医育融合视角下的托育机构孤独症谱系障碍婴幼儿融合照护实践

Integrated care practices for infants and toddlers with autism spectrum disorder in childcare settings from the perspective of medical-childcare integration

摘要

目的 初步评估温州市开展托育机构孤独症谱系障碍(ASD)婴幼儿融合照护模式效果,探索医育融合指导下的融合照护模式,为ASD患儿的早期干预提供依据。方法 2021年11月—2025年12月在温州市米宝托育园招募12名ASD患儿为研究对象。通过“医-康-育”全程衔接、“评估-干预”动态循环、“干预-保育”场景融合及“家-托-医”协同支持四大路径,将专业康复训练与托育日常照护有机结合,构建覆盖筛查、评估、干预、跟踪的一体化服务体系,形成融合照护模式。12例在托ASD婴幼儿接受至少6个月的融合照护服务模式干预,采用孤独症谱系及相关发育障碍儿童心理教育量表中文修订第三版(CPEP-3)于入托1个月内及后续每3个月进行评估,采用t检验和Wilcoxon符号秩检验对评估结果进行比较分析。结果 采用融合照护模式干预后,12例ASD婴幼儿CPEP-3评分较融合照护前改善,其中沟通、体能、社交互动、认知、语言等14个分领域得分在照护前后差异有统计学意义(P<0.05),而个人自理、适应行为2个分领域照护前后差异无统计学意义(P＞0.05)。结论 医育融合指导下的托育机构ASD婴幼儿融合照护模式显示出对其沟通、社交互动、认知、语言、运动等多个维度核心能力的明显改善效果,为托育场景下的ASD婴幼儿早期综合干预提供了可操作、可推广的实践经验。

Abstract

Objective To evaluate the effectiveness of the integrated care model for infants and toddlers with autism spectrum disorder (ASD) in childcare institutions in Wenzhou, and to explore the integrated care model guided by medical-childcare integration, so as to provide reference for early intervention of ASD children. Methods A retrospective single-group pretest-posttest study was conducted. Twelve infants and toddlers with ASD who received integrated care services at Wenzhou Mibao Childcare Center were enrolled in this study from November 2021 to December 2025. An integrated service system encompassing screening, assessment, intervention, and follow-up was established. This system integrated professional rehabilitation training into daily nursery care routines through four pathways: medical-rehabilitation-childcare linkage, a dynamic assessment-intervention cycle, integration of intervention into daily childcare routines, and collaborative home-childcare-medical support. All participants received integrated care for at least 6 months.The Chinese (Hong Kong) Version of Psychoeducational Profile-Third Edition (CPEP-3) was used for assessment within 1 month after enrollment and every 3 months thereafter. Paired t tests and Wilcoxon signed-rank tests were used for comparative analyses. Results After integrated care, most CPEP-3 domain scores increased compared with baseline. Statistically significant differences were observed in 14 domains (P<0.05) , such as communication, motor function, social interaction, cognition, and language-related domains, whereas no significant differences were observed in personal self-care or adaptive behavior(P>0.05). Conclusions Guided by the medical-childcare integration model, the integrated care model in childcare institutions significantly enhances communication, social interaction, cognition, language, and motor development in infants and toddlers with ASD. This model offers a practical and potentially scalable framework for implementing comprehensive early intervention in childcare settings.

关键词

孤独症谱系障碍 / 医育融合 / 融合照护 / 托育

Key words

autism spectrum disorder / medical-childcare integration / integrated care / childcare

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基金资助

国家重点研发计划(编号2024YFF0907801)