高功能孤独症谱系障碍儿童社交能力团体技能训练干预效果

胡莎莎; 赵啸; 朱珍珍; 刘晓丽; 王蓉; 胡珍玉; 张文武

doi:10.16835/j.cnki.1000-9817.2025064

高功能孤独症谱系障碍儿童社交能力团体技能训练干预效果

doi: 10.16835/j.cnki.1000-9817.2025064

宁波大学附属康宁医院儿童青少年诊疗中心，浙江 315201

基金项目:

浙江省医药卫生科技计划项目 2021KY1064)

详细信息

作者简介:
胡莎莎(1987-)，女，安徽蚌埠人，硕士，主治医师，主要研究方向为孤独症谱系障碍

通讯作者:
张文武，E-mail：knyyzww@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R748 B844.1
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- 被引次数: 0
出版历程
- 收稿日期: 2024-11-08
- 修回日期: 2025-01-07
- 网络出版日期: 2025-03-05
- 刊出日期: 2025-02-25

Effectiveness of group skills training intervention on social ability of high functional autism spectrum disorder children

Children and Adolescents Diagnosis and Treatment Center, the Affiliated Kangning Hospital of Ningbo University, Ningbo (315201), Zhejiang Province, China

摘要

摘要: 目的评估整合式团体社交技能训练对学龄期高功能孤独症谱系障碍(ASD)患儿社交能力的干预效果，为提高高功能ASD患儿社交能力提供参考。方法招募2021年1月—2023年12月在宁波大学附属康宁医院儿童精神科门诊就诊的7~12岁高功能ASD儿童62例，采用随机数字表法分为训练组和对照组各31例；训练组完成为期20周的结构化团体社交训练课程(包括心智解读课程和社交课程)，对照组只进行常规治疗。干预前后采用中文版Griffith共情测验父母评定版(GEM-PR)、社交反应量表(SRS)评估ASD儿童社交缺陷症状，使用情绪面孔识别任务及眼动轨迹测试社会性视觉注意的特征。组间比较采用t检验和Mann-Whitney U检验。结果基线时两组儿童GEM-PR评分(t=-1.20~-0.81)、SRS评分(t=-0.36~1.75)、情绪面孔识别率及反应时(t=-0.58~1.85)、眼动轨迹相关指标差异(U/t=-1.63~0.29)均无统计学意义(P值均>0.05)。干预后训练组GEM-PR总分和认知因子评分[18.00(10.00，24.00)，9.00(8.00，13.00)]均高于对照组[12.00(-1.00，18.00)，2.00(-2.00，7.00)]，SRS总分及社交认知、社交知觉、社交沟通、社交动机因子评分(73.23±14.20，16.16±2.72，6.58±2.50，24.29±5.61，9.52±3.73)均低于对照组(95.26±15.29，19.90±2.84，12.58±2.49，31.94±6.38，13.74±4.81)(U/t值分别为-2.38，-4.59；-5.88，-5.29，-9.47，-5.01，-3.87，P值均 < 0.05)；训练组情绪面孔识别总正确率及愤怒、恐惧、平静面孔识别率[(81.55±6.62)%，(76.86±12.06)%，(79.61±12.42)%，(94.27±6.26)%]均高于对照组[(70.55±13.82)%，(62.82±18.77)%，(67.18±18.85)%，(79.60±20.05)%]，反应时[(2 226.70±274.43)ms]低于对照组[(2 417.27±324.10)ms](t值分别为4.00，3.50，3.07，3.89，-2.42，P值均 < 0.05)；训练组眼动轨迹首次注视面孔的时间[764.74(748.64，793.73)ms]低于对照组[810.92(782.86，877.42)ms]，对面孔中高强度关注区域占比[(37.37±1.27)%]高于对照组[(30.34±1.23)%]，差异均有统计学意义(U/t值分别为3.44，8.89，P值均 < 0.05)。结论整合式团体社交训练能显著提升高功能ASD儿童社会交往能力、共情能力，增加对面孔的主动关注及识别能力，有利于促进ASD儿童的心智化发展。
- 孤独性障碍 /
- 心理学，社会 /
- 干预性研究 /
- 儿童
Abstract: Objective To evaluate the intervention efficacy of integrated group social skills training on social ability in school-age patients with high-functioning ASD, so as to provide a reference for improving social skills in children with high-functioning ASD. Methods From January 2021 to December 2023, 62 children aged 7-12 with high-functioning ASD who visited the Children's Psychiatry Outpatient Department of the Affiliated Kangning Hospital of Ningbo University were recruited, and were randomly divided into a training (n=31) and a control group (n=31) by a random number table method. The training group received a 20-week structured group social training program (mental interpretation courses and social courses), while the control group received only conventional treatment. Chinese version of Griffith Empathy Measure Parent Ratings (GEM-PR) and Social Response Scale (SRS) were used to assess the symptoms of social deficits before and after treatment. Emotional face recognition tasks and eye movement trajectories were used to test the characteristics of social visual attention in children with ASD. Group comparison was conducted using t-test and Mann-Whitney U test. Results At baseline, there were no significant differences in GEM-PR score (t=-1.20 to -0.81), SRS score (t=-0.36-1.75), emotional face recognition accuracy and reaction time (t=-0.58-1.85), and eye movement trajectory (U/t=-1.63-0.29) between the two group (P>0.05). After intervention, the total GEM-PR score and empathic cognitive factor score of training group [18.00(10.00, 24.00), 9.00(8.00, 13.00)] were significantly higher than those of the control group [12.00(-1.00, 18.00), 2.00(-2.00, 7.00)], and the total SRS score and social cognition, social perception, social communication, social motivation (73.23±14.20, 16.16±2.72, 6.58±2.50, 24.29±5.61, 9.52±3.73) were significantly lower than those of the control group (95.26±15.29, 19.90±2.84, 12.58±2.49, 31.94±6.38, 13.74±4.81) (U/t=-2.38, -4.59; -5.88, -5.29, -9.47, -5.01, -3.87, P < 0.05). The overall correct rate of emotional face recognition and the correct rate of angry, fearful and neutral faces recognition in the training group [(81.55±6.62)%, (76.86±12.06)%, (79.61±12.42)%, (94.27±6.26)%] were significantly higher than the control group [(70.55±13.82)%, (62.82±18.77)%, (67.18±18.85)%, (79.60±20.05)%], and the average reaction time [(2 226.70±274.43)ms] was lower than the control group [(2 417.27±324.10)ms] (t=4.00, 3.50, 3.07, 3.89, -2.42, P < 0.05). The time to first eye gaze [764.74 (748.64, 793.73) ms] in the training group was significantly lower than that in the control group [810.92 (782.86, 877.42) ms], and the proportion of moderate-to-high intensity attention area in the face [(37.37±1.27)%] was significantly higher than that in the control group [(30.34±1.23)%] (U/t=3.44, 8.89, P < 0.05). Conclusions Integrated group social training can significantly improve the social communication and empathy ability of high-functioning ASD children, increase active attention and recognition ability of faces, and improve mental development of children with ASD.
- Autistic disorder /
- Psychology, social /
- Intervention studies /
- Child
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表 1 基线与干预后两组儿童GEM-PR、SRS评分比较(x±s)

Table 1. Comparison of GEM-PR and SRS scores between two groups of children at baseline and after intervention(x±s)

