【作者】 张玲；

【导师】 唐久来； 吴德；

【作者基本信息】 安徽医科大学 ， 儿科学， 2008， 硕士

【摘要】 目的探讨引导式教育(Conductive Education,CE)训练孤独症(Autism)儿童的应用方法和治疗效果方法70例孤独症儿童均来自安徽省合肥市微雨培训中心和春芽培训中心,按照随机化的原则分为引导式教育组(CE group),非引导式教育组(un-CE group)各35例,同时进行为期半年的教育训练。采用孤独症治疗评估量表(autism treatmentevaluation checklist)即ATEC量表分别于训练前、训练3个月时、训练6个月时对两组儿童训练前后总分,语言项,社交项,感知觉项,行为项分值,以及各项训练前后下降分值等进行疗效评估。同时将两组儿童按年龄①2岁～;②4岁～;③6岁～10岁,分为三个层次,进行组间不同年龄层次的疗效比较分析。引导式教育组根据每个患儿的特点进行综合的评估,根据评估结果设计长远目标,制定近期计划,进行日课编排。由引导员负责课程(分为集体训练,个别训练,情景模拟课)的训练。内容包括交往、情感的训练;认知的训练;刻板行为的矫正;言语训练;生活自理能力的训练等。同时举办家长培训学校,将引导式教育融入到家庭训练中去。非引导式教育组采用传统的应用行为分析的教学模式。结果65例儿童顺利完成训练,平均年龄4.48±2.122岁。其中引导式教育组完成人数33例,完成率94.3%,非引导式教育组完成人数32例,完成率91.4%。结果显示:①两组内训练前后疗效自身比较,差异均具有显著性。提示训练是治疗儿童孤独症切实有效地方法;②训练3个月后引导式教育组儿童在社交项分值下降大于非引导式教育组儿童,差异有显著性(P＜0.05)。6个月后引导式教育组儿童在总分值,社交项,感知觉项上分值下降均大于与非引导式教育组儿童,差异有显著性(P＜0.05)。语言以及行为两项分值下降,两组之间虽没有统计学意义,但是可以看出引导式教育组儿童在这两项中的分数下降值均大于非引导式教育组儿童。分别为:—3.55±1.95,—5.03±2.54和—2.78±1.18,—4.69±3.44;③不同年龄层次训练前后疗效组间比较,在2岁～和4岁～年龄组,引导式教育组其ATEC总分值下降大于非引导式教育组,差异有显著性(P＜0.05)。6岁～10岁年龄组两组ATEC总分值均有下降,但差异无显著性(P=0.417)。其中引导式教育2岁～年龄组在语言,感知觉两项分值下降大于非引导式教育组,差异有显著性(P值分别为0.031,0.007,＜0.05)。引导式教育6岁～10岁年龄组在社交项上分值下降大于非引导式教育组,差异有显著性(P=0.049,＜0.05)。结论儿童孤独症是一种严重的多功能发育障碍,传统的训练模式过于被动,僵化,而引导式教育训练以娱乐性和节律性意向为特点,调动患儿自身功能的潜力,激发患儿的兴趣及主动参与意识。患儿及家长易于接受,本研究证实引导式教育为治疗儿童孤独症的有效方法。更多还原

【Abstract】 Objective The study aims to evaluate and analyze the therapeutic effect of Conductive Education(CE) on children with autism.Methods The 70 autistic children came from Wei-yu and Chun-ya training center.They were randomly assigned by1:1 proportion to receive CE training and un-CE training(traditional ABA method )for 6 months,and efficacy were rated by using Autism Treatment Evaluation Checklist(ATEC)(including total scores decrease, language,social intercourse,sensory cognitive awarenes and behavior scores)at before-training,3months later,6months later.At the same time each groups was divided into three layers according to ages(①2 years～,②4 years～,③6 years～10 years) and evaluate therapeutic effect within the group and between two groups.In CE group long term aim and short term aim were designed according to each children’s characteristic,at the same time set up the daily classes.Then conductors carry out the training.,including communication training,affective training,cognitive training, correct stereotyped behavior,speech training,living self-care ability training and so on.The parents were asked to take part in and learn the skills.The un-CE group received traditional ABA training.Results 65 autistic children completed the research,the CE group was 33(rate was 94.3%),the un-CE group was 32(rate was 91.4%).Their mean age was 4.48±2.122.It showed:①Compared the self-therapeutic effect treatment before and after in two groups,there were statistically difference.It hinted that training was the effective means to cure autism.②3 months later,The children’ sociability scores dropped down significantly in the CE group than it in the un-CE group,There was statistically difference(P＜0.05,Pearson correlation).6months later,the total scores,sociability,sensory cognitive awareness scores dropped down significantly in the CE group than those in the un-CE group(P＜0.05,Pearson correlation).Although there were no difference in language and behavior scores between the two groups.the scores dropped down larger than those in the un-CE group,-3.55±1.95,-5.03±2.54 and -2.78±1.18,-4.69±3.44.③Compared the therapeutic effect treatment before and after of different layers between the two groups,the total scores of 2 years～layer and 4 years～layer in the CE group dropped down significantly than those in the un-CE group(P＜0.05,Pearson correlation).Language and sensory cognitive awareness scores of 2 years～layer dropped down significantly than those in the un-CE group(P＜0.05,Pearson correlation),.Although there was no statistically difference in the total scores of 6 years～10 years layer between the two groups,there was statistically difference in sociability scores of this layer(P＜0.05,Pearson correlation).Conclusions Autism is a severe eurodevelopment disorder.Traditional training method are passive and rigid.The characteristic of Conductive Education is amusement and rhythmicity.It can irritate children’s interest and self-potentiality,and join the movement actively.it can be easily accepted.Our study also show it is effective on children with autism.更多还原