孤独症谱系障碍儿童通过远程医疗实现的家庭干预模式研究进展

doi:10.11852/zgetbjzz2023-0375

摘要/Abstract

摘要： 孤独症谱系障碍(ASD)的发病率逐年增高,早期、密集、持续的干预对ASD儿童的预后具有重要意义。然而医疗资源的缺乏和难以获取一直是困扰人们的难题,新冠肺炎疫情全球大流行更加剧了实施干预的难度。近年来人们对远程医疗模式和家庭干预的关注日益提升,研究表明通过远程医疗实现由父母介导的家庭干预方式是一种极具成本效益的干预方式,不仅能有效改善ASD儿童症状,也能克服地理的限制使得偏远地区的ASD儿童获得大量有效的医疗资源。然而,目前国内关于远程医疗模式和家庭干预的研究均较少,因此本文对目前国内外常见的通过远程医疗进行的家庭干预进行系统回顾,以期对今后国内的干预模式起到一定的参考作用,为广大偏远地区的ASD儿童干预带来希望。

关键词: 孤独症谱系障碍, 远程医疗, 家庭干预

Abstract: The incidence of autism spectrum disorder (ASD) is increasing annually. Early, intensive, and continuous intervention is crucial for the prognosis of children with ASD. However, the lack of accessible medical resources and the challenges posed by the global COVID-19 pandemic have exacerbated the difficulties in implementing interventions. Consequently, there has been a growing recognition of the telemedicine model and family intervention in recent years. Studies have shown that parent-mediated intervention through telemedicine is extremely cost-effective which can not only effectively improve the symptoms of ASD children, but also overcome geographical limitations and enable children with ASD in remote areas to obtain a large number of effective medical resources. However, there are few researches on telemedicine model and family intervention in China at present. Therefore, this paper systematically reviews the family intervention through telemedicine, in order to provide reference for the intervention model in China in the future and bring hope for the intervention of children with ASD in remote areas.

Key words: autism spectrum disorder, telemedicine, family-mediated intervention

中图分类号:

R749.94

詹阳湄, 李廷玉. 孤独症谱系障碍儿童通过远程医疗实现的家庭干预模式研究进展[J]. 中国儿童保健杂志, 2023, 31(12): 1340-1344.

ZHAN Yangmei, LI Tingyu. Review of the family-mediated intervention through telemedicine in children with autism spectrum disorder[J]. Chinese Journal of Child Health Care, 2023, 31(12): 1340-1344.

