奥尔夫音乐游戏治疗对孤独症谱系障碍儿童语言与社交功能的影响

Effects of Orff music game therapy on language and social skills of children with autism spectrum disorder

摘要

目的 观察奥尔夫音乐游戏治疗方法及以音乐任务为训练目标导向,对孤独症谱系障碍(ASD)儿童语言与社交功能的影响。方法 选取2021年1月1日至2022年12月31日在广州中医药大学附属南海妇产儿童医院儿童康复科进行康复治疗训练的2~7岁ASD儿童60例,将其随机分为观察组(n=30)与对照组(n=30);其中,观察组采用奥尔夫音乐游戏治疗方案结合特殊教育康复训练,对照组仅给予特殊教育康复训练.两组的治疗频次为每周3次,每次30分钟,持续治疗10次,休息2周后,再依照上述频次持续治疗10次,治疗6个月为1个疗程.分别于治疗前和疗程结束后1周内,运用北京首都儿科研究所的盖塞尔(Gesell)量表(GDS)、孤独症行为检查表(ABC)、孤独症治疗评估量表(ATEC)、语言行为评估量表(VerBAS)、音乐治疗评估量表对两组儿童进行评定分析。结果 在观察组和对照组中,组内治疗后的GDS量表的社会适应、个人社交、语言、大运动、精细运动5个能区得分均明显高于治疗前(观察组:t=-10.731~-2.174,P<0.05;对照组:t=-6.029~-2.064,P<0.05);观察组与对照组的组间比较,治疗后的观察组个人社交(t=5.373,P<0.001)和语言(t=6.187,P<0.001)得分均明显高于对照组.在观察组和对照组中,组内治疗后的ABC量表的感觉、交往、躯体运动、语言、生活自理5个领域得分和总分均明显低于治疗前(观察组:t=3.893~9.731,P<0.05;对照组:t=3.253~5.382,P<0.05);观察组与对照组的组间比较,治疗后观察组的感觉(t=-4.469,P<0.001)、语言(t=-4.733,P<0.001)得分和总分(t=-2.893,P<0.001)均明显低于对照组.在观察组和对照组中,组内治疗后的ATEC量表的行为、语言、社交、感知觉4个维度得分和总分均明显低于治疗前(观察组:t=9.459~14.007,P<0.05;对照组:t=2.096~8.487,P<0.05);观察组与对照组的组间比较,治疗后观察组的行为(t=-2.087,P<0.05)、语言(t=-3.781,P<0.001)、社交(t=-4.318,P<0.001)、感知觉(t=-2.728,P<0.001)得分和总分(t=-3.465,P<0.001)均明显低于对照组.在观察组和对照组中,组内治疗后的VerBAS量表的接受性语言能力、交流性语言能力、描述性语言能力3个能区得分和总分均明显高于治疗前(观察组:t=-5.731~-3.367,P<0.05;对照组:t=-6.734~-2.074,P<0.05);观察组与对照组的组间比较,治疗后观察组的接受性语言能力(t=2.134,P<0.05)、交流性语言能力(t=4.968,P<0.001)、描述性语言能力(t=1.086,P<0.05)得分和总分(t=13.093,P<0.001)均明显高于对照组.在观察组和对照组中,组内治疗后的音乐治疗评估量表的行为水平、音乐发育水平、情绪、交往4个项目得分和总分均明显高于治疗前(观察组:t=-18.743~-5.954,P<0.05;对照组:t=-14.034~-2.121,P<0.05);观察组与对照组的组间比较,治疗后的观察组行为水平(t=4.834,P<0.05)、音乐发育水平(t=3.967,P<0.05)、情绪(t=5.718,P<0.05)、交往(t=4.132,P<0.05)得分和总分(t=12.168,P<0.001)均明显高于对照组。结论 奥尔夫音乐游戏治疗对ASD儿童交流性语言及社交行为的表现方面均有明显的改善作用,存在积极的治疗意义.

