Parent-mediated early intervention for young children with autism spectrum disorder

 

Abstract

Background

Recent estimates concerning the prevalence of autistic spectrum disorder are much higher than those reported 30 years ago, with at least 1 in 400 children affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children.

Objectives

The objective of this review was to determine the extent to which parent-mediated early intervention has been shown to be effective in the treatment of children aged 1 year to 6 years 11 months with autistic spectrum disorder. In particular, it aimed to assess the effectiveness of such interventions in terms of the benefits for both children and their parents.

Search methods

A range of psychological, educational and biomedical databases were searched until January 2002.. Bibliographies and reference lists of key articles were searched, field experts were contacted and key journals were hand searched.

Selection criteria

Only randomised or quasi-randomised studies were included. Study interventions had a significant focus on parent-implemented early intervention, compared to a group of children who received no treatment, a waiting list group or a different form of intervention. There was at least one objective, child related outcome measure.

Data collection and analysis

Appraisal of the methodological quality of included studies was carried out independently by two reviewers. Differences between the included studies in terms of the type of intervention, the comparison groups used and the outcome measures were too great to allow for direct comparison.

Main results

The results of this review are based on data from two studies. Two significant results were found to favour parent training in one study: child language and maternal knowledge of autism. In the other, intensive intervention (involving parents, but primarily delivered by professionals) was associated with better child outcomes on direct measurement than were found for parent-mediated early intervention, but no differences were found in relation to measures of parent and teacher perceptions of skills and behaviours.

Authors' conclusions

This review has little to offer in the way of implications for practice: there were only two studies, the numbers of participants included were small, and the two studies could not be compared directly to one another. In terms of research, randomised controlled trials involving large samples need to be carried out, involving both short and long-term outcome information and full economic evaluations. Research in this area is hampered by barriers to randomisation, such as availability of equivalent services.

 

Plain language summary

Early intervention delivered by parents to young children with autism spectrum disorder

Children with autism spectrum disorder pose significant challenges within families. The involvement of parents in implementing intervention strategies designed to help their autistic children has a long history and is an approach used widely in current practiceFindings of the review are based on only two studies of sufficient quality and are therefore limited. There is some evidence to suggest that parent training may provide benefits to both children and parents. However, large-scale randomised controlled trials are needed, to involve both short and long-term outcome information, to evaluate for which children parent-mediated early intervention may be most beneficial, and to include economic evaluations.

 

摘要

背景

雙親居間，對有自閉疾患的幼童的早期介入

最近的估計顯示，自閉症疾患的盛行率要比30年前所報告的要高，每400個孩童就有至少1個被影響。這個族群的孩童和家庭相當需要醫療服務。長期以來把雙親納入執行介入策略，來幫忙這些自閉的孩童，被認為是有幫忙的。潛在的益處為，增加雙親及孩子的技巧及減低其壓力。

目標

這篇回顧的目標為確認對1歲到6歲11個月大、有自閉症疾患的孩童，雙親居間的早期介入程度多深才有效果。尤其在於依據對雙親和孩童的好處，評估這些介入方式的效果。

搜尋策略

搜尋包括心理、教育和生物醫學的資料庫。搜尋關鍵文獻的參考書目和相關資料清單；聯絡該領域的專家；並人工搜尋關鍵期刊。

選擇標準

只有隨機性或半隨機性的文獻被納入。文獻的介入方法特別著重在雙親居間的早期介入，並和其他族群的孩童，包括未接受治療的、在等待名單上的、或接受其他不同介入方式的來做比較。至少有一項客觀的、和孩童相關的結果量測。

資料收集與分析

由兩位回顧者分別獨立評估所選擇的試驗，其方法學上的品質。所選擇的試驗中，介入方法的種類、所比較的族群、和結果的量測，其歧異性太大了，以致於無法直接做比較。

主要結論

這篇回顧的結果是基於兩篇試驗的資料。在其中一篇試驗中，發現兩項結果具顯著意義，支持父母的訓練有幫助：即孩童的語言能力和母親對於自閉症的知識。另一篇研究則顯示，密集的介入模式 (包含雙親，但一開始是由專業人士來執行) 和雙親居中的早期介入比較起來，前者在孩童預後的直接量測上較佳，但是在雙親和老師對於技能與行為的感受之量測，兩著並沒有差異。

作者結論

這篇回顧在運用上只能提供一點貢獻；總共只有兩篇試驗，參與者的數量太小，而且兩篇試驗並沒有辦法被直接比較。就試驗層級而言，需要執行大規模的隨機對照試驗，內容應包括短程和長程的結果資料，以及經濟效益方面的充分評估。這個領域的研究在隨機分配的設計上有其侷限，例如相同服務的取得機會。

翻譯人

本摘要由成功大學附設醫院紀美宏翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

有自閉症疾患的孩童，在家庭中帶來相當大的挑戰。將雙親包含進介入的策略，來幫忙他們自閉症的孩子，這樣的做法已有著相當長的歷史，在現階段的臨床實行中也被廣泛的運用。這篇回顧所發現的結論只根基於兩篇有一定品質的試驗，所以結論是侷限的。某些證據顯示，雙親的訓練可能提供不論是孩童或雙親益處。然而，大規模的隨機控制試驗是需要的，內容應該包括短程和長程的結果資料，以及經濟效益方面的評估，以評估哪一種雙親居中的早期介入可以是最有益的。