孤独症谱系障碍ImPACT干预方案的改编及适应性调查

doi:10.3969/j.issn.1674-8115.2022.09.010

上海交通大学学报（医学版） ›› 2022, Vol. 42 ›› Issue (9): 1239-1246.doi: 10.3969/j.issn.1674-8115.2022.09.010

• 创新团队成果专栏 • 上一篇

孤独症谱系障碍ImPACT干预方案的改编及适应性调查

吴丹萍(), 任芳, 沈理笑, 薛敏波, 王俊丽, 李斐(), 徐明玉()

上海交通大学医学院附属新华医院发育行为儿童保健科，环境与儿童健康教育部重点实验室，上海 200092

收稿日期:2022-05-24 接受日期:2022-08-21 出版日期:2022-09-28 发布日期:2022-09-28
通讯作者: 李斐,徐明玉 E-mail:whuwdp@163.com;feili@shsmu.edu.cn;xumingyu@xinhuamed.com
作者简介:吴丹萍（1992—），女，心理治疗师，硕士；电子信箱：whuwdp@163.com。
基金资助:
上海市公共卫生体系建设三年行动计划(GWV-10.1-XK07);上海市卫生健康委员会先进适宜技术推广项目(2019SY068);上海市高水平地方高校创新团队(SHSMU-ZDCX20211100)

Adaptation and adaptability investigation of Improving Parents as Communication Teachers (ImPACT) program for autism spectrum disorder

WU Danping(), REN Fang, SHEN Lixiao, XUE Minbo, WANG Junli, LI Fei(), XU Mingyu()

Department of Child Health Care, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine; MOE-Shanghai Key Laboratory of Children's Environmental Health, Shanghai 200092, China

Received:2022-05-24 Accepted:2022-08-21 Online:2022-09-28 Published:2022-09-28
Contact: LI Fei,XU Mingyu E-mail:whuwdp@163.com;feili@shsmu.edu.cn;xumingyu@xinhuamed.com
Supported by:
Three-Year Construction Plan of Shanghai Municipal Health Commission(GWV-10.1-XK07);Project of Shanghai Municipal Health Commission(2019SY068);Innovative Research Team of High-level Local Universities in Shanghai(SHSMU-ZDCX20211100)

摘要/Abstract

摘要：

目的·对孤独症谱系障碍（autism spectrum disorder，ASD）家长介导干预项目“让家长成为孩子沟通训练的老师（Improving Parents as Communication Teachers，ImPACT）”进行中国文化背景下的改编和适应性调查。方法·改编过程按4个步骤进行：信息收集、初步改编设计、初步改编测试、进一步调整。信息收集部分邀请8位专家（6位儿科专家、2位心理治疗师）进行6次专家焦点小组讨论，并根据专家意见从语言、干预形式、方案结构、文化习俗等方面对ImPACT进行初步改编。然后招募16位ASD患儿家长，分成2批参加初步改编后的ImPACT团体治疗，并在初步改编测试阶段同步进行适应性调查。结果·初步改编方案的适应性调查结果显示：所有家长均认为“上课进度节奏把握得当，能跟着老师节奏完成课堂内容学习”，66.67%的家长认为“课程准备充分、讲解清晰、目标明确”，33.34%的家长则认为学习过程“提供了丰富例子，帮助理解干预技巧”。关于每次学习后的技能练习作业，83.33%的家长认为“轻松完成，能帮助自己更好地学习干预技巧”，且所有家长均认为“点评及时，点评的内容能帮助自己答疑解惑”。而针对家长反馈的难点，即第7次（塑造互动）、第6次（教授新的模仿和游戏技能）、第5次（教授新的沟通技能）干预，与专家小组讨论后，进行进一步调整，使得最终方案能更方便家长学习掌握。结论·经过改编和适应性调查，形成了更适合中国ASD儿童家庭的家长介导干预的ImPACT项目。

