目的 探索综合干预对孤独症儿童的疗效,为提高患儿生存能力提供参考依据。方法 依据美国精神障碍诊断统计手册第4版(DSM-IV)中孤独症的诊断标准,在专科收集60例(男51例,女9例,年龄1.5~5.5岁之间)孤独症患儿进行自身前后对照研究。采取诊断评估后,按照患儿特征制定个别化的教育干预治疗计划,治疗中采取应用行为分析疗法(ABA)、结构化教育(TEACCH)及关系发展干预(RDI)相融合的综合性干预措施,并强调家庭参与到患儿的治疗干预中。用孤独症治疗评估量表(ATEC)及婴儿-初中生社会生活能力量表(SM)进行干预疗效评估。 结果 60例患儿ATEC总分由训练前的(79.83±16.98)分下降到(46.82±6.95)分,量表中语言、社交、感知觉、行为四个分项目得分都明显下降,且<3岁干预组在语言、社交、行为上的分数下降较>3岁干预组更甚;SM由训练前的(7.43±1.16)分提高到(8.87±1.06)分,<3岁干预组提升优于>3岁干预组,差异均有统计学意义(P<0.01),表明通过综合干预,孤独症儿童在社交能力、语言能力及生活适应能力上得到一定程度提高,尤其是3岁前进行干预的孤独症儿童能力提高更为明显。 结论 综合干预在一定程度上可减轻孤独症症状及改善其适应能力。

Objective To study the efficacy of comprehensive intervention on the autistic children. Methods After 60 cases (boys 51,girls 9,aged from 1.5 to 6.5) with autism according to the DSM-IV were assessed,individual convention plan was made.The plan,emphasizing family involvement,was applied in training,including Applied Behavior Analysis (ABA),Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH) and Relationship Development Intervention (RDI).The scores of Autism Treatment Evaluation Checklist (ATEC) and Infant-Junior Middle school Social Adaptive Capacity Scale (SM)were investigated before and after training. Results The ATEC total score of 60 autistic children was significantly decreased from 79.83±16.98 to 46.82±6.95(P<0.01).The subscale scores including language,social intercourse,sensory and behavior were decreased(P<0.01),and the score of less than 3 years of age group was better than that of greater than 3 years group,and the difference was significant(P<0.01).The SM score was increased from 7.43±1.16 to 8.87±1.06,and the score of less than 3 years of age group was better than that of greater than 3 years group too,and the difference was significant(P<0.01). Conclusion The training strategy of comprehensive intervention in a certain extent could alleviate the symptoms of autism and improve its ability to adapt the society.