背景:学习困难儿童不仅有认知能力的偏异和智力结构发展不平衡,还伴有情绪和行为问题.目的:探讨综合干预对学习困难儿童认知、心理、情绪等多方面的干预效应.设计:以患儿为观察对象的病例分析.单位:福建医科大学附属协和医院儿内科.对象:选择1998-07/2001-07福建医科大学附属协和医院儿童医学心理专科门诊就诊的6～12岁儿童,其学习困难的诊断符合ICD-10中特殊学习技能发育障碍的诊断标准,其中智商＞70是诊断学习困难的必备条件.同时予以排除情绪障碍、智力缺陷、多动症、视听觉障碍及脑器质性疾病,并经过神经心理学专业1名教授确诊.自愿参加认知训练、行为干预、感觉综合训练,疗程满1年的患儿为观察人群.治疗技师与参与儿童比例为1:2,时间为90～120 min/次,每周二三次,24次为1个疗程,连续干预4次即1年.31名患儿进入最后的统计分析,男24例,女7例,平均年龄为(7.7±1.2)岁,平均智商87.5±8.6.方法:应用认知训练、行为干预、感觉综合训练相结合的方法,治疗6～12岁学习困难儿童31例,连续干预1年.使用联合型瑞文测验测定儿童推理能力,用拜瑞视觉动作统整发展测验测评儿童的视觉-动作的统合能力,用视觉注意数字划消测验和听觉注意广度和记忆顺背和倒背测评儿童注意力.用Achenbach儿童行为量表评定行为问题,用conners儿童行为问卷评定多动指数.主要观察指标:干预前后患儿推理能力、视觉-动作统合能力、注意力及心理行为的变化.结果:31例患儿进入1年后结果分析,无脱落.①干预后,儿童的推理能力得分、视觉-动作统合能力得分显著高于干预前(瑞文测验:干预前87.51±8.64,干预后90.03±8.70,t=-9.610,P＜0.001;拜瑞视一动统合测验:干预前6.75±1.74,干预后8.27±1.94,t=-9.002,P＜0.001).②视觉注意力数字划消测验错误率明显降低,听觉注意广度和记忆也显著提高(数字划消:干预前15.90±20.11,干预1年2.74±3.67;记忆的顺背:干预前7.70±1.60,干预1年11.23±1 23;记忆的倒背:干预前3.52±0.93干预1年6.97±0.16,P＜0.01).③conners量表多动症总分在干预后的3个月、6个月、1年均有不同程度的下降,与干预前比较差异显著(干预前22.65±3.53,干预3个月18.87±4.14,干预6个月15.65±3.92,干预1年12.65±3.36,t=7.35-15.36,P＜0.01).Achenbach儿童行为量表评定心理行为9项因子分在不同疗程明显下降.④学习成绩提高达87%(26/31).结论:认知训练及行为干预和感觉综合综合干预学习困难儿童,其针对性综合疗效可改善学习困难儿童认知、心理、情绪等多方面的症状,使视功能,听功能和大脑功能均得到刺激和提高.
