中医针灸加综合康复训练对孤独症患儿孤独症行为评定量表及孤独症评定量表评分的影响分析

目的 探讨对孤独症患儿实施中医针灸加综合康复训练的应用价值。方法 选取2019年12月至2021年12月临沂市康复医院就诊的200例孤独症患儿,按照干预方式分为对照组和观察组,各100例。对照组采取常规康复训练,观察组应用中医针灸加综合康复训练。比较两组患儿孤独症行为评定量表（ABC）、儿童孤独症评定量表（CARS）、艾森克人格问卷、平衡及功能评分,心内膜下缺血（ERP）波幅及潜伏期。结果 干预后,两组患儿ABC、CARS评分均降低,且观察组均低于对照组（均P <0.05）。干预后两组患儿ERP波幅升高,ERP潜伏期缩短,且观察组ERP波幅高于对照组,ERP潜伏期短于对照组（均P <0.05）。干预后,两组患儿各方面的艾森克人格问卷评分均降低,且观察组均低于对照组（均P <0.05）。干预后,两组患儿闭眼平衡、睁眼平衡、功能性行为均升高,且观察组均高于对照组（均P <0.05）。结论 中医针灸加综合康复训练在孤独症患儿干预中,可显著改善患儿症状,调节大脑认知电位,提高平衡及功能性,优化情绪,有临床应用价值。     

以家庭为中心的早期护理干预对孤独症患儿ATEC、CARS、ABC评分的影响

目的 探讨以家庭为中心的早期护理干预在孤独症患儿中的应用效果。方法 将2019年1月至2020年12月我院收治的70例孤独症患儿根据护理方案的不同分为常规组（35例,常规护理干预）和观察组（35例,常规护理干预+以家庭为中心的早期护理干预）。比较两组的干预效果。结果 干预后,观察组的孤独症治疗评估量表（ATEC）各维度评分及儿童孤独症评定量表（CARS）、孤独症行为量表（ABC）评分低于常规组,差异具有统计学意义（P<0.05）。观察组的护理满意度高于常规组,差异具有统计学意义（P<0.05）。结论 以家庭为中心的早期护理干预用于孤独症患儿中可改善疾病症状,减轻疾病程度,提高家长满意度,值得临床推广与应用。     

儿童孤独症行为训练92例疗效分析

目的：探讨行为训练对儿童孤独症的治疗效果。方法：对92例孤独症惠儿，实施行为训练，采用CARS于训练前和训练结束后进行量表评定。结果：训练后患儿CARS人际关系、语言、行为障碍等均明显改善，有非常显著性差异（P〈0.01）。结论：对孤独症患儿实施行为训练能帮助患儿减轻心身障碍，增强社会功能，降低残疾程度。     

综合康复训练对孤独症儿童康复效果分析

目的:探讨综合康复训练对儿童孤独症的康复效果。方法:对63例孤独症患儿采取应用行为分析法(ABA)、感觉统合训练、语言训练、音乐治疗、游戏治疗等综合康复训练10月,并请家长培训后参与医院的部分训练过程,训练前后分别用孤独症儿童行为检查量表(ABC)、儿童孤独症评定量表(CARS)及婴儿-初中生社会生活能力量表(SM)评估康复效果。结果:康复训练后,63例孤独症儿童ABC量表各因子得分及量表总分较前均下降,差异有统计学意义(P0.05);训练后CARS量表评估综合分较前下降,SM量表评估标准分较前增加,差异均有统计学意义(P0.05)。结论:综合康复训练能有效改善儿童孤独症的各种症状,提高患儿的生活能力。     

先天性聋儿伴有孤独症倾向的分析与护理干预

目的了解先天性聋儿伴有孤独症倾向的发生率并进行护理干预。方法采用儿童期孤独症评定量表（CARS）并结合美国精神障碍诊断和统计手册（DSM-IV）儿童孤独症的诊断标准,对51例先天性聋儿及44例正常儿童进行对照性测评,并对患有孤独症的聋儿进行护理干预,1个月后进行量表评定。结果本组先天性聋儿孤独症发生率为57%。2组患者CARS评分比较有显著性差异（P〈0.05或P〈0.001）。先天性聋儿孤独症护理干预前后CARS评分显示除对玩具等物品的使用和非言语沟通外,其余5项差异有统计学意义（P〈0.05或P〈0.001）。结论超过50%的先天性聋儿患者合并孤独症,护理干预能明显改善先天性聋儿的孤独症状。     

