早期干预对幼儿发展影响的研究

目的：探讨早期干预对幼儿躯体、智力、社会能力发展的影响，为早期教育提供依据。方法：随机抽取年龄为４２天至３个月的正常婴儿６０例为早期干预组，３５例为１岁干预组。早期干预组入组后即接受早期干预。婴儿一岁后两组接受同等干预。两岁半时，早期干预组４６例，１岁干预组３０例，此时，按相同条件抽取对照组５６例，三组幼儿采用贝利婴儿发展量表进行评估，测量身高、体重。结果：早期干预组的智力发展指数（ＭＤＩ＿     

Outcome of Early Intervention for Children With Autism

Since 1980, 12 peer-reviewed outcome studies (nine on behavior analytic programs, one on Project TEACCH, and two on Colorado Health Sciences) have focused on early intervention for children with autism. Mean IQ gains of 7-28 points were reported in studies of behavior analytic programs, and 3-9 in studies on TEACCH and Colorado. Cains were also reported on other measures in some studies. Individual children varied greatly in treatment responsivtty. No fully randomized studies have been published, and studies with features such as large sample sizes and blind examiners have been rare. Further progress is likely to require more rigorous clinical trials, more comprehensive pretreatment and follow-up assessments, and greater attention to brain-behavior relationships.     

Early Intervention with Mentally Handicapped Children: A Critical Appraisal of Applied Research

Research on the impact of early intervention with mentally handicappedchildren and their families has placed too much emphasis uponchild develop mental progress to the neglect of several importantparental and environmental variables upon which the child'sultimate development depends. Studies have also tended not toinclude process measures in their pro gram evaluation procedures.These two major issues and others related to the appropriatenessof traditional group research designs for the early interventionfield are examined through an analysis of 20 studies carriedout in five countries in the last 10 years.     

早期干预对早产儿智能影响的研究

目的：研究早期干预对早产儿的智能发育的影响。方法：将60名早产儿分为两组,一组接受培训中心有关早期干预的措施称早产儿干预组,另一组为早产儿对照组。另将30名足月健康儿作为正常对照组,三组小儿及家长均参加定期的常规儿童保健门诊检查和指导,并均于1岁和1岁半时采用张家健等0－4岁小儿发育诊断量表评定发育商（DQ）。结果：早产儿干预组和正常对照组的DQ无差别（P＞0．05）,这两组DQ都明显高于早产儿对照组（P＜0．01）。两组早产儿1岁半时的DQ均较1岁时提高（P＜0．01）,正常对照组则提高不明显（P＞0．05）,说明早产儿在1岁至1岁半期间明发展较足月健康儿快。此外,早产儿有2例智能低下（DQ＜70）,早产儿干预组则没有。结论：早期干预可有效地促进早产儿的智能发育。     

Depends on Who You Ask: What Maximizes Participation of Families in Early Intervention Programs

This two-part study was a preliminary investigation of the typesof procedures that could be useful in maximizing the participationof families in early intervention programs for their special-needsinfants, toddlers, and preschoolers. In Study 1, 64 professionalsin the early intervention field completed a survey that described29 potential techniques for maximizing participation of families.For each technique, the respondents endorsed whether they employedthe procedure, or would if they could. In addition, they ratedthe expected effectiveness of each procedure. Verbal praiseand encouragement were highly rated and almost universally inuse, as were various types of written and resource materials.Tangible reinforcement was seldom employed and professionalrespondents tended to indicate that they did not expect thatsuch techniques would be useful. In Study 2, 29 mothers of high-riskinfants and toddlers currently in early intervention rated thesame 29 procedures, but were significantly more likely to endorsethe use of tangible reinforcers and logistical support. Comparisonsamong respondents from professional and parent samples werediscussed, along with implications of the findings and necessarydirections for future research in this area.     

Revision of a Parent-Completed Developmental Screening Tool: Ages and Stages Questionnaires

Examined the Ages and Stages Questionnaires (ASQ), a seriesof 11 developmental questionnaires designed to be completedby parents and caregivers of young children from 4 to 48 monthsof age. The ASQ were recently revised and additional psychometricdata were gathered. Analyses on over 7,000 questionnaires indicatedhigh test-retest reliability, interobserver reliability, andinternal consistency Concurrent validity using standardizedmeasures yielded an overall agreement of 85%, with a range of76–91%. Specificity was high 'across questionnaire intervalswhile sensitivity was lower and varied across intervals. Useof parent-completed screening tools such as the ASQ is attractivein terms of costeffectiveness, parental involvement, and flexibiliryin administration procedures.     