Abstract

Objective To investigate effects of Orff music game therapy and music task-oriented training on language and social skills of children with autism spectrum disorder (ASD). Methods Sixty children with ASD aged 2-7 years who received rehabilitation training at Department of Child Rehabilitation, The Affiliated Nanhai Maternity and Children's Hospital of Guangzhou University of Traditional Chinese Medicine from January 1, 2021 to December 31, 2022 were selected and randomly divided into two groups: observation group (n=30) and control group (n=30). The children with ASD in the observation group received Orff music game therapy combined with special education rehabilitation training, while those in the control group received special education rehabilitation training only. All children in the two groups received music game therapy and/or special education rehabilitation training three sessions per week, 30 minutes for one session, lasting for 10 consecutive sessions followed by a two-week break, then another 10 sessions started again, so did for six months as a treatment course. Within one week before and after treatment and training the children were assessed by using Gesell Developmental Schedules (GDS) (translated and issued by Capital Institute of Pediatrics, Beijing), Autism Behavior Checklist (ABC), Autism Treatment Evaluation Checklist (ATEC), Verbal Behavior Assessment Scale (VerBAS) and Music Therapy Assessment Scale (self-designed based on The New Music Therapist's Handbook), and the assessment results of the children were analyzed statistically. Results After a course of treatment for six months, the children in the two groups achieved statistically significant improvements in all five domains of GDS such as adaptive behavior, personal-social, language, gross motor and fine motor as compared with baseline before treatment (for the observation group: t=-10.731 to -2.174, all P<0.05; for the control group: t=-6.029 to -2.064, all P<0.05), and the scores in personal-social (t=5.373, P<0.001) and language (t=6.187, P<0.001) of the children in the observation group were significantly higher than those in the control group after treatment. After a course of treatment all children in the two groups had significantly decreased ABC scores in all five domains as sensory, relating, body use, language and self-help, and total score (for the observation group: t=3.893-9.731, all P<0.05; for the control group: t=3.253-5.382, all P<0.05), and the scores in sensory (t=-4.469, P<0.001), language (t=-4.733, P<0.001) and total score (t=-2.893, P<0.001) in ABC scale of the children in the observation group after six-month treatment were significantly lower than those in the control group. After the six-month treatment, the scores in four dimensions of ATEC as health/physiological/behavior, speech/language/communication, sociability and sensory/cognitive awareness, and total score of all children in the two groups were significantly lower than those before treatment (for the observation group: t=9.459-14.007, all P<0.05; for the control group: t=2.096-8.487, all P<0.05), and the ATEC scores in health/physiological/behavior (t=-2.087, P<0.05) and speech/language/communication (t=-3.781, P<0.001), sociability (t=-4.318, P<0.001), sensory/cognitive awareness (t=-2.728, P<0.001), and total scores (t=-3.465, P<0.001) of the children in the observation group were significantly higher than those in the control group after treatment. After the six-month treatment, the VerBAS scores in all three domains as receptive language ability, communicative language ability and descriptive language ability, and total score (for the observation group: t=-5.731 to -3.367, all P<0.05; for the control group: t=-4.028 to -2.074, all P<0.05) of the all children in the observation group and the control group were significantly higher than those before treatment, and the VerBAS scores in receptive language ability (t=2.134, P<0.05), communicative language ability (t=4.968, P<0.001) and descriptive language ability (t=1.086, P<0.05), and total scores (t=13.093, P<0.001) of the children in the observation group were significantly higher than those in the control group after treatment. After the six-month music treatment, the scores in all four items of Music Therapy Assessment Scale as behavioral level, music development level, emotion and communication, and total score of all children in the observation group and the control group were significantly higher than those before treatment (for the observation group: t=-18.743 to -5.954, all P<0.05; for the control group: t=-14.034 to -2.121, all P<0.05), and the scores in all four items of Music Therapy Assessment Scale as behavioral level (t=4.834, P<0.05), music development level (t=3.967, P<0.05), emotion (t=5.718, P<0.05) and communication (t=4.132, P<0.05), and total score (t=12.168, P<0.001) of the children in the observation group were significantly higher than those in the control group after treatment. Conclusion Orff music game therapy can significantly improve communicative language and social behavior of the children with ASD, so it exerts an active therapeutic effect for those children with ASD.

关键词

奥尔夫音乐 / 孤独症谱系障碍 / 儿童 / 游戏治疗

Key words

Orff music / autism spectrum disorder / children / game therapy

参考文献

[1] 刘嘉宁, 陈燕惠. 孤独症谱系障碍儿童脑发育的研究进展[J]. 中国儿童保健杂志, 2019, 27(1): 51-55.

[2] 杨友, 金星明. 美国精神障碍诊断和统计手册第5版对儿童孤独症谱系障碍诊治的影响[J]. 中国儿童保健杂志, 2015, 23(12): 1278-1280, 1283.

[3] 贾美香. 提升对我国孤独症谱系障碍儿童发病状况及早期干预的关注[J]. 中国妇幼健康研究, 2023, 34(1): 1-4.

[4] 韦晴, 胡晓毅. 孤独症儿童的认知行为干预研究[J]. 应用心理学, 2018, 24(3): 234-242.

[5] 刘茜. 奥尔夫音乐治疗对孤独症儿童同伴关系影响的研究[D]. 杭州: 杭州师范大学, 2017.

