目的 评价父母介导的干预对孤独症谱系障碍(ASD)儿童症状改善的有效性,为ASD儿童的治疗、干预提供理论依据。方法 检索PubMed、Web of Science、Embase、CINAHL、知网、万方、维普以及Sinomed共8个数据库中关于父母介导的干预对ASD儿童影响的随机对照试验。检索时间为从建库到2022年9月,采用RevMan 5.3软件进行统计分析和其中的Cochrane协作工具进行文献的质量评价。结果 纳入了19篇随机对照试验(RCTs)研究,共纳入1 299名ASD儿童,Meta分析结果显示,父母介导的干预在患儿的社交(SMD=0.34,95%CI:0.16~0.52,P<0.05)、适应性行为(MD=5.48,95%CI:2.44~8.52,P<0.001)、共同关注(SMD=0.31,95%CI:0.05~0.56,P<0.05)以及ASD的严重程度(SMD＝-0.93,95%CI:-1.10~-0.77,P＜0.001)等方面都有改善,但是表达性语言、接受性语言方面以及在刻板行为方面的改善差异无统计学意义(P>0.05);对父母来说,其压力(SMD＝-0.30,95%CI:-0.54~-0.07,P=0.01)也有所减轻。结论 父母介导的干预对ASD儿童症状改善及减少父母压力都有有益的影响,但是还需要高质量的研究进一步验证。
Abstract
Objective To evaluate the efficay of parent-mediated intervention on the improvement of symptoms of children with autism spectrum disorder (ASD), in order to provide theoretical basis for the treatment and intervention of ASD children. Method Randomized controlled trials regarding the effects of parent-mediated intervention on ASD children were searched in eight databases, including PubMed, Embase, Web of Science, CINAHL, cnki, Wanfang, VIP and Sinomed. RevMan 5.3 software was used for statistical analysis and the Cochrane collaboration tool was used to evaluate the quality of the literature. Results A total of 1 299 ASD children from 17 randomized controlled trials (RCTs) were included in this study. Meta-analysis results showed that significant improvement was observed in core symptoms of ASD children with parent-mediated intervention, including social interaction (SMD=0.34, 95%CI: 0.16 - 0.52, P＜0.05), adaptive behavior (MD=5.48, 95%CI:2.44 - 8.52, P<0.001), shared or joint attention(SMD=0.31, 95%CI:0.05 - 0.56, P＜0.05) and the severity of autism (SMD=-0.93, 95%CI:-1.10 - -0.77, P＜0.001), but expressive language, receptive language and stereotyped behaviors had no significant improvement. After intervention, parents' stress was significantly reduced (SMD=-0.30, 95%CI:-0.54 - -0.07,P=0.01). Conclusion Parent-mediated interventions have a beneficial effect on symptoms improvement and parental stress reduction in ASD children, but high quality research is warranted to confirm the conclusion further.
关键词
孤独症谱系障碍 /
早期干预 /
父母 /
Meta分析
Key words
autism spectrum disorder /
early intervention /
parents /
Meta-analysis
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders: DSM-V [M]. 5th ed. Washington DC: American Psychiatric Public Inc, 2013: 53-59.
[2] The L. Progress in the USA for autistic spectrum disorder[J]. Lancet, 2018, 391(10132):1750.
[3] Maenner MJ, Shaw KA, Bakian AV, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 sites, United States, 2018[J]. Morbidity and mortality weekly report Surveillance summaries, 2021, 70(11):1-16.
[4] 中华医学会儿科学分会发育行为学组, 中国医师协会儿科分会儿童保健专业委员会, 儿童孤独症诊断与防治技术和标准研究项目专家组. 孤独症谱系障碍儿童早期识别筛查和早期干预专家共识[J]. 中华儿科杂志,2017, 55(12):890-897.
Developmental Behavioral Group of Chinese Medical Pediatrics Association, Child Health Professional Committee of Pediatrics Branch of Chinese Physicians Association, expert group of techniques and standards for diagnosis, prevention and treatment of childhood autism. Expert consensus on early identification screening and early intervention in children with autism spectrum disorders[J]. Chin J Pediatr, 2017, 55 (12):890-897.