Early Intervention for Trauma: Current Status and Future Directions

Although psychological debriefing (PD) represents the most common form of early intervention for recently traumatized people, there is little evidence supporting its continued use with individuals who experience severe trauma. This review identifies the core issues in early intervention that need to be addressed in resolving the debate over PD. It critiques the available evidence for PD and the early provision of cognitive-behavioral therapy (CBT). Based on available evidence, we propose that psychological first aid is an appropriate initial intervention, but that it does not serve a therapeutic or preventive function. When feasible, initial screening is required so that preventive interventions can be used for those individuals who may have difficulty recovering on their own. Evidence-based CBT approaches are indicated for people who are at risk of developing posttraumatic psychopathology. Guidelines for managing acutely traumatized people are suggested and standards are proposed to direct future research that may advance our understanding of the role of early intervention in facilitating adaptation to trauma.     

Developmental data on individuals with the Brachmann-de Lange syndrome

One hundred twenty-two patients with clinically confirmed Brachmann-de Lenge syndrome (BDLS) were evaluated developmentally. Recruitment was made from our genetics department and through meetings of the Cornelia de Lange Syndrome Foundation parent support group. Developmental information was obtained from records of physicians, schools and developmental centers, or from parents on each of the 122 individuals, allowing division in to four groups for study: group 1 (n = 48) underwent formal developmental assessments, which generated intelligence or developmental quotients, and had a completed parental questionnaire with specific developmental questions regarding ages of skills mastered; group II (n = 23) had additional developmental records available without formal testing, as well as the questionnaire; group III (n = 22) had a only a completed questionnaire; and group IV (n = 29) had formal developmental testing or other developmental records but no available questionnaire. These data were analyzed in order to be able to predict attainable psychomotor development. Average scores on formal testing were found to be in the mild to moderate level of mental retardation, ranging from below 30 to 85, with an average intelligence quotient of 53, higher than previously reported. Visual-spatial memory and perceptual organization skills were found to be strengths. Younger individuals born before 1980 demonstrated higher scores on testing. Early intervention appears to play a major role in the level of developmental achievement. © 1993 Wiley-Liss, Inc.     

早期干预对早产儿智能发育的影响

目的探讨早期干预对早产儿智能发育的影响，旨在降低其伤残率。方法将62例早产儿分为干预组（35例）和对照组（27例）。干预组早产儿出生后即提供发育支持护理，接受早期环境干预和综合康复功能训练，定期随访，对照组仅接受常规治疗及定期评估，用CDCC婴幼儿智能量表进行评估。结果6、9、12个月时干预组患儿智能发育指数（MDI）及心理运动发育指数（PDI）均优于对照组（P〈0．05）。12个月时干预组患儿智能发育指数（MDI）及心理运动发育指数（PDI）达到正常百分数85．7％，高于对照组（P〈0．05）。结论早期干预是促进早产儿智能发育的有效方法，可降低其伤残率。     

早期干预对智力发育低下婴幼儿智能发展的作用

目的探讨早期干预对智力发育低下婴幼儿智能发展的作用。方法以自愿来早教中心进行早期干预的智力发育低下婴幼儿（总发育商〈70）30名为试验组,另选择与其基本条件相同的婴幼儿30名为对照组。试验组除进行早期干预的培训工作外,还于培训前和培训3、6、9个月后各测评发育商（DQ）1次。对照组无培训工作,于入组时和9个月后各测评DQ1次。两组入组时均隔天肌肉注射脑活素2ml共30次,大于1岁的小儿则同时口服尼莫地平和叶酸。结果①试验组经培训9个月后,其总发育商平均值提高27.6分,高于对照组观察9个月后总发育商平均值提高3.7分,试验组总DQ值增加明显高于对照组（H=40.13,P〈0.01）。②试验组培训9个月后,24例总DQ值达中下水平以上（总DQ值〉80）,24例中14例达中等水平以上（总DQ值〉90）。③在30例试验组的智力发育低下婴幼儿基础总DQ值中5个能区的DQ值比较发现,大运动能力影响较其它4个能区的能力影响最少（P〈0.01）。结论早期干预对智力发育低下婴幼儿的智能发展有显著效果,其中药物干预的作用较小,培训工作的作用较大,早期干预是降低智力残疾发生率的有效措施。     

危险及有害饮酒的早期干预

目的 :对危险及有害饮酒者进行干预教育 ,随访观察干预后的效果。方法 :对 1 4 5例危险及有害饮酒者进行有关饮酒危害性的早期干预教育 ,发放自助手册 ,3个月后随访干预效果。结果 :(1 )干预后饮酒量较干预前下降了约 35% ,日饮 4标准杯的人数较干预前明显下降 (P <0 0 0 0 1 )。干预后饮酒频度从每周平均 4 - 5次降至 2 - 3次。每周饮酒大于 5次的人从 47 5 %降至 2 2 5 % ,下降差异有显著性 (P <0 0 0 0 1 )。干预后AUDIT总分和各因子分均较干预前明显下降 (P均小于 0 0 0 1 )。 (2 )干预后躯体损害、精神损害和社会问题总发生的情况 ,均较干预前明显减少 (P均 <0 0 0 1 )。结论 :对危险及有害饮酒者进行早期简短干预 ,可以明显减少饮酒量和饮酒频度 ,继而减少与酒相关的各种损害的发生     

