A new social communication intervention for children with autism: pilot randomised controlled treatment study suggesting effectiveness
A new social communication intervention for children with autism: pilot randomised controlled treatment study suggesting effectiveness
复制标题
DOI：
10.1111/j.1469-7610.2004.00338.x
复制
发表时间：
2004-11-01
影响因子：
7.6
通讯作者：
Adams, C
中科院分区：
文献类型：
--
作者：
Aldred, C;Green, J;Adams, C
背景资料：心理社会治疗是英国自闭症管理的主要手段，但其有效性缺乏系统的证据基础。在这方面的随机对照试验（RCT）研究很少，但由于该疾病的发育异质性，这些研究是必不可少的。我们的目的是测试一种新的基于理论的社会沟通干预，针对父母的沟通，在一个随机设计对常规护理单独。研究方法：干预是在现有护理的基础上进行的，包括6个月的每月定期治疗师接触，以及另外6个月的2个月巩固会议。它旨在教育父母，并培训他们掌握适合其子女个人能力的适当沟通方法。28名自闭症儿童被随机分配到这种治疗和常规治疗之间，根据年龄和基线严重程度分层。从干预开始后12个月，使用标准化工具测量结果。结果：所有研究病例均符合经典自闭症的完整自闭症诊断访谈（ADI）标准。在研究期间，治疗组和对照组的常规护理相似，治疗开始后无研究脱落。与对照组相比，积极治疗组在主要结局指标-自闭症诊断观察量表（ADOS）总分，特别是在互惠社会互动方面-以及表达性语言，沟通启动和亲子互动的次要指标方面表现出显着改善。在Vineland适应行为量表（沟通子领域）和ADOS刻板和限制行为领域中发现了暗示性但不显著的结果。结论：在典型自闭症中进行这种随机治疗试验设计是可行的，并且患者可以接受。这项试点研究表明，与常规护理相比，有针对性的（但相对非密集的）二元社会沟通治疗后，显着的额外治疗益处。这项研究需要在更大的独立样本上进行复制。它应该鼓励在这一领域进一步设计RCT。
Background: Psychosocial treatments are the mainstay of management of autism in the UK but there is a notable lack of a systematic evidence base for their effectiveness. Randomised controlled trial (RCT) studies in this area have been rare but are essential because of the developmental heterogeneity of the disorder. We aimed to test a new theoretically based social communication intervention targeting parental communication in a randomised design against routine care alone. Methods: The intervention was given in addition to existing care and involved regular monthly therapist contact for 6 months with a further 6 months of 2-monthly consolidation sessions. It aimed to educate parents and train them in adapted communication tailored to their child's individual competencies. Twenty-eight children with autism were randomised between this treatment and routine care alone, stratified for age and baseline severity. Outcome was measured at 12 months from commencement of intervention, using standardised instruments. Results: All cases studied met full Autism Diagnostic Interview (ADI) criteria for classical autism. Treatment and controls had similar routine care during the study period and there were no study dropouts after treatment had started. The active treatment group showed significant improvement compared with controls on the primary outcome measure - Autism Diagnostic Observation Schedule (ADOS) total score, particularly in reciprocal social interaction - and on secondary measures of expressive language, communicative initiation and parent-child interaction. Suggestive but non-significant results were found in Vineland Adaptive Behaviour Scales (Communication Subdomain) and ADOS stereotyped and restricted behaviour domain. Conclusions: A Randomised Treatment Trial design of this kind in classical autism is feasible and acceptable to patients. This pilot study suggests significant additional treatment benefits following a targeted (but relatively non-intensive) dyadic social communication treatment, when compared with routine care. The study needs replication on larger and independent samples. It should encourage further RCT designs in this area.