早期介入丹佛模式基础上联合神经反馈训练对孤独症谱系障碍儿童效果的随机对照试验

doi:10.3969/j.issn.1006-9771.2024.08.006

《中国康复理论与实践》 ›› 2024, Vol. 30 ›› Issue (8): 914-921.doi: 10.3969/j.issn.1006-9771.2024.08.006

早期介入丹佛模式基础上联合神经反馈训练对孤独症谱系障碍儿童效果的随机对照试验

吕倩倩¹, 王萌萌¹, 吴易凌², 杨晓真³, 马玲玲¹, 赵亚萍¹, 肖瑶¹, 桑杲¹^,²()

1.杭州市儿童医院康复科，浙江杭州市 310005
2.浙江中医药大学，浙江杭州市 310005
3.杭州师范大学，浙江杭州市 310005

收稿日期:2024-07-08 出版日期:2024-08-25 发布日期:2024-09-11
通讯作者: 桑杲(1972-)，女，汉族，浙江杭州市人，医学博士，主任中医师，主要研究方向：儿童生长发育及脑病康复。E-mail： sanggao@126.com
作者简介:吕倩倩(1994-)，女，汉族，安徽六安市人，医学硕士，住院医师，主要研究方向：孤独症谱系障碍的诊断、评估与康复治疗。
基金资助:
杭州市卫生科技计划重点项目(ZD20200135)

Effect of neurofeedback training based on early start Denver model on children with autism spectrum disorder: a randomized controlled trial

LÜ Qianqian¹, WANG Mengmeng¹, WU Yiling², YANG Xiaozhen³, MA Lingling¹, ZHAO Yaping¹, XIAO Yao¹, SANG Gao¹^,²()

1. Department of Rehabilitation Medicine, Hangzhou Children's Hospital, Hangzhou, Zhejiang 310005, China
2. Zhejiang Chinese Medical University, Hangzhou, Zhejiang 310005, China
3. Hangzhou Normal University, Hangzhou, Zhejiang 310005, China

Received:2024-07-08 Published:2024-08-25 Online:2024-09-11
Supported by:
Hangzhou Health Science and Technology Program(ZD20200135)

摘要/Abstract

摘要：

目的分析在早期介入丹佛模式(ESDM)基础上联合神经反馈训练对孤独症谱系障碍(ASD)儿童的效果。

方法 2020年8月至2024年5月，杭州市儿童医院60例ASD儿童随机分为对照组和观察组，每组30例。对照组接受ESDM治疗，观察组接受神经反馈训练联合ESDM治疗，共6个月。治疗前后采用中文版孤独症治疗评定量表(ATEC)和中文版儿童心理教育评估第3版(PEP-3)进行评定。

结果治疗后，观察组ATEC评分低于对照组(t = 3.545, P < 0.05)，PEP-3认知(t = 2.236, P = 0.029)、情感表达(t = 2.293, P = 0.025)、问题行为(Z = 2.099, P = 0.036)评分高于对照组；观察组ATEC评分治疗前后差值(Z = 3.620, P < 0.001)，以及PEP-3认知(Z = 2.920, P = 0.004)、问题行为(Z = 4.209, P < 0.001)治疗前后差值均高于对照组。

结论联合神经反馈训练能促进ESDM对ASD儿童的效果。

关键词: 孤独症谱系障碍, 儿童, 神经反馈训练, 早期介入丹佛模式, 随机对照试验

Abstract:

Objective To analyze the effect of neurofeedback training based on early start Denver model (ESDM) on children with autism spectrum disorder (ASD).

Methods From August, 2020 to May, 2024, a total of 60 children with ASD from Hangzhou Children's Hospital were randomly divided into control group (n= 30) and observation group (n= 30). The control group received ESDM intervention, while the observation group received neurofeedback training in addition, for six months. They were assessed with Autism Treatment Evaluation Checklist (ATEC) and Psycho-Educational Profile-3rd Edition (PEP-3).

