社交技能教育与促进项目对学龄期注意缺陷多动障碍儿童的干预效果

doi:10.11852/zgetbjzz2022-1109

摘要/Abstract

摘要： 目的探索社交技能教育与促进项目(PEERS^®)对6~8岁注意缺陷多动障碍(ADHD)儿童社交技能的干预效果,为该项目在我国小年龄组ADHD儿童中的临床应用提供证据。方法将2021年3—11月于上海市儿童医院儿童保健科确诊为ADHD的74名6~8岁儿童进行随机分组,干预组接受为期14周的PEERS训练,待干预组在干预组接受干预期间不接受干预。干预前、干预后14周分别使用儿童社交焦虑量表(SASC)、小学生社会技能家长评定表、Weiss功能量表父母版(WFIRS-P)、长处与困难问卷(SDQ)进行评估。结果在干预组接受14周训练后,SASC量表得分显示干预组的害怕否定评价(t=2.35)、社交回避苦恼得分(t=2.34)和量表总分(t=3.35)较干预前明显下降且低于待干预组,差异均有统计学意义(P＜0.05)。小学生社会技能评定量表得分显示干预组的交往意向(t=3.70)、群体威望(t=2.84)、社会敏感性(t=6.31)、掩饰性(t=2.34)、个体敏感性(t=3.10)、情感感受性(t=3.33)、表达技巧(t=5.95)、交往技巧(t=2.47)、社会表达与控制(t=7.24)、社会感受(t=7.71)、情感感受与控制得分(t=3.78)和量表总分(t=9.14)较干预前升高,且干预后得分均高于待干预组,差异均有统计学意义(P＜0.05)。WFIRS-P得分显示干预组家庭(t=3.06)、学习/学校(t=3.65)、自我观念(t=2.44)、社会活动(t=3.50)、冒险活动得分(t=7.29)和量表总分(t=8.25)较干预前明显降低,且干预后得分高于待干预组,差异均有统计学意义(P＜0.05)。SDQ量表得分显示除品行问题(t=1.57,P=0.122)和多动注意不能(t=1.78,P=0.08)外,干预组情绪症状(t=3.01)、同伴交往问题(t=1.78)、困难总分得分(t=5.72)较干预前明显降低(P<0.05),亲社会行为得分较干预前明显升高(t=3.07,P=0.003);且干预后得分均高于待干预组,差异均有统计学意义(P＜0.05)。干预后干预组SNAP-Ⅳ量表中多动-冲动得分较干预前显著降低(t=2.29,P=0.025),且与待干预组相比降低更明显,差异具有统计学意义(P＜0.05)。结论 PEERS训练能显著提高6~8岁ADHD儿童的社交技能,改善ADHD儿童的社交功能及部分核心症状。

关键词: 注意缺陷多动障碍, 社交技能教育与促进项目, 社交技能

Abstract: Objective To explore the effect of the program for the education and enrichment of relational skills (PEERS^®) on the social skills of children with attention deficit hyperactivity disorder (ADHD) aged 6 - 8 years, so as to provide evidence for the clinical application of this project in young ADHD children in China. Methods A total of 74 children aged 6 - 8 years who were diagnosed with ADHD in the Department of Child Health Care of Shanghai Children's Hospital from March to November 2021 were enrolled in this study, and were randomly divided into intervention group and control group. The intervention group received PEERS training for 14 weeks, while the control group did not receive any intervention until the intervention in this study was finished. Social Anxiety Scale for Children (SASC), Social Skills Parent Rating Scale for Primary School Students, Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) and Strengths and Difficulties Questionnaire (SDQ) were used for evaluation before and after the intervention. Results After 14 weeks of training, there was a statistically significant decrease in the fear of denial rating (t=2.35), social avoidance distress score (t=2.34) and total SASC score (t=3.35) in the intervention group compared with those before intervention, and the scores were significantly lower than those in the control group(P<0.05). In terms of the Social Skills Parent Rating Scale for Primary School Students, scores of intention to interact (t=3.70), group prestige (t=2.84), social sensitivity (t=6.31), masking (t=2.34), individual sensitivity (t=3.10), emotional sensibility (t=3.33), expression skills (t=5.95), interaction skills (t=2.47), social expression and control (t=7.24), social feelings (t=7.71), emotional feelings and control (t=3.78) and total scale score (t=9.14) after intervention were significantly higher than those before intervention in the intervention group,which were significantly higher than those of the control group after intervention (P<0.05). In terms of WFIRS-P, the intervention group had significantly higher scores for family (t=3.06), learning/school (t=3.65), self-concept (t=2.44), social activity (t=3.50), adventure activity score (t=7.29) and total scale (t=8.25) after intervention,which were significantly higher than those of the control group after intervention (P<0.05).Except for conduct problems (t=1.57, P=0.122) and hyperactive attention inability (t=1.78, P=0.08),the intervention group had significantly lower scores for emotional symptoms (t=3.01), peer interaction problems (t=1.78) and total difficulty score (t=5.72) after intervention,which were significantly higher than those of the control group after intervention (P<0.05). After intervention, the hyperactivity-impulsivity score on the SNAP-Ⅳ scale was significantly lower in the intervention group than that before intervention (t=2.29, P=0.025), and the decrease was more significant compared to the control group (P<0.05). Conclusion PEERS training can significantly improve the social skills of ADHD children aged 6 - 8 years, and improve social function and some core symptoms of ADHD children.

