以家庭为基地的短期结构化教育治疗儿童孤独症的疗效

Efficacy of home-based short term structured teaching on the outcome of autistic children

[目的]为改善孤独症儿童预后,对孤独症儿童开展了为期6个月的以家庭为基地的短期结构化教育。[方法]将60例孤独症儿童随机分为治疗组和对照组。治疗组儿童在接受评估后制定训练计划,同时培训家长,之后家长根据计划在家庭进行训练,特别强调根据孤独症儿童的认知特点进行环境布置和视觉安排,按照预定的常规、程序时间表以及由上述训练要素构成的个人工作系统开展训练。要求每周7d,每天训练6h,于训练开始前以及6月后采用"孤独症治疗评估量表"进行疗效评估。[结果]与对照组相比,治疗组孤独症儿童量表的总分由训练前的76.2分下降至54.9分(P<0.01),量表的语言、社会交往、感知觉和行为四个分项目的分数也均有显著下降(P<0.05),表明通过训练在语言能力、社会交往能力得到提高,异常感知觉状态和异常行为得到减少。[结论]以家庭为基地的结构化教育能够有效地改善孤独症儿童的预后。

[Objectives] To improve the developmental outcome of autistic children, a home-based structured teaching (ST) programme was carried out. This ST programme was a Chinese revision of TEACCH introduced by HeepKong Society of Hongkong. [Methods] 60 children were enrolled,30 of them received 6 months training. The other 30 autistic children were designed as control group. In ST group, the children were firstly assessed and the training plan was made. Then the parents were trained to carry out the plan in the home according to the requirement of TEACCH. The strategy used included visual structure, routine, environment arrangement, schedule and individualized working system. The parents were asked to train their children 6 hours a day, 7 days a week. After six months, both group were re-assessed by using Autism Treatment Evaluation Checklist (ATEC). [Results] For ST group, the ATEC total score was significantly decreased from 76. 2 to 54. 9 (P<0. 01). ATEC subscale scores of ST group were decreased from 17. 0 to 12. 7(language), 16. 7 to 10. 1(social ability), 20. 8 to 14. 4(sensory), 21. 8 to 16. 4(behavior), respectively (P<0. 05). Compared with the control group, the children in ST group were significantly improved in behavior, sensory perception, social interaction, language and total performance. [Conclusion] TEACCH is an effective programme to improve the developmental outcome of Chinese autistic children.