ABSTRACT

Objective: This study tested the efficacy of an intensive outpatient psychosocial treatment for children with autism spectrum disorder (ASD) without intellectual disability (ID).

Method: Eighty-eight children (ages 7–12 years) were randomly assigned to the treatment or control (waitlist) condition. The 18-week cognitive-behavioral treatment (two 90-min sessions per week) included small-group instruction and therapeutic activities targeting social/social-communication skills, face-emotion recognition, nonliteral language skills, and interest expansion. A behavioral system was used to increase skills development and reduce ASD symptoms. Efficacy was tested immediately following treatment (posttest), with maintenance assessed 4–6 weeks later (follow-up). Measures included parent ratings of the children’s social/social-communication skills, ASD symptoms, broad social skills, and behavior symptoms, child tests of social-cognitive skills (emotion recognition and nonliteral language), and behavioral observations.

Results:Significant effects favoring the treatment group were found at posttest on the primary measures of ASD symptoms (Social Responsiveness Scale, Second Edition; Constantino & Gruber, 2012) and social/social-communication skills (Adapted Skillstreaming Checklist; Lopata, Thomeer, Volker, Nida & Lee, 2008), and secondary measures of nonliteral language skills, broad social skills, and behavior symptoms (measures of emotion-recognition skills and social behaviors during structured game sessions were non-significant). The significant treatment effects found at posttest were all maintained at follow-up.

Conclusions: The outpatient treatment improved several core areas of functioning for children with ASD without ID. Additional elements may be needed to expand the efficacy of the treatment so that the observed skills/symptom improvements generalize to social interactions during gameplay.

摘要

目的：本研究测试了强化门诊心理社会治疗对没有智力障碍 (ID) 的自闭症谱系障碍 (ASD) 儿童的疗效。

方法：88 名儿童（7-12 岁）被随机分配到治疗组或对照组（候补名单）组。为期 18 周的认知行为治疗（每周两次 90 分钟）包括针对社交/社交沟通技巧、面部表情识别、非文字语言技能和兴趣扩展的小组指导和治疗活动。行为系统用于增加技能发展并减少 ASD 症状。治疗后立即测试疗效（后测），并在 4-6 周后评估维持情况（随访）。措施包括家长对儿童社交/社交沟通技巧、ASD 症状、广泛社交技能和行为症状的评分、儿童社交认知技能测试（情绪识别和非文字语言）以及行为观察。

结果：在 ASD 症状的主要测量指标（社会反应量表，第二版；Constantino & Gruber，2012）和社交/社会沟通技巧（改编技能流检查表；Lopata、Thomeer、Volker）的后测中发现有利于治疗组的显着效果, Nida & Lee, 2008)，以及非文字语言技能、广泛社交技能和行为症状的次要测量（结构化游戏会话期间情绪识别技能和社交行为的测量不显着）。在后测中发现的显着治疗效果在随访中均保持。

结论：门诊治疗改善了没有 ID 的 ASD 儿童的几个核心功能领域。可能需要额外的元素来扩大治疗的功效，以便观察到的技能/症状改善推广到游戏过程中的社交互动。