智力与发展性残疾儿童心理健康服务：基于WHO-FICs的研究

doi:10.3969/j.issn.1006-9771.2023.09.001

Abstract

Abstract:

Objective To systematically analyze the typical mental health conditions and psychological disorders of children with intellectual and developmental disabilities (IDD), to construct a mental health service system and psychological interventions to these mental health conditions of children with IDD.

Methods Based on the framework of the World Health Organization Family International Classifications (WHO-FICs), the mental health conditions and related functioning were analyzed, and the mental health service framework and proposed mental health interventions were constructed.

Results There were six main categories of mental health conditions for children with IDD: mood disorders (anxiety and depression), behavioral disorders (disruptive disorders and challenging behaviors, aggressive behaviors), traumatic disorders (post-traumatic stress disorder), mental disorders (schizophrenia), suicide and self-harm, and learning disabilities (developmental learning disabilities, attention deficit hyperactivity disorder). Mental health services for children with IDD involved in six dimensions: leadership and governance, fundraising, human resources, service delivery, mental health technologies, and information and research. Mental health services went through the continuum of health services from prevention, treatment, rehabilitation to health promotion. We delivered mental health services for children with IDD in three aspects: identifying and diagnosing mental health problems or conditions, analyzing the main factors caused mental health problems, and analyzing the environmental factors. Mental health service interventions mainly covered five categories: antidepressants, psychotherapy, stress management training, physical exercise training, healthy lifestyle education, consultation and support. Children with IDD may obtain the mental health services in hospitals, rehabilitation institutions, community and school settings.

Conclusion This study systematically analyzed the typical mental health status and related psychological functional impairments of children with IDD. Based on the World Health Organization health service system, a mental health service framework for children with IDD was constructed. Referring to the WHO's continuum of health services, a system of psychological intervention methods for children with IDD was established. Furthermore, the WHO-FICs were used to describe and code the functions of children with IDD, and the ICHI-β3 was applied to code and analyze the related psychological interventions.

Key words: children, intellectual and developmental disabilities, mental health conditions, mental health service, mental health intervention

CLC Number:

R749.93

WANG Shaopu, YANG Yaru, QIU Zhuoying, YANG Jian, YAO Meilin, SUN Hongwei, ZOU Min. Mental health services for children with intellectual and developmental disabilities: a WHO-FICs-based study[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(9): 993-1003.

