孤独症儿童早期介入丹佛模式的家庭治疗效果研究

Research on family therapy effects of early start Denver model on children with autism spectrum disorder

目的探讨早期介入丹佛模式(early start Denver model,ESDM)的家庭治疗对孤独症谱系障碍(autism spectrum disorder,ASD)儿童的干预效果。方法选取2017年7月至2018年7月来吉林大学第一医院发育行为儿科进行诊断的2~5岁ASD儿童93例,将其随机分为密集干预组(46例)和家长培训组(47例)。密集干预组接受ESDM密集训练,每天1 h,共6个月。家长培训组接受该康复机构的家长培训(每次1 h,每周1次),然后由家长在家中按教学计划进行每天1 h的康复训练,并在日常生活中随机教学,共6个月。两组干预前及干预6个月后均进行孤独症行为量表(autism behavior checklist,ABC)、儿童孤独症评定量表(childhood autism rating scale,CARS)、孤独症治疗评估量表(autism treatment evaluation checklist,ATEC)、Gesell发育量表(Gesell developmental scale,GDS)的评估,比较两组的疗效。结果干预6个月后,密集干预组与家长培训组两组ASD儿童的ABC总分、ABC的5个分区分值、CARS总分、AETC总分均较干预前下降,差异有统计学意义(P均<0.05),两组GDS中5个能区的发育商(development quotient,DQ)值较干预前提高,差异有统计学意义(P<0.05)。家长培训组干预后ABC总分、ABC量表中生活自理分区分值优于密集干预组,差异有统计学意义(P<0.05);密集干预组干预后CARS总分、GDS中语言能区DQ值优于家长培训组,差异有统计学意义(P<0.05)。干预后密集干预组ABC量表中感觉分区、交往分区、躯体运动分区、语言分区分值、ATEC总分及GDS中适应性、大运动、精细动作、个人社交的DQ值未明显优于家长培训组,差异无统计学意义(P>0.05)。结论康复机构指导下的ESDM家庭治疗可明显改善ASD儿童的感觉、交往、运动、适应性、个人社交方面的能力,改善程度与康复机构密集训练相近。

Objective To explore the effect of family therapy of early start Denver model(ESDM)on children with autism spectrum disorder(ASD).Methods 93 children with ASD aged 2-5 years old were selected from Department of Development-Behavioral Pediatrics,the First Hospital of Jilin University between July 2017 and July 2018.They were randomly divided into intensive intervention group(n=46)and parent training group(n=47).The intensive intervention group received intensive training of ESDM from early period in the rehabilitation institution,one hour per day for 6 months.The parent training group received the parent training(one hour each time,one time each week)in the rehabilitation institution,and then the parents conducted the rehabilitation training for one hour each day according to the teaching plan at home,and were randomly taught in daily life for 6 months.Before and after 6 months of intervention,the effect of the two groups were compared by evaluating the autism behavior checklist(ABC),childhood autism rating scale(CARS),autism treatment evaluation checklist(ATEC)and Gesell developmental scale(GDS).Results After 6 months,the total scores of ABC,CARS,ATEC and 5 partitions of ABC were significantly decreased in both groups,the differences were statistically significant(all P<0.05).Development quotient(DQ)of GDS were significantly improved in both groups,the differences were statistically significant(all P<0.05).The ABC total score and life self-care partition score in ABC in the parent training group after training were better than those in the intensive intervention group,the differences were statistically significant(all P<0.05).The CARS total score,the DQ of language of GDS in the intensive intervention group after training were better than those in the parent training group,the differences were statistically significant(all P<0.05).The sensory division,communication division,body movement division,language partition score in ABC,ATEC total score,DQ of adaptive,body movement,fine movement and individual social skills of GDS after training in the intensive intervention group were not significantly better than those in the parent training group,the differences were not statistically significant(P>0.05).Conclusion Family therapy of ESDM by the guidance of rehabilitation institution can improve the feeling,communication,movement,adaptability and individual social skills of ASD children.The degree of improvement is similar to that of intensive training in rehabilitation institutions.