[5] 武宇琦.孤独症谱系障碍儿童的早期识别[J].国际儿科学杂志,2018,45(12):955-958.
Wu YQ. Early recognition of children with autism spectrum disorder[J].Int J Pediatr, 2018, 45(12): 955-958.
[6] 莫书亮, 卜凡, 霍家佐, 等. 影响孤独症儿童评估、诊断和干预的家庭心理因素剖析[J].中国特殊教育, 2021(6):90-96.
Mo SL, Bu F, Huo JZ, et al. Analysis of Family Psychological factors affecting the Evaluation, diagnosis and intervention of Autistic Children[J]. Special Education in China, 2021(6):90-96.
[7] Nordhov SM, Ronning JA, Dahl LB, et al. Early intervention improves cognitive outcomes for preterm infants:Randomized controlled trial[J]. Pediatrics, 2012, 129(1):e9-e16.
[8] 邹卓, 刘芸, 黄浩宇, 等. 儿童孤独症谱系障碍流行现状和家庭干预的研究及策略[J]. 中国全科医学, 2020, 23(8):900-907.
Zou Z, Liu Y, Huang HY, et al. Study and strategy of epidemic status and family intervention of autism spectrum disorder in children[J]. Chin Gen Prac, 2020, 23 (8):900-907.
[9] Dawson G, Rogers S, Munson J, et al.Randomized, controlled trial of an intervention for toddlers with autism:The Early Start Denver Model[J]. Pediatrics, 2010, 125(1):e17-e23.
[10] Oono IP, Honey EJ, Mcconachie H. Parent-mediated early intervention for young children with autism spectrum disorders (ASD) [M]. Hoboken, New Jersey:John Wiley & Sons, Inc. 2013:2380-2479.
[11] Tonge BJ, Bull K, Brereton A, et al. A review of evidence-based early intervention for behavioural problems in children with autism spectrum disorder:The core components of effective programs, child-focused interventions and comprehensive treatment models[J]. Curr Opin Psychiatr, 2014, 27(2):158-165.
[12] Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses:the PRISMA statement[J]. PLoS Med, 2009, 6(7):e1000097.
[13] Bentenuto A, Bertamini G, Perzolli S, et al. Changes in developmental trajectories of preschool children with autism spectrum disorder during parental based intensive intervention[J]. Brain Sci, 2020, 10(5):289.
[14] Casenhiser DM, Shanker SG, Stieben J. Learning through interaction in children with autism:Preliminary data from asocial-communication-based intervention[J]. Autism, 2013, 17(2):220-241.
[15] Estes A, Vismara L, Mercado C, et al. The impact of parent-delivered intervention on parents of very young children with autism[J]. J Autism Dev Disord, 2014, 44(2):353-365.
[16] Green J, Charman T, Mcconachie H, et al. Parent-mediated communication-focused treatment in children with autism (PACT):A randomised controlled trial[J]. Lancet, 2010, 375(9732):2152-2160.
[17] Green J, Pickles A, Pasco G, et al. Randomised trial of a parent-mediated intervention for infants at high risk for autism:Longitudinal outcomes to age 3 years[J]. J Child Psychol Psychiatry, 2017, 58(12):1330-1340.
[18] Kasari C, Gulsrud A, Paparella T, et al. Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism[J]. J Consult Clin Psychol, 2015, 83(3):554-563.
[19] 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.
[20] Pickles A, Le Couteur A, Leadbitter K, et al. Parent-mediated social communication therapy for young children with autism (PACT):Long-term follow-up of a randomised controlled trial[J]. Lancet, 2016, 388(10059):2501-2509.
[21] Rickards AL, Walstab JE, Wright-Rossi RA, et al. A randomized, controlled trial of a home-based intervention program for children with autism and developmental delay[J]. J Dev Behav Pediatr, 2007, 28(4):308-316.