Key words: attention deficit hyperactivity disorder, program for the education and enrichment of relational skills, social skills

中图分类号:

R749.94

朱佩滢, 储莉婷, 马晨欢, 潘丽珠, 郭乃绮, 陆丁杰, 王瑜. 社交技能教育与促进项目对学龄期注意缺陷多动障碍儿童的干预效果[J]. 中国儿童保健杂志, 2023, 31(9): 951-956.

ZHU Peiying, CHU Liting, MA Chenhuan, PAN Lizhu, GUO Naiqi, LU Dingjie, WANG Yu. Effect of the program for the education and enrichment of relational skills on school-age children with attention deficit hyperactivity disorder[J]. Chinese Journal of Child Health Care, 2023, 31(9): 951-956.

参考文献

[1] Barnett R.Attention deficit hyperactivity disorder[J].Lancet,2016, 387 (10020): 737.
[2] Danielson ML, Bitsko RH, Ghandour RM, et al.Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016[J].J Clin Child Adolesc Psychol,2018, 47 (2): 199-212.
[3] Tudor HJ.ADHD is a social problem[J].BMJ,2013, 347: f7028.
[4] Chou W, Huang M, Chang Y, et al.Social skills deficits and their association with internet addiction and activities in adolescents with attention-deficit/hyperactivity disorder[J]. J Behav Addict,2017, 6 (1): 42-50.
[5] Froehlich T.Comparison of medication treatments for preschool children with ADHD: A first step toward addressing a critical gap[J].JAMA,2021, 325 (20): 2049-2050.
[6] Solmi M, Fornaro M, Ostinelli E, et al.Safety of 80 antidepressants, antipsychotics, anti-attention-deficit/hyperactivity medications and mood stabilizers in children and adolescents with psychiatric disorders:A large scale systematic meta-review of 78 adverse effects[J].World Psychiatry,2020, 19 (2): 214-232.
[7] Pérez de los Cobos J, Siñol N, Pérez V, et al. Pharmacological and clinical dilemmas of prescribing in co-morbid adult attention-deficit/hyperactivity disorder and addiction[J]. Br J Clin Pharmacol,2014,77(2):337-356.
[8] 祖燕飞,杜亚松,姚德胜,等. 上海孤独谱系障碍患儿、母亲社交PEERS团体训练效果的研究[J]. 中国儿童保健杂志,2020,28(5):502-505.
Zu YF, Du YS, Yao DS,et al. Study on the effect of social PEERS group training for mothers of children with loneliness spectrum disorder in Shanghai[J].Chin J Child Health Care, 2020, 28 (5): 502-505.(in Chinese)
[9] Laugeson EA, Gantman A, Kapp SK, et al.A randomized controlled trial to improve social skills in young adults with autism spectrum disorder: The UCLA PEERS(®) program[J].J Autism Dev Disord,2015, 45 (12): 3978-3789.
[10] Frankel F, Myatt R, Sugar C, et al.A randomized controlled study of parent-assisted Children's Friendship Training with children having autism spectrum disorders[J].J Autism Dev Disord,2010, 40 (7):827-842.
[11] 李改智, 杜亚松.社交技能教育和促进项目对孤独谱系障碍青少年社交技能的提升作用研究进展[J].中国儿童保健杂志,2017, 25 (9): 917-920.
Li GZ, Du YS.Research progress on the improvement of social skills of adolescents with loneliness spectrum disorder by social skills education and promotion program[J] Chin J Child Health, 2017, 25(9): 917-920.(in Chinese)
[12] 施萍.儿童年龄分期及胎儿期、围生期保健重点[J].中国社区医师,2011,27(42):28.
Shi P. Age staging of children and key health care points in fetal and perinatal period[J]. Chinese Community Physician, 2011, 27 (42):28.(in Chinese)
