home-based EIBI programs, completed the Working Alliance Inventory (WAI) (Horvath & Greenberg, 1989) plus other measures that assessed treatment process and outcome. In addition, eight independent consultants completed similar measures to assess perceptions of alliance, process, and outcomes of their consultees.The results showed parent ratings of the working alliance were significantly correlated with parent ratings of treatment acceptability for child treatment as well as for parent consultation. Parent ratings of alliance also correlated significantly with parent ratings of parent progress in consultation and child progress in treatment. Consultant ratings of alliance were significantly correlated with both parent progress and parent improvement in consultation. This suggests that the working alliance may be a contributing factor to the process and outcome of consultation with parents of children with ASD.The results of the present study were compared to the current literature on the therapeutic alliance and relationship factors in consultation. The limitations of the present study and suggestions for future research are also discussed.

L’intervention comportementale intensive (ICI) est l’intervention offerte par les services publics du Québec aux jeunes enfants diagnostiqués d’un trouble du spectre de l’autiste (TSA). Plusieurs organismes nationaux de santé considèrent l’ICI comme une intervention établie et de nombreuses méta-analyses soutiennent son efficacité. Cependant, les effets varient grandement d’un enfant à l’autre. Alors que certains enfants progressent significativement dans plusieurs sphères du développement, d’autres ne retirent qu’une modeste amélioration. Cette réponse différentielle à l’intervention demeure mal comprise : à l’heure actuelle, il n’y a pas de consensus sur la fiabilité des prédicteurs d’efficacité de l’ICI. L’objectif général de cette thèse est donc d’étudier la réponse différentielle à l’ICI dans un contexte québécois. Le premier article de cette thèse visait à évaluer les effets de l’ICI sur le fonctionnement adaptatif et les symptômes autistiques des enfants qui la reçoivent, de vérifier si les progrès se maintenaient dans le temps et d’identifier des prédicteurs d’efficacité. Les résultats ont révélé un changement non linéaire du fonctionnement adaptatif, caractérisé par une amélioration significative pendant la période d’intervention et un maintien des gains pendant la période de suivi, ainsi qu’une légère diminution linéaire des symptômes autistiques tout au long de l’étude. L’intensité de l’intervention, l’âge, le QI et les symptômes autistiques étaient associés soit à des progrès pendant la période d’intervention, soit à un maintien pendant la période de suivi. Le deuxième article investiguait la présence de sous-groupes plus homogènes (c.-à-d. des profils latents) chez les participants sur la base de leurs caractéristiques lors de leur entrée dans les services, examinait les prédicteurs sociodémographiques de l’appartenance à un profil particulier et vérifiait si l’appartenance aux profils était associée à une réponse différentielle à l’ICI. Nous avons trouvé quatre profils dans notre échantillon. Seul le revenu familial annuel prédisait l’appartenance au profil. Tous les profils ont progressé pendant de la période d’intervention, avec des changements d’ampleur variable. Au cours de la période de suivi, les profils ayant les manifestations les plus sévères ont montré une stabilité ou une amélioration du fonctionnement adaptatif, tandis que les deux profils ayant les manifestations les plus légères ont montré une légère diminution du fonctionnement adaptatif. Finalement, le dernier article visait à vérifier si l’apprentissage automatique (angl. machine learning) pouvait soutenir l’estimation du pronostic des enfants recevant de l’ICI. Pour ce faire, nous avons comparé la précision des prédictions (progrès versus pas de progrès) faites par cinq algorithmes et une assignation aléatoire. Les résultats indiquaient que les prédictions de tous les algorithmes étaient meilleures que l’assignation aléatoire. En conclusion, cette thèse discute des retombées des résultats la recherche, la pratique et pour le domaine de la psychoéducation. / Early intensive behavioral intervention (EIBI) is the intervention offered by public services in Quebec to young children diagnosed with an autism spectrum disorder (ASD). Several national health organizations consider EIBI as an established intervention and numerous meta-analyzes support its efficacy. However, its effects vary greatly from one individual to another. While some children progress significantly in several areas of development, others make only modest improvement. This differential response to intervention remains poorly understood: there is no consensus on the reliability of predictors of the efficacy of EIBI. Thus, the main purpose of this thesis is to study the differential response to EIBI in the Quebec context. The first article of this thesis aimed to assess the effects of EIBI on adaptive functioning and autistic symptoms in children with ASD, to verify whether the changes are maintained over time and to identify predictors of efficacy. The results revealed a non-linear change in adaptive functioning, characterized by a significant improvement during the intervention period and maintenance of gains during the follow-up period, as well as a marginal linear decrease in autistic symptoms from baseline to follow-up. Intervention intensity, age, IQ, and autistic symptoms were associated with either progress during the intervention or maintenance during follow-up. The second article investigated the presence of more homogeneous subgroups (i.e., latent profiles) among participants based on their characteristics when entering services, examined socio-demographic predictors of profile membership and assessed whether profile membership was associated with a differential response to EIBI. We found four profiles in our sample. Only annual family income predicted profile membership. All profiles progressed during the intervention period, with changes of varying magnitude. During follow-up, the profiles with the most severe manifestations showed stability or improvement in adaptive functioning, while the two profiles with the milder manifestations showed a marginal decrease in adaptive functioning. Finally, the last article aimed to test whether machine learning could support prognosis estimation for children receiving EIBI. To this end, we compared the accuracy of the predictions (progress versus no progress) made by five algorithms and a random assignment. The results showed that the predictions of all algorithms were better than random assignment. In conclusion, this thesis discusses the implications of the results for research, practice and the field of psychoeducation.

Training parents of a child with autism to increase the frequency of their child's social behavior may improve the quality of parent-child interactions. The purpose of this methodological study was to develop a direct observation method for rapidly sampling social harmony between parents and their toddlers with autism during parent training interactions. The current study used a pre and post probe design, with benchmark comparisons to test the discriminability of the measurement protocol across two sets of data. The first set of data came from pre and post training videos from a parent training program for children with a diagnosis of autism or at risk for a diagnosis. The second set of data came from videos of typically developing toddlers and their parents. The results of the study show that the measurement system differentiated in the level of harmonious engagement between the benchmark sample and the sample including children diagnosed with autism. The results are discussed in the context of future directions and the utility of the measurement system for behavior analytic practices in parent training and other settings where rapport and complex interactional behaviors are an intervention priority.