时间	组别	人数	统计值	GEM-PR^*			SRS
时间	组别	人数	统计值	认知	情感	总分	社交知觉	社交认知	社交沟通	社交动机	孤独症行为方式	总分
基线	训练组	31		1.00(-3.00, 4.00)	1.00(-5.00, 7.00)	3.00(-4.00, 16.00)	12.58±3.10	20.03±3.79	34.74±6.79	13.13±6.10	19.58±5.62	97.90±19.93
	对照组	31		2.00(-1.00, 7.00)	4.00(-2.00, 9.00)	11.00(0, 17.00)	12.68±2.50	19.58±3.03	32.90±6.68	13.65±5.31	17.35±4.33	95.55±17.26
			t/U值	-1.23	-0.98	-0.99	-0.14	0.52	1.08	-0.36	1.75	0.50
			P值	0.22	0.33	0.32	0.89	0.61	0.29	0.72	0.09	0.62
干预后	训练组	31		9.00(8.00, 13.00)	6.00(2.00, 9.00)	18.00(10.00, 24.00)	6.58±2.50	16.16±2.72	24.29±5.61	9.52±3.73	17.39±4.29	73.23±14.20
	对照组	31		2.00(-2.00, 7.00)	4.00(-1.00, 9.00)	12.00(-1.00, 18.00)	12.58±2.49	19.90±2.84	31.94±6.38	13.74±4.81	17.23±4.27	95.26±15.29
			t/U值	-4.59	-0.95	-2.38	-9.47	-5.29	-5.01	-3.87	0.15	-5.88
			P值	< 0.01	0.35	0.02	< 0.01	< 0.01	< 0.01	< 0.01	0.88	< 0.01
注：^*采用M(P₂₅，P₇₅)描述。

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表 2 基线与干预后两组儿童情绪面孔识别率、平均反应时比较(x±s)

Table 2. Comparison of emotional face recognition rate and average reaction time between two groups of children at baseline and after intervention(x±s)

时间	组别	人数	统计值	总正确率/%	悲伤面孔识别率/%	愤怒面孔识别率/%	恐惧面孔识别率/%	平静面孔识别率/%	愉快面孔识别率/%	平均反应时/ms
基线	训练组	31		72.65±11.12	53.06±21.80	69.76±14.32	70.32±22.38	79.52±26.53	91.53±6.41	2 382.09±343.48
	对照组	31		69.89±15.82	55.65±24.20	60.97±22.25	65.73±21.38	76.24±25.65	88.95±16.22	2 434.99±374.73
			t值	0.79	-0.44	1.85	0.83	0.54	0.82	-0.58
			P值	0.43	0.66	0.07	0.41	0.59	0.41	0.56
干预后	训练组	31		81.55±6.62	62.60±14.46	76.86±12.06	79.61±12.42	94.27±6.26	93.47±6.48	2 226.70±274.43
	对照组	31		70.55±13.82	56.15±20.80	62.82±18.77	67.18±18.85	79.60±20.05	88.65±13.67	2 417.27±324.10
			t值	4.00	1.42	3.50	3.07	3.89	1.78	-2.42
			P值	< 0.01	0.16	< 0.01	< 0.01	< 0.01	0.08	0.02

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表 3 基线与干预后两组儿童眼动追踪数据比较(x±s)

Table 3. Comparison of eye tracking data between two groups of children at baseline and after intervention(x±s)

时间	组别	人数	统计值	首次注视时间/ms	首次注视时长/ms	眼跳/ms	总注视时长/ms	面孔关注面积占比/%
基线	训练组	31		793.73(760.77, 862.59)^*	214.95±61.07	7.56±2.35	1 929.07±406.64	30.43±2.21
	对照组	31		809.05(758.40, 884.24)^*	243.27±75.08	7.83±2.03	1 966.25±582.89	30.32±1.39
			t/U值	0.29	-1.63	-0.49	-0.29	0.09
			P值	0.77	0.11	0.62	0.78	0.93
干预后	训练组	31		764.74(748.64, 793.73)^*	229.66(197.72，272.98)^*	7.43±1.38	1 810.38±311.78	37.37±1.27
	对照组	31		810.92(782.86, 877.42)^*	256.85(218.07, 298.12)^*	7.74±1.52	1 926.72±602.36	30.34±1.23
			t/U值	3.44	1.47	-0.86	-0.96	8.89
			P值	< 0.01	0.14	0.40	0.34	< 0.01
注：^*采用M(P₂₅，P₇₅)描述。

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