نوع مقاله : مقاله پژوهشی

نویسندگان

1 دانشگاه فردوسی مشهد

2 مرکز تحقیقات روان پزشکی و علوم رفتاری، دانشگاه علوم پژشکی مشهد

چکیده

هدف پژوهش حاضرطراحی درمان ترکیبی خانواده- محور مبتنی بر مدل تحول یکپارچه‌ی انسان و مقایسه‌ی اثربخشی آن با بازی درمانی فلورتایم بر بهبود نشانه‌های رفتاری اختلال طیف اوتیسم و استرس والدگری مادران آن‌ها می‌باشد. این مطا‌لعه در چهارچوب یک طرح تک آزمودنی در طول 6 ماه روی 12 کودک 8-3 ساله‌ی مبتلا به اختلال طیف اوتیسم و خانواده‌های آن‌ها اجرا شد و نتایج در سه ‌مرحله‌ی پیش ‌آزمون، پس ‌آزمون و پیگیری با مقیاس‌های استرس والدگری ومقیاس درجه‌بندی اوتیسم کودکی بررسی شد. بر اساس نتایج به دست آمده از این پژوهش، درصد بهبودی نشانه‌های رفتاری کودکان شرکتکننده در گروه درمان ترکیبی خانواده- محور به ویژه در خرده مقیاس‌های ارتباط با مردم، پاسخ هیجانی، ترس یا ناآرامی و ارتباط کلامی وهمچنین بهبودی استرس والدگری مادران آن‌ها به ویژه در خرده مقیاس‌های نارسایی توجه/ فزون کنشی، سلامت، دلبستگی و روابط با همسر از 50 درصد بیشتر و از نظر بالینی معنادار بود. اندازه اثر درمان نیز بالاتر از 80/0 برآورد شد. در مجموع می‌توان گفت؛ درمان ترکیبی خانواده- محور که در این مطالعه طراحی شده است، می‌تواند اثربخشی بازی درمانی فلورتایم را افزایش دهد و به عنوان یک رویکرد درمانی اثربخش در درمان این اختلال استفاده شود.

کلیدواژه‌ها

عنوان مقاله [English]

Designing Family-Centered Combined Treatment Based on the Human Integrated Development Model and Comparing its Effectiveness with Floor time Play Therapy on Behavioral Symptoms of Children with Autism Spectrum Disorder and the Parenting Stress of Their Mothers

نویسندگان [English]

  • Sh. Aali 1
  • S.A. AminYazdi 1
  • M.S. Abdekhodaei 1
  • A. Ghanaei Chamanabad 1
  • F. Moharreri 2

1

2

چکیده [English]

The purpose of the current research is to design a combined family-centered treatment based on a human integrated development model and to compare its effectiveness with floor time play therapy in improvingthebehavioral symptoms of children with autism spectrum disorder and the parenting stress of their mothers. The study was performed within a single-subject framework during 6 months on 12 three- to eight-year-old children with ASD and their families. The results were investigated in three stages (pretest, posttest and follow up) using parenting stress scales and the children’s autism scale. Based on the results obtained from the study, the improvement percentage of the behavioral symptoms of the children participating in the family-centered combined treatment group, especially in communicating with others, emotional responses, fear or unrest and verbal communication subscales as well as the parenting stress of their mothers―especially in inattention/ hyperactivity, health, attachment and relationships with spouse subscales―was more than 50 percent and the improvement rate was clinically significant. The effect size of treatment was estimated to be up to 0.80. In conclusion, the family-centered combined treatment designed in this study can increase the effectiveness of floor time and be used as an effective treatment approach in ASD treatment.

کلیدواژه‌ها [English]