参考文献

[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5[M]. 5th ed. Washington DC: American Psychiatric Association, 2013.
[2] Maenner MJ, Warren Z, Williams AR, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years—Autism and developmental disabilities monitoring network, 11 Sites, United States, 2020[J]. MMWR Surveill Summ, 2023,72(2):1-14.
[3] Zhou H, Xu X, Yan W, et al. Prevalence of autism spectrum disorder in China: A nationwide multi-center population-based study among children aged 6 to 12 years[J]. Neurosci Bull, 2020, 36(9):961-971.
[4] Liu Q, Hsieh WY, Chen G. A systematic review and meta-analysis of parent-mediated intervention for children and adolescents with autism spectrum disorder in mainland China, Hong Kong, and Taiwan[J]. Autism, 2020,24(8):1960-1979.
[5] Gallaway MS, Rigler J, Robinson S, et al. Trends in COVID-19 incidence after implementation of mitigation measures - Arizona, January 22-August 7, 2020[J]. MMWR Morb Mortal Wkly Rep, 2020, 69(40):1460-1463.
[6] Bearss K, Burrell TL, Challa SA, et al. Feasibility of parent training via telehealth for children with autism spectrum disorder and disruptive behavior: A demonstration pilot[J]. J Autism Dev Disord, 2018,48(4):1020-1030.
[7] De Nocker YL, Toolan CK. Using telehealth to provide interventions for children with ASD: A systematic review[J]. Rev J Autism Dev Disord, 2023,10(1):82-112.
[8] Ellison KS, Guidry J, Picou P, et al. Telehealth and autism prior to and in the age of COVID-19: A systematic and critical review of the last decade[J]. Clin Child Fam Psychol Rev,2021, 24(3):599-630.
[9] Ingersoll B, Wainer A. Initial efficacy of project ImPACT: A parent-mediated social communication intervention for young children with ASD[J]. J Autism Dev Disord, 2013, 43(12):2943-2952.
[10] Althoff CE, Dammann CP, Hope SJ, et al. Parent-mediated interventions for children with autism spectrum disorder: A systematic review[J]. Am J Occup Ther, 2019,73(3):7303205010p1-7303205010p13.
[11] Salomone E, Pacione L, Shire S, et al. Development of the WHO Caregiver Skills Training Program for developmental disorders or delays[J]. Front Psychiatry,2019,10:769.
[12] Tekola B, Girma F, Kinfe M, et al. Adapting and pre-testing the World Health Organization's Caregiver Skills Training Programme for autism and other developmental disorders in a very low-resource setting: Findings from Ethiopia[J]. Autism, 2020,24(1):51-63.
[13] Sengupta K, Shan H, Ghosh S, et al. World Health Organisation-Caregiver Skills Training(WHO-CST)Program: Feasibility of delivery by non-specialist providers in real-world urban settings in India[J]. J Autism Dev Disord, 2023, 53(4):1444-1461.
[14] Salomone E, Settanni M, Mcconachie H, et al. Pilot randomized controlled trial of the WHO Caregiver Skills Training in public health services in Italy[J]. J Autism Dev Disord, 2022, 52(10):4286-4300.
[15] Ferrante C, Sorgato P, Fioravanti M, et al. Supporting caregivers remotely during a pandemic: Comparison of WHO Caregiver Skills Training delivered online versus in person in public health settings in Italy[J]. J Autism Dev Disord, 2022:1-20. doi:10.1007/s10803-022-05800-y.
[16] Wong PWC, Lam YY, Lau JSP, et al. Adapting and pretesting the World Health Organization's Caregiver Skills Training Program for children with autism and developmental disorders or delays in Hong Kong[J]. Sci Rep, 2022,12(1):16932.
[17] Lau JSP, Lai SMK, Ip FTS, et al. Acceptability and feasibility of the World Health Organization's Caregiver Skills Training Programme (WHO CST) delivered via eLearning, video conferencing, and in-person hybrid modalities in Hong Kong[J]. Front Psychiatry, 2022, 13:915263.
[18] Montiel-Nava C, Tregnago M, Marshall J, et al. Implementing the WHO caregivers skills training program with caregivers of autistic children via telehealth in rural communities[J]. Front Psychiatry, 2022, 13:909947.
[19] Schreibman L, Dawson G, Stahmer AC, et al. Naturalistic developmental behavioral interventions: Empirically validated treatments for autism spectrum disorder[J]. J Autism Dev Disord, 2015,45(8):2411-2428.
[20] 吴丹萍, 任芳, 沈理笑,等. 孤独症谱系障碍ImPACT干预方案的改编及适应性调查[J]. 上海交通大学学报(医学版), 2022, 42(9): 1239-1246.
