(1) Educational intervention. The purpose of educational intervention is to improve the core symptoms, promote intellectual development, cultivate the ability of self-care and independent living, reduce the degree of disability, improve the quality of life, and strive to make some children have the ability to study, work and live independently after adulthood.
1.
(1) Early bull arrangement. Early diagnosis, early intervention, long-term treatment and daily intervention should be emphasized. For suspicious children, education intervention should also be carried out in time.
(2) scientific system. Clear and effective methods should be adopted to systematically educate and intervene children, including intervention training aimed at the core symptoms of autism, and training in promoting children's physical development, preventing and treating diseases, reducing nuisance behavior, improving intelligence, promoting self-care ability and social adaptability.
(3) individual training. Aiming at the problems existing in symptoms, intelligence and behavior of autistic children, individualized training is planned on the basis of evaluation. For children with severe autism, the teacher-student ratio of early training should be 1: 1. Group training should also be grouped according to children's development level and behavioral characteristics.
(4) Family participation. It is necessary to give children's families all-round support and education, improve the degree of family participation, help families evaluate the appropriateness and feasibility of educational intervention, and guide families to choose scientific training methods. Family economic status, parents' mentality, environment and social support will all affect children's prognosis. Parents should accept the facts and properly handle the relationship between children's educational intervention and life and work.
2. Intervention methods.
(1) behavioral analysis therapy.
Principles and purposes: ABA adopts behaviorism principle, focusing on positive reinforcement, negative reinforcement, differentiation reinforcement, regression, differentiation training, generalization training and punishment, to correct all kinds of abnormal behaviors of autistic children and promote their ability development.
The core of classic ABA is behavior round training (DTT), which is concrete and practical. Its main steps include the instruction given by the trainer, the reaction of the child, the reaction and pause of the trainer, and it is still in use now. Modern ABA combines other technologies on the basis of classic ABA, emphasizes emotional and interpersonal development, and adopts different steps and methods according to different goals.
When it is used to promote the ability development of autistic children and help children learn new skills, it mainly takes the following steps:
① Evaluate children's behaviors and abilities, and analyze the target behaviors. (2) Step by step to strengthen the training of decomposed tasks, and only train a decomposed task within a certain period of time. ③ Every time a child completes a decomposition task, he must be rewarded (positive reinforcement). The rewards are mainly food, toys and praise of oral and body posture, and the rewards gradually fade with the progress of children. (4) Using tips and fade-out techniques, give different levels of tips or help according to children's abilities, and gradually reduce tips and help with children's proficiency in what they have learned. ⑤ A short rest is needed between two task trainings.
(2) Treatment and education courses for children with autism and related disorders.
Principles and Objectives: Although autistic children have extensive developmental disabilities, they have certain advantages in vision. We should make full use of children's visual advantages to arrange the educational environment and training procedures, improve children's understanding and obedience to the environment, education and training contents, and comprehensively improve children's defects in language, communication, sensory perception and sports.
Steps: ① Arrange training venues according to different training contents, emphasizing visual cues, that is, the special arrangement of training venues and the special placement of toys and other items. (2) Establish a training schedule and pay attention to programmed training. ③ Determine the training contents, including children's imitation, thick and thin movements, perception, cognition, hand-eye coordination, language understanding and expression, self-care, socialization and emotion. ④ In teaching methods, it is required to make full use of language, posture, tips, labels, charts and words to improve children's understanding and mastery of training content. At the same time, behavior correction techniques such as behavior reinforcement principle are used to help children overcome abnormal behaviors and increase good behaviors. This course is suitable for hospitals, rehabilitation training institutions and families.
(3) Interpersonal relationship development intervention.
RDI is the representative of interpersonal training. Other methods include floor time, picture exchange system and joint attention training.
