Systematic review: emotion dysregulation and challenging behavior interventions for children and adolescents on the autism spectrum with graded key evidence-based strategy recommendations.
Systematic review: emotion dysregulation and challenging behavior interventions for children and adolescents on the autism spectrum with graded key evidence-based strategy recommendations.
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系统回顾：针对自闭症谱系儿童和青少年的情绪失调和挑战性行为干预措施，并提供分级的关键循证策略建议。
DOI：
10.1007/s00787-023-02298-2
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发表时间：
2023
影响因子：
6.4
通讯作者：
Mandell,DavidS
中科院分区：
文献类型：
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作者：
Nuske,HeatherJ;Young,AmandaV;Khan,FarzanaY;Palermo,EmmaH;Ajanaku,Bukola;Pellecchia,Melanie;Vivanti,Giacomo;Mazefsky,CarlaA;Brookman-Frazee,Lauren;McPartland,JamesC;Goodwin,MatthewS;Mandell,DavidS
攻击性等挑战性行为在自闭症儿童和青少年中非常普遍，可能会产生毁灭性的影响。之前对挑战性行为干预措施的评论并不包括针对情绪失调的干预措施，而情绪失调是挑战性行为的常见原因。我们回顾了针对学龄前儿童和青少年的情绪失调和挑战性行为干预措施，以确定哪些循证策略对减少/预防情绪失调/挑战性行为具有最实证支持。我们回顾了 95 项研究，包括 29 项小组设计和 66 项单例设计。我们排除了非行为/心理社会干预措施和仅针对内化症状的干预措施。我们应用编码系统来识别基于自闭症实践指南的离散策略，并添加了儿童心理健康障碍中常见的策略和证据分级系统。具有最高质量证据的策略（具有低偏倚风险的多项随机对照试验）是家长实施的干预、情绪调节训练、强化、视觉支持、认知行为/教学策略和基于前因的干预。关于结果，大多数研究都包括挑战性行为测量，而很少包括情绪失调测量。这篇评论强调了明确教授情绪调节技能、积极强化替代/替代行为、使用视觉和元认知、主动应对压力源以及让父母参与的重要性。它还呼吁进行更严格设计的研究，并将情绪失调作为未来试验的结果/中介。
Challenging behavior, such as aggression, is highly prevalent in children and adolescents on the autism spectrum and can have a devastating impact. Previous reviews of challenging behavior interventions did not include interventions targeting emotion dysregulation, a common cause of challenging behavior. We reviewed emotion dysregulation and challenging behavior interventions for preschoolers to adolescents to determine which evidence-based strategies have the most empirical support for reducing/preventing emotion dysregulation/challenging behavior. We reviewed 95 studies, including 29 group and 66 single case designs. We excluded non-behavioral/psychosocial interventions and those targeting internalizing symptoms only. We applied a coding system to identify discrete strategies based on autism practice guidelines with the addition of strategies common in childhood mental health disorders, and an evidence grading system. Strategies with the highest quality evidence (multiple randomized controlled trials with low bias risk) were Parent-Implemented Intervention, Emotion Regulation Training, Reinforcement, Visual Supports, Cognitive Behavioral/Instructional Strategies and Antecedent-Based Interventions. Regarding outcomes, most studies included challenging behavior measures, while few included emotion dysregulation measures. This review highlights the importance of teaching emotion regulation skills explicitly, positively reinforcing replacement/alternative behaviors, using visuals and metacognition, addressing stressors proactively, and involving parents. It also calls for more rigorously designed studies and for including emotion dysregulation as an outcome/mediator in future trials.