Effect Of Caregiver Factors And Parent-child Dyadic Synchrony On The Efficacy Of PCBI Interaction

【Object】Children with autism spectrum disorder(ASD)who participated in the“Play-based Communication and Behavior Intervention(PCBI)” were studied to explore the efficacy of the PCBI very early intervention model,and systematically evaluate the impact of caregiver factors on the efficacy of the PCBI very early intervention model.And to analyze and compare the changes of the engagement states of ASD children and their caregivers in parent-child interaction before and after PCBI,and then to explore the impact of parent-child dyadic synchrony on the efficacy of the PCBI very early intervention model.【Methods】Study one: the effect of caregiver factors on the efficacy of PCBI very early interventionFrom December 2017 to February 2019,101 children with ASD,aged 13~30months,were recruited in this study.They were trained for PCBI very early intervention in Nanjing Brain Hospital.The Autism Treatment Evaluation Checklist and the Gesell Developmental Schedules were used to evaluate the efficacy of the PCBI very early intervention.Parenting Stress Index Short Form,General Self-Efficacy Scale,and the self-developed Caregiver Training Course Evaluation Scale and the Homework Completion Level Scale were used to assess the level of parental stress,self-efficacy,curriculum satisfaction and acceptance.A pair of sample t-test was used to analyze the ASD symptoms,developmental level andcaregiver factors of ASD children before and after intervention.Multivariate regression analysis was used to explore the relationship between caregiver factors and the effects of PCBI very early intervention.Study two: the study of parent-child dyadic synchrony in PCBI very early interventionSeventy children with ASD,aged 13~30 months,were recruited in this study.They were trained for PCBI very early intervention in the Nanjing Brain Hospital from December 2017 to January 2019.Clinical psychological scales were used to assess the developmental level of ASD and the caregiver factors of their parents before and after PCBI.Fifteen minutes Free-play videos were finished before and after PCBI.The later 5 minutes were coded by the 5s interval to frequencies of parent-child dyadic synchrony.The paired-sample t-test was used to analyze the parent-child interaction engagement states before and after the intervention.The bivariate correlation analysis was used to analyze the dyadic synchrony and the efficacy of PCBI intervention.Multivariate regression analysis was used to analyze the effects of dyadic synchrony and the engagement states of caregivers and children on PCBI very early intervention.【Results】Study one: the effect of caregiver factors on the efficacy of PCBI very early intervention(1)At the end of 12 weeks PCBI very early intervention,there was a significant decrease in the scores of the ATEC((35)= 17.58±15.86)than that of the ATEC before intervention(P < 0.05);the adaptive developmental quotient((35)= 6.23±14.57),the fine action developmental quotient((35)= 5.87±18.35),the language developmental quotient((35)= 13.01±19.55)and the personal social developmental quotient((35)=5.52±15.24)in Gesell Developmental Schedules was significantly higher than thatbefore intervention(P < 0.05).(2)At the end of PCBI very early intervention,there was a significant decrease in the scores of Parenting Stress Index Short Form((35)=5.11±14.43,P < 0.05).(3)Acceptance of the intervention mode l(β= 0.63),and mastery of the caregivers’ skills(β= 0.16)in the caregiver factors have a positive predictive effect on the effect of PCBI very early intervention(P < 0.05).Study two: the study of parent-child dyadic synchrony in PCBI very early intervention(1)At the end of 12 weeks PCBI very early intervention,the positive engagement states((35)= 3.11±8.11)of caregivers in parent-child interaction increased compared with that before intervention,and the negative engagement states((35)=-1.86±7.52)and disengagement states((35)=-1.33±3.21)decreased compared with before intervention(P < 0.05);(2)At the end of PCBI very early intervention,the positive engagement states((35)= 7.14±9.39)of ASD children in parent-child interaction increased compared with that before intervention,and the object engagement((35)=-7.27±14.82)decreased compared with before intervention(P < 0.05);(3)At the end of PCBI very early intervention,the dyadic synchrony((35)= 6.97±9.41)in parent-child interaction increased compared with that before intervention(P < 0.05).(4)the level of language development of ASD children(β= 0.30)before intervention,caregiver’s acceptability of the intervention model(β= 0.35)had a positive predictive effect on the dyadic synchrony model in the PCBI very early intervention(P < 0.05).(5)The dyadic synchrony difference(β= 2.96),the child negative engagement states difference(β= 2.62),the child disengagement states difference(β= 2.31)and the child object engagement difference(β= 3.97)in parent-child interaction had a positive predictive effect on the efficacy of PCBI very early intervention(P < 0.05).【Conclusion】(1)In the early intervention of ASD,the caregiver factor was very important.The mastery of the caregiver’s skill and the acceptability of the intervention model of the caregiver had a certain predictive effect on the early intervention.(2)Parent-child dyadic synchrony,the children negative engagement states,the children disengagement states and the children object states had predictive value for the treatment of very early intervention.The therapist could predict the effect and adjust the changes by evaluating these four aspects during the intervention.