综合性干预对孤独症谱系障碍儿童影响的追踪研究

Follow-up study on the effects of comprehensive intervention on children with autism spectrum disorder

目的追踪通过综合性干预且临床症状和社会适应能力有显著改善的孤独症谱系障碍(ASD)儿童,在干预撤销1年后,其临床症状、语言能力、社会生活适应能力、社会交往能力和心灵解读(ToM)技能的变化情况。方法选取重庆市儿童孤独症康复治疗中心2015—2020年确诊的35例ASD儿童和35名典型发育儿童参与研究,ASD儿童干预时年龄在3~7岁之间,平均(4.60±1.14)岁。ASD组在干预前(T1)、干预结束时(T2)和干预结束1年后(T3)分别接受儿童孤独症评定量表(CARS)、心理教育量表第三版(PEP-3)、韦氏智力量表第四版(WPPSI-Ⅳ)、婴儿-初中生社会生活适应量表(S-M)、社交反应量表(SRS)和心灵解读任务测试(ToM任务测试);典型发育儿童接受WPPSI-Ⅳ、SRS和ToM任务测试。结果综合性干预对ASD儿童的临床症状、社会生活适应能力和言语智力发展都有显著改善作用;和T2相比,ASD患儿T3的CARS得分无显著变化;ASD组SRS和ToM能力都显著低于典型发育组;T2、T3的CARS得分和T3的WPPSI-Ⅳ智商能显著预测ASD患儿T3的ToM;T2的S-M量表得分能显著预测ASD患儿T3的SRS得分。结论ASD患儿经综合性干预,在临床症状和社会适应能力上所获得的各项进步在干预撤销后会保持稳定。ASD儿童ToM和社交能力的发展受不同心理能力的影响。

Objective To analyze the changes in clinical symptoms,language ability,social adaptation,social communication,and Theory of Mind(ToM)skills of children with autism spectrum disorder(ASD)for 1 year after intervention cessation,who have already finished comprehensive intervention and had improved clinical symptoms and social adaptation.I Methods Thirty-five children with ASD diagnosed in Chongqing Rehabilitation and Treatment Center for Children with ASD from 2015 to 2020 were selected in this study,and 35 typically developed children were enrolled.ASD children were 3 to 7 years old when receiving intervention,with an average age of(4.60±1.14)years old.ASD children were assessed at pre-intervention(T1),post-intervention(T2),and 1 year after the end of the intervention(T3)by the Childhood Autism Rating Scale(CARS),Psycho-Educational Profile,3rd edition(PEP-3),Wechsler Preschool and Primary Scale of Intelligence,4th edition(WPPSI-IV),Normal Development of Social Skills from Infant to Junior High School Children(S-M),Social Responsiveness Scale(SRS)and ToM task,while the typically developed children received assessment by WPPSI-IV,SRS and ToM task.Results Comprehensive intervention significantly improved clinical symptoms,social adaptation and language development of ASD children.There was no significant change in CARS scores between T2 and T3.Children with ASD showed significantly lower SRS score and ToM abilities compared to the typically developed children.CARS scores at T2 and T3,as well as WPPSI-IV intelligence quotient at T3 significantly predicted ToM ability of ASD children at T3.S-M score at T2 significantly predicted SRS score of ASD children at T3.Conclusions The improvements in clinical symptoms and social adaptation that ASD children gained with comprehensive interventions remain stable after the intervention is withdrawn.The development of ToM and social communication abilities in ASD children is in fluenced by different psychological abilities.