[22] Tellegen CL, Sanders MR. A randomized controlled trial evaluating a brief parenting program with children with autism spectrum disorders[J]. J Consult Clin Psychol, 2014, 82(6):1193-1200.
[23] Tonge B, Brereton A, Kiomall M, et al. A randomised group comparison controlled trial of 'preschoolers with autism':A parent education and skills training intervention for young children with autistic disorder[J]. Autism, 2014, 18(2):166-177.
[24] Turner-Brown L, Hume K, Boyd BA, et al. Preliminary efficacy of family implemented TEACCH for toddlers:Effects on parents and their toddlers with autism spectrum disorder[J]. J Autism Dev Disord, 2019, 49(7):2685-2698.
[25] Valeri G, Casula L, Menghini D, et al. Cooperative parent-mediated therapy for Italian preschool children with autism spectrum disorder:A randomized controlled trial[J]. Eur Child Adolesc Psychiatry, 2020, 29(7):935-946.
[26] 惠军丽. 家庭共同参与干预在自闭症儿童康复中的应用效果观察[J]. 首都食品与医药,2020, 27(10):22.
Hui JL. Observation on the effect of family intervention in the rehabilitation of autistic children[J]. Food and Medicine in the Capital, 2020, 27 (10):22.
[27] 孙艳萍, 李文艳. 早期家庭护理干预在儿童孤独症患儿中的应用效果分析[J]. 中外女性健康研究,2015(19):149,55.
Sun YP, Li WY. Analysis of the effect of early family nursing intervention in children with autism[J]. Women's Health Research,2015(19):149,55.
[28] 徐燕, 马春霞, 陈清华. 家庭综合干预护理在儿童孤独症中的应用效果[J]. 人人健康,2019(21):420.
Xu Y, Ma CX, Chen QH. Application effect of family comprehensive intervention nursing in children with autism[J]. Health For All, 2019(21):420.
[29] Malucelli ERS, Antoniuk SA, Carvalho NO. The effectiveness of early parental coaching in the autism spectrum disorder[J]. Jornal de pediatria, 2021, 97(4):453-458.
[30] 张雅如, 陶洪梅, 阳光, 等. 专业人员指导下孤独症谱系障碍儿童家长执行的家庭康复疗效观察的前瞻性研究[J].中国当代儿科杂志, 2021, 23(12):1256-1261.
Zhang Y, Tao HM, Yang G, etal. A prospective study on the efficacy of family rehabilitation performed by parents of children with autism spectrum disorders under the guidance of professionals[J]. Chin J Contemp Pediatr, 2021, 23 (12):1256-1261.
[31] 徐慧, 张建新, 张梅玲. 家庭教养方式对儿童社会化发展影响的研究综述[J]. 心理科学, 2008(4):940-942,959.
Xu H, Zhang JX, Zhang ML. A review of the research on the influence of family rearing styles on children's socialization development[J]. Psychological Science, 2008(4):940-942:59.
[32] 杨志伟, 刘少文, 李雪荣. 儿童行为问题、学业成绩与家庭环境的相关模型研究[J]. 中国心理卫生杂志, 2000, 15(4):263-266.
Yang ZW, Liu SX, Li XR. A study on the model of children's behavioral problems, academic achievement and family environment[J]. Chin J Mental Health, 2000,15(4):263-266.
[33] 刘娟, 黄雪花, 刘娅. 孤独症患儿临床护理干预的研究进展[J]. 护理学报, 2017, 24(14):36-39.
Liu J, Huang XH, Liu Y. Research progress of clinical nursing intervention for autistic children[J]. Journal of Nursing, 2017, 24 (14):36-39.
[34] Cheuk S, Lashewicz B. How are they doing? Listening as fathers of children with autism spectrum disorder compare themselves to fathers of children who are typically developing[J]. Autism, 2015, 20(3):343.
基金
江苏省科教强卫工程青年医学人才项目(QNRC2016100);江苏省第十五批“六大人才高峰”高层次人才项目(wsw-125)
PDF(2619 KB)
