早期介入丹佛模式的密集训练结合家长培训对孤独症谱系障碍儿童疗效及其对父母育儿压力的影响

Effect of parental training based on Early Start Denver Model combined with intensive training on children with autism spectrum disorder and its impact on parenting stress

目的探讨早期介入丹佛模式(ESDM)的密集训练结合家长培训对孤独症谱系障碍(ASD)儿童的治疗作用及其对父母育儿压力的影响。方法选取2018年8月至2019年1月诊断为ASD的2~5岁患儿70例为研究对象,随机分为ESDM组和家长培训组(n=35)。ESDM组接受ESDM密集训练,家长培训组在进行ESDM密集训练的基础上,家长另需接受ESDM技能培训。研究过程中每组各脱落2例。治疗前及治疗3个月后两组均采用孤独症行为量表(ABC)、儿童孤独症评定量表(CARS)、孤独症治疗评估量表(ATEC)和父母育儿压力指数简表(PSI-SF)进行评估。结果经3个月治疗后,两组的ABC、CARS、ATEC总分均较治疗前降低(P<0.05)。治疗前后两组组间ABC、CARS及ATEC总分比较差异均无统计学意义(P>0.05)。两组治疗前后ABC、CARS、ATEC总分差值比较差异均无统计学意义(P>0.05)。治疗3个月后,两组的PSI-SF总分较治疗前均降低(P<0.05),其中ESDM组的困难儿童维度分数较治疗前降低(P<0.05),而家长培训组在育儿愁苦、亲子互动失调、困难儿童3个维度的分数均较治疗前降低(P<0.05)。治疗前后两组组间PSI-SF评分比较差异均无统计学意义(P>0.05)。与ESDM组相比,家长培训组治疗前后父母PSI-SF总分及育儿愁苦、困难儿童2个维度分数差值均升高(P<0.05)。结论ESDM密集训练结合家长培训及单纯ESDM密集训练均可改善2~5岁ASD儿童的核心症状,同时缓解父母育儿压力;但ESDM密集训练结合家长培训对缓解父母育儿压力的效果更为显著。

Objective To explore the effect of parental training based on the Early Start Denver Model(ESDM)combined with intensive training on the treatment outcome of children with autism spectrum disorder(ASD)and its impact on parenting stress.Methods Seventy children aged 2-5 years who were diagnosed with ASD were enrolled in the study.They were divided into an ESDM group and a parental training group by the random number table method(n=35 each).The ESDM group received intensive training based on ESDM.In addition to intensive ESDM-based training,parents of the children in the parental training group received ESDM skills training.Both groups were assessed by Autism Behavior Checklist(ABC),Childhood Autism Rating Scale(CARS),Autism Treatment Evaluation Checklist(ATEC)and Parenting Stress Index-Short Form(PSI-SF)before and after the intervention of 3 months.Results After 3 months of intervention,the total scores of ABC,CARS and ATEC were both significantly decreased in the two groups(P<0.05).There was no significant difference in the total scores of ABC,CARS and ATEC between the two groups before and after intervention(P>0.05).The change between ABC,CARS and ATEC total scores in the two groups had no significant difference(P>0.05).After 3 months of intervention,the total scores of PSI-SF were both significantly decreased in the two groups(P<0.05).The difficult child sub-scale scores in PSI-SF were significantly decreased in the ESDM group(P<0.05).While three sub-scale scores of parent distress,parent-child dysfunctional interaction and difficult child in PSI-SF were significantly decreased in the parental training group(P<0.05).Before and after intervention of 3 months,no significant difference was found in PSI-SF total scores between the two groups.Compared with the ESDM group,the change between PSI-SF total scores and two sub-scales of PSI-SF(parent distress and difficult child)were significantly bigger in the parental training group(P<0.05).Conclusions Both the combination of intensive training and parent training based on ESDM and ESDM intensive training alone can improve the core symptoms of children with ASD aged 2-5 years and relieve the parenting stress,however,the former is more effective in relieving parenting stress.