以游戏为基础促进交流与行为的干预对孤独症谱系障碍幼儿的疗效

Effect of play-based communication and behavior intervention on toddlers with autism spectrum disorder

目的对比分析以游戏为基础促进交流与行为的干预(PCBI)方法与应用行为分析(ABA)方法治疗孤独症谱系障碍(ASD)幼儿的近期疗效。方法以2017年11月至2018年5月南京医科大学附属脑科医院74例19~30个月的ASD患儿为研究对象,入组后将患儿按随机数字表法分为PCBI组和ABA组,分别给予PCBI和ABA干预12周。训练前后分别采用波特奇早期发育核查表、孤独症疗效评定量表(ATEC)进行发育水平和干预疗效的评估。采用t检验对比分析2组干预前后各项评估得分是否存在显著差异。结果 1.与ABA组比较,PCBI组患儿干预12周后波特奇早期发育核查表的认知得分增加较高(ΔPCBI=9.03分,ΔABA=4.27分,t=3.997)、社会行为得分增加较少(ΔPCBI=8.87分,ΔABA=16.91分,t=-4.022),差异均有统计学意义(均P<0.001);而2组在波特奇早期发育核查表的总分及语言、运动、生活自理得分增加相当,差异均无统计学意义(均P>0.05)。2.与ABA组比较,PCBI组患儿干预12周后ATEC评估的社交、感知觉及行为分量表得分下降的程度相当,差异均无统计学意义(均P>0.05);而ATEC评估的总分(ΔPCBI总分=14.89分,ΔABA总分=22.22分,t=2.209)及语言分量表得分(ΔPCBI语言=2.89分,ΔABA语言=6.43分,t=2.515)下降的程度较低,差异均有统计学意义(均P<0.05)。结论运用PCBI超早期干预方法进行幼儿期ASD干预12周,可显著提高其发育水平,并减轻临床症状。以家长指导为主且占用医疗康复资源较少的PCBI超早期干预与机构内ABA干预的近期疗效相当。

Objective To compare and analyze the short-term effect of play-based communication and behavior intervention (PCBI) and applied behavioral analysis (ABA) on the treatment of toddlers with autism spectrum disorder (ASD). Methods Seventy-four ASD toddlers aged from 19 to 30 months were recruited in Nanjing Brain Hospital Affiliated to Nanjing Medical University from November 2017 to May 2018.The toddlers who participated in this study were randomly assigned into PCBI group and ABA group, then they were intervened weekly by PCBI or ABA for a total of 12 weeks.Portage Early Development Checklist and autism treatment evaluation checklist (ATEC) were used to estimate the toddlers′ developmental level and the treatment efficacy respectively.The t-test was used to reveal whether there was significant difference between the 2 groups before and after intervention. Results (1)Compared with the ABA group, there was a significant increase in cognitive scores (ΔPCBI=9.03 scores,ΔABA=4.27 scores, t=3.997) and a significant decrease in social behavior scores (ΔPCBI=8.87 scores,ΔABA=16.91 scores, t=-4.022) of the Portage Early Development Checklist after 12 weeks of intervention in the PCBI group, and there were statistically significant differences(all P<0.001);while the total score and the scores of language, movement, and self-care subscale of Portage Early Development Checklist were also increased after PCBI intervention but without significant diffe-rences(all P>0.05).(2)Compared with the ABA group, after 12 weeks of PCBI intervention, the scores of social contact, perception, behavior of ATEC were decreased, but the difference was not significant (P>0.05);the total score of ATEC scale(ΔPCBI total=14.89 scores,ΔABA total=22.22 scores, t=2.209)and the scores of language subscale(ΔPCBI language=2.89 scores,ΔABA language=6.43 scores, t=2.515)were decreased significantly, and there were statistically significant differences (all P<0.05). Conclusions After 12 weeks of the very early intervention of PCBI, the ASD toddlers all improved in clinical symptoms and developmental level.Compared with ABA intervention, PCBI very early intervention with parental guidance was comparable in short term efficacy, and PCBI was not taking up as much medical rehabilitation resources as ABA.