揹景:學習睏難兒童不僅有認知能力的偏異和智力結構髮展不平衡,還伴有情緒和行為問題.目的:探討綜閤榦預對學習睏難兒童認知、心理、情緒等多方麵的榦預效應.設計:以患兒為觀察對象的病例分析.單位:福建醫科大學附屬協和醫院兒內科.對象:選擇1998-07/2001-07福建醫科大學附屬協和醫院兒童醫學心理專科門診就診的6～12歲兒童,其學習睏難的診斷符閤ICD-10中特殊學習技能髮育障礙的診斷標準,其中智商＞70是診斷學習睏難的必備條件.同時予以排除情緒障礙、智力缺陷、多動癥、視聽覺障礙及腦器質性疾病,併經過神經心理學專業1名教授確診.自願參加認知訓練、行為榦預、感覺綜閤訓練,療程滿1年的患兒為觀察人群.治療技師與參與兒童比例為1:2,時間為90～120 min/次,每週二三次,24次為1箇療程,連續榦預4次即1年.31名患兒進入最後的統計分析,男24例,女7例,平均年齡為(7.7±1.2)歲,平均智商87.5±8.6.方法:應用認知訓練、行為榦預、感覺綜閤訓練相結閤的方法,治療6～12歲學習睏難兒童31例,連續榦預1年.使用聯閤型瑞文測驗測定兒童推理能力,用拜瑞視覺動作統整髮展測驗測評兒童的視覺-動作的統閤能力,用視覺註意數字劃消測驗和聽覺註意廣度和記憶順揹和倒揹測評兒童註意力.用Achenbach兒童行為量錶評定行為問題,用conners兒童行為問捲評定多動指數.主要觀察指標:榦預前後患兒推理能力、視覺-動作統閤能力、註意力及心理行為的變化.結果:31例患兒進入1年後結果分析,無脫落.①榦預後,兒童的推理能力得分、視覺-動作統閤能力得分顯著高于榦預前(瑞文測驗:榦預前87.51±8.64,榦預後90.03±8.70,t=-9.610,P＜0.001;拜瑞視一動統閤測驗:榦預前6.75±1.74,榦預後8.27±1.94,t=-9.002,P＜0.001).②視覺註意力數字劃消測驗錯誤率明顯降低,聽覺註意廣度和記憶也顯著提高(數字劃消:榦預前15.90±20.11,榦預1年2.74±3.67;記憶的順揹:榦預前7.70±1.60,榦預1年11.23±1 23;記憶的倒揹:榦預前3.52±0.93榦預1年6.97±0.16,P＜0.01).③conners量錶多動癥總分在榦預後的3箇月、6箇月、1年均有不同程度的下降,與榦預前比較差異顯著(榦預前22.65±3.53,榦預3箇月18.87±4.14,榦預6箇月15.65±3.92,榦預1年12.65±3.36,t=7.35-15.36,P＜0.01).Achenbach兒童行為量錶評定心理行為9項因子分在不同療程明顯下降.④學習成績提高達87%(26/31).結論:認知訓練及行為榦預和感覺綜閤綜閤榦預學習睏難兒童,其針對性綜閤療效可改善學習睏難兒童認知、心理、情緒等多方麵的癥狀,使視功能,聽功能和大腦功能均得到刺激和提高.
배경:학습곤난인동불부유인지능력적편이화지력결구발전불평형,환반유정서화행위문제.목적:탐토종합간예대학습곤난인동인지、심리、정서등다방면적간예효응.설계:이환인위관찰대상적병례분석.단위:복건의과대학부속협화의원인내과.대상:선택1998-07/2001-07복건의과대학부속협화의원인동의학심리전과문진취진적6～12세인동,기학습곤난적진단부합ICD-10중특수학습기능발육장애적진단표준,기중지상＞70시진단학습곤난적필비조건.동시여이배제정서장애、지력결함、다동증、시은각장애급뇌기질성질병,병경과신경심이학전업1명교수학진.자원삼가인지훈련、행위간예、감각종합훈련,료정만1년적환인위관찰인군.치료기사여삼여인동비례위1:2,시간위90～120 min/차,매주이삼차,24차위1개료정,련속간예4차즉1년.31명환인진입최후적통계분석,남24례,녀7례,평균년령위(7.7±1.2)세,평균지상87.5±8.6.방법:응용인지훈련、행위간예、감각종합훈련상결합적방법,치료6～12세학습곤난인동31례,련속간예1년.사용연합형서문측험측정인동추리능력,용배서시각동작통정발전측험측평인동적시각-동작적통합능력,용시각주의수자화소측험화은각주의엄도화기억순배화도배측평인동주의력.용Achenbach인동행위량표평정행위문제,용conners인동행위문권평정다동지수.주요관찰지표:간예전후환인추리능력、시각-동작통합능력、주의력급심리행위적변화.결과:31례환인진입1년후결과분석,무탈락.①간예후,인동적추리능력득분、시각-동작통합능력득분현저고우간예전(서문측험:간예전87.51±8.64,간예후90.03±8.70,t=-9.610,P＜0.001;배서시일동통합측험:간예전6.75±1.74,간예후8.27±1.94,t=-9.002,P＜0.001).②시각주의력수자화소측험착오솔명현강저,은각주의엄도화기억야현저제고(수자화소:간예전15.90±20.11,간예1년2.74±3.67;기억적순배:간예전7.70±1.60,간예1년11.23±1 23;기억적도배:간예전3.52±0.93간예1년6.97±0.16,P＜0.01).③conners량표다동증총분재간예후적3개월、6개월、1년균유불동정도적하강,여간예전비교차이현저(간예전22.65±3.53,간예3개월18.87±4.14,간예6개월15.65±3.92,간예1년12.65±3.36,t=7.35-15.36,P＜0.01).Achenbach인동행위량표평정심리행위9항인자분재불동료정명현하강.④학습성적제고체87%(26/31).결론:인지훈련급행위간예화감각종합종합간예학습곤난인동,기침대성종합료효가개선학습곤난인동인지、심리、정서등다방면적증상,사시공능,은공능화대뇌공능균득도자격화제고.
