Cohen Howard, Amerine-Dickens Mila, Smith Tristram
Valley Mountain Regional Center, Stockton, CA, USA.
J Dev Behav Pediatr. 2006 Apr;27(2 Suppl):S145-55. doi: 10.1097/00004703-200604002-00013.
Although previous studies have shown favorable results with early intensive behavioral treatment (EIBT) for children with autism, it remains important to replicate these findings, particularly in community settings. The authors conducted a 3-year prospective outcome study that compared 2 groups: (1) 21 children who received 35 to 40 hours per week of EIBT from a community agency that replicated Lovaas' model of EIBT and (2) 21 age- and IQ-matched children in special education classes at local public schools. A quasi-experimental design was used, with assignment to groups based on parental preference. Assessments were conducted by independent examiners for IQ (Bayley Scales of Infant Development or Wechsler Preschool and Primary Scales of Intelligence), language (Reynell Developmental Language Scales), nonverbal skill (Merrill-Palmer Scale of Mental Tests), and adaptive behavior (Vineland Adaptive Behavior Scales). Analyses of covariance, with baseline scores as covariates and Year 1-3 assessments as repeated measures, revealed that, with treatment, the EIBT group obtained significantly higher IQ (F = 5.21, p = .03) and adaptive behavior scores (F = 7.84, p = .01) than did the comparison group. No difference between groups was found in either language comprehension (F = 3.82, p = .06) or nonverbal skill. Six of the 21 EIBT children were fully included into regular education without assistance at Year 3, and 11 others were included with support; in contrast, only 1 comparison child was placed primarily in regular education. Although the study was limited by the nonrandom assignment to groups, it does provide evidence that EIBT can be successfully implemented in a community setting.
尽管先前的研究表明，早期强化行为治疗（EIBT）对自闭症儿童有良好效果，但重复这些研究结果仍然很重要，尤其是在社区环境中。作者进行了一项为期3年的前瞻性结果研究，比较了两组：（1）21名儿童，他们每周从一家复制洛瓦斯EIBT模式的社区机构接受35至40小时的EIBT；（2）21名年龄和智商匹配的儿童，在当地公立学校的特殊教育班级。采用了准实验设计，根据家长的偏好进行分组。由独立考官进行智商（贝利婴儿发展量表或韦氏学前和小学智力量表）、语言（雷诺尔发育语言量表）、非语言技能（梅里尔-帕尔默心理测试量表）和适应性行为（文兰适应性行为量表）的评估。以基线分数作为协变量，以第1至3年的评估作为重复测量的协方差分析显示，经过治疗，EIBT组的智商（F = 5.21，p = . 03）和适应性行为得分（F = 7.84，p = .01）显著高于对照组。两组在语言理解（F = 3.82，p = .06）或非语言技能方面均未发现差异。在第3年，21名接受EIBT治疗的儿童中有6名在没有帮助的情况下完全融入了正规教育，另外11名在有支持的情况下融入了正规教育；相比之下，对照组中只有1名儿童主要被安排在正规教育中。尽管该研究受到分组非随机分配的限制，但它确实提供了证据表明EIBT可以在社区环境中成功实施。