Results After treatment, the score of ATEC was lower in the observation group than in the control group (t= 3.545, P < 0.05), the scores of cognition (t= 2.236, P = 0.029), emotional expression (t= 2.293, P = 0.025) and problem behavior (Z= 2.099, P = 0.036) were higher in the observation group than in the control group. The score differences of ATEC (Z= 3.620, P < 0.001), and cognition (Z= 2.920，P < 0.05) and problem behaviors (Z= 4.209, P < 0.05) of PEP-3 before and after intervention were higher in the observation group than in the control group.

Conclusions Combination of neurofeedback training could improve the effect of ESDM on ASD.

Key words: autism spectrum disorder, children, neurofeedback training, early start Denver model, randomized controlled trial

中图分类号:

R749.93

吕倩倩, 王萌萌, 吴易凌, 杨晓真, 马玲玲, 赵亚萍, 肖瑶, 桑杲. 早期介入丹佛模式基础上联合神经反馈训练对孤独症谱系障碍儿童效果的随机对照试验[J]. 《中国康复理论与实践》, 2024, 30(8): 914-921.

LÜ Qianqian, WANG Mengmeng, WU Yiling, YANG Xiaozhen, MA Lingling, ZHAO Yaping, XIAO Yao, SANG Gao. Effect of neurofeedback training based on early start Denver model on children with autism spectrum disorder: a randomized controlled trial[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(8): 914-921.

图/表 5

表1

表2

表3

表4

两组治疗前后PEP-3评分的Mann-Witney U检验"

项目	组别	n	测试	M(Q_L, Q_U)	Z值	P值
语言表达	对照组	30	前测	18.00(10.25, 22.00)	1.169	0.242
		30	后测	21.00(13.00, 25.75)
	观察组	30	前测	21.50(4.00, 28.75)	1.539	0.124
		30	后测	24.50(10.00, 32.75)
	治疗前两组比较				0.583	0.559
	治疗后两组比较				0.754	0.450
语言理解	对照组	30	前测	23.00(16.25, 27.75)	1.753	0.080
		30	后测	27.50(22.50, 31.75)
	观察组	30	前测	26.00(13.25, 30.00)	2.288	0.022
		30	后测	31.50(20.50, 36.00)
	治疗前两组比较				0.754	0.450
	治疗后两组比较				1.323	0.185
小肌肉	对照组	30	前测	28.50 (22.25, 33.00)	2.455	0.014
		30	后测	33.00(31.00, 37.00)
	观察组	30	前测	30.00 (22.00, 35.75)	2.046	0.041
		30	后测	35.50(28.50, 38.75)
	治疗前两组比较				0.651	0.515
	治疗后两组比较				0.549	0.583
大肌肉	对照组	30	前测	23.00(22.00, 26.00)	2.996	0.003
		30	后测	28.00(24.25, 28.00)
	观察组	30	前测	25.00(22.00, 29.00)	2.350	0.019
		30	后测	29.00(26.50, 30.00)
	治疗前两组比较				1.084	0.278
	治疗后两组比较				1.954	0.051
模仿	对照组	30	前测	14.50(8.25, 17.00)	2.627	0.009
		30	后测	18.00 (14.00, 19.00)
	观察组	30	前测	16.00(12.00, 18.00)	3.242	0.001
		30	后测	19.00(16.00, 20.00)
	治疗前两组比较				1.174	0.240
	治疗后两组比较				1.288	0.198
行为特征-非语言	对照组	30	前测	20.00(17.25, 24.00)	1.558	0.119
		30	后测	23.00(20.00, 26.00)
	观察组	30	前测	23.00(18.00, 27.00)	1.838	0.066
		30	后测	25.00(21.25, 27.75)
	治疗前两组比较				1.141	0.254
	治疗后两组比较				1.624	0.104
行为特征-语言	对照组	30	前测	7.50(3.00, 12.75)	1.869	0.067
		30	后测	11.50(8.00, 14.75)
	观察组	30	前测	11.00(3.00, 15.00)	1.663	0.096
		30	后测	15.00(6.00, 18.00)
	治疗前两组比较				1.163	0.248
	治疗后两组比较				1.148	0.251
问题行为	对照组	30	前测	9.00 (6.25, 10.75)	1.310	0.190
		30	后测	10.00(7.50, 11.75)
	观察组	30	前测	9.00(6.25, 10.00)	2.651	0.008
		30	后测	12.00(10.00, 15.00)
	治疗前两组比较				0.476	0.634
	治疗后两组比较				2.099	0.036
个人自理	对照组	30	前测	16.00(13.00, 20.75)	1.342	0.180
		30	后测	19.00(15.00, 21.00)
	观察组	30	前测	17.00(14.00, 20.00)	1.266	0.211
		30	后测	18.50(15.00, 22.00)
	治疗前两组比较				0.533	0.594
	治疗后两组比较				0.267	0.790
适应行为	对照组	30	前测	18.00(14.25, 22.75)	0.912	0.362
		30	后测	19.00 (15.50, 24.00)
	观察组	30	前测	17.00(15.25, 20.00)	1.033	0.306
		30	后测	18.00 (15.25, 23.50)
	治疗前两组比较				0.267	0.790
	治疗后两组比较				-0.379	0.705