早期介入丹佛模式对孤独症谱系障碍儿童康复效果与家长育儿压力的影响

目的：分析早期介入丹佛模式（ESDM）对孤独症谱系障碍（ASD）儿童康复效果与家长育儿压力的影响。方法：回顾性分析周口市中心医院儿童康复科2019年5月至2021年3月收治的50例孤独症谱系障碍患儿的临床资料,按护理方式不同分为对照组和研究组,各25例。对照组实施常规干预,研究组接受ESDM干预。比较两组威斯康星卡片分类测验（WCST）结果,干预前后孤独症行为量表（ABC）、儿童孤独症评定量表（CARS）、孤独症治疗评估量表（ATEC）父母育儿压力指数简表（PSI-SF）、父母症状问卷（PSQ）评分。结果：干预后,研究组ABC、CARS、ATEC、PSI-SF、PSQ评分均低于对照组（P<0.05）;干预后,研究组WCST测试中各评分均低于对照组（P<0.05）;干预后,研究组家长PSI-SF、PSQ评分均低于对照组（P<0.05）。结论：ESDM模式在ASD儿童康复中应用效果良好,可缓解患儿孤独症行为,降低家长育儿压力。     

阶梯式家长课堂干预模式对孤独症谱系障碍儿童社交能力和生活自理能力的影响

摘要 目的：探讨阶梯式家长课堂干预模式和常规康复治疗对孤独症谱系障碍儿童社交能力和生活自理能力的影响。 方法：纳入2020年1月—2021年1月期间我院接诊的40例孤独症谱系障碍儿童作为研究对象，按照随机数表法分为观察组和对照组，对照组20例孤独症谱系障碍儿童接受常规康复训练，观察组20例除给予常规康复训练外，采用阶梯式家长课堂干预模式进行治疗。治疗前和治疗后2组分别采用行为检查量表（autism behavior checklist， ABC）评分、孤独症疗效评估表（autism treatment evaluation checklist， ATEC）评分、儿童孤独症评定量表（childhood autism rating scale， CARS）评分、功能独立性评定量表（functional independence measure for children， WeeFIM）进行评定。 结果：治疗前，两组之间一般资料及相关量表评定均无显著性差异（P>0.05）。治疗后，2组ABC评分均低于治疗前，差异有显著性意义（P<0.05）；治疗后，2组ATEC总分及社交能力得分均低于治疗前，且观察组明显低于对照组，差异有显著性意义（P<0.05）；治疗后，2组CARS总分及人际关系等各维度得分均低于治疗前，且观察组明显低于对照组，差异有显著性意义（P<0.05）；治疗后，2组WeeFIM评分高于治疗前，观察组明显高于对照组，差异有显著性意义（P<0.05）。 结论：阶梯式家长课堂干预模式可提高孤独症谱系障碍儿童社交能力和生活自理能力。     

先天性聋儿伴有孤独症倾向的分析与护理干预

目的了解先天性聋儿伴有孤独症倾向的发生率并进行护理干预。方法采用儿童期孤独症评定量表（CARS）并结合美国精神障碍诊断和统计手册（DSM-IV）儿童孤独症的诊断标准,对51例先天性聋儿及44例正常儿童进行对照性测评,并对患有孤独症的聋儿进行护理干预,1个月后进行量表评定。结果本组先天性聋儿孤独症发生率为57%。2组患者CARS评分比较有显著性差异（P〈0.05或P〈0.001）。先天性聋儿孤独症护理干预前后CARS评分显示除对玩具等物品的使用和非言语沟通外,其余5项差异有统计学意义（P〈0.05或P〈0.001）。结论超过50%的先天性聋儿患者合并孤独症,护理干预能明显改善先天性聋儿的孤独症状。     

儿童孤独症行为训练92例疗效分析

目的探讨行为训练对儿童孤独症的治疗效果.方法对92例孤独症患儿,实施行为训练,采用CARS于训练前和训练结束后进行量表评定.结果训练后患儿CARS人际关系、语言、行为障碍等均明显改善,有非常显著性差异(P＜0.01).结论对孤独症患儿实施行为训练能帮助患儿减轻心身障碍,增强社会功能,降低残疾程度.     

