亲子绘画和创意手工疗法对学龄前期孤独症谱系障碍儿童及其母亲效果评价的前瞻性随机对照研究

Effects of parent-child painting and creative crafting therapy on preschool children with autism spectrum disorder and their mothers: a prospective randomized controlled trial

摘要:

目的 探讨亲子绘画和创意手工疗法对学龄前期轻中度孤独症谱系障碍儿童核心症状及其母亲亲职压力和希望水平的影响。 方法 采用区组随机分组方法，将56对学龄前期轻中度孤独症谱系障碍儿童及其母亲随机分为试验组和对照组，每组各28对。对照组采用应用行为分析法进行干预；试验组在此基础上，采用亲子绘画和创意手工疗法。两组干预时间均为20周。采用孤独症行为评定量表（Autism Behavior Checklist，ABC）、社交反应量表（Social Responsiveness Scale，SRS）、短式亲职压力量表（Parenting Stress Index-Short Form，PSI-SF）和Herth希望指数量表（Herth Hope Index，HHI），评估干预前和干预后（20周的干预时间结束后）儿童核心症状及其母亲的亲职压力和希望水平。 结果 共49对母子参与了全程研究（试验组25对，对照组24对）。干预后试验组儿童社会交往维度、语言维度、社交沟通维度和社交动机维度得分及ABC总分和SRS总分均低于对照组（P<0.05）。干预后试验组母亲的亲职愁苦维度和亲子互动关系失调维度得分及PSI-SF总分均低于对照组（P<0.05），而试验组母亲的HHI总分及各维度得分均高于对照组（P<0.05）。 结论 在应用行为分析干预的基础上，采用亲子绘画和创意手工疗法可进一步改善学龄前期轻中度孤独症谱系障碍儿童的核心症状和社交互动，减轻母亲的亲职压力，提高其希望水平。

Abstract:

Objective To study the effects of parent-child painting and creative crafting therapy on the core symptoms of preschool children with mild-to-moderate autism spectrum disorder (ASD) and the parenting stress and hope level of their mothers. Methods A total of 56 preschool children with mild-to-moderate ASD and their mothers were divided into an experimental group and a control group using the block randomization method, with 28 pairs in each group. The subjects in the control group received an applied behavior analytic intervention and those in the experimental group received parent-child painting and creative crafting therapy in addition to the intervention in the control group. The intervention time was 20 weeks for both groups. Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), Parenting Stress Index-Short Form (PSI-SF), and Herth Hope Index (HHI) were used to evaluate the core symptoms of children and the parenting stress and hope level of their mothers before and after 20 weeks of intervention. Results Forty-nine child-mother pairs completed the study (25 pairs in the intervention group and 24 pairs in the control group). The children in the experimental group had significantly lower scores of social interaction, language, social communication, and social motivation and total scores of ABC and SRS compared with those in the control group (P<0.05). The mothers in the experimental group had significantly lower scores of parental distress and parent-child dysfunctional interaction and total score of PSI-SF (P<0.05) and significantly higher total score of HHI and scores of each dimension compared with those in the control group (P<0.05). Conclusions The combination of applied behavior analytic intervention with parent-child painting and creative crafting therapy can more effectively improve the core symptoms and social interaction of preschool children with mild-to-moderate ASD, reduce the parenting stress of mothers and improve their hope level.