关键词: 孤独症谱系障碍, 家长介导干预, ImPACT干预项目, 方案改编, 适应性调查

Abstract:

Objective ·To adapt and investigate the adaptability of the parent-mediated intervention program “Improving Parents as Communication Teachers (ImPACT)” for autism spectrum disorder (ASD) under the background of Chinese culture. Methods ·There were 4 procedures of adaptation: information gathering, preliminary adaptation design, preliminary adaptation test, and adaptation refinement. In the information collection part, 8 experts (6 pediatrics and 2 psychotherapists) were invited to have 6 focus group discussions, and preliminary adaptation was made in the aspects of language, intervention form, program structure, cultural customs, etc., according to expert suggestions. Then 16 ASD parents were recruited to participate in the ImPACT program after the preliminary adaptation. Adaptative investigation of ImPACT was carried out simultaneously in the preliminary adaptation test stage. Results ·The adaptability investigation results of preliminary adaptation program showed that all parents believed that “the pace of the program was well controlled, and they could follow the rhythm of the therapist to complete the learning of skills”. Among these parents, 66.67% believed that “the course was fully prepared, the explanation was clear, and the goal was clear”, and 33.34% believed that “rich examples were provided to help understand intervention skills” in the learning process. As for the feedback of skill practice homework after each session, 83.33% of parents believed that “homework could be easily completed, and help them better learn intervention skills”, and all parents believed that “comments were timely, and the content of comments could help them answer questions and solve doubts”. The difficulties in mastering, i.e., the 7th session (shaping the interaction), the 6th session (teaching new imitation and play skills), and the 5th session (teaching new communication skills) were further adjusted after discussion with the expert group to make the final plan more convenient for parents to master. Conclusion ·After adaptation and adaptability investigation, a parent-mediated intervention program ImPACT which is more suitable for the families of ASD children in China has been formed.

Key words: autism spectrum disorder (ASD), parent-mediated intervention, ImPACT program, scheme adaptation, adaptability investigation

中图分类号:

R749.94

吴丹萍, 任芳, 沈理笑, 薛敏波, 王俊丽, 李斐, 徐明玉. 孤独症谱系障碍ImPACT干预方案的改编及适应性调查[J]. 上海交通大学学报（医学版）, 2022, 42(9): 1239-1246.

WU Danping, REN Fang, SHEN Lixiao, XUE Minbo, WANG Junli, LI Fei, XU Mingyu. Adaptation and adaptability investigation of Improving Parents as Communication Teachers (ImPACT) program for autism spectrum disorder[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(9): 1239-1246.

图/表 5

参考文献 17

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Field of adaptation	Original program	Detail of preliminary adaptation
Language	English	The researchers in the team who were proficient in both Chinese and English translated the original program and the record sheet to form the first draft of the simplified Chinese version of the program， and checked against the original English version to ensure the consistency between the Chinese version and the original version
Form of intervention	There are 6 sessions （2 h each session） of group therapy， and 6 sessions （1 h each session） of individual therapy. Group therapy alternated with individual therapy once a week	Only group therapy was carried out， but the parents′ skill practice feedback before each group therapy was extended to strengthen the parents′ mastery of the previous skill
Structure of program	Six sessions of group therapy： ① Getting started. ② Focusing on your child and adjusting your communication. ③ Creating opportunity. ④ Teaching new communication skills. ⑤ Teaching new imitation and playing skills. ⑥ Shaping the interaction and moving forward	It was difficult for parents to master two social skills （focusing on your child and adjusting your communication） in the second session， and try to use them in daily life， so that we divided the second session into 2 sessions， which gave parents more time to ask questions and understand the details. The number of group therapy sessions increased from 6 to 7
Cultural custom	The names of people， toys and game scenes in the accompanying videos conformed to the Western cultural environment	Equivalent substitutions were made according to domestic standards and customs to conform to the Chinese context. For example， names like “Johnny” and “Michael” were replaced with “小明（Xiaoming）” and “小芳（Xiaofang）” in the Chinese context； “Wheels on the bus” was replaced with “宝宝巴士（Baby bus）”. Game action “Cool hot water with ice” was replaced with “blow”