[13] Gnanavel S, Robert RS.Diagnostic and statistical manual of mental disorders, fifth edition, and the impact of events scale-revised[J].Chest,2013, 144 (6): 1974-1975.
[14] 樊宁. 注意缺陷多动障碍患儿社交功能特点及干预效果的研究[D].上海:上海交通大学,2020.
Fan N.Study on the characteristics of social function and intervention effect of children with attention deficit hyperactivity disorder [D].Shanghai:Shanghai Jiaotong University, 2020.(in Chinese)
[15] 孟红. 小学生社会技能家长评定表的编制与试用研究[D]. 长沙:湖南师范大学,2004.
Meng H.A Study on the preparation and trial use of the Parent Assessment Form for Primary School Students' Social Skills[D].Changsha: Hunan Normal University, 2004.(in Chinese)
[16] Laugeson EA, Frankel F, Gantman A, et al.Evidence-based social skills training for adolescents with autism spectrum disorders:The UCLA PEERS program[J].J Autism Dev Disord,2012, 42 (6): 1025-1036.
[17] Gardner DM, Gerdes AC, Weinberger K.Examination of a parent-assisted, friendship-building program for adolescents With ADHD[J].J Atten Disord,2019, 23 (4): 363-373.
[18] Idris S, Van Pelt B J, Jagersma G, et al.A randomized controlled trial to examine the effectiveness of the Dutch version of the Program for the Education and Enrichment of Relational Skills (PEERS®)[J].BMC Psychiatry,2022, 22 (1): 293.
[19] Shum K, Cho W, Lam L, et al.Learning how to make friends for Chinese adolescents with autism spectrum disorder: A randomized controlled trial of the Hong Kong Chinese version of the PEERS® intervention[J]. J Autism Dev Disord,2019, 49 (2): 527-541.
[20] Greca AL, Dandes SK, Wick P, et al.Development of the Social Anxiety Scale for children: Reliability and concurrent validity[J]. Clin Child Psychol P,1988, 17 (1): 84-91.
[21] 李飞, 苏林雁, 金宇. 儿童社交焦虑量表的中国城市常模[J]. 中国儿童保健杂志, 2006, 14(4):335-335.
Li F, Su LY, Jin Yu.Chinese urban norm of Children's Social Anxiety Scale[J].Chin J Child Health Care, 2006, 14 (4): 335-335.(in Chinese)
[22] 钱英,杜巧新,曲珊,等.Weiss功能缺陷量表父母版的信效度[J].中国心理卫生杂志,2011,25(10):767-771.
Qian Y, Du QX, Qu S, et al.Reliability and validity of the Chinese version of Weiss Functional Impairment Scale-Parent form for school age children[J].Chinese Mental Health Journal,2011, 25 (10): 767-771.(in Chinese)
[23] 许文兵,王孟成,邓嘉欣,等. 长处和困难问卷中文版的信度概化分析[J]. 中国临床心理学杂志,2019,27(1):67-72.
Xu WB, Wang MC,Deng JX, et al. Reliability generalization analysis of the Chinese Version of the Strengths and Difficulties Questionnaire[J]. Chinese Journal of Clinical Psychology, 2019,27(1):67-72.(in Chinese)
[24] 井卫英, 陈会昌, 孙铃. 幼儿的游戏行为及其与社会技能,学习行为的典型相关分析[J]. 心理发展与教育, 2002, 18(2):12-16.
Jing WY, Chen HC, Sun L. Children's play behavior and its typical correlation analysis with social skills and learning behavior[J] Psychological Development and Education, 2002, 18 (2): 12-16.(in Chinese)
[25] 顾静雯, 闻萍, 刘明霞,等. 注意缺陷多动障碍患儿社会功能损害的情况[J]. 中华实用儿科临床杂志, 2015,30(8):633-634.
Gu JW, Wen P, Liu MX, et al. Impairment of social function in children with attention deficit hyperactivity disorder[J] Chinese Journal of Practical Pediatrics, 2015,30(8):633-634.(in Chinese)