目的 研究家庭共同活动框架下的游戏治疗对幼儿孤独症谱系障碍(ASD)的疗效,为探索ASD患儿能长期坚持家庭训练的有效干预方式提供科学依据。方法 选取2022年9月—2024年4月在赣州市妇幼保健院就诊的120例12～48月龄的ASD幼儿为研究对象,运用随机数字表法分为3组,观察组采用家长培训及实操教学,受试对象每天进行家庭共同活动游戏3h;常规干预组接受常规应用行为分析(ABA)干预治疗;家庭养育组不接受干预治疗,采用家庭养育照护方式管理。干预周期为6个月,采用Gesell发育诊断量表对患儿的治疗效果进行评估。结果 观察组、常规干预组和家庭养育组儿童性别、年龄分布差异无统计学意义(P＞0.05)。干预前3组儿童的总发育商、适应性、语言和个人-社交能力差异均无统计学意义(P＞0.05);干预后结果显示,三组间总发育商、适应性发育商、语言发育商、个人-社交发育商比较,差异有统计学意义(F=15.010、4.942、14.102、22.665,P＜0.05)。观察组的总发育商、适应性发育商、语言发育商、个人-社交发育商(69.51±9.17、62.23±10.61、54.95±12.41、61.21±13.58)均比家庭养育组(60.18±9.92、54.73±11.36、44.38±10.71、47.81±11.74)更高,差异有统计学意义(P＜0.05);观察组的总发育商、语言发育商、个人-社交发育商(69.51±9.17、54.95±12.41、61.21±13.58)均比常规干预组(59.65±8.56、42.50±11.28、44.63±8.50)更高,差异有统计学意义(P＜0.05)。结论 通过培训家长,在家中进行共同活动框架的游戏,可有效提升ASD幼儿适应性、语言能力及个人-社交能力,减轻家庭的经济负担,提升带养效率,这种模式有望成为ASD家庭长期坚持的有效干预方式,值得在ASD幼儿及其家庭中广泛推广。
Abstract
Objective To investigate the efficacy of play therapy within the framework of family co-activities for children with autism spectrum disorder(ASD), in order to provide a scientific basis for exploring effective intervention methods that enable long-term adherence to family-based training for children with ASD. Methods A total of 120 children aged 12 to 48 months with ASD, who visited the Ganzhou Maternity and Child Healthcare Hospital from September 2022 to April 2024, were selected as study participants. They were randomly divided into three groups using a random number table. The observation group received parent training and hands-on teaching, with the subjects engaging in family co-activity play for 3 hours per day. The conventional intervention group underwent conventional applied behavior analysis(ABA) intervention therapy. The home care group did not receive any intervention treatment and was managed through routine home care practices. The intervention period lasted for 6 months, and the Gesell Developmental Scale was used to assess the treatment outcomes of the children. Results There were no statistically significant differences in gender and age distribution among children in the observation group, conventional intervention group, and home care group(P＞0.05).Before the intervention, there were no statistically significant differences in total developmental quotient(DQ), adaptability, language, and personal-social skills among children in the three groups(P＞0.05). After the intervention, statistically significant differences were observed in total DQ, adaptive DQ, language DQ, and personal-social DQ among the three groups(F=15.010, 4.942, 14.102, 22.665, P＜0.05). Compared with the home care group, the observation group had higher total DQ(69.51±9.17 vs. 60.18±9.92), adaptive DQ(62.23±10.61 vs. 54.73±11.36), language DQ(54.95±12.41 vs. 44.38±10.71), and personal-social DQ(61.21±13.58 vs. 47.81±11.74) (P＜0.05). Compared with the conventional intervention group, the observation group had higher total DQ(69.51±9.17 vs.59.65±8.56), language DQ(54.95±12.41vs.42.50±11.28), and personal-social DQ(61.21±13.58 vs.44.63±8.50)(P＜0.05). Conclusions By training parents to engage in co-activity play at home,play therapy within the framework of family co-activities can effectively improve the adaptability, language ability, and personal-social skills of children with ASD, reducing the economic burden on the family and improving the efficiency of caregiving. This model has the potential to become an effective long-term intervention method for ASD families and is worthy of widespread promotion among children with ASD and their families.
关键词
孤独症谱系障碍 /
游戏治疗 /
家庭康复 /
康复治疗
Key words
autism spectrum disorder /
play therapy /
family rehabilitation /
rehabilitation therapy
中图分类号：
R394
R395.5
R749.94
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参考文献
[1] 杨友,金星明.《美国精神障碍诊断和统计手册》(第5版)对儿童孤独症谱系障碍诊治的影响[J].中国儿童保健杂志,2015,23(12):1278-1280,1283.
