背景:针对神经发散儿童认知功能的干预措施通常集中在单一功能上,例如工作记忆训练。他们通常专注于“赤字”模型,而缺乏对理解个人优势和困难领域的重视,以此作为适当支持的先决条件。这些儿童认知特征的多维性质和表型变异性表明,需要一个多成分定制的干预计划,重点是理解和支持单个儿童的认知功能。
目标:“EPIC”干预(爱丁堡儿童和青少年心理教育干预)的重点是改善认知,神经发散儿童的学习和行为,例如患有注意力缺陷多动障碍(ADHD)或自闭症的儿童。在我们之前的联合制作工作的基础上,本研究旨在使用参与式方法来开发与我们的关键原则相关的EPIC实践和材料,其中包括心理教育,多组分,个性化的方法,优势和困难分析,并将孩子的个人优势和困难与内部和外部策略配对。我们还着手评估EPIC的可行性和可接受性,并与神经发散的儿童及其父母和老师一起试用这种新颖的工具包干预措施。
方法:干预实践,EPIC的材料和策略是与神经分化儿童共同制作的,他们的父母,教师和临床医生采取优势和困难的方法。确定心理教育活动和策略实践(例如思维导图,分块),在为期两周的为期8周的计划中,进行了可行性测试和试点数据收集。11名7至12岁的神经分化儿童完成了16次个性化计划。通过在儿童和教师访谈中得出的定性报告以及儿童的享乐评级来确定可接受性和可行性。在参与干预前后收集了试点评估数据,和跨认知评估(CANTAB,简讯),教育程度(WIAT)以及家长和教师问卷,测量临床症状和行为(Conners,AQ,SDQ,自我感知)。将数据与匹配的神经发散治疗照常对照组进行比较(N=9)。
结果:共同制作的EPIC干预措施既可行,也可被儿童接受,父母和他们的老师。试点数据表明,为期8周的干预改善了认知(短期和工作记忆)和识字(接受词汇,口语单词流利,听力理解)。干预组的父母报告的儿童行为困难和攻击性也有所改善,和教师报告的学术能力。产生的效应大小(Cohen'sd)范围为0.65至2.83。家长在参加该计划一年后接受采访时报告说,他们继续使用EPIC策略。
结论:本研究完全符合我们的目标。“EPIC”(爱丁堡儿童和青少年心理教育干预)在家庭和学校环境中是可行的,并改善了认知的一系列方面,神经发散儿童的学习和行为。我们的研究结果表明,EPIC适合在全面试验中进行评估。
BACKGROUND: Interventions focused on cognitive function in neurodivergent children typically focus on single functions, e.g. working memory training. They are often focused on \'deficit\' models and lack an emphasis on understanding areas of individual strengths and difficulties as a prerequisite to appropriate support. The multidimensional nature and phenotypic variability of cognitive profiles in these children indicate a need for a multicomponent-tailored intervention programme focused on understanding and supporting an individual child\'s cognitive functioning.
OBJECTIVE: The \'EPIC\' intervention (Edinburgh
Psychoeducation Intervention for Children and Young People) is focused on improving cognition, learning and behaviour in neurodivergent children such as those with attention deficit hyperactivity disorder (ADHD) or who are autistic. Building on our previous co-production work, this study aimed to use a participatory methods approach to develop EPIC practices and materials in relation to our key principles which include
psychoeducation, multicomponent, individualised approach, strengths and difficulties profiling and pairing of a child\'s individual strengths and difficulties with internal and external strategies. We also set out to assess the feasibility and acceptability of EPIC, and pilot this novel tool-kit intervention with neurodivergent children and their parents and teachers.
METHODS: The intervention practices, materials and strategies of EPIC were co-produced with neurodivergent children, their parents, teachers and clinicians taking a strengths and difficulties approach. Identification of
psychoeducation activities and strategy practices (e.g. mind-maps, chunking), testing of feasibility and collection of pilot data were conducted over a bi-weekly 8-week programme. Eleven neurodivergent children aged 7 to 12 completed the 16-session individualised programme. Acceptability and feasibility were ascertained via qualitative reports elicited within child and teacher interviews and child ratings of enjoyment. Pilot evaluation data was collected pre- and post-intervention participation, and across cognitive assessments (CANTAB, BRIEF), educational attainment (WIAT) and parent and teacher questionnaires measuring clinical symptoms and behaviour (Conners, AQ, SDQ, self-perception). Data was compared with a matched neurodivergent treatment-as-usual control group (N = 9).
RESULTS: The co-produced EPIC intervention was both feasible to deliver and acceptable to children, parents and their teachers. Pilot data identified that the 8-week intervention improved cognition (short-term and working memory) and literacy (receptive vocabulary, oral word fluency, listening comprehension). Improvements in the intervention group were also found for parent-reported child behavioural difficulties and aggression, and teacher-reported scholastic competence. Effect sizes generated (Cohen\'s d) ranged from 0.65 to 2.83. Parents reported continuing to use EPIC strategies when interviewed over a year after participating in the programme.
CONCLUSIONS: The current study met our objectives fully. \'EPIC\' (Edinburgh
Psychoeducation Intervention for Children and Young People) is feasible in home and school contexts and improves a range of aspects of cognition, learning and behaviour in neurodivergent children. Our findings show EPIC is suitable to be assessed within a full-scale trial.