表4

表5

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组别	n	性别(男/女)/n	年龄/月	CARS-2
对照组	30	24/6	54.53±17.43	35.50(33.00, 43.75)
观察组	30	23/7	53.37±17.08	36.50(32.25, 44.00)
χ²/t/Z值		0.098^a	0.260^b	0.243^c
P值		0.754	0.796	0.807

组别	n	测试	$\bar{x}\pm s$	t值	P值
对照组	30	前测	91.33±18.63	1.688	0.097
		后测	83.53±17.12
观察组	30	前测	82.17±20.37	2.952	0.005
		后测	67.70±17.48
治疗前两组均值差			9.17±5.04	1.819	0.074
治疗后两组均值差			15.83±4.47	3.545	< 0.001

项目	对照组(n = 30)	观察组(n = 30)	Z值	P值
ATEC评分	3.00 (2.00, 6.00)	12.00 (6.00, 21.50)	3.620	< 0.001
PEP-3评分
认知	5.00 (2.25, 11.75)	9.00 (7.25, 13.75)	2.920	0.004
语言表达	3.50 (2.00, 4.00)	4.00 (2.25, 5.75)	1.437	0.151
语言理解	3.50 (1.25, 5.75)	5.50 (3.25, 7.00)	1.718	0.085
小肌肉	4.00 (1.25, 8.00)	3.50 (2.00, 5.75)	0.712	0.480
大肌肉	3.00 (1.00, 5.00)	2.00 (0.00, 5.75)	0.592	0.554
模仿	3.00 (2.00, 4.00)	2.00 (2.00, 4.00)	0.473	0.636
情感表达	2.00 (1.25, 2.00)	2.00 (1.25, 3.00)	0.997	0.319
社交互动	2.00 (1.00, 3.00)	2.00 (1.00, 2.00)	0.804	0.421
行为特征-非语言	1.00 (1.00, 3.00)	2.00 (1.00, 4.00)	0.580	0.562
行为特征-语言	2.00 (0.25, 2.75)	2.50 (1.00, 3.75)	0.931	0.352
问题行为	0.00 (0.00, 2.00)	2.00 (2.00, 4.00)	4.209	< 0.001
个人自理	1.00 (0.00, 3.75)	1.00 (1.00, 2.00)	0.319	0.750
适应行为	0.00 (0.00, 2.00)	1.00 (0.00, 2.00)	0.114	0.913

早期介入丹佛模式基础上联合神经反馈训练对孤独症谱系障碍儿童效果的随机对照试验

Effect of neurofeedback training based on early start Denver model on children with autism spectrum disorder: a randomized controlled trial

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