家长教育培训结合早期介入丹佛模式在孤独症谱系障碍儿童早期干预中的应用效果

The effect of parents'education and training combined with early intervention of Denver model in early intervention of children with autism spectrum disorder

目的探讨家长教育培训结合早期介入丹佛模式(ESDM)在孤独症谱系障碍(ASD)儿童早期干预中的应用效果。方法选取2020年5—12月在武汉科技大学附属孝感医院诊断为ASD的患儿50例为研究对象,患儿年龄为2~5岁,随机分为ESDM组和家长教育培训组,每组各25例。ESDM组患儿采用ESDM进行康复治疗,家长教育培训组患儿在ESDM组基础上,家长接受ESDM干预技能教育培训。两组患儿治疗前和治疗3个月后均采用儿童孤独症评定量表(CARS)、孤独症行为量表(ABC)及孤独症治疗评估量表(ATEC)进行评估。采用Excel软件双人双份录入原始数据建立数据库,采用SPSS 22.0软件进行数据分析。结果治疗前,两组患儿ABC、CARS及ATEC总分[ESDM组(79.36±9.43)分、(33.56±2.04)分及(72.64±11.67)分,家长教育培训组(78.72±10.40)分、(34.00±2.14)分及(71.76±12.30)分]比较,差异均无统计学意义(t=0.23、-0.74及0.26,均P>0.05)。治疗后,两组患儿ABC、CARS及ATEC总分[ESDM组(66.96±9.21)分、(29.92±2.30)分及(63.36±10.23)分,家长教育培训组(59.92±9.54)分、(28.91±2.37)分及(57.68±10.17)分]均低于治疗前,差异均有统计学意义(ESDM组t=16.19、17.92及19.42,家长教育培训组t=34.32、24.99及22.55,均P<0.05);两组患儿ABC总分比较,差异有统计学意义(t=2.66,P<0.05),而两组患儿CARS、ATEC总分比较,差异均无统计学意义(t=1.54、1.97,均P>0.05)。治疗后,ESDM组患儿ABC量表躯体运动能区、交往能区、言语能区及生活自理能区分数均低于治疗前,差异均有统计学意义(均P<0.05);感觉能区总分低于治疗前,但差异无统计学意义(P>0.05)。治疗后,家长教育培训组患儿ABC量表躯体运动能区、感觉能区、交往能区、言语能区及生活自理能区分数均低于治疗前,差异均有统计学意义(均P<0.05)。结论家长教育培训和ESDM均可有效改善2~5岁ASD儿童的核心症状,但家长教育培训在改善2~5岁ASD儿童核心症状方面效果更显著。

Objective To explore the application effect of parents'education and training combined with early intervention Denver model(ESDM)in early intervention of children with autism spectrum disorder(ASD).Methods 50 children with ASD diagnosed in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from May to December 2020 were selected as the study subjects.The children were 2 to 5 years old.They were randomly divided into ESDM group and parent education training group,with 25 cases in each group.Children in the ESDM group were treated with ESDM for rehabilitation.Children in the parent education and training group received ESDM intervention skill education and training on the basis of the ESDM group.Both groups of children were evaluated with the Children's Autism Rating Scale(CARS),the Autism Behavior Scale(ABC)and the Autism Treatment Evaluation Scale(ATEC)before and after 3 months of treatment.Results Before treatment,the total score of ABC,CARS and ATEC in the two groups[ESDM group(79.36±9.43)points,(33.56±2.04)points and(72.64±11.67)points,parent education training group(78.72±10.40)points,(34.00±2.14)Compared with(71.76±12.30)points],the difference was not statistically significant(t=0.23,-0.74 and 0.26,all P>0.05).After treatment,the total score of ABC,CARS and ATEC in the two groups[ESDM group(66.96+9.21)points,(29.92±2.30)points and(63.36±10.23)points in the parent education and training group(59.92±9.54)points,(28.91±2.37)points and(57.68±10.17)points]were lower than those before treatment,and the difference was statistically significant(ESDM group t=16.19,17.92 and 19.42,parent education and training group t=34.32,24.99 and 22.55,allP<0.05);There was a statistically significant difference in the total score of ABC between the two groups(t=2.66,P<0.05),but there was no statistically significant difference in the total score of CARS and ATEC between the two groups(t=1.54,1.97,all P>0.05).After treatment,the scores of somatic motor energy area,communication energy area,speech energy area and self-care energy area of the children in the ESDM group were lower than those before treatment,and the difference was statistically significant(all P<0.05);the total score of sensory area was lower than that before treatment,but the difference was not statistically significant(P>0.05).After treatment,the scores of children in the parent education and training group in the somatic motor energy area,sensory energy area,communication energy area,speech energy area and self-care energy area of the ABC scale were significantly lower than those before treatment(all P<0.05).Conclusion Both parental education and training and ESDM can effectively improve the core symptoms of children with ASD aged 2-5,but parental education and training are more effective in improving the core symptoms of children with ASD aged 2-5.