Field of adaptation	Original program	Detail of preliminary adaptation
Language	English	The researchers in the team who were proficient in both Chinese and English translated the original program and the record sheet to form the first draft of the simplified Chinese version of the program， and checked against the original English version to ensure the consistency between the Chinese version and the original version
Form of intervention	There are 6 sessions （2 h each session） of group therapy， and 6 sessions （1 h each session） of individual therapy. Group therapy alternated with individual therapy once a week	Only group therapy was carried out， but the parents′ skill practice feedback before each group therapy was extended to strengthen the parents′ mastery of the previous skill
Structure of program	Six sessions of group therapy： ① Getting started. ② Focusing on your child and adjusting your communication. ③ Creating opportunity. ④ Teaching new communication skills. ⑤ Teaching new imitation and playing skills. ⑥ Shaping the interaction and moving forward	It was difficult for parents to master two social skills （focusing on your child and adjusting your communication） in the second session， and try to use them in daily life， so that we divided the second session into 2 sessions， which gave parents more time to ask questions and understand the details. The number of group therapy sessions increased from 6 to 7
Cultural custom	The names of people， toys and game scenes in the accompanying videos conformed to the Western cultural environment	Equivalent substitutions were made according to domestic standards and customs to conform to the Chinese context. For example， names like “Johnny” and “Michael” were replaced with “小明（Xiaoming）” and “小芳（Xiaofang）” in the Chinese context； “Wheels on the bus” was replaced with “宝宝巴士（Baby bus）”. Game action “Cool hot water with ice” was replaced with “blow”

Item	Demographic information
ASD child
Age/year	4.00±0.85
Confirmed the age/year	3.56±0.93
Gender/n （%）
Male	10 （83.3）
Female	2 （16.7）
Only child or not/n （%）
Yes	10 （83.3）
No	2 （16.7）
Language/n （%）
No words	3 （25.0）
Word or phrase	8 （66.7）
Sentence	1 （8.3）
Parent
Age/year	35.1±5.97
Main caregiver/n （%）
Mother	12 （100）
Father	0 （0）
Marital status/n （%）
Married	12 （100）
Single	0 （0）
SES/n （%）
Low	3 （25.0）
Middle	6 （50.0）
High	3 （25.0）

Item	Demographic information
ASD child
Age/year	4.00±0.85
Confirmed the age/year	3.56±0.93
Gender/n （%）
Male	10 （83.3）
Female	2 （16.7）
Only child or not/n （%）
Yes	10 （83.3）
No	2 （16.7）
Language/n （%）
No words	3 （25.0）
Word or phrase	8 （66.7）
Sentence	1 （8.3）
Parent
Age/year	35.1±5.97
Main caregiver/n （%）
Mother	12 （100）
Father	0 （0）
Marital status/n （%）
Married	12 （100）
Single	0 （0）
SES/n （%）
Low	3 （25.0）
Middle	6 （50.0）
High	3 （25.0）

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[2]	李圆圆，文静，杨亭，郭敏，朱江，陈立，陈洁，李廷玉. 孤独症谱系障碍患儿睡眠问题与行为表现的关系[J]. 上海交通大学学报（医学版）, 2019, 39(5): 505-.
[3]	李珂,江晓东，季忆婷,李斐 . 孤独症谱系障碍儿童胃肠问题检出情况初探[J]. 上海交通大学学报（医学版）, 2017, 37(11): 1507-.

孤独症谱系障碍ImPACT干预方案的改编及适应性调查

Adaptation and adaptability investigation of Improving Parents as Communication Teachers (ImPACT) program for autism spectrum disorder

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