早期介入丹佛模式治疗儿童孤独症谱系障碍的初步应用

Preliminary application of Early Start Denver Model in children with autism spectrum disorder

目的探讨早期介入丹佛模式(ESDM)对孤独症谱系障碍(ASD)患儿的治疗效果。方法选取2017年9月至2018年1月诊断为ASD的2～5岁儿童40例,随机分为常规干预组和ESDM干预组,每组各20例。对照组行常规干预治疗,试验组给予ESDM干预治疗。干预前及干预3个月后均采用异常行为量表(ABC)、儿童孤独症评定量表(CARS)、临床总体印象-病情严重程度(CGI-S)量表评估,干预3个月后行临床总体印象-改善度(CGI-I)评估。结果与干预前比较,干预3个月后常规干预组和ESDM干预组的ABC、CARS总分较前均降低(P<0.01),其中常规干预组在ABC的社会退缩和多动2个分区分数较前降低(P<0.01),而ESDM干预组在ABC的情绪不稳、社会退缩、多动和刻板行为4个分区分数较前降低(P<0.01)。与常规干预组比较,ESDM干预组干预前后ABC总分差、ABC 3个分区差(情绪不稳、社会退缩、多动)及CARS总分差值更大(P<0.05)。干预3个月后,CGI-I评分显示ESDM干预组病情改善优于常规干预组(P<0.05)。结论常规干预及ESDM干预均可改善2～5岁ASD儿童的社会退缩、多动等异常行为,但ESDM干预较常规干预在改善ASD儿童异常行为方面效果更显著。

Objective To investigate the clinical effect of the Early Start Denver Model（ESDM）in children with autism spectrum disorder（ASD）.Methods Forty children aged 2-5 years who were diagnosed with ASD from September 2017 to January 2018 were enrolled in the study and were randomly divided into conventional intervention group and ESDM intervention group（n=20 each）.Both groups were assessed by the Aberrant Behavior Checklist（ABC）,Childhood Autism Rating Scale（CARS）,and Clinical Global Impression-Severity（CGI-S）scale before intervention and by the ABC,CARS,CGI-S scale,and Clinical Global Impression-Improvement（CGI-I）scale after 3 months of intervention.Results After 3 months of intervention,the total scores of ABC and CARS were both significantly decreased in the two groups（P〈0.01）;the scores on the social withdrawal and hyperactivity subscales of ABC were significantly decreased in the conventional intervention group（P〈0.01）,and the scores on the mood swings,social withdrawal,hyperactivity,and stereotyped behavior subscales of ABC were significantly decreased in the ESDM intervention group（P〈0.01）.Compared with the conventional intervention group,the ESDM intervention group had significantly greater changes in total score of ABC,scores on three subscales of ABC（mood swings,social withdrawal,and hyperactivity）,and total score of CARS after intervention（P〈0.05）.After 3 months of intervention,the CGI-I scoring system showed that the disease improvement was significantly better in the ESDM intervention group than in the conventional intervention group（P〈0.05）.Conclusions Both conventional intervention and ESDM intervention can improve the social withdrawal and hyperactivity in children with ASD aged 2 to 5 years,but ESDM is more effective in improving the aberrant behavior of children with ASD.