Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
J Am Acad Child Adolesc Psychiatry. 2021 Nov;60(11):1404-1418. doi: 10.1016/j.jaac.2021.03.024. Epub 2021 May 6.
To examine the feasibility and preliminary efficacy of a group behavioral parenting intervention for emotional and behavioral problems (EBPs) in young autistic children.
This was a feasibility pilot randomized controlled trial comparing a 12-week group behavioral parenting intervention (Predictive Parenting) to an attention control (Psychoeducation). Parents of 62 autistic children 4 to 8 years of age were randomized to Predictive Parenting (n = 31) or Psychoeducation (n = 31). The primary outcome was a blinded observational measure of child behaviors that challenge. Secondary outcomes were observed child compliance and parenting behaviors; parent- and teacher-reported child EBPs; self-reported parenting practices, stress, self-efficacy, and well-being. Cost-effectiveness was also explored.
Recruitment, retention, completion of measures, treatment fidelity, and parental satisfaction were high for both interventions. There was no group difference in primary outcome: mean log of rate 0.18 lower (d, 90% CI = -0.44 to 0.08) in Predictive Parenting. Differences in rates of child compliance (0.44, 90% CI = 0.11 to 0.77), facilitative parenting (0.63, 90% CI = 0.33 to 0.92) and parent-defined target symptom change (-0.59, 90% CI -0.17 to -1.00) favored Predictive Parenting. There were no differences on other measures. Predictive Parenting was more expensive than Psychoeducation, with a low probability of being more cost-effective.
Feasibility was demonstrated. There was no evidence from this pilot trial that Predictive Parenting resulted in reductions in child EBPs beyond those seen following Psychoeducation; in addition, the effect size was small, and it was more expensive. However, it showed superiority for child compliance and facilitative parenting with moderate effect sizes. Future, definitive studies should evaluate whether augmented or extended intervention would lead to larger improvements.
Autism Spectrum Treatment and Resilience (ASTAR); https://www.isrctn.com/; 91411078.
考察针对自闭症儿童情绪和行为问题的小组行为养育干预的可行性和初步疗效。
这是一项可行性初步随机对照试验，比较了为期 12 周的小组行为养育干预（预测性养育）与注意力对照组（心理教育）。62 名 4 至 8 岁自闭症儿童的父母被随机分为预测性养育组（n=31）或心理教育组（n=31）。主要结局是对具有挑战性的儿童行为进行盲法观察测量。次要结局是观察儿童的依从性和养育行为；家长和教师报告的儿童情绪和行为问题；自我报告的养育实践、压力、自我效能感和幸福感。还探讨了成本效益。
对于两种干预措施，招募、保留、完成措施、治疗可信度和家长满意度都很高。主要结局无组间差异：预测性养育组的对数率平均低 0.18（d，90%CI=-0.44 至 0.08）。儿童依从性（0.44，90%CI=0.11 至 0.77）、促进性养育（0.63，90%CI=0.33 至 0.92）和家长定义的目标症状变化（-0.59，90%CI=-0.17 至-1.00）的差异有利于预测性养育。其他指标没有差异。预测性养育比心理教育更昂贵，具有较低的成本效益可能性。
该研究证明了其可行性。从这项初步试验中没有证据表明，与心理教育相比，预测性养育能减少儿童的情绪和行为问题；此外，效果量较小，而且更昂贵。然而，它在儿童依从性和促进性养育方面表现出优势，具有中等效应量。未来，应通过确定性研究评估增强或扩展干预是否会带来更大的改善。
自闭症谱系治疗和恢复（ASTAR）；https://www.isrctn.com/；91411078。