  • family-centered combined treatment
  • floor time play therapy
  • family developmental function
  • functional-emotional development
  • autism spectrum disorder
فارسی
جلالی مقدم، نیلوفر؛ پوراعتماد، حمیدرضا؛ صدق‌پور، بهرام صالح؛ خوشابی، کتایون و چیمه، نرگس (1386). راهبردهای مقابله‌ای والدین کودکان مبتلا به اختلالات فراگیر تحولی. فصلنامه خانواده پژوهی، 3 (12)، 761-774.
خرم‌آبادی، راضیه؛ پوراعتماد، حمیدرضا؛ طهماسیان، کارینه وچیمه، نرگس (1388). مقایسه استرس والدگری در مادران کودکان مبتلا به اختلال اتیسم با مادران کودکان بهنجار. فصلنامه خانواده پژوهی، 5 (19)، 387-399.
خوشابی، کتایون؛ فرزادفرد، سیده‌زینب؛ کاکاسلطانی، بابک؛ پوراعتماد، حمیدرضا و نیک‌خواه، حمیدرضا (1389). بررسی راهبردهای مقابله‌ای و میزان تنیدگی در مادران کودکان مبتلا به اوتیسم و مقایسه‌ی آن با مادران کودکان عادی.فصلنامه‌یخانواده‌پژوهی، (21) 97-87.
رافعی، طلعت (1385). اتیسم، ارزیابی و درمان. تهران: دانژه.
سرابی‌جماب، ملیحه؛ حسن آبادی، حسین؛ مشهدی، علی و اصغری نکاح، محسن (1390). تأثیر آموزش والدین بر خودکارآمدی مادران کودکان مبتلا به درخوردماندگی. مجله‌ اصول بهداشت روان، 13 (1)، 93-84.
عالی، شهربانو؛ امین‌یزدی، سید امیر؛ عبدخدایی، محمد سعید؛ غنایی چمن آباد، علی و محرری، فاطمه (زیر چاپ). کارکرد تحولی خانوادة کودکان مبتلا به اختلال‌های طیف اوتیسم. مجله دانشکده پزشکی مشهد.
علی‌اکبری دهکردی، مهناز؛ علی‌پور، احمد؛ چیمه، نرگس و محتشمی، طیبه (1391). اثر روش درمانی پاسخ محور مبتنی بر والدین در بهبود کودکان دارای اتیسم، فصلنامه ایرانی کودکان استثنائی، 12 (1)، 12-1.
گال، مردیت؛ بورگ، والتر و گال، جویس (1383). روش‌های تحقیق کمی و کیفی در علوم‌تربیتی و روانشناسی. (ج 1). (مترجمان احمدرضا نصر و همکاران). تهران: سمت.
 
