L'évaluation du programme Prevent-Teach-Reinforce pour réduire les comportements problématiques en contexte familial chez les enfants ayant un trouble du spectre de l'autisme

Children with an Autism spectrum disorder (ASD) diagnosis sometimes show challenging behaviors such as aggressive or stereotyped behaviors. The presence of such behavior can have harmful consequences for both the children and the people living with them. For example, the child may be limited in his or her learning and experience social isolation. Parents may experience high levels of parental stress. In order to respond to these problems, this thesis evaluated a parental adaptation of the Prevent-Teach-Reinforce model (PTR; Dunlap et al., 2010), a program designed to reduce children’s challenging behaviors and increase their desirable behaviors in school settings. Based on the principles of positive behavioral support, this program aims to achieve its objectives by implementing a behavioral intervention taking into account the behavioral function of the challenging behavior. The intervention includes intervention strategies to modify the behavior’s antecedents, to teach desirable behaviors and to modify the behavior’s consequences. A randomized controlled study demonstrated the effectiveness of the PTR for school-aged children and two studies evaluated it in home settings for children with developmental disorders, using single case experimental designs. This thesis, comprising three articles, is the first randomized study evaluating the PTR in family settings to reduce challenging behaviors of children with ASD. The first article describes the adaptations made to the initial program in order to implement it with children with an ASD diagnosis receiving early intensive behavioral intervention or in family settings. In addition, a parallel was made between the PTR and the key principles from the psychoeducation field. The second article presents the main results of this thesis, with the 24 families which received two distinct interventions: the PTR for eight weeks or a theoretical training for about three hours. Analyzes of variance were conducted to evaluate the effectiveness of the PTR. In sum, children of both groups saw a reduction in challenging behaviors and an increase in desirable behaviors. It is therefore not possible to rule on the unique effectiveness of the PTR to reduce challenging behaviors. Parents implemented the PTR with great fidelity and rated the PTR with a very high level of social validity. The third article presents the results on parental stress. Initial parental stress scores were associated with the severity the child’s problem behaviors, showing a moderate correlation between the two concepts. On the other hand, an analysis of variance showed that parental stress only decreased for parents who implemented the PTR. In conclusion, this thesis has shown that PTR may be effective in decreasing problem behaviors and in increasing desirable behaviors of children with ASD. However, more studies are needed to confirm these hypotheses. These studies should include more subjects and compare the PTR to a group of children not receiving any type of intervention to reduce challenging behaviors.

Keyphrases: Prevent-Teach-Reinforce, intervention parentale, Parental stress, Family-based intervention, Implementation fidelity, Social validity