儿童语言发育迟缓的影响因素及综合干预的疗效研究

The influencing factors of child language retardation and the efficacy of comprehensive intervention

目的 探讨儿童语言发育迟缓的影响因素,分析综合干预的有效性。方法 选取2019年7月至2020年7月因语言问题就诊于南京市儿童医院康复科的1~4岁儿童120例,将诊断为语言发育迟缓儿童60例作为语迟组,再将其分为干预组30例、对照组30例;语言发育正常儿童60例作为正常组。干预组给予综合训练,包括一对一语言训练、认知训练、社会交往训练、家庭语言康复指导,对照组给予家庭语言康复指导。在干预前、后,采用(S-S)语言发育迟缓检查(CRRC版)对儿童进行语言发育评估,并对家长进行现场问卷调查,分析儿童语言发育迟缓的影响因素。结果 孕期感染史、出生缺氧史、出生其他高危因素、居住区域、出生孕周、喂养方式、父母受教育程度、儿童主要带养人、带养人和儿童每天互动时间、儿童每天接触电子产品时间、儿童饮食行为均与儿童语言发育迟缓有关联(χ^(2)值分别为15.701、14.652、15.680、13.575、13.297、5.647、9.130、16.611、13.889、11.847、20.245、4.596,P<0.05)。Logistic回归分析显示,儿童每天接触电子产品时间≤1h、居住区域为城镇、儿童主要带养人为父母、饮食正常均为儿童语言发育迟缓的保护因素(χ^(2)值分别为4.714、8.857、7.505、7.178,P<0.05),而母亲受教育程度低于高中、带养人和儿童每天互动时间≤2h、出生有其他高危因素、出生孕周<37周、有孕期感染史均为儿童语言发育迟缓的危险因素(χ^(2)值分别为4.978、5.938、11.979、6.153、3.988,P<0.05)。训练2个月后,干预组与对照组S-S语言发育评估的符号形式与指示内容和基础性过程操作性课题儿童年龄阶段分布比较差异均有统计学意义(χ^(2)值分别为12.519、11.907,P<0.05);干预组与对照组符号形式与指示内容、基础性过程操作性课题的儿童语言发育水平提升等级数比较差异均有统计学意义(t值分别为4.846、7.249,P<0.05)。结论 儿童语言发育迟缓与先天危险因素(出生危险因素、孕期感染因素等)和后天家庭语言环境密切相关。相比家庭语言指导,综合干预训练疗效更佳。

Objective To explore the influencing factors of language retardation and analyze the effectiveness of comprehensive intervention.Methods A total of 120 children aged 1-4 who went to the rehabilitation department of Nanjing Children′s Hospital for language problems from July 2019 to July 2020 were selected, 60 children diagnosed with language delay were considered as delayed language group, then they were divided into 30 cases in the intervention group, 30 cases in the control group;60 children with normal language development as normal group.The intervention group gave comprehensive training, including one-to-one language training, cognitive training, social communication training, and family language rehabilitation guidance, and the control group gave family language rehabilitation guidance.Before and after the intervention, children were assessed by the(S-S) language developmental delay examination(CRRC version),a field questionnaire survey was conducted on parents to analyze the influencing factors of children′s language development retardation.Results History of infection during pregnancy, history of birth hypoxia, other high risk factors at birth, the area of residence, birth gestational week, feeding mode, parents′ education, the time of children′s main caregivers, caregivers and children interacting per day, children′s daily exposure to electronics, and children′s eating behavior were all associated with children′s language development delay(χ=15.701,14.652,15.680,13.575,13.297,5.647,9.130,16.611,13.889,11.847,20.245 and 4.596,respectively, P<0.05).Logistic regression analysis showed that children′s daily exposure to electronic products≤1 h, the home address is urban, main caregiver is their parent, and euphagia were protective factors of language retardation(χ=4.714,8.857,7.505 and 7.178,respectively, P<0.05),however, maternal education was lower than high school, daily interaction between caregivers and children≤2 h/d, other high risk factors at birth, gestational week<37,and the history of infection during pregnancy were risk factors for language development delay(χ^(2)=4.978,5.938,11.979,6.153 and 3.988,respectively, P<0.05).After 2 months of training, the symbol form of the S-S language developmental assessment and the indicator content and the age distribution of the basic between the intervention and control groups were statistically significant(χ=12.519 and 11.907,respectively, P<0.05),there were statistical significant differences between the symbol form and the indicator content of the intervention group and the control group, and the improvement of children′s language development level of the basic process operational topics(t=4.846 and 7.249,respectively, P<0.05).Conclusion Child language delay is closely related to innate risk factors(birth risk factors, infection factors during pregnancy, etc.) and acquired family language environment.Compared with family language guidance, the comprehensive intervention training is more effective.