Figures/Tables 3

心理健康问题	疾病	ICD-11编码	疾病特征	主要功能障碍 (ICF编码)
情绪障碍	焦虑症	广泛性焦虑障碍(6B00)	焦虑症状明显，持续至少几个月，也可能更久，表现为普遍的忧虑(即“自由浮动的焦虑”)或对多个日常事件的过度担心，通常涉及家庭、健康、财务、学校或工作等	身体功能特殊精神功能：注意力功能(b140)、情感功能(b152) 活动学习和应用知识(d1)、一般任务和要求(d2)、交流(d3)、家庭生活(d6)、人际交往和人际关系(d7)
	焦虑症	特定恐惧症(6B03)	明显和过度恐惧或焦虑，持续发生在接触或暴露于一个或多个特定对象的预期或情况(例如接近某些动物，飞行，高度封闭的空间，看到血或受伤)比例的实际危险。恐惧的对象或情况是避免或忍受强烈的恐惧或焦虑。症状至少持续几个月，严重到足以在个人、家庭、社会、教育、职业或其他重要功能领域造成严重痛苦或严重损害
	抑郁症	抑郁障碍	抑郁情绪(如悲伤、易怒、空虚)或失去快乐，并伴有其他认知、行为或神经营养症状，这些症状严重影响个体的功能能力	身体功能整体精神功能：睡眠功能(b134)；特殊精神功能：注意力功能(b140)、情感功能(b152)、思维功能(b160)、语言精神功能(b167) 活动学习和应用知识(d1)、一般任务和要求(d2)、交流(d3)、活动(d4)、家庭生活(d6)、人际交往和人际关系(d7)
		恶劣心境障碍(6A72)	持续性抑郁情绪(即持续2年或更长)，持续一天中的大部分时间，而且持续更多天。儿童和青少年抑郁情绪表现为普遍易怒。抑郁情绪伴随其他症状，如活动的兴趣或乐趣明显减弱，注意力不集中或犹豫不决，自我价值低或过度或不适当的内疚等，对未来无望，睡眠不安或睡眠增加，食欲减弱或增加，精力不足或疲劳
		双相障碍I型(6A60)	一种发作性心境障碍，定义为发生一次或多次躁狂或混合发作。躁狂发作是一种持续至少一周的极端情绪状态，除非通过以欣快、易激惹或膨胀为特征的治疗干预缩短，以及活动增加或能量增加的主观体验，并伴有其他特征性症状，例如言语快速或压力、思想飞翔、自尊或浮夸增加、睡眠需求减少、分心、冲动或鲁莽行为，以及不同情绪状态之间的快速变化(即情绪不稳定)
行为障碍	破坏性障碍和挑战性行为	对立违抗障碍(6C90)	一种持续的(如6个月或以上)明显违抗、不听话、挑衅或恶意行为的模式，这种行为发生的频率比在相同年龄和发展水平的个体中通常观察到的要高，而且不局限于与兄弟姐妹的互动。对立违抗性障碍可能表现为普遍的、持续的愤怒或易怒的情绪，经常伴随着严重的脾气爆发，或在任性、争辩和违抗行为。这种行为模式的严重程度足以对个人、家庭、社会、教育、职业或其他重要功能领域造成重大损害	身体功能特殊精神功能：注意力功能(b140)、情感功能(b152)、语言精神功能(b167) 活动一般任务和要求(d2)，交流(d3)，家庭生活(d6)，人际交往和人际关系(d7)，主要生活领域(d8)，社区、社会和公民生活(d9)
	破坏性障碍和挑战性行为	反社会品行型障碍(6C91)	重复和持续的行为模式，侵犯他人的基本权利或与年龄相适应的主要社会规范、规则或法律，例如对人或动物的攻击、破坏财产、欺骗或盗窃，以及严重违反规则的行为。行为模式的严重程度足以导致个人、家庭、社会、教育、职业或其他重要功能领域的严重损害
	攻击性行为	攻击性行为(MB23.0)	旨在威胁或伤害他人或损害财产的行为，可能是身体、口头或象征性的(如违背他人利益的行为)。攻击性行为可能是适当的和自我保护的，或不适当的、敌对的和破坏性的
创伤障碍	创伤后应激障碍	创伤后应激障碍(6B40)	可能在暴露于极具威胁性或可怕的事件或一系列事件后发生。症状持续至少数周，并导致个人、家庭、社会、教育、职业或其他重要功能领域的严重损害	身体功能整体精神功能：能量和驱力功能(b130)；特殊精神功能：注意力功能(b140)、情感功能(b152) 活动一般任务和要求(d2)，交流(d3)，家庭生活(d6)，人际交往和人际关系(d7)，主要生活领域(d8)，社区、社会和公民生活(d9)
创伤障碍	创伤后应激障碍	复杂性创伤后应激障碍(6B41)	可能在暴露于一个或一系列具有极端威胁性或可怕性质的事件之后出现的障碍，特点是在情感调节方面存在严重而持久的问题；认为自己被削弱、失败或毫无价值的信念，伴随着与创伤事件相关的羞愧、内疚或失败感；维持人际关系和感觉与他人亲近有困难。这些症状对个人、家庭、社会、教育、职业或其他重要功能领域造成重大损害
精神病	精神障碍	精神分裂症(6A20)	多种精神模式紊乱，包括思维(如妄想、思维形式混乱)、知觉(如幻觉)、自我体验(如个人的感情、冲动、思想或行为受外力控制的体验)、认知(如:注意力、言语记忆和社会认知受损)、意志(如失去动机)、情感(如迟钝的情绪表达)和行为(如行为显得奇怪或无目的、不可预测或不恰当的情绪反应，干扰了行为的组织)。可出现精神运动障碍，包括紧张症持续的妄想、持续的幻觉、思维障碍、受影响、被动或控制的经历被认为是核心症状	身体功能整体精神功能：意识功能(b110)；特殊精神功能：注意力功能(b140)、记忆功能(b144)、心理运动功能(b147)、情感功能(b152)、思维功能(b160)、高水平认知功能(b164)、语言精神功能(b167) 活动学习和应用知识(d1)、一般任务和要求(d2)、交流(d3)、活动(d4)、家庭生活(d6)、人际交往和人际关系(d7)
精神病	精神障碍	未特指的神经发育障碍(6A0Z)	神经发育障碍是在发育期间出现的行为和认知障碍，涉及在获得和执行特定的智力、运动、语言或社会功能方面的重大困难	身体功能整体精神功能：智力功能(b117)、整体心理社会功能(b122)；特殊精神功能：高水平认知功能(b164)、语言精神功能(b167) 活动学习和应用知识(d1)、一般任务和要求(d2)、交流(d3)、活动(d4)、家庭生活(d6)、人际交往和人际关系(d7)
自杀和自我伤害	自杀	自杀企图(MB23.R)	一种有意识地企图结束自己生命的自残行为	身体功能整体精神功能：意识功能(b110)、整体心理社会功能(b122) 活动学习和应用知识(d1)、一般任务和要求(d2)、交流(d3)、活动(d4)、家庭生活(d6)、人际交往和人际关系(d7)
自杀和自我伤害	自杀	自杀行为(MB23.S)	为实现结束生命的愿望而采取的具体行动，如购买枪支或囤积药物，但不构成实际的自杀企图
学习障碍	学习困难	发育性学习障碍(6A03)	在学习学术技能方面存在显著且持续的困难，包括阅读、写作或算术。个人在受影响的学术技能方面的表现明显低于实际年龄和一般智力功能水平，并导致个人学术或职业功能的显著损害	身体功能整体精神功能：智力功能(b117)；特殊精神功能：思维功能(b160)、语言精神功能(b167) 活动学习和应用知识(d1)、一般任务和要求(d2)、交流(d3)、活动(d4)、家庭生活(d6)、人际交往和人际关系(d7)
学习障碍	学习困难	注意缺陷多动障碍，主要表现为注意力不集中(6A05.0)	主要特征为注意力不集中。注意力不集中指在没有高水平刺激或频繁奖励的任务上难以保持注意力，分心和组织问题	身体功能整体精神功能：能量和驱力功能(b130)；特殊精神功能：注意力功能(b140) 活动学习和应用知识(d1)、一般任务和要求(d2)

