Abstract: Objective To compare and analyze the effect of joint attention(JA)and peer-mediated intervention(PMI)on the treatment of children with autism spectrum disorders(ASD),in order to provide evidence for optimizing intervention programs. Methods Totally 60 ASD children who have typically developed siblings in Henan Children′s Hospital from January 2019 to June 2020 were recruited in this study,and were divided into JA group(n=30)and PMI group(n=30)according to their performance intellectual quotient.Childhood Autism Rating Scale(CARS),Early Social-Communication Scale(ESCS)and Infant-Junior Middle School Social Adaptive Capacity Scale(SM) were used to evaluate children′s performance before intervention,after intervention and 4 weeks in intervention.The differences in scores before and after intervention were compared. Results The differential value of the score in indication follow,fixation follow and eye change before and after intervention between JA group and PMI group were significantly different(t=2.25,2.12,2.33,P＜0.05),which was not significant in terms of finger indication and active display(P>0.05).In terms of the differential value of CARS score before and after treatment,there was no significant difference between the JA group and PMI group(P>0.05).In 4 weeks after intervention,there were no significant differences in indication follow,fixation follow and eye change before and after intervention between JA group and PMI group(P>0.05).At the end of intervention and 4 weeks after the intervention,the score difference of SM scale in PMI group was higher than that in JA group,and the difference was significant(t=2.56,2.29,P<0.05). Conclusions Both JA and PMI have positive effects on children with ASD.Compared with PMI,JA has a good immediate effect on the improvement of response joint attention ability,but the maintenance effect of the two methods is similar.However,PMI is superior than JA in improving social adaptation ability.

Key words: autism spectrum disorder, joint attention, peer-mediated

摘要： 目的 对比分析共同注意(JA)和同伴介入(PMI)疗法治疗孤独症谱系障碍(ASD)儿童的干预效果,为优化ASD儿童的干预方案提供参考。方法 选择2019年1月-2020年6月间就诊于河南省儿童医院的60名具有正常发育同胞的ASD儿童为研究对象,依操作智商进行配对分组,分为共同注意组(n=30)和同伴介入组(n=30)。对两组ASD儿童分别实施JA训练和PMI法干预,在干预前、干预结束时和干预结束4周后分别采用孤独症评定量表(CARS),早期社会交流量表(ESCS)、婴儿-初中生社会生活能力量表(SM)进行评估,比较两组干预前后得分的差值。结果 干预结束时JA组在指示跟随、注视跟随、注视交替项目干预前后评分差值高于PMI组,差异有统计学意义(t=2.25、2.12、2.33,P<0.05),两组手指指示和主动展示项目干预前后评分差值比较差异无统计学意义(P>0.05)。PMI组CARS量表干预前后的评分差值与JA组相比,差异无统计学意义(P>0.05)。干预结束4周后,JA组与PMI组干预前后指示跟随、注视跟随、注视交替项目评分差值差异无统计学意义(P>0.05)。干预结束时和干预结束4周后PMI组SM量表的评分差值均高于JA组,差异具有统计学意义(t=2.56、2.29,P<0.05)。结论 共同注意和同伴介入疗法均对ASD儿童的干预起到积极作用,共同注意训练对响应性共同注意能力的提升有较好的即时效果,但两种方法的维持效果相当;同伴介入训练对社会适应能力的提高优于共同注意训练。

关键词: 孤独症谱系障碍, 共同注意, 同伴介入