自然发展行为干预融合团体沙盘游戏治疗对孤独症儿童康复的临床研究

A clinical study of naturalistic developmental behavioral intervention integrated with group sandplay therapy for the rehabilitation of children with autism spectrum disorder

摘要

目的 探究自然发展行为干预(NDBI)融合团体沙盘游戏疗法对孤独症(ASD)儿童的康复疗效。方法 选取2022年6月至2023年6月在陕西省康复医院进行康复训练的60名ASD儿童为研究对象,随机分为对照组和实验组各30名.对照组采用传统团体沙盘游戏疗法,实验组在传统团体沙盘游戏中融入NDBI干预方法,均治疗6个月.治疗前后分别应用孤独症治疗评估量表(ATEC)、社交互动观测指标量表评估ASD儿童的言语、社交、感觉、行为表现,以及沙具摆放、沙盘主题的变化,对比两组康复疗效的差异。结果 治疗前两组的基本特征、ATEC评分、社交互动观测指标评分、治愈主题评分差异均无统计学意义(P>0.05);治疗后两组各评分均较治疗前显著改善(t值介于-10.500~17.675之间,P<0.05);治疗后实验组ATEC评分总分及言语、社交维度得分均优于对照组,差异有统计学意义(t值分别为-3.074、-3.801、-4.003,P<0.05);治疗后实验组社交互动观测指标总分及沙具使用、社交互动、治愈主题维度得分均优于对照组,差异有统计学意义(t值分别为5.653、2.946、5.659、3.126,P<0.05)。结论 相比传统沙盘游戏疗法,NDBI技术融合团体沙盘游戏治疗能帮助ASD儿童提高言语、社交能力,促进其积极能量的流动,最大限度唤醒ASD儿童的内在力量,改善ASD社交行为、沟通及情绪障碍等核心症状,值得在儿童康复机构推广应用.

Abstract

Objective To investigate the rehabilitative effects of naturalistic developmental behavioral intervention (NDBI) integrated with group sandplay therapy on children with autism spectrum disorder (ASD). Methods A total of 60 children with ASD who underwent rehabilitation training at Shaanxi Provincial Rehabilitation Hospital from June 2022 to June 2023 were selected as the study subjects, with 30 children randomly assigned to the control group and 30 children to the experimental group. The control group was treated with traditional group sandplay therapy, and the experimental group was treated with NDBI integrated into traditional group sandplay therapy, both treatments lasting for 6 months. Before and after the treatment, the Autism Treatment Evaluation Scale (ATEC) and the Social Interaction Observation Index Scale were applied to evaluate the speech, social, sensory, and behavioral performance of the children with ASD, as well as the changes in sandtray placement and themes, to compare the differences in the rehabilitation effectiveness between the two groups. Results The differences in basic characteristics, ATEC scores, social interaction observation index scores, and therapeutic theme scores between the two groups before treatment were not statistically significant (P>0.05). After treatment, all scores of the two groups showed significant improvements compared with those before treatment (t values ranged from -10.500 to 17.675, P<0.05). After treatment, the total ATEC scores and scores for the speech and social dimensions in the experimental group were better than those in the control group, with statistically significant differences (t values were -3.074, -3.801 and -4.003, respectively, P<0.05). After treatment, the total scores of social interaction observation indexes and the scores for the dimensions of sandtray use, social interaction, and therapeutic themes in the experimental group were better than those in the control group, with statistically significant differences (t values were 5.653, 2.946, 5.659 and 3.126, respectively, P<0.05). Conclusion Compared with traditional sandplay therapy, the integration of NDBI techniques into group sandplay therapy can help improve the speech and social skills of children with ASD, promote the flow of their positive energy, and maximize the awakening of their inner strengths. This approach also improves core symptoms such as social behaviors, communication, and emotional disorders in ASD children. Therefore, it is worth promoting and applying in pediatric rehabilitation institutions.

关键词

自然发展行为干预 / 团体沙盘游戏 / 孤独症 / ATEC量表 / 社交互动 / 康复

Key words

naturalistic developmental behavioral intervention / group sandplay therapy / autism spectrum disorder / ATEC scale / social interaction / rehabilitation

参考文献

[1] Posar A, Visconti P. Omega-3 supplementation in autism spectrum disorders: a still open question? [J]. J Pediatr Neurosci, 2016, 11(3): 225-227.

[2] 沙鹏, 张海滨, 雷江华. 沙盘游戏疗法应用于孤独症儿童干预的研究述评[J]. 现代特殊教育, 2023(8): 54-62.

[3] 刘桂萍. 沙盘游戏治疗技术对儿童孤独症交流能力及想象力的影响[J]. 中国妇幼健康研究, 2018, 29(4): 399-402.

[4] 刘桂华, 黄龙生, 钱沁芳, 等. 阶梯式融合性箱庭疗法对学龄前轻中度孤独症谱系障碍患儿核心症状及睡眠管理的效果评价[J]. 中国当代儿科杂志, 2019, 21(8): 743-748.

[5] 李华. 沙盘游戏治疗自闭症儿童的康复效果观察[J]. 山西医药杂志, 2021, 50(8): 1284-1286.

[6] 肖石花, 李晶. 自然发展行为干预在孤独症早期干预中的应用[J]. 心理科学进展, 2023, 31(12): 2350-2367.

[7] Schreibman L, Dawson G, Stahmer A C, et al. Naturalistic developmental behavioral interventions: empirically validated treatments for autism spectrum disorder [J]. J Autism Dev Disord, 2015, 45(8): 2411-2428.

[8] Tchaconas A, Adesman A. Autism spectrum disorders: a pediatric overview and update [J]. Curr Opin Pediatr, 2013, 25(1): 130-144.

[9] Hsiao Y J, Higgins K, Pierce T, et al. Parental stress, family quality of life, and family-teacher partnerships: families of children with autism spectrum disorder [J]. Res Dev Disabil, 2017, 70: 152-162.

[10] Vernetti A, Senju A, Charman T, et al. Simulating interaction: using gaze-contingent eye-tracking to measure the reward value of social signals in toddlers with and without autism [J]. Dev Cogn Neurosci, 2018, 29: 21-29.

[11] 陈洁, 李春霖, 冯海英. 自然发展行为干预法在自闭症儿童康复训练中的应用[J]. 教育观察, 2019, 8(41): 57-58,114.

[12] 董丽娇. 自然发展行为干预法在自闭症儿童康复训练中的应用分析[J]. 中文科技期刊数据库(文摘版)医药卫生, 2023, 5: 10-12.

[13] 张春林, 张国兵, 伍业光. 团体沙盘游戏治疗孤独症谱系障碍的效果分析[J]. 中华行为医学与脑科学杂志, 2021, 30(6): 540-545.

[14] Germain B, Eppinger M A, Mostofsky S H, et al. Recent advances in understanding and managing autism spectrum disorders [J]. J Child Neurol, 2015, 30(14): 1887-1920.

[15] MacDonald J, Ahearn W H. Teaching observational learning to children with autism [J]. J Appl Behav Anal, 2015, 48(4): 800-816.

[16] 王艳霞, 卢国斌, 葛品, 等. 学龄前期孤独症谱系障碍儿童交叉式团体与个体沙盘干预的疗效比较[J]. 中国当代儿科杂志, 2019, 21(4): 342-347.

基金资助

陕西省自然科学研究计划面上项目(2022JMG612)

西安市科技计划医学研究项目(23YXYJ0122)

中国残联课题听力语言残疾预防与康复(2023CDPFHSG18)