1.5~2.5岁孤独症谱系障碍儿童的喂养困难干预研究

An intervention study on feeding difficulties of children aged 1.5 to 2.5 years with autism spectrum disorders

目的通过对孤独症谱系障碍(autism spectrum disorder,ASD)儿童的喂养困难进行干预研究,为开展ASD儿童喂养困难的诊治和综合康复治疗工作提供新思路,增添新依据。方法选取2019年3月—2020年6月在湖北省妇幼保健院儿保科特殊儿童康复中心训练的ASD儿童为研究对象,采用干预试验方法,通过以应用行为分析为原理、围绕营养与喂养为中心的家长理论与实操培训的综合喂养干预方案对患儿进行为期6个月的干预,观察其干预后喂养困难变化情况。结果324名合并有喂养困难的ASD儿童经干预后,28.70%的儿童转为不伴有喂养困难,且喂养困难评分显示轻、中、重度喂养困难的ASD儿童分别有91.19%、96.36%、100.00%的患儿得到改善;干预后喂养困难评分总量表得分及4个分量表(儿童喂养行为、生长状况、口腔、家长喂养行为)得分均较干预前下降,且差异均具有统计学意义(均P<0.05)。多因素分析显示母亲妊娠期糖尿病是影响喂养困难干预效果的危险因素,家庭人均月收入高、采用指导的干预方案及持续时间长、智力发展指数高是保护因素。结论综合喂养干预方案可有效改善合并有喂养困难的ASD儿童的喂养行为、生长发育和口腔状况。

Objective To study the effects of clinical interventions on feeding difficulty of children with autism spectrum disorder(ASD)in order to provide new ideas and evidence for diagnosis,treatment and comprehensive rehabilitation of these children.Methods ASD children trained in the Special Children’s Rehabilitation Center of the Child Protection Department of Hubei Maternal And Child Health Hospital from March 2019 to June 2020 were selected as the research object,using the intervention test method,the children were intervened for 6 months through the comprehensive feeding intervention scheme of parent theory and practical training centered on nutrition and feeding based on the principle of applied behavior analysis,and the changes of feeding difficulties were observed after the intervention.Results 324 ASD children with comorbid feeding difficulty were enrolled,28.70%children’s symptoms disappeared after intervention.Assessed by feeding difficulty assessment scale,the percentage of symptoms improved in the ASD children with comorbid mild,moderate,and severe feeding difficulties were 91.19%,96.36%,and 100.00%respectively.The scores of feeding difficulty assessment scale and the four subscales(children’s feeding behaviors,growth status,oral cavity,parent feeding behaviors)were all decreased significantly after intervention(allP<0.05).Multivariate analysis showed that maternal gestational diabetes was a risk factor,while high monthly income per person of the family,long duration of guided intervention and high index of intellectual development were protective factors of the intervention effectiveness.Conclusion The comprehensive feeding intervention program is effective in improving their feeding behaviors,growth and development,and oral status for ASD children with comorbid feeding difficulty.