目的 探讨专业人员指导下，由家长执行的家庭康复对孤独症谱系障碍（autism spectrum disorder，ASD）儿童的治疗作用。 方法 前瞻性选取ASD儿童60例（月龄24~60个月），随机分为观察组和常规组。常规组儿童仅对家长进行线上理论培训。观察组儿童家长，除线上理论培训外，还进行专业人员团队指导下由家长执行的家庭康复。采用心理教育评估第3版（Psycho-Education Profile Third Edition，PEP-3）、儿童期孤独症评定量表（Childhood Autism Rating Scale，CARS）评估两组儿童干预前、干预后能力变化情况。 结果 经6个月干预后，观察组PEP-3量表各维度和常规组大部分维度得分较干预前提高（P<0.01）；两组CARS量表得分较干预前降低（P<0.05）。与常规组相比，干预后观察组儿童PEP-3量表语言理解、语言表达、大肌肉、小肌肉、个人自理、适应行为维度得分提高（P<0.05），CARS量表得分降低（P<0.05）。 结论 对家长培训，由家长执行的干预可以提升ASD儿童的能力，改善其核心临床症状；但以专业人员组成的团队为资源平台，以家长为主要干预力量的家庭康复服务模式，对提升ASD儿童语言、运动等能力，改善其症状严重程度的效果更为显著。
Abstract
Objective To study the efficacy of family rehabilitation treatment performed by parents under the guidance of professionals in children with autism spectrum disorder (ASD). Methods In the prospective study, 60 children with ASD, aged 24-60 months, were randomly divided into an observation group and a conventional group. The parents of the children in the conventional group received an online training on basic knowledge and rehabilitation training of ASD alone, and those in the observation group received the online training and performed family rehabilitation treatment under the guidance of a professional team. Psycho-Education Profile Third Edition (PEP-3) and Childhood Autism Rating Scale (CARS) were used to evaluate the changes in related abilities after intervention. Results After 6 months of intervention, the scores of all dimensions of the PEP-3 scale in the observation group and most dimensions of the conventional group significantly increased (P<0.01); the CARS scale scores of the two groups significantly decreased (P<0.05). Compared with the conventional group, the observation group had significant increases in the scores of the dimensions of language understanding, language expression, gross motor, fine motor, self-care ability of daily living (P<0.05), and adaptive behavior (P<0.05), as well as a significant reduction in the CARS score (P<0.05). Conclusions An online training on basic knowledge and rehabilitation training of ASD for parents can improve the abilities and core clinical symptoms of children with ASD. The family rehabilitation treatment model with a team of professionals as the resource platform and parents as the performer has a more significant efficacy on improving the language, sports, and other abilities and alleviating the severity of the symptoms in children with ASD.
关键词
孤独症谱系障碍 /
家庭康复 /
疗效 /
儿童
Key words
Autism spectrum disorder /
Family rehabilitation /
Efficacy /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 美国精神医学学会. 精神障碍诊断与统计手册[M]. 张道龙, 刘春宇, 童慧琦, 等译. 5版. 北京: 北京大学出版社, 2015: 46-55.
2 Maenner MJ, Shaw KA, Baio J, et al. Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 sites, United States, 2016[J]. MMWR Surveill Summ, 2020, 69(4): 1-12. PMID: 32214087. PMCID: PMC7119644. DOI: 10.15585/mmwr.ss6904a1.
3 刘贤, 林穗方, 陈文雄, 等. 中国儿童孤独症谱系障碍患病率Meta分析[J]. 中国儿童保健杂志, 2018, 26(4): 402-406. DOI: 10.11852/zgetbjzz2018-26-04-15.
4 邵智, 郝建萍(Grace Hao). 儿童自闭症康复治疗学[M]. 重庆: 西南师范大学出版社, 2018: 5-10.
5 Davis H. Counselling parents of children with chronic illness or disability[M]. New Jersy: Wiley-Blackwell, 1993: 110.
6 Edwards GS, Zlomke KR, Greathouse AD. RUBI parent training as a group intervention for children with autism: a community pilot study[J]. Res Autism Spectr Disord, 2019, 66: 101409. DOI: 10.1016/j.rasd.2019.101409.