Differential Outcomes Associated with Early Medical Complications in Premature Infants

This study evaluated the effects of several early medical complicationson the intellectual and motoric development of premature verylow birth weight (VLBW) infants. A large cohort of prematureinfants was grouped according to the following complicationsat birth: (a) intraventricular hemorrhage with respiratory distresssyndrome (IVH-RDS); (b) respiratory distress syndrome withoutintraventricular hemorrhage (RDS-no IVH); (c) bronchial-pulmonarydysplasia without IVH (BPD); (d) bronchial-pulmonary dysplasiawith IVH(BPD-IVH); and (e) hydrocephalus (HYD) secondary toIVH. These complications are frequently associated with prematurityand were hypothesized to have differential effects on laterdevelopmental outcome. Premature infants in the five diagnosticgroups received the Bayley Scales of Infant Development at 6,12, and 24 months of age. Results reveal that the IVH-RDS andRDS-no IVH infants perform similarly and show performance inthe average range for their chronological age by 24 months.In contrast, the infants in the BPD and HYD groups have generallylower scores, which remain in the delayed range throughout thefollow-up period. These results show that IVH is associatedwith poorer intellectual outcomes only when it is accompaniedby BPD or progressive hydrocephalus. In addition, longer periodsof hospitalization, which are associated with BPD, have a significantlynegative effect on later outcome. The implication of these resultsfor early intervention is discussed.     

Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial

Background

Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms.

Objective

To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients.

Methods

Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale—Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented.

Results

The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001).

Conclusions

Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD).     

The Neurobehavioral Assessment Scale as an Instrument for Early Long-Term Prognosis and Intervention in Major Disability in High-Risk Infants

Evaluated the hypothesis that more effective prognosis is achievedby assessing the modifiability of infants' reactions than byevaluating the presence or absence of normal/abnormal reactions.To evaluate this hypothesis the Neurobehavioral Assessment Scale(NAS) was developed. The NAS assesses the extent to which infantscan change their responses in functional contexts. The NAS wasadministered to 102 high-risk infants repeatedly over the first16 months of life. Analysis confirmed that the modiftabilityof performance was predictive of outcome significantly earlierin development than scoring the same items in terms of theirnormalcy or abnormalcy.     

早期干预对脑损伤大鼠学习记忆及神经生长因子的影响

目的:探讨早期干预对缺氧缺血性脑损伤(HIBD)大鼠学习记忆功能的影响及机制.方法:结扎SD大鼠一侧子宫角血管建立HIBD模型,采用早期触摸和丰富环境刺激进行早期干预,为期28天.以一次被动回避反应、脑干听觉诱发电位(BAEP)、神经生长因子(NGF)作为检测指标.结果:干预组大鼠(18只)被动回避反应步入潜伏期(STL)长于非干预组(15只);BAEP的Ⅱ、Ⅳ波潜伏期(PL)及Ⅰ～Ⅳ波峰间期(IPL)短于非干预组;脑组织内NGF的含量高于非干预组(P＜0.05).结论:早期干预可有效改善HIBD大鼠学习记忆功能;提高脑组织内源性NGF的水平是早期干预促进HIBD大鼠脑功能修复的机制之一.     

Six-Month Outcomes of a Web-Based Intervention for Users of Amphetamine-Type Stimulants: Randomized Controlled Trial

Background

The use of amphetamine-type stimulants (ATS) places a large burden on health services.

Objective

The aim was to evaluate the effectiveness of a self-guided Web-based intervention (“breakingtheice”) for ATS users over 6 months via a free-to-access site.

Methods

We conducted a randomized trial comparing a waitlist control with a fully automated intervention containing 3 modules derived from cognitive behavioral therapy and motivation enhancement. The main outcome was self-reported ATS use in the past 3 months assessed at 3- and 6-month follow-ups using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Secondary outcomes were help-seeking intentions (general help-seeking questionnaire), actual help seeking (actual help-seeking questionnaire), psychological distress (Kessler 10), polydrug use (ASSIST), quality of life (European Health Interview Survey), days out of role, and readiness to change. Follow-up data were evaluated using an intention-to-treat (ITT) analysis with a group by time interaction.

