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。
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.
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
Key words
attention deficit hyperactivity disorder /
program for the education and enrichment of relational skills /
social skills
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基金
上海市卫生健康委员会公共卫生体系建设三年行动计划(2020-2022年)重点学科建设项目子课题(GWV-10.1-XK19);上海市卫生健康委员会老龄化和妇儿健康研究专项计划(2020YJZX0203)
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