孤独症儿童饮食行为问题及相关干预

目的 调查孤独症谱系障碍(ASD)患儿饮食行为问题,探索通过家长教育、以家庭为主体的综合饮食干预的疗效。方法 选取2017年12月-2018年12月在复旦大学附属儿科医院儿保科门诊就诊并确诊的18~72月龄ASD患儿为研究对象,采用问卷调查饮食行为,对存在饮食行为问题的家庭给予饮食指导,为期1个月。同时对儿童进行体格测量,检测血清营养学指标。结果 研究最终调查310名儿童,其中51.0%的ASD儿童有挑食行为,其他高发的行为问题有进餐容易分心(35.3%)、进餐要看电视或玩玩具(25.5%)、不愿在餐桌进餐(19.0%)。ASD儿童体重过重(11.6%)及肥胖(11.2%)的比例较高,个别儿童维生素A、维生素D、维生素B₁₂、锌降低。本研究最终干预问题条目有7条,每个问题条目干预过程中都有不同比例的儿童得到改善。同时个别条目干预中发现主要照顾者为父母及主要照顾者文化程度高的干预改善率更高(OR＞1,P＜0.05)。结论 ASD儿童饮食行为问题发生率高,应推动以家庭为单位的ASD儿童饮食行为临床干预。

Research and intervention of eating behavior problems of children with autism

Objective To observe the eating behavior problems in children with autism spectrum disorder (ASD),and to explore the therapeutic effect of integrated diet intervention method based on family by parents education. Methods ASD children aged 18 to 72 months diagnosed in the Children′s Healthcare Department of Children′s Hospital of Fudan University were enrolled in this study from December 2017 to December 2018.A self-designed questionnaire was used to investigate the dietary behavior of children with ASD,and dietary guidance was given to the families of children with dietary behavior problems for one month.All children conducted physical measurement and their serum nutrition indexes were tested. Results Totally 310 ASD children were investigated,of whom 51.0% were picky eaters.Other behavioral problems included easily distracted by eating (35.3%),watching TV or playing with toys while eating (25.5%),and unwilling to eat at the table (19.0%).Overweight (11.6%) and obesity (11.2%) were of high prevalence in ASD children.And few children had decreasing levels of vitamin A,vitamin D,vitamin B₁₂ and zinc.The final intervention items in this study included 7 items.Different proportions of children improved in each item after intervention.It was found that the behavior improvement rate was higher when the caregivers were parents and the primary caregivers were highly educated(OR＞1,P<0.05). Conclusion Eating behavior problems in ASD children are high, and clinical intervention based on family is supposed to be promoted.