孤独症谱系障碍患儿照料者压力及其影响因素的研究

发布时间：2018-05-20 13:10

本文选题：孤独症谱系障碍 + 照料者压力/育儿压力　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探索孤独症谱系障碍(Autism Spectrum Disorders,ASD)的照料者压力情况及影响照料者压力的相关因素,从而为临床相关问题的筛查和干预供有针对性指导。[方法]纳入符合 DSM-5(The Diagnostic and Statistical Manual of Mental Disorders-5)诊断标准的ASD患者168例以及性别、年龄匹配的正常对照143例。两组均填写自编的一般情况调查表,并通过照料者压力问卷(Caregivers Strain Questionnaire,CGSQ)评估照料者压力水平。此外,通过孤独症儿童行为量表(Autism Behavior Checklist,ABC1)评估患儿的临床症状、通过异常行为量表(Aberrant Behavior Checklist,ABC2)和 Conners 多动指数问卷(Conners Index of Hyperactivity,CIH)来评估 ASD 患儿刻板、多动、自伤、易激惹等异常行为情况、通过医院焦虑抑郁量表(Hospital Anxiety and Depression Scale,HAD)评估ASD患儿照料者的情绪状态。[结果]1.ASD组CGSQ总分及客观压力、主观外在性压力、主观内在性压力得分均高于正常对照组(P值均0.05);2.照料者(包括父亲、母亲、其他)焦虑阳性检出率为55例(34.59%)、抑郁阳性检出率为57例(35.84%),焦虑和抑郁任意一种情绪检出阳性的为73例(45.91%);照料者(包括父亲、母亲、其他)填写HAD量表总分及各分量表得分情况间差异无统计学意义,P值均0.05;3.根据自定义的标准,近4周各种异常行为的发生率分别为易激惹67.26%、多动62.5%以及自伤14.29%,存在易激惹、多动、自伤三种行为患儿的父母的照料者压力高于无相应行为患儿的父母,差异有统计学显著性(P值均0.05);4.相关单因素分析提示:与CGSQ总分及客观压力、主观外在性压力、主观内在性压力得分均相关的因素包括:母亲文化程度越低以及父母关系越差则CGSQ总分及各维度得分越高(P值均0.05);ABC1总分以及运动、交往、感觉维度分越高CGSQ总分及各则维度得分越高(P值均0.05);患儿多动行为(CIH)总分越高则CGSQ总分及各维度得分越高(P值均0.05);ABC2总分越高CGSQ总分及各维度得分越高(P值0.05);ABC2量表的自伤、多动、刻板行为、及刻板语音或言语得分越高则CGSQ总分及各个维度得分越高(P值均0.05);5.回归方程分析显示:多重线性回归分析显示HAD总分越高、ABC2总分越高、父母关系越差、进行特殊教育和训练、ABC2自伤得分越高则CGSQ总分及客观压力得分越高(R2=0.531,p0.05;R2=0.509,p0.05);HAD 总分越高、ABC2易激惹及多动得分越高则CGSQ主观外在性压力得分越高(R2=0.393,p0.05);HAD总分越高、CIH总分越高、存在行走及运动发育迟缓则CGSQ主观内在性压力得分越高(R2=0.468,p0.05)。[结论]1.ASD患儿照料者的压力显著高于正常对照组儿童的照料者;2.各种异常行为在ASD患儿中普遍存在,除刻板行为外,各种异常行为在过去4周的发生率分别为易激惹67.26%、多动62.5%以及自伤14.29%。异常行为是加重ASD照料者压力的重要因素;此外,ASD患儿的父母关系越差、照料者存焦虑抑郁情绪、患儿目前接受特殊教育和训练、以及患儿存在行走及运动发育迟缓可加重ASD患儿照料者的压力。
[Abstract]:[Objective] to explore the stress situation of the caregivers of Autism Spectrum Disorders (ASD) and the related factors affecting the stress of the caregivers, so as to provide specific guidance for the screening and intervention of clinical related problems. [Methods] included the diagnostic criteria of DSM-5 (The Diagnostic and Statistical Manual of Mental). 168 patients with ASD and 143 cases of sex, age matched normal control. The two groups filled out the self-made general questionnaire and assessed the stress level of the caregivers through the Caregivers Strain Questionnaire (CGSQ). In addition, the children's clinical data (Autism Behavior Checklist, ABC1) was used to evaluate the clinical value of the children. The symptoms were assessed by the Aberrant Behavior Checklist (ABC2) and the Conners hyperactivity Index questionnaire (Conners Index of Hyperactivity, CIH) to assess the abnormal behaviors of ASD children, such as stereotypes, hyperactivity, self injury, irritability and so on. [results]1.ASD group CGSQ total score and objective pressure, subjective external pressure, subjective internal pressure score were higher than normal control group (P value 0.05); 2. caregivers (including father, mother, other) positive rate of anxiety was 55 cases (34.59%), depression positive rate was 57 cases (35.84%), anxiety and depression of any kind of emotional examination. The positive was 73 cases (45.91%); the caregivers (including father, mother, other) had no statistical difference between the total score of the HAD scale and the scores of each subscale, and the value of P was 0.05. 3. according to the custom standard, the incidence of all kinds of abnormal behavior in the last 4 weeks were irritability 67.26%, hyperactivity 62.5%, and self injury 14.29%, and there was irritability, hyperactivity, self. The stress of the caregivers of the parents who were injured in three kinds of behavior was higher than that of the parents who had no corresponding behavior. The difference was statistically significant (P value was 0.05). The 4. related single factor analysis suggested that the factors related to the total score of CGSQ and the objective pressure, the subjective external pressure and the subjective internal pressure score include the lower the mother's level of culture and the relationship between the parents. The score of CGSQ total score and all dimensions was higher (P 0.05), and the higher the total score of ABC1 and movement, communication, the higher the score of CGSQ and the dimensions of each dimension (P value was 0.05); the higher the total score of the children's hyperdynamic behavior (CIH), the higher the score of CGSQ total score and each dimension (P value was 0.05); the higher the ABC2 total score, the higher the total score of CGSQ and the higher scores of the dimensions of each dimension (the higher score of the ABC2 total score and the dimensions of each dimension). The P value was 0.05); the higher the score of CGSQ total and each dimension (the P value was 0.05), the higher the score of CGSQ and each dimension, the higher the score of the ABC2 and the stereotyped speech or speech score, the 5. regression analysis showed that the higher the total score of HAD, the higher the total ABC2 score, the worse the relationship between the father and mother, the special education and training of the ABC2, the higher the score of the ABC2 self injury. The higher the score of CGSQ and the objective pressure (R2=0.531, P0.05; R2=0.509, P0.05), the higher the total HAD score, the higher the ABC2 irritability and the higher the hyperactivity score, the higher the subjective external pressure score of CGSQ (R2=0.393, P0.05), the higher the total score of the HAD, the higher the total CIH score, the higher the walking and movement development delay, the higher the subjective intrinsic pressure score. [Conclusion] [Conclusion: [Conclusion] the stress of]1.ASD children in]1.ASD is significantly higher than that of children in normal control group; 2. abnormal behaviors are common in children with ASD. In addition to stereotyped behavior, the incidence of various abnormal behaviors in the past 4 weeks is irritability 67.26%, hyperactivity 62.5% and self injured 14.29%. abnormal behavior are important for increasing the pressure of ASD caregivers. In addition, the poorer the parents of ASD children, the caregivers have anxiety and depression, the children are currently receiving special education and training, and the existence of walking and motor retardation in the children can aggravate the stress of the caregivers of the children of ASD.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.94

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