干预类别	干预属性	干预方法	ICHI编码	干预内容	干预场景
治疗类	药物治疗	使用抗抑郁药	药物治疗处方(PZX.TI.ZZ)	药物的处方和/或给药(如果是注射)，并就药物的安全摄入或服用(如果是自我指导)和潜在不良影响提供咨询和建议	医院
治疗类	心理治疗	心理咨询	未特指的心理功能咨询(AS1.PP.ZZ)；未特指的整体心理功能咨询(AT2.PP.ZZ)	提供与大脑功能相关的治疗或支持性沟通，包括整体心理功能(如意识、能量和驱动)和特定的心理功能(如记忆、语言和计算心理功能)；提供与意识、定向、智力、整体社会心理、气质和个性、能量、驱动力和睡眠功能相关的治疗和/或支持性沟通	医院和康复机构
		心理治疗	未特指的心理治疗(AS1.PQ.ZZ)	心理治疗使用不同的心理方法(例如精神分析或心理动力学疗法、行为或认知疗法以及综合或整体方法)来帮助儿童消除或控制症状，改善患有精神疾病(如抑郁症、焦虑症、应激障碍)或情绪困难(如日常生活困难)的人的心理社会功能。心理治疗是通过专业人员和患者之间互动来实现	医院和康复机构
		CBT	认知-行为功能的训练(AS1.PG.ZZ)；	CBT是一种心理疗法，它结合了认知成分(旨在以不同的方式思考，例如通过识别和挑战不切实际的负面想法)和行为成分(旨在以不同的方式做事，例如通过帮助人们做更有价值的活动)。在CBT治疗期间，练习有助于个人培养适当的应对技能。CBT包括练习、教育和建议，以帮助个人发展适当的应对技能，以应用于具有挑战性的情况	医院、康复机构、学校和家庭
预防类和健康促进类	心理健康促进	压力管理培训	能量和驱力功能训练(ATI.PH.ZZ)	压力管理是指应对压力、紧急情况或其他压力源的身体、心理和情绪影响的能力。压力管理培训使用不同的方法(如心理、放松或正念练习)，旨在发展或提高成功应对压力情况的技能。压力管理培训通常包括特定练习和特定技巧的使用方面的教育、建议和培训	医院、康复机构和学校
预防类和健康促进类	活动干预心理健康促进	身体活动训练	未特指的改变和保持身体姿势的训练(SH2.PH.ZZ)；未特指的步行和移动训练(SJ2.PH.ZZ)	各种体育锻炼(如有氧或强化锻炼、平衡或协调锻炼、身心锻炼)，无论是否负重，都适合提高运动能力、肌肉力量、关节灵活性、自主运动、平衡、步态和行走，并有助于减轻疼痛和疲劳，这是一种辅助性的干预。根据个人的需要，在指导或协助下，计划定期体育锻炼训练(包括锻炼方面的教育和建议)，通过有规律的身体活动提升心理健康水平	学校和社区
预防类和健康促进类	心理健康教育	健康生活方式的教育、建议和支持	未特指的心理健康教育(AS1.PM.ZZ)	健康生活方式教育包括提供有关旨在促进健康和预防疾病的行为的信息，如定期体育活动、健康营养和避免物质滥用(酒精、烟草、毒品)。通过健康教育与咨询向儿童提出促进心理健康的方法并且建立和保持健康的生活方式。为儿童提供心理健康支持服务，协助儿童在行为康复过程中改变一些心理行为问题，预防风险	学校和社区