لاتین
Abidin, R. (1990). Parenting Stress Index (PSI): Pediatric Psychology Press.
Baron-Cohen, S. (2008). Autism and asperger syndrome: Oxford University Press.
Brobst, J. B., Clopton, J. R., & Hendrick, S. S. (2009). Parenting children with autism spectrum disorders the couple's relationship. Focus on Autism and Other Developmental Disabilities, 24 (1), 38-49.
Carter, A. S., Davis, N. O., Klin, A., & Volkmar, F. R. (2005). Social development in autism. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds). Handbook of autism and pervasive developmental disorders: Vol. 1. Diagnosis, development, neurobiology, and behavior. Hoboken, NJ: John Wiley & Sons.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed). Hillsdale. NJ: Erlbaum.
Coucouvanis, J., Hallas, D., & Farley, J. N. (2012). Autism Spectrum Disorder. Child and adolescent behavioral health: a resource for aAdvanced practice psychiatric and primary care practitioners in nursing, 238- 259.
Dionne, M., & Martini, R. (2011). Floortime play with a child with autism: A single-subject study. Canadian Journal of Occupational Therapy, 78 (3), 196-203.
Greenspan, S., & Shanker, S. (2004). The first Idea: how symbols, language and intelligence evovled from our primate ancestors to modern humans. Reading, Pereus Books.
Greenspan, S. I., & Wieder, S. (1997). Developmental patterns and outcomes in infants and children with disorders in relating and communicating: A chart review of 200 cases of children with autistic spectrum diagnoses. Journal of Developmental and Learning Disorders, 1, 87-142.
Greenspan, S. I., & Wieder, S. (2006). Infant and early childhood mental health: a comprehensive developmental approach to assessment and intervention: American Psychiatric Pub.
Greenspan, S., & Wieder, S. (2005). Can children with autism master the core deficits and become empathetic, creative and reflective? A ten to fifteen year follow-up of a subgroup of children with autism spectrum disorders (ASD) who received a comprehensive developmental, individual -difference, relationship-based (DIR) approach. Journal of Developmental and Learning Disorders, 9, 39-61.
Greenspan, S. I., & Wieder, S. (2009). Engaging autism: using the floortime approach to help children relate, communicate, and think: Da Capo Press.
Harris, K. R., Graham, S., MacArthur, C., Reid, R., & Mason, L. H. (2011). Self-regulated learning processes and children's writing. Handbook of self-regulation of learning and performance, 187-202.
Hersen, M., & Barlow, D. H. (1976). Single case experimental designs: Strategies for studying behavior change. New York: Pergamon Press.
Hilton, J. C., & Seal, B. C. (2007). Brief Report: Comparative ABA and DIR Trials in Twin Brothers with Autism. Autism Developmental Disorder, 37, 1197-1201.
Ingersoll, B., & Schreibman, L. (2006). Teaching reciprocal imitation skills to young children with autism using a naturalistic behavioral approach: Effects on language, pretend play, and joint attention. Journal of Autism and Developmental Disorders, 36 (4), 487-505.
Ivey, J. K. (2004). What do parents expect? A study of likelihood and
importance issues for children with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 19 (1), 27-33.
Keen, D., Couzens, A., Muspratt, S., & Rodger, S. (2010). The effects of a parent-focused intervention for children with a recent diagnosis of autism spectrum disorder on parenting stress and competence. Research Autism Spectrum Disorder, 4 (2): 229-41.
Kheir, N., Ghoneim, O., Sandridge, A. L., Al-Ismail, M., Hayder, S., & Al-Rawi, F. (2012). Quality of life of caregivers of children with autism in Qatar. Autism, 16 (3), 293-298.
Liao, S.-T., Hwang, Y.-S., Chen, Y.-J., Lee, P., Chen, S.-J., & Lin, L.-Y. (2014). Home-based DIR/ Floortime™ Intervention Program for Preschool Children with Autism Spectrum Disorders: Preliminary Findings. Physical & occupational therapy in pediatrics.
Macks, R. J., & Reeve, R. E. (2007). The adjustment of non-disabled siblings of children with autism. Journal of autism and developmental disorders, 37 (6), 1060-1067.
Mahoney, G., & Perales, F. (2003). Using Relationship-Focused Intervention to Enhance the Social-Emotional Functioning of Young Children with Autism Spectrum Disorders. Topics in Early Childhood Special Education, 23 (2), 74-86.
Moh, T. A., & Magiati, I. (2012). Factors associated with parental stress and satisfaction during the process of diagnosis of children with autism spectrum disorders. Research in Autism Spectrum Disorders, 6 (1), 293-303.
Nee, J. E. (2013). Behavior & Developmental Treatment Models for Autism Spectrum Disorders: Factors Guiding Clinician Preference and Perceptions. Master of Social Work Clinical Research Papers. 238-250.
Paivio, A. (2014). Mind and its evolution: a dual coding theoretical approach: Psychology Press.
Pajareya, K., & Nopmaneejumruslers, K. (2011). A pilot randomized controlled trial of DIR/ Floortime™ parent training intervention for pre-school children with autistic spectrum disorders. Autism, 15 (5), 563-577.
Pakenham, K. I., Samios, C., & Sofronoff, K. (2005). Adjustment in mothers of children with asperger syndrome an application of the double ABCX model of family adjustment. Autism, 9 (2), 191-212.
Powers, M. (1989). Children with Autism and their Families. Children with Autism: A Parent’s Guide, 105-139.
Reichman, N. E., Corman, H., & Noonan, K. (2008). Impact of child disability on the family. Maternal and Child Health Journal, 12 (6), 679-683.
Samadi, S. A., Mahmoodizadeh, A., & McConkey, R. (2012). A
national study of the prevalence of autism among five-year-old children in Iran. Autism, 16 (1), 5-14.
Schopler, E., Reichler, R. J., DeVellis, R. F., & Daly, K. (1980). Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS). Journal of Autism and Developmental Disorders, 10 (1), 91-103.
Sivberg, B. (2002). Family System and Coping Behaviors A comparison between parents of children with autistic spectrum disorders and parents with non-autistic children. Autism, 6 (4), 397-409.
Solomon, A. H., & Chung, B. (2012). Understanding autism: How family therapists can support parents of children with autism spectrum disorders. Family Process, 51 (2), 250-264.
Solomon, R., Necheles, J., Ferch, C., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism the PLAY project home consultation program. Autism, 11 (3), 205-224.
Surman, C. B., Biederman, J., Spencer, T., Yorks, D., Miller, C. A., Petty, C. R., & et al. (2011). Deficient emotional self-regulation and adult attention deficit hyperactivity disorder: a family risk analysis. American Journal of Psychiatry, 168 (6), 617-623.
Tomanik, S., Harris, G. E., & Hawkins, J. (2004). The relationship between behaviours exhibited by children with autism and maternal stress. Journal of Intellectual and Developmental Disability, 29 (1), 16-26.
Tonge, B., Brereton, A., Kiomall, M., Mackinnon, A., King, N., & Rinehart, N. (2006). Effects on parental mental health of an education and skills training program for parents of young children with autism: A randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 45 (5), 561-569.
Tunali, B., & Power, T. G. (2002). Coping by redefinition: Cognitive appraisals in mothers of children with autism and children without autism. Journal of Autism and Developmental Disorders, 32 (1), 25-34.
Wang, P., Michaels, C. A., & Day, M. S. (2011). Stresses and coping strategies of Chinese families with children with autism and other developmental disabilities. Journal of Autism and Developmental Disorders, 41 (6), 783-795.
Weiss, M. J. (2002). Hardiness and social support as predictors of stress in mothers of typical children, children with autism, and children with mental retardation. Autism, 6 (1), 115-130. ##
Weiss, P. R. (2000). Emotion and Learning. Training & Development, 54 (11), 44-48.