国际心理健康与精神病学杂志

探索对自闭症学龄前儿童生活质量影响最大的适应不良行为类型

费丝·科克

适应不良行为对患有自闭症谱系障碍 (ASD) 的学龄前儿童的健康相关生活质量 (HRQOL) 的影响相对较少。本研究旨在探索在控制背景特征（年龄、月总收入、住房类型和每日睡眠时间）和适应功能的情况下，不同类型的适应不良行为（内化、反社会和外化）对该群体的 HRQOL 的影响程度。

收集了 KK 妇女儿童医院 99 名自闭症儿童看护者的独立行为修订版 (SIB-R) 量表和背景特征问卷。这些问卷用于评估这些儿童的适应不良行为的严重程度、适应功能水平和一些背景特征。使用儿童生活质量量表 (PedsQL) 评估这些与这些儿童的心理社会和身体 HRQOL 之间的关系。

自闭症谱系障碍 (ASD) 是一种慢性神经发育障碍，其表现为社交和沟通障碍，以及行为、活动或兴趣的有限、枯燥。自闭症的发病率似乎在世界范围内呈上升趋势，据估计，每 88 人中就有 1 人患有自闭症。

由于其发病率高、持续性强和相关障碍水平高，化学失衡范围问题被认为是严重的整体健康问题。这种弱点不仅与 ASD 的核心表现有关，还与 ASD 患者经常经历的一系列并发状况有关，包括情感和社交问题、睡眠、饮食和饮食问题、触觉敏感性、学习和学习障碍，以及并发健康和心理健康分析。这些并发状况对 ASD 儿童的父母和教育者来说可能比 ASD 的核心特征更令人担忧，并严重影响行为管理、学习获得和社交关系的发展。

问题行为（或本文中提到的适应不良行为）在患有自闭症的幼儿中很常见，这些行为被描述为麻烦、破坏性、暴力或完全令人沮丧的行为。例如，Dominick 等人发现 32.7% 的自闭症儿童表现出暴力行为，包括打人、

 

kicking, gnawing, and squeezing others. More than seventy five
percent of these kids indicated forceful practices both at home and outside the home, and hostility was coordinated toward
more than one individual in 92% of cases. Self-damaging conduct, including head slamming, hitting oneself, and gnawing oneself, was available in very nearly 33% of youngsters with ASD. Besides, 70.9% of youngsters with ASD had encountered a time of serious hissy fits and, for 60% of these kids, fits of rage happened consistently and were a steady (as opposed to wordy) issue during the period in which they were available.

A few creators have noticed a solid negative connection between the capacity to impart and the commonness of maladaptive conduct in small kids with ASD. Self-damaging practices among kids with ASD have likewise been connected to their responsive and additionally expressive correspondence shortfalls. It follows that when treatment programs center around building up the small kid's relational abilities to the degree that they can fill in as viable substitution practices, a decrease in the maladaptive conduct may result.

Maladaptive practices are especially hazardous in bunch settings, for example, early intercession administrations, childcare administrations, and preschools, as they can be problematic to the learning system and posture critical difficulties to the kids with ASD themselves, their companions, and staff. Consequently, maladaptive practices are among the most regularly recognized hindrances to the incorporation of youngsters with ASD in bunch settings.

Further, when maladaptive practices become a built up part of a youngster's conduct collection, they are probably not going to diminish and, as indicated by Berg et al., will normally remain or decline without intercession. Whenever left untreated, these practices can fundamentally lessen a kid's social and instructive open doors by restricting their admittance to accessible medicines, learning exercises, communications with others, network encounters and, specifically, their capacity to progress to, and partake in, school programs. Notwithstanding negatively affecting kids with ASD themselves, various examinations have demonstrated that guardians' degree of mental trouble is related with the seriousness of their kid's maladaptive practices just as their ASD side effects.

Accordingly, early intercessions for little youngsters with ASD should consolidate the administration of maladaptive practices . Given the connection between maladaptive practices and deficiencies in correspondence and social abilities, it is significant that intercession approaches focus on these center shortages. Myers and Johnson contend that the essential objectives of intercession for kids with ASD ought to be to augment the youngster's practical autonomy and personal satisfaction by lessening the center manifestations of ASD; encourage improvement and learning; advance socialization; diminish maladaptive practices; teach and backing families. They propose that, notwithstanding focusing on correspondence and social abilities, contemporary extensive intercession approaches for ASD should focus on a decrease in troublesome or maladaptive conduct by utilizing observationally upheld systems, including useful conduct appraisal (FBA). FBA is "the way toward deciding the expectation a wrong conduct serves for acquiring an ideal result and supplanting that conduct with a more fitting one that achieves a similar objective".

The overall significance of early mediation for ASD is broadly perceived, and is upheld by examines indicating better results with prior treatment. Early intercession for ASD, particularly that initiating before the time of 3 years, brings about fundamentally improved results comparative with mediation starting further down the road. Early intercession in the principal long stretches of life offers the best potential for kids as mind pliancy is most noteworthy during this period, empowering the foundation and redesign of neuronal systems in light of natural incitement

Multiple Regression revealed that Maladaptive behaviors have greater impact on HRQOL than Adaptive skills and background characteristics. Asocial maladaptive behaviors have the most unique influence on HRQOL out of the three Maladaptive behaviors, suggesting difficulties in social interaction and communication manifested by children with ASD play the largest role in their HRQOL at this age. Adaptive skills have a smaller but still unique impact on HRQOL, while background characteristics are not significant.

The specific types of Asocial Maladaptive behavior and their impact of HRQOL in this age group can be further studied with ASD-specific scales like Social Responsive Scale (SRS) and Repetitive Behaviors Scale-Revised (RBS-R). More targeted behavioral intervention can be then developed to improve the quality of life amongst preschool children with ASD.

Biography:

F. Kok is a Fourth Year Medical Student at Lee Kong Chian School of Medicine, National Technological University, Singapore.S.P. Yeleswarapu is a Consultant at the Department of Children Development at KK Women’s and Children Hospital, Singapore. She is also an Adjunct Assistant Professor with Duke-NUS Medical School, Singapore.

第 32 届心理与行为健康国际会议，2020 年 4 月 22 日至 23 日

摘要引用：

Faith Kok，探索对自闭症学龄前儿童生活质量影响最大的适应不良行为类型，2020 年心理健康大会，第 32 届心理和行为健康国际会议，2020 年 4 月 22 日至 23 日