目的 探讨影响孤独症谱系障碍(ASD)患儿康复干预效果的相关因素,为优化个体化康复策略提供依据。方法 采用回顾性队列研究,选择2020年12月—2025年3月期间浙江大学医学院附属儿童医院康复科入训的75例ASD患儿为研究对象,患儿接受基于循证医学研究的多元化干预,随访时长0.76(0.39, 1.19)年。收集患儿的临床资料与相关背景信息及Griffiths发育评估量表随访数据,采用广义估计方程模型评估康复干预时长及相关背景因素对ASD患儿Griffiths发育商变化的影响。结果 经康复干预,患儿语言(Z=4.04)、个人-社会(t=3.43)、手眼协调(t=2.07)、表现(t=2.68)、逻辑推理(t=5.23)5个维度发育商及总发育商(t=3.93)显著提升(P<0.05)。干预时长>1.0年时,患儿个人-社会(β=8.55)、语言(β=11.01)、手眼协调(β=5.55)、表现(β=8.02)、逻辑推理(β=10.63)能区DQ均显著提高(P<0.05)。多种背景因素对干预疗效具有显著主效应,其中早产、普通话环境、父亲高文化程度、父母年龄较大与更佳的发育商提升相关(P<0.05)。干预时长与患儿的性别、照护者结构等因素存在显著交互作用(P<0.05)。男性患儿在个人-社会上的获益随干预时间显著增加(χ2=12.993,P=0.005);照护结构方面,初期由父母或祖辈照护的儿童提升较快,长期则以“两代人共同抚养”模式最优。 结论 ASD患儿的干预疗效受多重背景因素影响,干预时间越长,发育商提升越明显。应综合考虑患儿个体特征与家庭因素,制定更具针对性的干预策略。
Abstract
Objective To identify background factors influencing outcomes of rehabilitation interventions in children with autism spectrum disorder (ASD), so as to provide evidence for the optimization of individualized rehabilitation strategies. Methods A retrospective cohort study was conducted on 75 children diagnosed with ASD who received evidence-based and diversified interventions at the Department of Rehabilitation, Children's Hospital, Zhejiang University School of Medicine between December 2020 and March 2025. The follow-up duration was 0.76 (0.39, 1.19) years. Clinical and demographic data, as well as follow-up data from the Griffiths Developmental Scales were collected. Generalized estimating equations (GEE) were used to assess the effects of intervention duration and background factors on changes in developmental quotients (DQs) across Griffiths subscales. Results After intervention, significant improvements were observed in the DQs for language (Z=4.04), personal-social (t=3.43), hand-eye coordination (t=2.07), performance (t=2.68), logical reasoning (t=5.23), and general developmental quotient (t＝3.93) (P<0.05). Notably, DQs in domains of personal-social (β=8.55), language (β=11.01), hand-eye coordination (β=5.55), performance (β=8.02), and logical reasoning (β=10.63) significantly improved for children who received intervention for more than one year (P<0.05). Multiple background factors showed significant main effects on intervention efficacy. Among them, prematurity, Mandarin-speaking environment, father's high educational level, and parents of appropriate age were associated with higher DQ improvements (P<0.05). Significant interaction effects were found between intervention duration and factors such as the child's gender and caregiver structure (P<0.05). For male children, the benefits in personal-social increased significantly with intervention duration (χ2=12.993, P=0.005). In terms of caregiving structure, children initially cared for exclusively by parents or grandparents showed faster improvement, whereas the co-parenting by two generations model proved to be optimal in the long term(P<0.01). Conclusions Rehabilitation outcomes in children with ASD are shaped by multiple individual and family background factors. Longer intervention duration is associated with higher DQs. Tailored and sustained intervention strategies should be developed based on a comprehensive consideration of individual characteristics and family factors.
关键词
孤独症谱系障碍 /
康复干预 /
Griffiths发育评估量表
Key words
autism spectrum disorder /
rehabilitation intervention /
Griffiths Developmental Scales
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基金
国家自然科学基金(62306270、32500952);浙江省“尖兵”“领雁”研发攻关计划(2023C03003)
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