社交技能训练干预儿童行为问题的多中心随机对照研究

A multi-center randomized controlled trial of social skills training among children with behavior problems

目的评定社交技能训练改善儿童行为问题的可行性和有效性。方法采用多中心随机对照设计，在全国6个中心以Runer儿童行为问卷为评定方法，共纳入7—13岁行为问题患儿441例，其中干预组216例，等待组225例，给予干预组患儿为期12周的社交技能训练，于基线及干预结束后分别用Rutter儿童行为问卷（父母版和教师版）以及Achenbach儿童行为量表（CBCL）父母问卷进行评定。结果在基线可匹配的前提下：（1）Rutter儿童行为父母问卷干预后干预组总分、A分和N分均低于等待组，差异有统计学意义（P=0．000，P=0．000，P=0．000），其差值和减分率差异均有统计学意义（均P=0．000），干预后干预组47．69％临床痊愈，等待组24．89％临床痊愈，差异有统计学意义（x^2=24．84，P=0．000）。（2）Rutter儿童行为教师问卷干预后干预组总分、A分和N分均低于等待组，差异有统计学意义（P=0．000，P=0．003，P=0．002），其差值和减分率差异均有统计学意义（P=0．000，P=0．002，P=0．016，P=O．000，P=0．001，P=0．002），干预后干预组56．02％临床痊愈，等待组38．22％临床痊愈，差异有统计学意义（X^2：14．01，P=0．000）。（3）Achenbach儿童行为量表干预后干预组总分、体诉和违纪因子分均低于等待组，差异均有统计学意义（P=0．000，P=0．000，P=0．002），只有攻击因子分差异无统计学意义（P=0．078），干预组干预后总分、体诉、攻击和违纪因子分的差值和减分率明显高于等待组，两组各分差异均有统计学意义（P=0．000，P=0．000，P=0．006，P=0．015，P=0．000，P=0．000，P=0．000，P=0．012）。结论社交技能训练对中国儿童内向性行为和外向性行为问题均有效。

Objective To investigate the feasibility and effectiveness of a social skills training program in children with child behavior disorders. Methods A total of 441 children, aged 7-13 years old, from 6 centers were randomized into intervention （ n = 216） and waitlist group （ n = 225 ）. The social skills training program was offered to the intervention group 1 hour weekly for totally 12 weeks. The Rutter Parent ＆ Teacher Scale and Achenbach Child Behavior Checklist （CBCL） were used at baseline and completion of intervention. Results Change of total score, neurotic factor score and antisocial factor score of Rutter Parent Scale in the intervention group was significantly larger than that in the waitlist group （P = 0. 000, P = 0. 000, P= 0. 000）. The clinical cure rate of the intervention group （47.69%） was significantly higher than that of the waitlist group （24. 89% ） after intervention （X^2= 24. 84, P = 0. 000）. Change of total score, neurotic factor score and antisocial factor score of Rutter Teacher Scale in the intervention group was significantly larger than that in the waitlist group （ P = 0. 000, P = 0. 003, P = 0. 002 ）. The clinical cure rate of the intervention group （ 56.02% ） was significantly higher than that of the waitlist group （ 38.22% ） after intervention（X^2 = 14. 01, P = 0. 000）. The total score, somatic complaint score and delinquent score of Achenbach Child Behavior Checklist （CBCL） of the intervention group decreased significantly than that of the waitlist group after intervention （P = 0. 000, P = 0. 000, P = 0. 002） with the exception of aggressive behavior score （ P = 0. 078 ） . The difference and decrease rate of total score, somatic complaint score, delinquent score and aggressive behavior score of intervention group were significantly higher than that of the waitlist group after intervention（P = 0. 000, P = 0. 000, P =0. 006, P = 0. 015, P = 0. 000, P = 0. 000, P =0. 000, P = 0. 012 ）. Conclusion This study provides supports for the use of social skills training program to improve children＇s behavior problems in both family and school settings.