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心理健康状况	主要疾病与功能障碍	干预类型	干预场景
情绪障碍	焦虑症抑郁症	抗抑郁药；心理咨询与治疗； CBT；压力管理培训；情绪相关的身体活动；健康生活方式的教育、建议和支持	心理健康教育课程；心理健康干预，包括治疗、服务；融入身体活动的心理健康教育或治疗
行为障碍	破坏性障碍和挑战性行为攻击性行为	心理咨询与治疗；心理咨询； CBT；活动干预	心理健康干预，包括治疗、服务
创伤障碍	创伤后应激障碍	心理咨询与治疗；行为干预； CBT；活动干预	心理健康干预，包括治疗、服务
精神病	精神障碍	抗抑郁药；心理治疗； CBT；压力管理培训；身体活动训练	心理健康教育课程；心理健康干预，包括治疗、服务；融入身体活动的心理健康教育或治疗
自杀和自我伤害	自杀	抗抑郁药；心理治疗；压力管理培训；身体活动训练；健康生活方式的教育、建议和支持	心理健康教育课程；心理健康干预，包括治疗、服务
学习障碍	发育性学习障碍注意缺陷多动障碍	身体活动训练；心理咨询与治疗； CBT	融入身体活动的心理健康教育或治疗；心理健康教育课程；心理健康干预，包括治疗、服务

Mental health services for children with intellectual and developmental disabilities: a WHO-FICs-based study

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