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

Meta-analysis of the efficacy of parent-mediated intervention in the treatment of autism spectrum disorder

目的评价父母介导的干预对孤独症谱系障碍(ASD)儿童症状改善的有效性,为ASD儿童的治疗、干预提供理论依据。方法检索PubMed、Web of Science、Embase、CINAHL、知网、万方、维普以及Sinomed共8个数据库中关于父母介导的干预对ASD儿童影响的随机对照试验。检索时间为从建库到2022年9月,采用RevMan 5.3软件进行统计分析和其中的Cochrane协作工具进行文献的质量评价。结果纳入了19篇随机对照试验(RCTs)研究,共纳入1299名ASD儿童,Meta分析结果显示,父母介导的干预在患儿的社交(SMD=0.34,95%CI:0.16~0.52,P<0.05)、适应性行为(MD=5.48,95%CI:2.44~8.52,P<0.001)、共同关注(SMD=0.31,95%CI:0.05~0.56,P<0.05)以及ASD的严重程度(SMD=-0.93,95%CI:-1.10~-0.77,P<0.001)等方面都有改善,但是表达性语言、接受性语言方面以及在刻板行为方面的改善差异无统计学意义(P>0.05);对父母来说,其压力(SMD=-0.30,95%CI:-0.54~-0.07,P=0.01)也有所减轻。结论父母介导的干预对ASD儿童症状改善及减少父母压力都有有益的影响,但是还需要高质量的研究进一步验证。

Objective To evaluate the efficay of parent-mediated intervention on the improvement of symptoms of children with autism spectrum disorder(ASD),in order to provide theoretical basis for the treatment and intervention of ASD children.Methods Randomized controlled trials regarding the effects of parent-mediated intervention on ASD children were searched in eight databases,including PubMed,Embase,Web of Science,CINAHL,cnki,Wanfang,VIP and Sinomed.RevMan 5.3 software was used for statistical analysis and the Cochrane collaboration tool was used to evaluate the quality of the literature.Results A total of 1299 ASD children from 17 randomized controlled trials(RCTs)were included in this study.Meta-analysis results showed that significant improvement was observed in core symptoms of ASD children with parent-mediated intervention,including social interaction(SMD=0.34,95%CI:0.16-0.52,P<0.05),adaptive behavior(MD=5.48,95%CI:2.44-8.52,P<0.001),shared or joint attention(SMD=0.31,95%CI:0.05-0.56,P<0.05)and the severity of autism(SMD=-0.93,95%CI:-1.10--0.77,P<0.001),but expressive language,receptive language and stereotyped behaviors had no significant improvement.After intervention,parents′stress was significantly reduced(SMD=-0.30,95%CI:-0.54--0.07,P=0.01).Conclusion Parent-mediated interventions have a beneficial effect on symptoms improvement and parental stress reduction in ASD children,but high quality research is warranted to confirm the conclusion further.