7 Dale N. Working with families of children with special needs: partnership and practice[M]. London: Routledge, 1995: 2-10.
8 Hume K, Steinbrenner JR, Odom SL, et al. Evidence-based practices for children, youth, and young adults with autism: third generation review[J]. J Autism Dev Disord, 2021, 51(11): 4013-4032. PMID: 33449225. DOI: 10.1007/s10803-020-04844-2.
9 Downs A, Downs RC. Training new instructors to implement discrete trial teaching strategies with children with autism in a community-based intervention program[J]. Focus Autism Other Dev Disabl, 2013, 28(4): 212-221. DOI: 10.1177/1088357612465120.
10 李丹. 孤独症干预的关键性技能训练法[M]. 北京: 北京大学出版社, 2014: 199-201.
11 杨玉凤. 儿童发育行为心理评定量表[M]. 北京: 人民卫生出版社, 2016: 199-207.
12 Deb SS, Retzer A, Roy M, et al. The effectiveness of parent training for children with autism spectrum disorder: a systematic review and meta-analyses[J]. BMC Psychiatry, 2020, 20(1): 583. PMID: 33287762. PMCID: PMC7720449. DOI: 10.1186/s12888-020-02973-7.
13 Ingersoll B, Straiton D, Caquias NR. The role of professional training experiences and manualized programs in ABA providers' use of parent training with children with autism[J]. Behav Ther, 2020, 51(4): 588-600. PMID: 32586432. DOI: 10.1016/j.beth.2019.09.004.
14 Manohar H, Kandasamy P, Chandrasekaran V, et al. Brief parent-mediated intervention for children with autism spectrum disorder: a feasibility study from South India[J]. J Autism Dev Disord, 2019, 49(8): 3146-3158. PMID: 31053990. DOI: 10.1007/s10803-019-04032-x.
15 Ho MH, Lin LY. Efficacy of parent-training programs for preschool children with autism spectrum disorder: a randomized controlled trial[J]. Res Autism Spectr Disord, 2020, 71: 101495. DOI: 10.1016/j.rasd.2019.101495.
16 Bradshaw J, Bearss K, McCracken C, et al. Parent education for young children with autism and disruptive behavior: response to active control treatment[J]. J Clin Child Adolesc Psychol, 2018, 47(sup1): S445-S455. PMID: 29048234. PMCID: PMC6242765. DOI: 10.1080/15374416.2017.1381913.
17 Blackman AL, Jimenez-Gomez C, Shvarts S. Comparison of the efficacy of online versus in-vivo behavior analytic training for parents of children with autism spectrum disorder[J]. Behav Anal Res Pract, 2020, 20(1): 13-23. DOI: 10.1037/bar0000163.
18 Akhani A, Dehghani M, Gharraee B, et al. Parent training intervention for autism symptoms, functional emotional development, and parental stress in children with autism disorder: a randomized clinical trial[J]. Asian J Psychiatr, 2021, 62: 102735. PMID: 34171493. DOI: 10.1016/j.ajp.2021.102735.
19 高迪, 于婷, 李春丽, 等. 早期介入丹佛模式的密集训练结合家长培训对孤独症谱系障碍儿童疗效及其对父母育儿压力的影响[J]. 中国当代儿科杂志, 2020, 22(2): 158-163. PMID: 32051084. PMCID: PMC7390010. DOI: 10.7499/j.issn.1008-8830.2020.02.014.
20 McGarry E, Vernon T, Baktha A. Brief report: a pilot online pivotal response treatment training program for parents of toddlers with autism spectrum disorder[J]. J Autism Dev Disord, 2020, 50(9): 3424-3431. PMID: 31190197. DOI: 10.1007/s10803-019-04100-2.
21 ShafferDR, KippK. 发展心理学[M]. 邹泓, 等, 译. 8版. 北京: 中国轻工业出版社, 2009: 231-254.
基金
重庆英才·创新领军人物专项（CQYC20200303136）；重庆市技术创新与应用发展专项（cstc2020jscx-msxmX0078）。
PDF(555 KB)
