フェイス・コック
自閉症スペクトラム障害（ASD）の就学前児童の健康関連の生活の質（HRQOL）に対する不適応行動の影響は、比較的未調査です。本研究では、背景特性（年齢、月間総収入、住宅タイプ、毎日の睡眠時間）と適応機能が制御されている場合、このグループのさまざまなタイプの不適応行動（内在化、非社会的、外在化）がHRQOLに及ぼす影響の範囲を調査することを目的としています。
KK 女性・小児病院で治療を受けている ASD の子供の保護者 99 人から、改訂版独立行動尺度 (SIB-R) と背景特性質問票が収集されました。これらは、これらの子供の不適応行動の重症度、適応機能のレベル、およびいくつかの背景特性を評価するために使用されました。これらの子供の心理社会的および身体的 HRQOL とこれらの特性の関係は、小児生活の質評価尺度 (PedsQL) で評価されました。
自閉症スペクトラム障害 (ASD) は、社会的なつながりやコミュニケーションの障害、行動、活動、興味の限定的で退屈な例を特徴とする慢性的な神経発達障害です。ASD の有病率は世界中で増加傾向にあり、約 88 人に 1 人が ASD に罹患していると推定されています。
化学物質の不均衡レベルの問題は、その発生段階、根深い持続性、および関連障害のレベルが高いことから、重大な一般健康問題とみなされています。この弱点は、ASD の中核症状だけでなく、ASD の人々が通常経験する感情的および社会的問題、睡眠、ケアおよび摂食の問題、触覚過敏、学習および学業障害、ならびに共障害および精神的健康の診断など、さまざまな併発症状にも起因します。これらの併発症状は、ASD の中核症状と同等かそれ以上に ASD の子供の保護者および教育者にとって大きな懸念事項であり、行動管理、学習習得、および社会的つながりの発達に重大な影響を及ぼします。
問題行動（または本論文では不適応行動と呼んでいる）は、厄介で、有害で、暴力的で、または全体的に退屈な行動として説明され、ASDの幼児によく見られる。例えば、ドミニクらは、ASDの子供の32.7％が、殴る、
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回国際精神・行動健康会議、2020年4月22日〜23日
抄録引用:
フェイス・コック、「自閉症の幼児の生活の質に最も影響を与える不適応行動のタイプの調査」、メンタルヘルスコングレス2020、第32回国際メンタルヘルスおよび行動健康会議、2020年4月22日〜23日
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