[2] Baio J, Wiggins L, Christensen DL,et al.Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 Sites, United States,2014[J].MMWR,2018,67(45):1280.
[3] Rodriguez-Gomez DA, Garcia-Guaqueta DP, Charry-Sánchez JD,et al.A systematic review of common genetic variation and biological pathways in autism spectrum disorder[J].BMC Neurosci,2021,22(1):60.
[4] Anney R,Klei L,Pinto D,et al.A genome-wide scan for common alleles affecting risk for autism[J].Hum Mol Genet,2010,19(20):4072-4082.
[5] 高迪,于婷,李春丽,等.早期介入丹佛模式的密集训练结合家长培训对孤独症谱系障碍儿童疗效及其对父母育儿压力的影响[J].中国当代儿科杂志,2020,22(2):158-163.
Gao D,Yu T, Li CL, et al.Effects of parental training based on Early Start Denver Model combined with intensive training on children with autism spectrum disorder and its impact on parenting stress[J]. Chin J Contemp Pediatr,2020,22(2):158-163.(in Chinese)
[6] Zhou BR,Xu Q,Li HP,et al.Effects of parent-implemented early start denver model intervention on Chinese toddlers with autism spectrum disorder:A non-randomized controlled trial[J].Autism Res,2018,11(4):654-666.
[7] 林欢喜,刘潘婷,童梅玲,等.父母介导的干预在孤独症谱系障碍治疗中应用效果的Meta分析[J].中国儿童保健杂志,2023,31(3):304-310.
Lin HX,Liu PT,Tong ML,et al.Meta-analysis of the effiacy of parent-mediated intervention in the treatment of autism spectrum disorder[J].Chin J Child Health Care,2023,31(3):304-310.(in Chinese)
[8] 美国精神医学学会.精神障碍诊断与统计手册[M].张道龙,刘春宇,童慧琦,等.5版.北京:北京大学出版社, 2015:46-55.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders(5th ed.)[M].Zhang DL,Liu CY,Tong HQ,et al.Beijing:Peking University Press,2015:46-55.(in Chinese)
[9] 徐秀,邹小兵,柯晓燕,等.孤独症谱系障碍婴幼儿家庭实施早期干预专家共识[J].中国循证儿科杂志,2021, 16(5):327-332.
[10] World Health Organization. Improving early childhood development: WHO guideline[M].Geneva: World Health Organization,2020.
[11] 王石换,邹小兵,邹园园,等.早期介入丹佛模式对孤独症谱系障碍婴幼儿的疗效分析[J].中国儿童保健杂志,2021,29(12):1300-1303.
Wang SH,Zou XB,Zou YY,et al.Efficacy of Early Start Denver Model on toddlers with autism spectrum disorder[J].Chin J Child Health Care,2021,29(12):1300-1303.(in Chinese)
[12] 中华人民共和国卫生部.儿童孤独症诊疗康复指南[J].中国儿童保健杂志,2011,19(3):289-294.
[13] 周翔,陈强,陈红,等.Gesell发育量表对2岁内孤独症谱系障碍患儿的应用研究[J].中国儿童保健杂志,2016,24(12):1329-1331.
Zhou X,Chen Q,Chen H,et al.Application of the Gesell Developmental Schedules on autism spectrum disorder children under two years of age[J].Chin J Child Health Care,2016,24(12):1329-1331.(in Chinese)
[14] 于婷,高迪,张雪城,等.孤独症儿童早期介入丹佛模式的家庭治疗效果研究[J].发育医学电子杂志,2020,8(3):246-251.
Yu T,Gao D,Zhang XC,et al.Research on family therapy effects ofearly start Denver model on children with spectrum autism[J]. J Dev Med(Electronic Version) ,2020,8(3):246-251.(in Chinese)
[15] Deb SS,Retzer A,Roy M,et al.The effectiveness of parent training for children with autism spectrum disorder:A systematic review and Meta-analyses[J].BMC Psychiatry,2020,20(1):583.
[16] 国家统计局.2020年第七次全国人口普查主要数据[R/OL].(2021-11-26)https://www.stats.gov.cn/sj/pcsj/rkpc/d7c/202303/P020230301403217959330.pdf
[17] 孟栩辉,姜志梅,刘安南,等.家庭干预治疗孤独症谱系障碍儿童疗效的Meta分析[J].中国康复医学杂志,2024,39(3):399-404.
[18] Lee JD,Terol AK,Yoon CD,et al.Parent-to-parent support among parents of children with autism:A review of the literature[J].Autism,2024,28(2):263-275.
基金
江西省卫生健康委科技计划项目(No.202312010)
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