【经济学人】治疗自闭症儿童，先从父母着手 | 2016.10.29 | 总第713期

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First, treat the parents

治疗自闭症儿童，先从父母着手

Turning mothers and fathers into therapists helps autistic children

对父母进行治疗可以帮助治疗自闭症儿童

Oct 29th 2016 | From the print edition

2016年10月29日|摘自印刷版

AUTISM may bring a lifetime of disability and difficulty to the most severely afflicted. As children, they often struggle to communicate, are anxious in situations unproblematic for anyone else and may behave in repetitive ways that disturb others. As adults, they may be shunned—or even ostracised.

自闭症可能会困扰那些严重患者的一生，给他们的生活带来障碍和困难。自闭症儿童很难与人沟通，经常对一些对别人看来都不是问题的情景感到焦虑并且会重复进行一些妨碍他人的行为。成人自闭症患者可能会回避甚至排斥他人。

Medical science has little to offer. Drugs have limited effects, and although there have been claims for many years that therapies aimed at training a child directly to behave in desirable ways (known as behavioural intervention) can work, the evidence they actually do so is poor. All this, observes Tony Charman, a clinical psychologist at King’s College, London, leaves parents of autistic children vulnerable to false promises. Only this month, for example, a four-year-old boy had to be taken to hospital in Britain after being subjected to a bizarre array of treatments described as “holistic medicine”.

医学治疗方法不多。药物作用有限，并且尽管这些年来，各种旨在纠正孩子行为的直接训练治疗方法(也叫作行为干预)都宣称行得通，但是能证明其有效的证据却少得可怜。据来自伦敦国王学院的临床心理学家托尼·查尔曼研究，这很容易让自闭症儿童的父母受到虚假承诺的欺骗。比如，就在本月，一个四岁的英国小男孩，在经受了一系列所谓"整体医学"的神奇治疗后，被送进了医院。

Incidences of such quackery should be reduced by a study published in this week’s Lancet by Dr Charman and his colleagues. The “Pre-school Autism Communication Trial” (PACT) attempted to answer, once and for all, the question of whether behavioural intervention in autism works—and, in particular, whether it does so in the most severe cases. It is the largest such trial yet attempted, and the one with the longest period of follow up. Its answer was: yes, it does. The PACT team found not only that, if carried out correctly, behavioural intervention has an immediate effect, but also that this effect persists. Even six years after therapy, autistic children could communicate better and had a lower level of repetitive behaviour than did a control group of their peers.

查尔曼和他的同事在这周的《柳叶刀》中说道，这些骗术应该被遏止。PACT（学龄前儿童自闭症实验）项目就干预行为能否有效治疗自闭症这个问题进行了干脆地回答(特别是在多数病情较重的情况下）。这是迄今为止跟进时间最长、最大型的试验项目。答案是:是的，确实有效。PACT项目团队发现如果正确地实施行为干预，不仅会立马见效，而且效果还可以长期保持。另一个对照组相比，即使六年过后，自闭症儿童依然能够更好的交流，并且他们的重复性行为也变少了。

The crux of PACT was the nature of the intervention employed. This was designed to train not the children but their parents. The idea was to alter parental behaviour in ways that would then go on to encourage desirable changes in offspring. Specifically, PACT’s intervention trained parents how to communicate with an autistic child. This is rarely a problem with “neurotypical” children, who provide plenty of opportunities for engagement. But autistic children can be difficult to engage with, and their attempts at communication can be so subtle that parents need assistance in detecting them, and advice about how to respond appropriately.

行为干预的性质是PACT项目的研究重心。此项目是设计出来对父母进行训练的，而非自闭症儿童。这种做法就是通过改变父母的行为，进而鼓励孩子在行为方式朝着理想的方向改变。明确地说，PACT项目的行为干预就是训练父母如何与自闭症儿童交流。这对于正常儿童来说基本不是问题，因为他们会和父母进行大量的互动。但是和自闭症儿童很难互动，而且他们尝试交流的举动是如此的细小以至于父母需要指导帮助才能察觉到，并且这个项目还会给父母就如何回应孩子作出建议。

The approach used by PACT involved parents being videoed while playing with their children. Those videos were then replayed to the parents under the tutelage of a speech therapist, who pointed out moments, which might not otherwise have been obvious, when children were attempting to communicate. Even just turning towards a parent may be such an attempt. Having seen when to respond, parents then learned how to do so in the way a therapist would, in order to draw the child out.Parents are thus taught to become therapists themselves.

PACT使用的方法是对与孩子们玩耍的父母进行录像。并且在语言治疗师的监控下重播给父母看，由治疗师们指出当孩子们在尝试与父母互动时那些看起来不起眼的举动。期待您的翻译，您可以将翻译留言到文章底部，第二天会有详细解析哦。进而教会父母如何成为治疗师。

Family values 

家庭价值

This therapy, encouragingly, is neither invasive nor intensive nor costly. It involves sessions once a fortnight for six months, and then a further six sessions, once a month. The results, though not startling, are encouraging. In families who were coached, the percentage of children with severe symptoms (such as having difficulties speaking and learning things) fell from 55% to 46%. In those who formed the control group, and were not so coached, they actually rose—from 50% to 63%.

鼓舞人心的是，这种治疗既不会显得有攻击性、非常刻意并且费用也不高。它的前期疗程连续六个月，每隔两个星期一次，之后的六次疗程是每月一次。其结果，虽不至于震惊，却足以振奋人心。经过训练的家庭，拥有言语和学习障碍等严重症状的孩子的百分比从55%降到了46%。而未经训练的对照组的百分比却上升了，由50%上升到了63%。

The study adds to evidence that therapy delivered by parents is helpful for a range of childhood mental-health conditions, including aggression and anxiety. Yet, in the case of autism, some crucial scientific questions remain to be answered. One is whether the age of intervention matters. A second is whether this approach might help less severely afflicted children than those chosen for the study. And a third is whether a similar approach, taught to teachers rather than parents, might permit the method to be extended to schools.

研究表明父母的治疗对于一系列儿童心理健康(包括攻击性为和焦虑心理)有着极大的帮助。然而就自闭而言，决定性的科学难题还有待解决。其中一个是介入治疗的年龄是否重要。第二个是这个方法对病情严重的孩子的效果会不会没有参与实验的孩子好。还有就是用一个类似的、用来训练老师而非父母的方法，是否可以将PACT的方法推广到学校。

Perhaps the greatest unanswered question, though, is practical. It is how such a therapy might be adopted swiftly and widely. Those involved in the PACT study have already made a start on this. They are creating training materials to be posted on their website, so that therapists who work with autistic children can adapt their methods accordingly. With luck, those methods will spread, and the lives of such children will improve accordingly.

最大的实际性问题就是如何把这个方法迅速地得到推广出去。PACT的研究内容已经对此奠定了基础。他们正在编写训练资料，准备将其公布到网站上，因而自闭儿童的治疗师可以根据资料选取适合的治疗方法。如果幸运的话，这些方法可以得到推广，自闭症孩子的生活也会相应改善。

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