早期介入丹佛模式在不同病情程度孤独症谱系障碍儿童康复中的应用研究

Application of early start Denver model in the rehabilitation of children with autism spectrum disorder of different conditions

目的研究早期介入丹佛模式(ESDM)在不同病情程度孤独症谱系障碍(ASD)儿童康复中的效果。方法选取2018年2月—2019年4月在新郑市中医院就诊的ASD儿童120例,随机分为试验组与对照组各60例,每组根据美国《精神障碍诊断与统计手册》第5版(DSM-5)病情程度分为Ⅰ、Ⅱ、Ⅲ级,试验组采用早期介入丹佛模式治疗,对照组采用传统康复治疗。干预前及干预6个月后均采用儿童孤独症评定量表(CARS)、自闭症儿童心理教育量表第3版(PEP-3)评估康复效果。结果干预6个月后,试验组Ⅰ级、Ⅱ级患儿CARS评分低于对照组,差异有统计学意义(t=4.447、6.280,P<0.05),试验组和对照组Ⅲ级CARS评分差异无统计学意义(t=0.159,P=0.875)。两组Ⅰ、Ⅱ级患儿在PEP-3分项目中的模仿、情感表达、社交互动、非语言行为特征干预效果比较,差异有统计学意义(χ^(2)=3.908、4.910、6.112、4.185,P<0.05),但两组Ⅲ级患儿间PEP-3评分差异无统计学意义(P>0.05)。结论早期介入丹佛模式和常规干预模式相比,在轻中度ASD儿童中更有优势,尤其在改善ASD儿童的模仿及不良行为上(情感表达、社交活动、非语言行为特征)效果明显,在重度ASD儿童中未发现明显优势。

Objective To analyze the effect of Early Start Denver Model(ESDM)in the rehabilitation of children with autism spectrum disorder(ASD)with different degrees of condition.Methods A total of 120 ASD patients treated in Xinzheng Hospital of Traditional Chinese Medicine from February 2018 to April 2019 were enrolled in this study,and were randomly divided into experimental group(n=60)and control group(n=60).Children in each group was divided into gradeⅠ,Ⅱ,andⅢaccording to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders(DSM-5).The experimental group was treated with ESDM,while the control group was given traditional rehabilitation.Childhood Autism Rating Scale(CARS)and the Psychoeducational Profile-Third Edition(PEP-3)were used to evaluate the rehabilitation effect before intervention and six months after intervention.Results After 6 months of intervention,the CARS score of children with gradeⅠandⅡASD in the experimental group was significantly lower than that in the control group(t=4.447,6.280,P<0.05).There was no statistically significant difference between the test group and the control group in the gradeⅢCARS scores(t=0.159,P=0.875).The scores of imitation,emotional expression,social interaction and nonverbal behavior in the PEP-3 score of children in experimental group of gradeⅠandⅡwere significantly different from those of the control group(χ^(2)=3.908,4.910,6.112,4.185,P<0.05),butthere were no significant differences the PEP-3 scores in gradeⅢchildren between the two groups(P>0.05).Conclusion The ESDM model was more effective in children with mild to moderate autism compared to the conventional intervention model,especially in improving imitation,emotional expression,social activities and nonverbal behavior in children with autism,but no significant advantage is found in children with severe autism.