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學齡前自閉症孩童用餐問題與介入之文獻回顧

A Systematic Review of Mealtime Problems and Interventions in Preschool Children With Autism Spectrum Disorder

摘要


研究背景:學齡前自閉症孩童的用餐問題雖可能隨年齡增長而改善,但自閉症孩童仍較典型發展孩童具更高比例表現較嚴重的行為和感覺問題。雖然有行為、感覺動作處理和以家長為基礎的三種介入方式,但目前尚未有探討用餐問題並整合三種介入之系統性回顧檢視這些療法的效果。目的:本回顧旨在整理學齡前自閉症孩童的用餐相關問題和因子,並納入介入型文獻以探討治療效果。方法:主要透過PubMed、Scopus等電子資料庫查找文獻,納入條件包含(1)研究對象涵蓋學齡前兒童(2)以中英文發表(3)經獨立審查且有完整全文。結果:本文共收錄20篇文獻,並根據牛津大學實證醫學中心證據等級表發現其中只有2篇層級1的隨機分派研究。結果顯示2~6歲的自閉症孩童具行為、感覺處理、家長壓力及營養攝取相關問題。行為介入可有效改善孩童用餐問題,感覺處理介入效果仍未有明確定論,而家長為主之介入或許可減輕照護壓力。論:本篇回顧顯示自閉症兒童用餐問題相關的研究實證層級多偏低,行為介入能有效降低孩童之固著行為或挑食狀況。與家人一起或家長作為角色模範可做為改變用餐環境的方式,也可能有助於減輕家長照護壓力,未來研究應深入探究情境因子的影響並提供更多高層級研究以探討此重要議題。

並列摘要


Background: Mealtime problems may decrease with increasing age in preschool children with Autism Spectrum Disorder (ASD). However, children with ASD have more behavioral and sensory problems than children with typical development. Although there are three interventions as behavior, sensory-motor processing and parent-based ones, there is no systematic review discussing the mealtime problems and examining the effectiveness of three interventions. Purpose: This review aimed to present the mealtime problems and related factors in preschool children with ASD, and include related studies for discussing treatment effectiveness. Method: A comprehensive search was performed through the electronic database as Pubmed, Scopus…etc. The inclusion criteria included: (1) preschool children, (2) Chinese or English studies, and (3) full text with an independent review process. Results: There were 20 studies and only two randomized controlled trials had level I evidence categorized by Oxford CEBM. Results showed that children with ASD aged between 2-to-6-year-old had behavioral, sensory processing, parental stress, and nutritional intake related problems. Behavior interventions can improve children's mealtime behaviors. The effectiveness of sensory processing intervention is inconclusive and parent-based intervention may decrease caregiver's stress. Conclusion: This review demonstrates most studies have low level of evidence related to the mealtime problems in children with ASD. Behavior interventions can effectively reduce children's stereotypic behaviors or picky eating. Eating with the families or parents as role models are examples of changing mealtime environments, which may decrease parents' parenting stress. Future studies should delve into the influences of contextual factors and provide higher level evidence on this important issue.

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