早期介入丹佛模式对孤独症谱系障碍婴幼儿的疗效分析

Effect of early start denver model on toddlers 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)婴幼儿干预效果,为改善ASD预后提供依据。方法招募2015年6月—2017年6月中山大学附属第三医院儿童发育行为中心临床诊断为ASD的婴幼儿60例。随机分为两组:实验组30例,均接受ESDM干预;对照组30例,为干预等待的ASD婴幼儿。干预时间为每周1次,每次1 h,持续24周。干预前进行基线系统评估,干预后两组均完成儿童心理教育评估(PEP-3)、Gesell量表评估。结果 ESDM组和对照组月龄、性别差异无统计学意义,干预前两组沟通、社交互动、重复刻板行为、认知、语言、精细动作差异亦无统计学意义(P>0.05)。干预后ESDM组语言、个人-社交较对照组明显提高,差异具有统计学意义(t=2.215、2.379,P<0.05);ESDM组认知、语言表达、语言理解、小肌肉、模仿、行为特征-非语言的原积分较对照组明显提升,差异有统计学意义(t=2.336、2.510、2.416、2.578、2.017、2.150,P<0.05)。此外,ESDM组Gesell量表中的语言发育商干预前后的差值高于对照组,差异有统计学意义(Z=2.105,P<0.05)。结论经ESDM模式干预后,ASD婴幼儿语言、社交明显改善,认知、语言表达、语言理解、小肌肉、模仿能力明显提升,行为特征-非语言的刻板行为明显减少。

Objective To explore the effect of early start denver model(ESDM) on toddlers with autism spectrum disorder(ASD), in order to provide evidence for improving the prognosis of ASD. Methods A total of 60 ASD toddlers were recruited from June 2015 to June 2017 in Child Developmental & Behavioral Center, the Third Affiliated Hospital of Sun Yat-sen University, and were randomly divided into experimental group(n=30) and control group(n=30).Children in experimental group received ESDM intervention, while the control group was in the period of waiting for intervention.The ESDM intervention lasted one hour once a week for 24 weeks.Baseline system assessments were conducted before intervention, PEP-3 and Gesell Development Scale(GDS) were completed in both two groups after intervention. Results Before intervention, there were no statistically significant differences in age, gender, communication, social interaction, repetitive and stereotyped behavior, cognition, language and fine movements between the experimental group and control group(P >0.05).Compared with control group, language and personal-social scores in ESDM group were significantly improved(t=2.215, 2.379, P<0.05).Furthermore, the raw score of cognition, language expression, language understanding, small muscles, imitation and non-language behavioral characteristics in ESDM group was significantly improved(t=2.336, 2.510, 2.416, 2.578, 2.017, 2.150, P<0.05).In addition, the score gaps of language development quotient of GDS in the ESDM group were significantly higher than those in the control group before and after intervention(Z=2.105, P<0.05). Conclusions After ESDM intervention, the language and social communication, cognitive, verbal expression and comprehension, fine movements and imitation abilities of ASD toddlers are significantly improved. Additionally, non-verbal stereotypical behaviors significantly reduce in ASD toddlers.