孤独症谱系障碍儿童ESDM家长培训在社区中的应用研究

Application of ESDM Parent Training for Children With Autism Spectrum Disorder in Community

目的研究社区开展早期介入丹佛模式(early start Denver model,ESDM)家长基本技能培训课程对提升孤独症谱系障碍(autism spectrum disorder,ASD)家庭干预的效果。方法招募2019年1月—2021年12月在厦门市儿童医院确诊的64例ASD儿童及其家长作为研究对象,随机分为干预组(n=32)和对照组(n=32),干预组采用小组集中授课模式,由受过专业培训并具有实践操作经验的ESDM干预治疗师为家长逐章讲解ESDM(中文版)内容,并对家长的家庭实操视频进行点评及针对性现场演示,对照组采用自学模式,根据ASD干预知识知晓度调查表问卷及ESDM教学技术准确度评定系统分别对两组家长课程前后的家庭干预视频进行评分,比较两组家长对ESDM基本技能的掌握情况,应用0~6岁儿童智能发育筛查测验(the mental developmental screening test,DST)和孤独症儿童家长评定量表(autism behavior check list,ABC)对家庭干预前和干预后6个月的儿童发育水平和ASD核心症状进行评估。结果经过10周的家长培训课后,两组家长家庭干预知识调查表、ESDM家长教学技术准确度评分总分较课前均增高,干预组较对照组提升更明显,差异有统计学意义(P<0.05)。经过6个月的家庭干预实践,干预组社会适应和智力能区发育商(development quotient,DQ)均较干预前进步明显,差异有统计学意义(P<0.05),且干预后,干预组较对照组进步更明显,差异有统计学意义(P<0.05)。结论家长学习ESDM基本技能掌握教学技术可以在儿童日常生活活动融入干预训练目标,同时若能有ESDM实践的治疗师进行授课督导更能显著提升家长技能水平,从而在家长和儿童的日常生活中大大增加儿童的学习机会,为ASD家庭实施早期干预专家共识后期标准制定提供了借鉴内容。

Objective To study the effect of community training course in early start Denver model(ESDM)on improving the family intervention of autism spectrum disorder(ASD).Methods A total of 64 children with ASD and their parents diagnosed in Xiamen Children's Hospital from January 2019 to December 2021 were recruited and randomly divided into an intervention group(n=32)and a control group(n=32).The intervention group was given a centralized group teaching mode,and the ESDM intervention therapists with professional training and practical operation experience explained the contents of the ESDM(Chinese version)chapter by chapter for the parents.In addition,comments were made on and targeted on-site presentations were made to parents'family practical exercise videos.In the control group,self-study mode was adopted.According to the ASD intervention knowledge awareness questionnaire and the ESDM teaching technology accuracy evaluation system,the family intervention videos of parents in the two groups before and after the course were scored,and the parents'mastery of the basic skills of ESDM in the two groups was compared.The mental development screening test(DST)for children aged 0–6 years old and the autism behavior check list(ABC)scale were used to assess the developmental level of children and the core symptoms of ASD before and after family intervention at 6 months.Results After 10 weeks of parent training,the total score of parent family intervention knowledge questionnaire and parentteaching fidelity rating of ESDM were higher than before the class,and the intervention group improved more significantly than the control group,and the difference was statistically significant(P<0.05).After 6 months of family intervention,the social adaptation and development quotient(DQ)in the intervention group were significantly improved compared with those before intervention,and the differences were statistically significant(P<0.05).Moreover,after intervention,the improvement in the intervention group was more significant than that in the control group,and the differences were statistically significant(P<0.05).Conclusion Parents learn ESDM basic skills teaching technology can be in children's daily life activities into intervention training objectives,at the same time if can have ESDM practice therapist teaching supervision can significantly improve parents skills level,thus in parents and children's daily life greatly increase children's learning opportunities,for ASD family early intervention expert consensus standard provides reference.