BACKGROUND:Children with learning difficulty often present with cognitive impairments and imbalanced development of intelligence accompanied by emotional and behavioral problems.OBJECTIVE:To evaluate the therapeutic effects of integrated interventions in multiple aspects for children with learning difficulties.DESIGN:A case-control study of children with learning difficulties.SETTING:Department of Pediatric Internal Medicine, Union Hospital Affiliated to Fujian Medical University.PARTICIPANTS:This study involved school-age children of 6 to 12years old with learning difficulties who came to the department specialized in pediatric psychology for consultation from July 1998 to July 2001. The diagnosis of learning difficulties conformed to the diagnostic criteria for special learning disability in ICD-10 with IQ ＞ 70 as an essential condition. Children with emotional disorders, mental deficiency, hyperactivity,visual and auditory dysfunctions and organic cerebral diseases were excluded. The diagnosis was further verified by a professor specialized in neuropsychology. The children voluntarily participated in the cognitive training, behavioral intervention and comprehensive trainings of senses and those who fulfilled the one-year treatment were included in this study. The ratio of therapists to the children was 1:2, and each session of treatment lasted for 90-120 minutes given 2-3 times a week, and a treatment course consisted of 24 sessions. The children were supposed to complete 4 consecutive treatment courses. Totally 31 children completed the treatment courses, including 24 boys and 7 girls with the mean age of(7.7±1.2)years who had an average IQ of 87.5±8.6.grated interventions for one year consisting of cognitive training, behavioral intervention and comprehensive training of the senses. Raven's Deductive Reasoning test and Beery Visual-Motor Integration Test were use to examine the deductive reasoning ability and visual-motor integration of the children, and visual attention test and auditory attention test, as well as sequential and reverse-sequence memory tests were employed to test their attentions. Achenbach children behavioral scale was applied to evaluate the children's behavioral problems, and Conners' questionnaire for children's behavioral problem was used to measure their attention-deficit/hyperactivity disorder (ADHD) index.MAIN OUTCOME MEASURES:Changes in the deductive reasoning ability, capability of visual-motor integration, attention and psychological behaviors after one year of intervention.RESULTS:All the 31 patients children entered the result analysis with no loss. After one year of integrated intervention, the children had significantly improved scores for Raven's Deductive Reasoning Test (87.51 ±8.64 vs 90.03±8.70, t=-9.610, P ＜ 0.001) and Beery Visual-Motor Integration Test (6.75±1.74 vs 8.27±1.94, t=-9.002, P ＜ 0.001). Obvious improvement was also seen in the visual attention test (15.90±20.11 vs 2.74±3.67), scope of auditory attention and memory (7.70±1.60 vs 11.23±1.23for sequential memory and 3.52±0.93 vs 6.97±0.16 for reversed-sequence memory, P ＜ 0.01). The total scores for ADHD assessment declined to different extents at 3 and 6 months during the treatment and upon the completion of the treatment (22.65±3.53 vs 18.87±4.14 at month 3, 5.65±3.92at month 6 and 12.65±3.36 at one year, t=7.35-15.36, P ＜ 0.01). The scores for 9 psychobehavioral items in Achenbach children behavioral scale obviously declined were also reduced significantly during the therapy,and 87% (26/31) of the children had obviously improved academic performance.CONCLUSION:Interventions integrating cognitive training, behavioral intervention and comprehensive training of the senses may produce good and persistent effect on the cognitive and emotional symptoms of children with learning difficulties, resulting in obviously improved visual, auditory and brain functions.