心理剧对自闭症患儿社交障碍干预的研究

目的：探讨心理剧对自闭症患儿社会交往障碍的干预效果。方法选取12名年龄、家庭背景等相仿的自闭症患儿,随机抽取2名作为研究组,实施个性化的心理剧训练,其余10名作为对照组;采用儿童孤独症评定量表（CARS）于整个研究过程前后对两组患儿进行量表评定,同时采用孤独症儿童行为评定量表（ABC量表）中的社交因子于每次训练后对研究组进行社交障碍评定。结果研究组患儿CARS中人际关系、行为障碍等有所改善（P＜0．01）,ABC量表显示社交障碍呈减轻趋势。结论心理剧训练能帮助患儿改善社会交往障碍,增强其社会功能。     

个体化培训治疗儿童孤独症

Autismbelongtopervasivedevelopmentdisorders(PDDs).Thereareneuropsychiatricdisorderscharacterizedbypatternofdelayanddevianceinthedevelopmentofsocial,communicative,speechandlanguage,andbehavioralproblems.Theseconditionshavetheironsetinthefirstyearsoflife,disruptdiversedevelopmentalprocesses,andareoftenassociatedwithmentalretardation犤1犦.Kanner(1943)reported11casesandnamedearliest“InfantAutism”.Gillbergetal犤2犦reviewthearticles,theyfindthepreva-lencegettinghigher.Theprevalenceis0.02%before…     

Malignant Hyperthermia Preparedness Training: Using Cognitive Aids and Emergency Checklists in the Perioperative Setting

PurposeThe purpose of this project was to prepare perioperative staff at a military ambulatory surgical center to respond to a malignant hyperthermia crisis effectively with the assistance the Stanford emergency manual cognitive aid.DesignThis is an evidence-based practice improvement project.MethodsMultidisciplinary perioperative staff at a military ambulatory surgical center participated in an in-service about the Stanford emergency manual cognitive aid tool, and a simulation exercise was conducted to practice using the tool during a malignant hyperthermia crisis. Preproject and postproject implementation surveys were to used to measure staff perceptions of and willingness to use cognitive aids/emergency checklists during perioperative emergencies.FindingsStaff positive perception of and willingness to use the Stanford emergency manual cognitive aid improved after implementation of an education session and simulation exercise with the checklist tool.ConclusionsIntroduction of the Stanford emergency manual cognitive aid to multidisciplinary perioperative staff with an in-service and simulated malignant hyperthermia scenario improved staff perception of cognitive aid use during emergencies. Use of cognitive aid checklists during simulated perioperative emergencies was shown to reduce missed critical treatment steps.     

患者转出交接核查表在神经外科重症监护室的应用

目的 探讨NICU转出交接核查表在NICU的应用效果.方法 对2009年12月～2010年8月采用传统口头式交接的323例NICU住院患者(对照组)与2010年9月～2011年5月采用转出交接核查表的298例NICU住院患者(观察组)的交接耗时、交接问题发生率、患者满意度方面进行比较.结果 观察组较对照组交接耗时缩短,交接问题发生率降低,住院患者满意度明显提高,差异有显著意义(P＜0.05).结论 运用“患者转出交接核查表”后,患者转出交接过程趋于标准化,减少交接环节中的薄弱点,提高了护理质量,保证了患者的安全,增加了患者及家属对护士的信任感.     

