孤独症儿童母亲亲职压力的6个月随访

Parenting stress in mothers of children with autism: A 6-month follow-up study

目的：探讨孤独症儿童母亲在养育和照料患儿过程中亲职压力的变化趋势及相关因素.方法：选取符合美国精神障碍诊断与统计手册第4版（DSM-Ⅳ）孤独症诊断标准的78名儿童及其母亲（n=78）,研究基线时使用0～6儿童神经心理发育量表、婴儿-初中生社会生活能力量表、儿童孤独症评定量表（CARS）、孤独症行为评定量表（ABC）评估儿童的发育商、适应行为、疾病严重程度、行为问题；采用流调用抑郁自评量表（CES-D）、焦虑自评量表（SAS）、亲职压力指标简表（PSI-SF）评估孤独症儿童母亲抑郁状态、焦虑状态及亲职压力水平.分别在研究3个月和研究6个月时再次使用亲职压力指标简表（PSI-SF）对母亲亲职压力进行评估.结果：3个月与6个月时,母亲的亲职压力指标简表中亲职压力总分[（101.9±17.9）,（99.9±17.6） vs.（103.1±18.6）]、亲职愁苦得分[（35.3±9.4）,（33.7±8.5）vs.（36.9±8.3）]均低于基线（P＜0.05）；3个月时困难儿童得分高于6个月时得分[（34.6±8.1）vs.（32.5±7.2）,P＜0.05],但与研究基线相比差异无统计学意义.多层线性模型分析显示,6个月中母亲亲职压力指标简表得分呈下降趋势（P＜0.001）,与基线相比,3个月、6个月时母亲亲职压力指标简表的得分每隔3个月分值降低1.19.基线时,孤独症儿童的婴儿-初中生社会生活能力量表得分与母亲的PSI-SF得分呈负相关（β=-0.20,P＜0.01）,儿童的CARS（β=0.92,P＜0.01）及母亲的CES-D（β=0.69,P＜0.01）、SAS （β=0.89,P＜0.01）均与母亲的PSI-SF得分呈正相关.儿童的婴儿～初中生社会生活能力量表得分（β=-0.02,P＜0.05）及母亲的SAS得分（β=0.1,P＜0.01）与6个月时的母亲亲职压力指标简表得分仍然相关.结论：孤独症儿童母亲存在较高的亲职压力,母亲焦虑程度越高、儿童适应行为能力越低时母亲亲职压力可能越高.

Objective：To explore the change with time and related factors of parenting stress in mother of children with autism.Methods：In this follow-up study,78 children with autism and their mothers （n =78） were selected.At baseline,the Neuropsychological Development Examination Table for Children Aged 0-6 Years Old,Infants-Junior Middle School Students＇Social-Life Abilities Scales,Childhood Autism Rating Scale （CARS）,and Autism Behavior Checklist （ABC） were used to assess children＇s developmental quotient （DQ）,adaptive behavior,severity of autism and behavioral problem respectively.The Self-Rating Anxiety Scale （SAS）,Center for Epidemiological Studies-Depression scale （CES-D）,and Parenting Stress Index-Short Form （PSI-SF） were used to assess the mothers＇anxiety,depression and parenting stress.All mothers were interviewed and completed PSI-SF at 3-month and 6-month after baseline.Results：The PSI-SF total scores [（101.9 ± 17.9）,（99.9 ± 17.6） vs.（103.1 ± 18.6）]and scores of ＂parental distress＂ [（35.3 ± 9.4）,（33.7 ± 8.5） vs.（36.9 ± 8.3）] were lower at 3-month and 6-month than at baseline （Ps ＜0.05）.The scores of PSI-SF ＂difficult child＂ was higher at 3-month than at 6-month [（34.6 ±8.1） vs.（32.5 ±7.2）,P ＜0.05],but were not different from that at baseline.Hierarchical linear model analyze showed that the PSI-SF total scores decreased approximately 1.19 points in every three months during the 6 months.At baseline,the scores of the Infants-Junior Middle School Students＇ Social-Life Abilities Scales （β =-0.20,P ＜ 0.01） was negatively correlated with the PSI-SF total scores,and the scores of CARS （β =0.92）,CES-D （β =0.69） and SAS （β =0.89） were positively correlated with the PSI-SF total scores （Ps ＜0.01）.At 6-month,the Infants-Junior Middle School Students＇Social-Life Abilities Scales （β =-0.02） and SAS （β =0.10） were correlated with the PSI-SF total scores （Ps ＜ 0.05）.Conclusion：It suggests that the mothers of children with autism may have parenting stress.Poorer adaptive behavior skills in children with autism and more anxiety in mothers may be related to mother＇s parenting stress.