Principle: It is generally believed that attention deficit and theory of mind deficit are the core defects of children's autism. Co-attention deficit means that children can't form the ability to pay attention to something at the same time as normal babies from infancy. The defect of theory of mind mainly refers to children's lack of ability to speculate on other people's psychology, which is manifested by lack of eye contact, inability to form common attention and inability to distinguish other people's facial expressions. Therefore, children have no social reference ability, can't share their feelings and experiences with others, and can't establish feelings and friendship with their relatives. RDI can improve children's common attention ability, deepen their understanding of others' psychology and improve their interpersonal skills through interpersonal training.
Steps: ① Evaluate and determine the development level of children's interpersonal relationship. ② According to the evaluation results, according to the law and order of normal children's interpersonal relationship development, they were trained in gazing, social reference, interaction, coordination, sharing emotional experience and enjoying friendship in turn. ③ Carry out gradual and diversified training game activities. Activities are mostly led by parents or training teachers, including various interactive games, such as eye contact, facial expression discrimination, hide and seek, "two people with three legs", throwing and catching the ball, etc. Trainers are required to have rich and exaggerated expressions without losing the truth, and their intonation is cadence.
(4) Other intervention methods.
Floor time training also takes interpersonal relationship and social interaction as the main content of training. Different from RDI, floor time training determines the training content according to children's activities and interests. During the training process, the trainer constantly creates changes, surprises and difficulties while cooperating with the children's activities, and guides the children to improve their problem-solving ability and social communication ability in a free and happy time. Training activities are distributed in all periods of daily life.
We should fully consider factors such as time and economy, and carefully choose auxiliary treatment methods such as sensory integration therapy and auditory integration therapy.
(2) medication. At present, there is a lack of drugs for the core symptoms of autism in children, and drug therapy is an auxiliary symptomatic treatment.
1. Basic principles.
(1) principle of balanced development: children aged 0-6 should focus on rehabilitation training, and drugs are not recommended. If behavioral problems are prominent and other intervention measures are ineffective, drugs can be used cautiously on the premise of strictly grasping the indications or target symptoms. Children over 6 years old can choose appropriate drugs according to the degree to which the target symptoms or complications affect their life or rehabilitation training.
(2) The principle of balancing the side effects and curative effects of drugs: drug therapy is only a symptomatic, temporary and auxiliary measure for autistic children, so whether to choose drug therapy should be carefully decided on the basis of fully considering the side effects.
(3) The principle of informed consent: Autistic children must explain the possible effects and risks to their guardians before taking the medicine, and take the medicine on the premise of fully knowing and signing the informed consent form.
(4) The principle of single and symptomatic medication: as an auxiliary measure, only when certain symptoms are prominent (such as serious stereotyped repetition, attack, self-injury and destruction, serious emotional problems, serious sleep problems and extreme hyperactivity). ) will consider medication. We should choose drugs according to their categories, indications, safety and efficacy, and try to use a single drug.
(5) The principle of gradually increasing the dose: determine the initial dose according to the individual differences of autistic children, such as age, weight and physical health, and increase the dose day by day or week according to the clinical efficacy and side effects until the target symptoms are controlled. The dosage of the drug shall not exceed the recommended dosage in the drug instructions.
2. Main side effects of various drugs.
(1) antipsychotics.
It mainly includes extrapyramidal side effects such as tremor, hand shaking and muscle rigidity, as well as neuroendocrine side effects such as weight gain and prolactin increase, which has a sedative effect on some children. Occasionally, gastrointestinal reactions such as dry mouth, nausea and vomiting can be seen.
(2) antidepressants.
Include gastrointestinal discomfort, anorexia, nausea, diarrhea, headache, anxiety, nervousness, insomnia, burnout, sweating, trembling, dizziness or top-heaviness. Use with caution or disable for patients with hepatic and renal insufficiency.
(3) Drugs for ADHD and attention deficit.
Include epigastric discomfort, nausea, fatigue, palpitation and elevated blood pressure.
3. Chinese medicine treatment.
There are cases of treating children's autism by acupuncture, decoction and other traditional Chinese medicine methods, but the therapeutic effect needs to be verified.