经听觉统合训练改善听觉传导功能的孤独症谱系障碍患儿核心症状的变化分析

Effect of auditory integration training on core symptoms in children with autism spectrum disorders whose auditory conduction dysfunction repaired

目的探究接受听觉统合训练(auditory integration training,AIT)后听觉传导功能障碍得到缓解的孤独症谱系障碍患儿核心症状的改善情况。方法将存在听觉诱发电位异常的ASD患儿分入AIT组(接受训练后恢复正常的组成试验组)、对照组A组(空白对照组)、对照B组(应用行为分析训练组),分别在各组入组时、入组1个月后、入组3个月后进行波特奇发育检核表、儿童孤独症评定量表(CARS)、孤独症治疗评定量表(ATEC)评估,以各因子分数的变化值评价核心症状改善水平。结果入组时试验组、对照A组及对照B组CARS[分别为(36.31±4.08)分,(36.33±3.76)分,(36.33±5.14)分]及ATEC语言[分别为(19.08±6.43)分,(16.40±6.42)分,(18.48±5.96)分]、社交[分别为(15.63±7.13)分,(16.05±7.57)分,(16.19±7.19)分]、感知[分别为(16.78±5.39)分,(16.92±6.75)分,(17.12±6.73)分]、自理[分别为(15.98±8.71)分、(17.93±8.22)分、(17.26±8.93)]评分均差异无统计学意义(均P>0.05)。入组1月、3月后,重复测量方差分析显示,试验组、对照B组、对照组A组CARS分值[1月:(33.96±3.79)分,(35.09±4.38)分,(34.30±3.98)分;3月:(32.95±3.15)分,(36.86±3.86)分,(33.95±3.90)分]的影响:时间主效应显著(F=22.308,P<0.01),组别主效应不显著(F=2.647,P>0.05),时间与组别存在交互作用(F=8.626,P<0.01);对ATEC语言[1月:(16.18±7.10)分,(18.62±6.63)分,(13.40±5.44)分;3月:(14.13±6.13)分,(18.40±6.35)分,(10.75±5.17)分]、社交[1月:(12.31±6.68)分,(17.76±6.82)分,(15.08±6.75)分;3月:(10.71±5.42)分,(16.31±6.30)分,(12.15±7.30)分]、感知觉[1月:(14.37±5.86)分,(17.43±7.22)分,(18.58±6.92)分;3月:(10.35±5.43)分,(16.44±7.05)分,(16.68±7.37)分]分量表分值的影响,时间主效应显著(F=35.534,40.729,40.401,均P<0.01),组别主效应亦显著(F=7.600,6.193,7.675,均P<0.01),时间与组别存在交互作用(F=7.602,3.355,7.649,均P<0.05),事后多重比较示:试验组与对照B组、对照A组与对照B组在干预后ATEC语言量表分值差异有统计学意义(I1-J1=-1.69,P1<0.05;I2-J2=-4.98,P2<0.01);试验组与对照A组在干预后ATEC社交量表分值差异有统计学意义(I-J=-4.54,P<0.01);试验组与对照A组、试验组与对照B组在干预后ATEC感知觉量表分值差异有统计学意义(I1-J1=-3.16,P1<0.05;I2-J2=-4.89,P2<0.01);对ATEC自理能力分量表分值影响的时间主效应显著(F=22.876,P<0.01),组别主效应亦显著(F=3.427,P<0.05),时间与组别无交互作用(F=1.885,P>0.05),事后多重比较示:试验组与对照A组在干预后ATEC自理能力量表分值差异有统计学意义(I-J=-4.46,P<0.05)。结论AIT训练后听觉传导功能恢复正常的ASD患儿的核心症状也能得到明显改善。

Objective To explore the improvement of core symptoms in children with autism whose auditory pathway dysfunction were repaired after accepting auditory integration training(AIT).Methods The ASD children with abnormal auditory evoked potentials were divided into AIT group(the ones whose BAEP return to normal after AIT training into test group),control group A(blank control group)and control group B(ABA training group).The ASD children were assessed by Portage Development Checklist,Child Autism Rating Scale(CARS)and Autism Therapy Assessment Scale(ATEC)at the time of admission,one month after admission,three months after admission.The curative effect with the change value of each factor fraction was evaluated.Results At the time of enrollment,there were no significant differences among the scores of CARS((36.31±4.08),(36.33±3.76),(36.33±5.14))as well as ATEC language((19.08±6.43),(16.40±6.42),(18.48±5.96)),social((15.63±7.13),(16.05±7.57),(16.19±7.19)),and perception((16.78±5.39)(16.92±6.75),(17.12±6.73))and self-care((15.98±8.71),(17.93±8.22),(17.26±8.93),respectively))in the AIT group,control group B and control group A.After one month and three months from enrollment,the scores of CARS were((33.96±3.79),(35.09±4.38)and(34.30±3.98),respectively after one month;(32.95±3.15),(36.86±3.86)and(33.95±3.90),respectively)after three months in the AIT group,control group B and control group A.The repeated measurement analysis of variance showed that the main effect of time was significant(F=22.308,P<0.01),the main effect of group was not significant(F=2.647,P>0.05),and there was interaction between time and group(F=8.626,P<0.01).For the scores of ATEC language(one month:(16.18±7.10),(18.62±6.63),(13.40±5.44);three months:(14.13±6.13),(18.40±6.35),(10.75±5.17)),social(one month:(12.31±6.68),(17.76±6.82),(15.08±6.75);three months:(10.71±5.42),(16.31±6.30),(12.15±7.30)),perception(one month:(14.37±5.86),(17.43±7.22),(18.58±6.92);three months:(10.35±5.43),(16.44±7.05),(16.68±7.37))in AIT group,control group B and control group A.The main effect of time was significant(F=35.534,40.729,40.401,all P<0.01),the main effect of group was also significant(F=7.600,6.193,7.675,all P<0.01),and there was interaction between time and group(F=7.602,3.355,7.649,all P<0.05).Multiple comparisons showed that there were statistically significant differences between the AIT group and the control group B,the control group A and the control group B in the scores of ATEC language scale after intervention(I1-J1=-1.69,P1<0.05;I2-J2=-4.98,P2<0.01)between the AIT group and the control group A in the scores of ATEC social scale after intervention(I-J=-4.54,P<0.01).There were significant differences between the AIT group and the control group A,the AIT group and the control group B in the scores of ATEC perception scale after intervention(I1-J1=-3.16,P1<0.05;I2-J2=-4.89,P2<0.01);for the scores of ATEC self-care ability subscale the main effect of time was significant(F=22.876,P<0.01),the main effect of group was also significant(F=3.427,P<0.05),and time and group had no interaction(F=1.885,P>0.05).Multiple comparisons showed that the scores of ATEC self-care ability scale between the AIT group and the control group A were statistically significant(I-J=-4.46,P<0.05).Conclusion The results of this study show that AIT training can improve the core symptoms of the ASD children whose BAEP returns to normal.