A study of systematic family intervention on 1-2 years old toddlers at high risk for autism spectrum disorders / 中华实用儿科临床杂志

ABSTRACT

Objective:To examine the efficacy of systematic family intervention (a parent-implemented early start Denver model, P-ESDM) on toddlers at high risk of autism spectrum disorders (IHRASD) who were aged 1 to 2.Methods:The developmental screening for infants aged 1-2 years in Hefei city was performed by using the standardized screening method.The monitoring network of referral-assessment-P-ESDM guidance-follow up-early intervention effect assessment was conducted on the screened children with positive results.A total of 110 patients with IHRASD aged 1 to 2 years were detected.Sixty-three cases that met the inclusion criteria and volunteered to take part in this study were divided P-ESDM group (31 cases) and the control group (32 cases). They were assessed before intervention, 3 and 6 months after intervention separately.Parents of the patients in the P-ESDM group attended 12 weeks of family intervention training courses, 1 hour per week, while parents of the patients in the control group rejected interventions available from us.Results:The proportion of fathers with college degree or above (71.0% vs.43.8%, χ2=7.315, P=0.026) and proportion of mothers with high school/secondary school degree or above (83.9% vs.65.6%, χ2=5.264, P=0.072) were significantly higher in the P-ESDM group than in the control group.Three months after intervention, the P-ESDM group showed decreased Aberrant Behavior Checklist (ABC) scores [29.0(20.0, 45.0) scores vs.48.0(33.0, 50.0) scores, Z=-2.298, P=0.022]and increased Infant-Junior Middle School Social Adaptive Capacity Scale (SM) scores[ 10.0(9.0, 10.0) scores vs.9.0(8.0, 10.0) scores, Z= -2.045, P=0.041], compared with the control group.No significant improvement was found by the Gesell tests in the development quotients (EQs) of five energy areas, namely, the adaptive energy area [(83.86±18.03) scores vs.(75.34±10.49) scores, t=1.734, P=0.090], big movement energy area [(90.24±10.79) scores vs.(85.20±8.97) scores, t=1.595, P=0.118], fine movement energy area [(85.18±14.99) scores vs.(83.41 ± 9.28) scores, t=0.429, P=0.670], language energy area [(59.28±15.01) scores vs.(51.09±9.37) scores, t=1.981, P=0.054] and individual-society energy area [(67.13±14.86) scores vs.(63.50±7.85) scores, t=0.908, P=0.369]. Twelve months after intervention, the P-ESDM group demonstrated significantly decreased ABC scores[20.0(12.0, 33.0) scores vs.45.0(32.3, 52.8) scores, Z=-3.783, P=0.000], increased SM scores[10.0(9.0, 10.0) scores vs.9.0(8.3, 10.0) scores, Z=-2.974, P=0.003], increased EQ of adaptive energy area [(80.83±17.20) scores vs.(72.34 ± 13.18) scores, t=2.203, P= 0.031], increased EQ of the individual-society energy area[(71.87±17.30) scores vs.(62.18±13.91) scores, t= 2.454, P= 0.017]and increased EQ of the language energy area[(68.96±19.93) scores vs.(53.42±14.88) scores, t= 3.515, P= 0.001], compared with the control groups. Conclusions:Early screening, diagnosis, and P-ESDM intervention can improve the outcome of young children aged 1 to 2 years at high risk of ASD.P-ESDM intervention for 12 months demonstrates obvious effects in patients with IHRASD.