音乐疗法对孤独症谱系障碍患儿干预效果的Meta分析

目的系统评价音乐疗法对孤独症谱系障碍(ASD)患儿干预效果,以期为ASD的康复训练提供参考。方法运用RevMan5.3软件,对2000年1月1日—2017年12月31日国内外发表的有关音乐疗法对ASD患儿干预的随机对照试验研究进行Meta分析,根据异质性检验结果选择固定效应模型或随机效应模型,计算SMD值及95%CI,评估发表偏倚,进行敏感性分析和亚组分析。结果最终纳入20篇文献,累计干预组614例,对照组622例。合并效应量结果显示,音乐疗法对ASD患儿的总体效果显著(SMD=-0.74,95%CI:-1.14^-0.34,P<0.001),可提高患儿的社会交往能力(SMD=-0.81,95%CI:-1.08^-0.54,P<0.001),语言功能(SMD=-0.57,95%CI:-0.84^-0.29,P<0.001),语言交流能力(SMD=0.92,95%CI:0.41~1.44,P<0.001),但对ASD患儿社会行为的干预效果不显著(SMD=-0.85,95%CI:-0.61~0.03,P>0.05)。亚组分析显示,音乐疗法对ASD患儿非语言交流能力改善不显著(SMD=0.45,95%CI:-0.11~1.01,P=0.12)。结论音乐疗法能够改善ASD患儿总体效果、社会交往、语言功能和语言交流能力。不鼓励单独使用音乐疗法来管理ASD患儿的核心特征,但音乐疗法可作为其他综合行为和教育干预计划组成的一部分。同时应针对ASD患儿的具体表现采取个性化的整合方案。

Meta-analysis on the effect of music therapy on children with autism spectrum disorder

Objective To evaluate the effect of music therapy on children with autism spectrum disorder (ASD) systematically, in order to provide evidence for further rehabilitation of ASD children. Methods Randomized controlled trial studies on the effect of music therapy on ASD children from 2000 to 2017 were analyzed by Meta-analysis with Rev Man 5.3 software. The fixed effect model or random effect model was selected by the heterogeneity test results. The SMD value and 95%CI were calculated, publication bias was evaluated, and sensitivity analysis was conducted. Subgroup analysis was conducted according to different duration time of intervention. Results Totally 20 published articles were selected, including 614 intervention cases and 622 control cases. The values of SMD and 95%CI of music therapy for overall effect of ASD children were of statistical significance(SMD=－0.74, 95%CI:－1.14－－0.34, P＜0.001). Also, music therapy improved social interaction skills(SMD=－0.81, 95%CI:－1.08－－0.54, P＜0.001), language function(SMD=－0.57,95%CI:－0.84－－0.29, P＜0.001) and language communication(SMD= 0.92,95%CI:0.41－1.44,P＜0.001)of ASD children significantly except for social behaviors (SMD=－0.85,95%CI:－0.61-0.03,P＞0.05). Subgroup analysis showed that music therapy did not significantly improve non-language communication skills of ASD children(SMD=0.45,95%CI:－0.11－1.01,P=0.12). Conclusions Music therapy has positive effect on core symptoms of ASD children, including the overall effect, social interaction, language function and language communication. However, it is suggested to combine music therapy with other comprehensive intervention and education interventions instead of conducting music therapy alone. Meanwhile, individualized and comprehensive interventions are expected according to the different symptoms of ASD children, in order to promote their better rehabilitation.