Effect of types of educational institutions on social-communication functions among children with autism spectrum disorder: an observation study
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摘要:
目的 探索就读于普通学校及特殊教育机构的学龄期孤独症谱系障碍(ASD)儿童在1年观察期内的社会交往功能的变化，为开展针对性的教育提供参考。 方法 对象来自于2017—2018年中山大学公共卫生学院儿童与青少年心理与行为发展研究中心招募的ASD儿童，共获得两个时点有完整数据的44名儿童。在基线及随访期间对家长进行问卷调查，调查内容包括儿童的基本情况、社交反应量表(SRS)、长处与困难问卷(SDQ)、社交沟通量表(SCQ)、儿童焦虑情绪筛查量表(SCARED)、注意缺陷多动障碍评定量表(SNAP-Ⅳ)。 结果 相较于普通学校就读的患儿，基线水平上SRS总分(114.56±6.02, 93.63±3.82)及其亚量表得分(社交知觉：13.54±0.71, 11.02±0.45；社交认知：22.73±1.16, 18.19±0.73；社交沟通：37.47±2.12, 30.40±1.35；孤独症行为方式：23.11±1.70, 19.02±1.08)、SCQ总得分(20.37±1.60, 12.92±1.02)及其亚量表得分(社会互动领域：8.77±0.92, 4.23±0.58；沟通领域：6.07±0.55, 4.19±0.35)在特殊教育机构的患儿中更高(P值均 < 0.05)。进一步比较基线和随访结果，时间效应以及时间与教育环境的交互作用均无统计学意义(P值均>0.05)。 结论 相较于特殊教育机构，就读于普通学校的学龄期ASD患儿社交障碍程度更低；在1年观察期内，教育环境与儿童的症状变化不存在关联。家长应根据患儿自身能力选择教育环境，学校应加强特殊教育的资源建设和教师技能培训。 Abstract:Objective To explore changes in the social interactions of school-aged children with autism spectrum disorder (ASD) enrolled in ordinary schools and special education institutions during a one-year observation period. Methods A total of 44 children with ASD were recruited from the Research Center of Children and Adolescent Psychological and Behavioral Development in the Department of Public Health, Sun Yat-sen University, during 2017 and 2018. At the baseline and follow-up periods, a self-report questionnaire (completed by parents) was administered in order to collect demographic information related to the children, the survey included the Social Responsiveness Scale (SRS), Strengths and Difficulties Questionnaire (SDQ), Social Communication Questionnaire (SCQ), Screen for Child Anxiety Related Emotional Disorder (SCARED) and the Swan-son Nolan and Pelham, Version Ⅳ Scale(SNAP-Ⅳ). Results At baseline, compared with children in ordinary schools, the total score of SRS (114.56±6.02, 93.63±3.82) and its subscale scores (social awareness: 13.54±0.71, 11.02±0.45; social cognition: 22.73±1.16, 18.19±0.73; social interaction: 37.47±2.12, 30.40±1.35; autistic mannerisms: 23.11±1.70, 19.02±1.08) were higher in children attending special education institutions, as well as the SCQ total score (20.37±1.60, 12.92±1.02) and its subscale scores(social interaction domain: 8.77±0.92, 4.23±0.58; social communication domain: 6.07±0.55, 4.19±0.35)(P < 0.05). Further comparison of baseline and follow-up results showed no significant difference in time effect or in the interaction between time and the educational environment(P>0.05). Conclusion Compared with special education institutions, school-aged children with ASD in ordinary schools had lower levels of social impairment. During the one-year observation period, there was no correlation between the educational environment and changes in symptoms of children and their parents. Parents should choose an appropriate educational environment according to the children's abilities, and ordinary schools and teachers should be prepared for inclusive education. -
