Objective: To explore the curative effect of progressively integrated sandplay therapy on core symptoms and sleep management in preschool children with mild-to-moderate autism spectrum disorder (ASD).
Methods: A total of 50 mild-to-moderate ASD preschool children were randomly divided into an experimental group (n=25) and a control group (n=25). The control group was treated with structured teaching and auditory integration training (AIT). Based on these, the experimental group was treated with progressively integrated sandplay therapy. The Autism Behavior Checklist (ABC), Children Autism Rating Scale (CARS), Social Responsiveness Scale (SRS), Children's Sleep Habit Questionnaire (CSHQ) and emotion recognition tools were used to evaluate the overall curative effect before treatment and 3 months after treatment.
Results: The experimental group had significantly lower scores of feeling, social interaction, somatic motor, language factor, total ABC and total CARS than the control group (P<0.05). The experimental group had also significantly lower scores of social cognition, social communication, social motivation, autistic behavior factor and total SRS than the control group (P<0.05). The experimental group had a significantly higher accurate rate of recognition of the upper facial expression and lower facial expression than the control group (P<0.05). The experimental group had significantly lower scores of bedtime resistance, sleep onset, sleep duration, night waking, daytime sleepiness, and total CSHQ than the control group (P<0.05). The experimental group had significantly reduced themes of wounding and significantly increased themes of healing after sandplay therapy (P<0.05).
Conclusions: Progressively integrated sandplay therapy can effectively improve the core symptoms and sleep quality of preschool children with mild-to-moderate ASD, which can be used as an early rehabilitation measure.
目的: 探讨阶梯式融合性箱庭疗法对学龄前轻中度孤独症谱系障碍（ASD）患儿核心症状及睡眠管理的疗效。
方法: 将50例轻中度ASD患儿随机分为对照组和试验组，每组各25例。对照组采取结构化教育方式结合听觉统合训练；试验组在对照组基础上，接受阶梯式融合性箱庭疗法。采用孤独症行为评定量表（ABC）、儿童孤独症评定量表（CARS）、社交反应量表（SRS）、睡眠习惯问卷（CSHQ）和情绪识别工具，评定治疗前和治疗3个月后的疗效。
结果: 试验组在感觉因子、社会交往因子、躯体运动因子、语言因子、ABC总分、CARS总分方面均低于对照组（P＜0.05）；试验组社会认知、社会沟通、社会动机、孤独症行为方式和SRS总分均低于对照组（P＜0.05）；试验组正立和倒置面孔的情绪识别正确率均高于对照组（P＜0.05）；试验组睡眠阻抗、入睡延迟、睡眠持续时间、睡眠觉醒、日间困倦和CSHQ总分均低于对照组（P＜0.05）。试验组终末箱庭创伤主题个数少于初始箱庭，治愈主题个数多于初始箱庭（P＜0.05）。
结论: 采用阶梯式融合性箱庭疗法可显著改善学龄前轻中度ASD患儿的核心症状和睡眠状况，可作为早期康复手段。