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目的通过对孤独症儿童随访调查,分析治疗环境及治疗依从性与儿童孤独症预后的相关性。方法选取2011至2012年在无锡市人民医院儿童保健科确诊的孤独症患儿120例进行2年后随访。其中95例在机构训练的儿童作为研究组,25例未训练儿童作为对照组。采用孤独症儿童行为量表(ABC)和0~6岁小儿神经心理发育检查表对两组患儿进行评估并发放自制的一般情况调查问卷和治疗依从性量表。结果复诊时研究组ABC总分明显低于对照组(P<0.01),发育商(DQ)值高于对照组(P<0.01)。研究组按机构性质、规模面积、学历组成分别进行比较,结果 ABC、DQ值改善方面无差异(P均>0.05)。按训练方式分组比较:包含结构化教育的综合训练组在ABC方面较另两组改善明显(P均<0.01)。按费用情况比较,公费训练儿童比自费训练儿童在ABC方面改善程度更大(P<0.05)。对治疗依从性总分和ABC改善值、DQ增加值进行相关性分析:依从性总分与ABC改善程度呈正相关(r=0.435,P<0.01);依从性总分与DQ增加值无明显相关性(r=0.155,P>0.05)。以ABC改善值作为因变量进行多因素回归分析,有3个自变量(训练方式、依从性总分、费用情况)对因变量(ABC改善值)有显著影响(P<0.05,P<0.01)。结论孤独症儿童的训练与预后密切相关,训练机构的性质、规模面积、治疗人员学历对孤独症儿童的预后无明显影响,而治疗费用情况、治疗方式和家长治疗依从性与预后密切相关。家庭作业完成情况较差以及家长对训练的了解程度不够直接影响了家长的治疗依从性。
Objective To investigate the relationship between the treatment environment and treatment compliance and the prognosis of children with autism through the follow-up survey of children with autism. Methods A total of 120 autistic children diagnosed in Children’s Health Department of Wuxi People’s Hospital from 2011 to 2012 were followed up for 2 years. Among them, 95 cases were children with institutional training as study group and 25 cases with untrained children as control group. The autistic children behavior scale (ABC) and neuropsychological developmental checklist of 0 ~ 6 years old children were used to evaluate the two groups of children and the self-made general questionnaire and treatment compliance scale were given. Results At the time of referral, the total score of ABC in the study group was significantly lower than that of the control group (P <0.01), and the value of the developer (DQ) was higher than that of the control group (P <0.01). The study group according to the nature of institutions, the size of the area, academic composition were compared, the results of ABC, DQ value was no difference (P> 0.05). Grouping by training: The comprehensive training group with structured education improved significantly in ABC compared with the other two groups (all P <0.01). On a cost-by-case basis, children who paid training on public expenses improved more on ABC than children who paid training at their own expense (P <0.05). Correlation analysis showed that the total score of adherence was positively correlated with the improvement of ABC (r = 0.435, P <0.01). The total score of adherence was not significantly correlated with the increase of DQ (R = 0.155, P> 0.05). The multivariate regression analysis with ABC improvement as the dependent variable had significant effects on the dependent variable (ABC improvement) (P <0.05, P <0.01) with three independent variables (training method, total compliance score and cost) . Conclusion The training of children with autism is closely related to the prognosis. The nature of the training institutions, the size of the area and the qualifications of medical staff have no significant effect on the prognosis of children with autism. However, the cost of treatment, the treatment mode, and the adherence to parental treatment are closely related to the prognosis. Poor homework completion and poor parental understanding of training have a direct impact on parental compliance.