孤独症儿童短期住院个体化培训与家庭培训的对照

Short-term hospitalization individualization therapy versus family therapy in treatment of childhood autism

观察属于儿童心理广泛发育障碍的儿童孤独症特教培训方法短期住院个体化培训与家庭培训疗效差异。方法:纳入中国心理卫生协会儿童青少年心理卫生中心1998-10/2001-05期间部分住院个体化培训患儿和跟踪随访家庭培训患儿77例,住院个体化培训患儿40例和家庭培训患儿37例。住院个体化培训组由专业孤独症培训师根据患儿症状制定个体化培训方案,每位教师全日负责培训1位患儿,内容涉及言语、社交、行为、认知、生活自理等。家庭培训组主要由父母根据培训师的指导建议,在家自行培训。培训时间3～4个月。均于短期培训前后分别接受孤独症行为评定量表、儿童孤独症评定量表和儿童适应行为量表评定,比较两组疗效。结果:参与者共77例均进入数据分析。①两组患儿培训前,孤独症行为评定量表、儿童孤独症评定量表、儿童适应行为量表总分及儿童适应行为量表独立、认知、社会/自制3因子分差异无显著性意义(t=0.839～1.517,P>0.05)。②培训后,住院个体化培训组较培训前病情全面缓解,包括孤独症行为评定量表、儿童孤独症评定量表、儿童适应行为量表总分及儿童适应行为量表独立、认知、社会/自制分等(t=2.469～6.008,P<0.05)。而家庭培训组除儿童适应行为量表独立因子较培训前无改善(t=1.383,P>0.05)外,其他量表分亦显著下降(t=2.427～4.902,P<0.05)。③培训后,住院个体化培训组儿童孤独症评定量表总分较家庭培训组低(t=2.508,P<0.05),住院个体化培训组儿童适应行为量表独立和社会/自制因子分较家庭培训组高(t=1.803～2.205,P<0.05)。结论:短期家庭培训和住院个体化培训都可能对孤独症儿童的功能恢复和发展起到积极作用,而对于孤独症儿童独立能力的改善,住院个体化培训疗效优于家庭培训,提示对孤独症社会能力的改善需要采用多方位的策略完成,而不能孤立于社会或集体之外进行。

AIM： To compare the effects of short-term hospitalization individualization therapy and family therapy on childhood autism. METHODS： A total of 77 children with autism, including 40 ones received hospitalization therapy and 37 ones received family therapy from October 1998 to May 2001 were selected from Child and Adolescent Psychological Health Center of Chinese Psychological Health Association. Patients in the hospitalization individualization therapy group were treated with training schemes, which were designed by special autistic trainers according to children＇s symptoms. One trainer took charge of one child for all day long, and the contents referred to speech, social intercourse, behavior, cognition, self-care in life etc. Children in family therapy group were trained by parents at home according to the instructions and advices of trainers. The time of training was 3-4 months. Subjects were scaled by autism behavior checklist, childhood autism rating scale and adaptive behavior scale before and after the short-term training to compare the curative effects of two groups. RESULTS： A total of 77 subjects were involved in the analysis of results. （1） There were no significant differences in scores of independence, cognition and social/self-control factors in autism behavior checklist, childhood autism rating scale and adaptive behavior scale between the two groups before therapy （t=0.839-1.517, P 〉 0.05）. （2）After short-term therapy, the pathogenetic conditions of children in the hospitalization individualization therapy group were significantly ameliorated than those in the family therapy group, including the scores of three factors in three scales mentioned above （t=2.469-6.008, P 〈 0.05）, whereas in children of the family therapy group, all scale scores were remarkably reduced except the independence factor score in child adaptive behavior scale （t=2.427 -4.902, P 〈 0.05）. （3）After therapy, the total score of childhood autism rating scale scores in the hospitalization individualization therapy group was significantly lower than the family therapy group （t=2.508, P 〈 0.05）. The scores of independence factor and social/self-control factor of adaptive behavior scale in the hospitalization individualization therapy group were significantly higher than family therapy group （t=1.803-2.205, P 〈 0.05）. CONCLUSION： Both short-term family therapy and hospitalization individualization therapy can positively affect the functional recovery and development of children with autism, while as to the amelioration effect on independent capacity of autistic children, that of hospitalization individualization therapy is superior to family therapy, which indicate that comprehensive strategies should be adopted to ameliorate the social capacity of autistic children, and therapy that isolated with society or congregation is not adoptable.