反应中断再定向干预孤独症谱系障碍儿童刻板语言的效果:Scoping综述

Effect of response interruption and redirection as a behavioral intervention on vocal stereotypy in children with autism spectrum disorder:a scoping review

目的对运用反应中断再定向干预孤独症谱系障碍(ASD)儿童刻板语言的研究进行Scoping综述分析。方法检索EBSCO、PubMed、Web of Science、中国知网、万方数据库中使用反应中断再定向的方法对ASD儿童的刻板语言进行干预的相关文献,提取文献中的数据信息对其进行Scoping综述。结果最终纳入16篇英文文献,均采用单一受试时间序列研究设计。共涉及41例ASD儿童,出现刻板语言行为的ASD儿童基本语言功能有显著差异。刻板语言表现为语言和非语言声音两种形式。多数研究使用实验功能评价来确认刻板语言的功能,绝大多数ASD儿童刻板语言的功能为自动强化。实验功能评价以Iwata等的范式为主,其他评价范式在此范式基础上进行一定的改变,使操作更简洁。反应中断再定向常在个别化的情境中进行,少数研究尝试在特殊教育班级中进行。因刻板语言和其他行为的障碍程度不同,干预时长和频率差异较大。通过比较传统反应中断再定向与其变形程序对刻板语言的改善效果发现,改变再定向任务内容,减少再定向任务数量及不同执行时长对其效果没有显著影响。反应中断再定向与匹配刺激的非后效强化、反应代价、语言操作训练、药物治疗等方法进行比较的结果认为,反应中断再定向及其他方法(除药物治疗)都可以在一定程度上减少ASD儿童的刻板语言,并促进适当行为的出现,但反应中断再定向与匹配刺激、反应代价等其他方法共同使用会更有效。结论伴有刻板语言的ASD儿童具有不同功能性语言表现,其刻板语言表现形式包括语言和非语言的声音。刻板语言绝大多数功能为自动强化。反应中断再定向作为一种行为干预,均在个别化的情境下进行,干预时长和频率根据ASD儿童的刻板语言及其他行为障碍的严重程度等进行调整。改变再定向指令内容、数量等的变形反应中断再定向不会对行为改善结果有显著影响,匹配刺激和反应代价等其他干预方法也能够有效地减少刻板语言,但反应中断再定向与这些方法一同使用可能效果更好。反应中断再定向干预不仅可以有效改善ASD儿童语言功能,减少刻板语言,还能增加适当语言、任务参与、指令服从。

Objective To review the effect of response interruption and redirection intervention on vocal stereotypy in children with autism spectrum disorder(ASD).Methods Literatures on response interruption and redirection intervention for vocal stereotypy in children with ASD were retrieved from databases of EBSCO,PubMed,Web of Science,CNKI,and Wanfang data.The information of the literatures was extracted to conduct a scoping review.Results A total of 16 English literatures were included.All researches employed a single-subject time series study design.A total of 41 children with ASD were involved.Significant differences were found in levels of basic verbal functioning of children with ASD.Vocal stereotypy was characterized by both verbal and nonverbal forms.Most of the reviewed researches used experimental functional assessment to analyze the function of vocal stereotypy.In most cases,the function of vocal stereotypy was automatic reinforcement.Iwata et al.'s paradigm was dominantly adopted in performing experimental functional assessment across researches.Other related paradigms developed based on Iwata et al.'s paradigm to make operating process more concise were also used for experimental functional assessment in reviewed researches.Response disruption and redirection was often conducted in individualized setting,with a few researches conducted in special education classes.The time and frequency of interventions varied widely across subjects due to the levels of impairment in vocal stereotypy and other behaviors.According to a comparison of the effects of traditional response interruption and redirection and its morphing procedures,it was found that changing the content of the redirection task,reducing the number of redirection tasks,and varying the duration of execution did not impact the improvement of vocal stereotypy.Based on the comparisons of response interruption and redirection with matched stimuli,response cost,verbal manipulation training,and medication,it was found that both response interruption and redirection and other methods(except for medication)could reduce vocal stereotypy and promote the emergence of appropriate behaviors in children with ASD.Combining response interruption and redirection with other techniques,such as stimulus matching and response costs,yielded more favorable improvement of vocal stereotypy in children with ASD.Conclusion ASD children with vocal stereotypy show different levels of functional language,and vocal stereotypy is generally characterized by both verbal and nonverbal formats.The function of vocal stereotypy is mostly automatic reinforcement.Response interruption and redirection as a behavioral intervention is mostly conducted in individualized setting,and the time and frequency of interventions depend on the levels of vocal stereotypy and other behaviors problems.Changing the content and number of redirection instructions does not significantly influence the improvement of vocal stereotypy in children with ASD.Other intervention methods such as matching stimulus and response cost are able to reduce vocal stereotypy in children with ASD,but response interruption and redirection used in conjunction with these methods show more favorable improvements.Response interruption and redirection interventions can not only reduce vocal stereotypy in children with ASD,but also increase appropriate vocalizations,task engagement and command obedience.