[6] 王献娜, 李华钰, 骆维维. 音乐治疗在孤独症谱系障碍儿童康复训练中的应用研究[J]. 中国妇幼健康研究, 2017, 28(S2): 166-167.

[7] 唐强, 赵晓倩, 郑婷婷, 等. 孤独症谱系障碍的中西医康复治疗进展[J]. 世界中西医结合杂志, 2019, 14(8): 1180-1184.

[8] 王洁, 马骁琪. 小学音乐课堂教学中奥尔夫乐器的运用探微——以无音高打击类乐器为例[J]. 北方音乐, 2018, 38(23): 186-187.

[9] 杨玉凤, 杜亚松. 儿童孤独症谱系障碍康复训练指导[M]. 北京. 人民卫生出版社, 2020.

[10] Shi S, Wang J, Wang Y, et al. Effects of different types of visual music on the prefrontal hemodynamics of children with autism spectrum disorder based on functional near-infrared spectroscopy[J]. Transl Pediatr, 2023, 12(2): 162-171.

[11] Quintin E M. Music-evoked reward and emotion: relative strengths and response to intervention of people with ASD[J]. Front Neural Circuits, 2019, 13: 49.

[12] Shamrock, Mary. Orff-Schulwerk: an integrated foundation[J]. Music Educators Journal, 1997, 83(6): 41-44.

[13] Lense M D, Camarata S. Press-play: musical engagement as a motivating platform for social interaction and social play in young children with ASD[J]. Music Sci (Lond), 2020, 3: 10.1177/2059204320933080.

[14] Banks, Susan. Orff-Schulwerk teaches musical responsiveness[J]. Music Educators Journal, 1982, 68(7): 42-43.

[15] 李晓琳, 刘芬玉, 钟月春. 团体认知干预疗法联合奥尔夫音乐治疗对孤独症患者情绪及注意力的影响[J]. 中国疗养医学, 2022, 31(10): 1103-1105.

[16] 姜孟昕. 奥尔夫音乐治疗对孤独症谱系儿童社会交往、情绪和注意力的疗效研究[D]. 武汉: 武汉音乐学院, 2020.

[17] Nabiollah S G, Mahbubeh H, Irandokht F, et al. Music therapy: an effective approach in improving social skills of children with autism[J]. Advanced Biomedical Research, 2015, 4(1): 157.

[18] 刘逸姝, 刘曦, 张子健, 等. 音乐训练影响儿童语音意识的认知神经机制[J]. 生物化学与生物物理进展, 2022, 49(9): 1672-1686.

[19] 张伟锋, 赵得琴. 音乐游戏在学前智障儿童综合主题教学中的应用[J]. 现代特殊教育, 2017, 318(15): 47-49.

[20] 倪欣怡. 在音乐教学中引用奥尔夫乐器研究[J]. 科普童话, 2019(14): 41.

[21] 王芳菲. 儿童音乐治疗中乐器的使用方法及其效果[C]//中国音乐治疗学会(Chinese Music Therapy Association). 中国音乐治疗学会第十三届学术交流大会论文集. 2017: 49-56.

[22] Sacsh M, Jonas K, Sarkissian A D, et al. Increased engagement of the cognitive control network associated with music training in children during an fMRI Stroop task[J]. PLoS One, 2017, 12(10): e0187254.

[23] 刘春宁. 音乐与儿童大脑发育[J]. 黄河之声, 2020, 565(16): 156-157.

[24] Senkal O A, Muhtar Z. Role of Orff music therapy in improving auditory processing skills in children with intellectual disability[J]. Niger J Clin Pract, 2021, 24(7): 1005-1014.

[25] 黄敏. 浅谈奥尔夫音乐律动教学对智障儿童学习的影响[J]. 新课程(上), 2019, 481(5): 188-189.

[26] Geretsegger M, Elefant C, Mössler K A, et al. Music therapy for people with autism spectrum disorder[J]. Cochrane Database Syst Rev, 2022, 5: CD004381.

[27] Baldassarri S, Passerino S, Ramis S, et al. Videogame-based case studies for improving communication and attention in children with ASD[J]. Interacción, 2018: 1-8.

[28] 赵爽. 奥尔夫音乐教学法对学龄前儿童思维开发之研究[D]. 济南: 山东大学, 2014.

[29] 甘群. 浅谈音乐调理课堂对孤独症儿童的运用[J]. 小学教学研究, 2016(26): 40-41.

[30] 杨晓玲, 黄悦勤, 贾美香, 等. 孤独症行为量表试测报告[J]. 中国心理卫生杂志, 1993(6): 279-280,275.

基金资助

佛山市卫生健康局医学科研项目(20220006)