Key words:
- Education /
- Organizations /
- Autistic disorder /
- Communication /
- Child
1) 利益冲突声明 所有作者声明无利益冲突。 -
表 1 不同教育机构ASD患儿社交反应量表得分比较(x±s)
Table 1. Comparison of Social Responsiveness Scale (SRS) scores of children with ASD in different educational institutions(x±s)
学校 时间 社交知觉 社交认知 社交沟通 社交动机 孤独症行为方式 总得分 普通学校 基线 11.02±0.45 18.19±0.73 30.40±1.35 15.01±0.95 19.02±1.08 93.63±3.82 (n=30) 随访 11.05±0.49 18.01±0.80 27.25±1.46 13.82±1.03 16.26±1.17 86.39±4.15 特殊教育机构 基线 13.54±0.711 22.73±1.161 37.47±2.121 17.71±1.50 23.11±1.701 114.56±6.021 (n=14) 随访 13.02±0.662 22.79±1.082 38.06±1.992 17.93±1.402 21.22±1.592 113.03±5.632 P时间值 0.69 0.95 0.47 0.70 0.11 0.39 P教育环境值 < 0.01 < 0.01 < 0.01 0.01 < 0.01 < 0.01 P时间×教育环境值 0.62 0.90 0.26 0.55 0.75 0.55 注： 1在基线水平上与普通学校患儿比较，P < 0.05；2随访后，与普通学校患儿比较，P < 0.05。 
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表 2 不同教育机构ASD患儿社交沟通量表得分比较(x±s)
Table 2. Comparison of Social Communication Questionnaire (SCQ) scores of children with ASD in different educational institutions(x±s)
学校 时间 重复及刻板的行为模式领域 社会互动领域 沟通领域 总得分 普通学校 基线 4.05±0.36 4.23±0.58 4.19±0.35 12.92±1.02 (n=30) 随访 3.60±0.39 4.07±0.63 3.62±0.38 11.63±1.10 特殊教育机构 基线 4.44±0.57 8.77±0.921 6.07±0.551 20.37±1.601 (n=14) 随访 4.55±0.55 8.47±0.902 5.29±0.532 19.15±1.562 P时间值 0.72 0.77 0.15 0.37 P教育环境值 0.18 < 0.01 < 0.01 < 0.01 P时间×教育环境值 0.54 0.93 0.81 0.96 注： 1在基线水平上与普通学校患儿比较，P < 0.05；2随访后，与普通学校患儿比较，P < 0.05。
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表 3 不同教育机构ASD患儿长处与困难问卷得分比较(x±s)
Table 3. Comparison of Strengths and Difficulties Questionnaire (SDQ) scores of children with ASD in different educational institutions(x±s)
学校 时间 多动 情绪症状 亲社会行为 同伴交往问题 品行问题 总得分 普通学校 基线 7.04±0.36 3.29±0.36 4.75±0.45 6.04±0.30 2.87±0.30 23.96±0.96 (n=30) 随访 6.65±0.40 3.02±0.40 5.10±0.50 5.73±0.33 3.02±0.33 23.53±1.07 特殊教育机构 基线 7.55±0.59 2.58±0.60 3.23±0.74 6.61±0.49 2.47±0.49 22.40±1.58 (n=14) 随访 7.76±0.53 3.17±0.54 3.12±0.661 7.54±0.441 1.81±0.451 23.38±1.43 P时间值 0.86 0.75 0.84 0.44 0.52 0.84 P教育环境值 0.11 0.58 0.01 0.01 0.06 0.53 P时间×教育环境值 0.50 0.35 0.68 0.10 0.29 0.57 注： 1随访后，与普通学校患儿比较，P < 0.05。
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表 4 不同教育机构ASD患儿情绪行为问题检出率/%
Table 4. The detection rate of emotional behavior problems in children with ASD in different educational institutions/%
学校 时间 SCARED SNAP-Ⅳ 社交恐怖 分离性焦虑 躯体化/惊恐 广泛性焦虑 总体 注意力不集中 多动/冲动 普通学校 基线 50.0 46.7 26.7 53.3 56.7 46.7 30.0 (n=30) 随访 46.7 30.0 20.0 63.3 56.7 43.3 23.3 特殊教育机构 基线 50.0 28.6 14.3 35.7 64.3 71.4 50.0 (n=14) 随访 69.2 53.8 23.1 38.5 76.9 64.3 35.7 P时间值 0.43 0.99 0.82 0.86 0.43 0.81 0.41 P教育环境值 0.45 0.83 0.72 0.09 0.35 0.08 0.16 P时间×教育环境值 0.33 0.07 0.40 0.73 0.54 0.82 0.80
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