Results

We randomized 160 people (intervention: n=81; control: n=79). At 6 months, 38 of 81 (47%) intervention and 41 of 79 (52%) control participants provided data. ATS scores significantly declined for both groups, but the interaction effect was not significant. There were significant ITT time by group interactions for actual help seeking (rate ratio [RR] 2.16; d=0.45) and help-seeking intentions (RR 1.17; d=0.32), with help seeking increasing for the intervention group and declining for the control group. There were also significant interactions for days completely (RR 0.50) and partially (RR 0.74) out of role favoring the intervention group. However, 37% (30/81) of the intervention group did not complete even 1 module.

Conclusions

This self-guided Web-based intervention encouraged help seeking associated with ATS use and reduced days out of role, but it did not reduce ATS use. Thus, this program provides a means of engaging with some sections of a difficult-to-reach group to encourage treatment, but a substantial minority remained disengaged.

Trial Registration

Australian and New Zealand Clinical Trials Registry: ACTRN12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343307 (Archived by WebCite at http://www.webcitation.org/6Y0PGGp8q).     

早期家庭心理干预对首发精神分裂症患者康复的影响

目的探讨家庭心理干预对首发精神分裂症患者康复效果的影响。方法采用对照研究的方法,对驻马店市精神病医院108例首发精神分裂症住院患者进行1年的家庭心理干预,并进行了两年的随访,应用简明精神症状评定量表（BPRS）和社会功能缺陷筛选量表（SDSS）量表对患者进行比较。结果1年后、两年后的历次评定中,研究组病人BPRS和SDSS量表评分明显低于对照组,差异有显著性（P〈0．01）。结论家庭心理干预有利于提高精神分裂症患者疗效,改善其社会功能,防止精神分裂症的复发。     

Participants,Usage, and Use Patterns of a Web-Based Intervention for the Prevention of Depression Within a Randomized Controlled Trial

Background

Although Web-based interventions have been shown to be effective, they are not widely implemented in regular care. Nonadherence (ie, participants not following the intervention protocol) is an issue. By studying the way Web-based interventions are used and whether there are differences between adherers (ie, participants that started all 9 lessons) and nonadherers, more insight can be gained into the process of adherence.

Objective

The aims of this study were to (1) describe the characteristics of participants and investigate their relationship with adherence, (2) investigate the utilization of the different features of the intervention and possible differences between adherers and nonadherers, and (3) identify what use patterns emerge and whether there are differences between adherers and nonadherers.

Methods

Data were used from 206 participants that used the Web-based intervention Living to the full, a Web-based intervention for the prevention of depression employing both a fully automated and human-supported format. Demographic and baseline characteristics of participants were collected by using an online survey. Log data were collected within the Web-based intervention itself. Both quantitative and qualitative analyses were performed.

Results

In all, 118 participants fully adhered to the intervention (ie, started all 9 lessons). Participants with an ethnicity other than Dutch were more often adherers (χ² ₁=5.5, P=.02), and nonadherers used the Internet more hours per day on average (F_1,203=3.918, P=.049). A logistic regression showed that being female (OR 2.02, 95% CI 1.01-4.04; P=.046) and having a higher need for cognition (OR 1.02; 95% CI 1.00-1.05; P=.02) increased the odds of adhering to the intervention. Overall, participants logged in an average of 4 times per lesson, but adherers logged in significantly more times per lesson than nonadherers (F_1,204=20.710; P<.001). For use patterns, we saw that early nonadherers seemed to use fewer sessions and spend less time than late nonadherers and adherers, and fewer sessions to complete the lesson than adherers. Furthermore, late nonadherers seemed to have a shorter total duration of sessions than adherers.

Conclusions

By using log data combined with baseline characteristics of participants, we extracted valuable lessons for redesign of this intervention and the design of Web-based interventions in general. First, although characteristics of respondents can significantly predict adherence, their predictive value is small. Second, it is important to design Web-based interventions to foster adherence and usage of all features in an intervention.

Trial Registration

Dutch Trial Register Number: NTR3007; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3007 (Archived by WebCite at http://www.webcitation.org/6ILhI3rd8).     

早期干预对独生子女健全人格发展的对照研究

目的:探讨早期干预对儿童心身健康的全面发展和培养独生子女健全人格的影响.方法:采用由国内专家创建的独生子女健全人格培养方案对0～6岁独生子女进行干预指导,通过Achenbach儿童行为量表及幼儿性格发展趋向量表评定幼儿心理卫生状况、儿童社会适应行为量表测定社会适应能力、儿童气质量表评定气质类型、中国比奈测定智商,并设37例对照组.结果:研究组行为问题检出率为6.67%,低于对照组的13.5%和全国流调的14.3%;研究组智商高于对照组,差异有统计学显著性(t=3.752,P<0.001);社会适应能力气质评定两组差异无统计学显著性(P均>0.05).但V9维度(反应阈)研究组得分明显低于对照组,提示研究组趋于易养.结果:经对幼儿培养的早期干预,其健全人格指标优于非干预组.