Siblings and Family Environments of Persons With Autism Spectrum Disorder: A Review of the Literature

OBJECTIVES: The purpose of this literature review is to summarize studies on siblings of individuals with autism spectrum disorders (ASD) in four major areas, to identify gaps in the literature, and to propose future directions for research of siblings of persons with ASD. DESIGN AND METHODS: A systematic review of research published within the past 10 years in peer review journals includes investigations on siblings' and parental characteristics, as well as sibling behaviors, relationships, and adaptation. Twelve studies are synthesized to include purpose, findings, and discussion relating it to previous work. RESULTS: Siblings are influenced by the context of their families that are impacted by biological, psychological, sociological, and ecological factors. Research studies are primarily exploratory and no intervention studies are identified. CONCLUSION: The literature review of parental and sibling characteristics, relationships, and adaptation support intervention measures for siblings and family members of persons with autism. Assessment of siblings is necessary to identify those who may be at risk for future adjustment problems and maladaptive behaviors.     

Parent Perceptions of Efficacy for Strategies used to Facilitate Sleep in Children with Autism

Autism is a relatively common developmental disability that has neurobiological origins and is characterized by pervasive deficits in social interaction, communication and range of interests. In a previously published article, the authors described commonly occurring sleep problems in children with autism [Williams, P. G., Sears, L. L., and Allard, A. (2004). J. Sleep Res. 13: 265–268.] Current estimates of sleep disorders in this population range from 44 to 83% [Richdale, A. (1999). Develop. Med. Child Neurol. 41: 60–66]. Parents often have to devise their own strategies for dealing with sleep problems. This study surveyed interventions being used by families of children with autism. Likert-based surveys were sent out to 500 families of autistic children with 210 returned. Based on records of psychological testing, survey responses for these children were categorized into mental retardation (MR) or not mental retardation (not MR) groups. Among the most frequently used behavior interventions for both groups were establishing a regular bedtime and waking time, providing a darkened room, reading to the child, and providing toys to play with in bed. Behavioral strategies considered most effective included establishing a regular bedtime, bringing the child into the parents’ bed, wrapping the child, using a noise masker, and allowing the child to have toys in his bed. When surveys were divided into MR/not MR groups, some differences in perceived effectiveness of behavioral interventions for sleep were noted. Reading a story and using a nightlight were perceived as much less effective for the MR group as compared to those in the not MR group. In general, medications were used much less frequently than behavioral interventions to help with sleep. When comparisons between the MR/not MR groups were made, no statistically significant differences were seen for perceived effectiveness of medications. This study points to the need for more systematic study of sleep problems and interventions for children with autism.     

Autism and the Courts

Ann M. Rhodes
Column Editor: Ann M. Rhodes
Ask the Expert provides research-based answers to practice questions submitted by JSPN readers .     

Done or Almost Done? Improving OSCE Checklists to Better Capture Performance in Progress Tests

Construct: The impact of using nonbinary checklists for scoring residents from different levels of training participating in objective structured clinical examination (OSCE) progress tests was explored. Background: OSCE progress tests typically employ similar rating instruments as traditional OSCEs. However, progress tests differ from other assessment modalities because learners from different stages of training participate in the same examination, which can pose challenges when deciding how to assign scores. In an attempt to better capture performance, nonbinary checklists were introduced in two OSCE progress tests. The purposes of this study were (a) to identify differences in the use of checklist options (e.g., done satisfactorily, attempted, or not done) by task type, (b) to analyze the impact of different scoring methods using nonbinary checklists for two OSCE progress tests (nonprocedural and procedural) for Internal Medicine residents, and (c) to determine which scoring method is better suited for a given task. Approach: A retrospective analysis examined differences in scores (n = 119) for two OSCE progress tests (procedural and nonprocedural). Scoring methods (hawk, dove, and hybrid) varied in stringency in how they awarded marks for nonbinary checklist items that were rated as done satisfactorily, attempted, or not done. Difficulty, reliability (internal consistency), item-total correlations and pass rates were compared for each OSCE using the three scoring methods. Results: Mean OSCE scores were highest using the dove method and lowest using the hawk method. The hawk method resulted in higher item-total correlations for most stations, but there were differences by task type. Overall score reliability calculated using the three methods did not differ significantly. Pass–fail status differed as a function of scoring methods and exam type, with the hawk and hybrid methods resulting in higher failure rates for the nonprocedural OSCE and the dove method resulting in a higher failure rate for the procedural OSCE. Conclusion: The use of different scoring methods for nonbinary OSCE checklists resulted in differences in mean scores and pass–fail status. The results varied with procedural and nonprocedural OSCEs.