Wu DP, Ren F, Shen LX,et al. Adaptation and adaptability investigation of Improving Parents as Communication Teachers (ImPACT) program for autism spectrum disorder[J].J Shanghai JT Univ(Medical Science), 2022, 42(9): 1239-1246.(in Chinese)
[21] Stahmer AC, Rieth SR, Dickson KS, et al. Project ImPACT for toddlers: Pilot outcomes of a community adaptation of an intervention for autism risk[J]. Autism, 2020,24(3):617-632.
[22] Hao Y, Franco JH, Sundarrajan M, et al. A pilot study comparing tele-therapy and in-Person therapy: Perspectives from parent-mediated intervention for children with autism spectrum disorders[J]. J Autism Dev Disord, 2021,51(1):129-143.
[23] Green J, Aldrend C, Charman T, et al. Paediatric autism communication therapy-generalised(PACT-G)against treatment as usual for reducing symptom severity in young children with autism spectrum disorder: Study protocol for a randomised controlled trial[J]. Trials, 2018,19(1):514.
[24] Green J, Leadbitter K, Ellis C, et al. Combined social communication therapy at home and in education for young autistic children in England (PACT-G): A parallel, single-blind, randomised controlled trial[J]. Lancet Psychiatry, 2022,9(4):307-320.
[25] Jurek L, Occelli P, Denis A, et al. Efficacy of parent-mediated communication-focused treatment in toddlers with autism (PACT) delivered via video conferencing:A randomised controlled trial study protocol[J]. BMJ Open, 2021,11(4):e044669.
[26] Marino F, Chila P, Failla C, et al. Tele-assisted behavioral intervention for families with children with autism spectrum disorders: A randomized control trial[J]. Brain Sci, 2020,10(9):649.
[27] Roane HS, Fisher WW, Carr JE. Applied behavior analysis as treatment for autism spectrum disorder[J]. J Pediatr, 2016,175:27-32.
[28] Granich J, Dass A, Busacca M, et al. Randomised controlled trial of an iPad based early intervention for autism: TOBY playpad study protocol[J]. BMC Pediatr, 2016,16(1):167.
[29] Whitehouse AJO, Granich J, Alvares G, et al. A randomised controlled trial of an iPad-based application to complement early behavioural intervention in autism spectrum disorder[J]. J Child Psychol Psychiatry, 2017,58(9):1042-1052.
[30] Vivanti G, Stahmer AC. Can the early start denver model be considered ABA practice?[J]. Behav Anal Pract, 2020,14(1):230-239.
[31] Laugeson EA, Frankel F. Social skills for teenagers with developmental and autism spectrum disorders:The PEERS treatment manual[M]. New York: Routledge, 2010.
[32] Mandelberg J, Laugeson EA, Cunningham TD, et al. Long-term treatment outcomes for parent-assisted social skills training for adolescents with autism spectrum disorders: The UCLA PEERS Program[J]. J Ment Health Res Intellect Disabil, 2014,7(1): 45-73.
[33] Carr EG, Durand VM. Reducing behavior problems through functional communication training[J]. J Appl Behav Anal, 1985,18(2):111-126.
[34] Suess AN, Romani PW, Wacker DP, et al. Evaluating the treatment fidelity of parents who conduct in-home functional communication training with coaching via telehealth[J]. J Behav Educ, 2014, 23(1): 34-59.
[35] Bearss K, Burrell TL, Challa SA, et al. Feasibility of parent training via telehealth for children with autism spectrum disorder and disruptive behavior: A demonstration pilot[J]. J Autism Dev Disord, 2018,48(4):1020-1030.
[36] Keefer A, Vasa RA. Dinosaur: An integrated cognitive-behavioral treatment for anxiety in young children with ASD[J]. J Neurodev Disord, 2021,13(1):46.
[37] Hepburn SL, Blakeley-Smith A, Wolff B, et al. Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study[J]. Autism, 2016, 20(2):207-218.
[38] Reaven JA, Blakeleysmith A, Nichols S, et al. Facing your fears: Group therapy for managing anxiety in children with high-functioning autism spectrum disorders[J]. J Autism Dev Disord, 2011,42. doi.org/10.1007/s10803-011-1355-1
[39] Mazurek MO, Petroski GF. Sleep problems in children with autism spectrum disorder: Examining the contributions of sensory over-responsivity and anxiety[J]. Sleep Med, 2015, 16(2):270-279.
[40] Mccrae CS, Chan WS, Curtis AF, et al. Telehealth cognitive behavioral therapy for insomnia in children with autism spectrum disorder: A pilot examining feasibility, satisfaction, and preliminary findings[J]. Autism, 2021, 25(3):667-680.