20.500.12556/DKUM-87184 Vpliv psihoedukacijske skupine za starše otrok z motnjo avtističnega spektra in vedenjsko nespečnostjo na duševno zdravje staršev in težavno vedenje njihovih otrok doktorska disertacija Influence of psychoeducational group for parents of children with autistic spectrum disorders and behavioral insomnia on their mental health and challenging behaviour of their children Motnje avtističnega spektra (MAS) spadajo med razvojno-nevrološke motnje, ki se pogosto pojavljajo sočasno z drugimi stanji. Motnje spanja so pri otrocih z MAS zelo pogoste (prevalenca sega od 40 do 80 %). Med njimi je najpogostejša vedenjska nespečnost, kljub temu pa so dokazi o učinkovitosti vedenjskih intervencij za razreševanje omenjenih težav omejeni. Spanje je pomembno za kognitivno delovanje, razpoloženje, duševno zdravje in kardiovaskularno, cerebrovaskularno ter presnovno zdravje. V pričujoči doktorski disertaciji smo oblikovali in preučevali učinkovitost psihoedukativne intervencije za starše otrok z avtizmom, ki so imeli pridruženo vedenjsko nespečnost. Intervencijo smo oblikovali po principih vedenjsko-kognitivne paradigme. Predvidevali smo, da bo v okviru psihoedukacijske skupine prišlo do zmanjšanja splošnih težav s spanjem otrok z avtizmom (npr. manj nočnega prebujanja, daljšega časa spanja, krajšega časa uspavanja), kar bo pozitivno vplivalo na duševno zdravje staršev ter starševski stres in na zmanjšanje težavnega vedenja otrok z MAS. Skupno je v raziskavi sodelovalo 26 otrok z MAS in njihovih staršev, ki smo jih razdelili v intervencijsko in kontrolo skupino. Vključitveni kriteriji so bili naslednji: potrjena diagnoza MAS po MKB-10, ki jo je postavil ustrezno usposobljen strokovnjak (npr. klinični psiholog, pediater, specialist otroške in mladostniške psihiatrije); starost otroka od dveh do 11 let; težave na področju spanja so morale biti povezane z večernim uspavanjem ali s pogostim nočnim zbujanjem oziroma s kombinacijo obeh (tj. vedenjsko nespečnostjo) in so trajale vsaj tri mesece. Izključitveni kriteriji pa so bili naslednji: prisotnost vedenjskih znakov obstruktivne spalne apneje (OSA); epilepsija; senzorne motnje – gluhota; pridružena motnja v duševnem razvoju (MDR); prejemanje melatonina za uravnavanje motenj spanja ali druge oblike farmakološkega zdravljenja; starši otrok z avtizmom s slabim znanjem slovenskega jezika, kar bi lahko vplivalo na razumevanje posameznih ukrepov in izpolnjevanje vprašalnikov. Intervencijska skupina je obsegala šest zaporednih 60-minutnih tedenskih srečanj. Za merjenje spremembe na področju spanja pri otrocih z MAS smo uporabili modificiran vprašalnik o spalnih navadah otrok (CSHQ-A). Starši otrok v intervencijski skupini so po zaključku programa poročali o statistično pomembnem zmanjšanju težav na lestvici spalne tesnobe, nočnih zbujanj oz. parasomnije in skupnih težav na področju spanja, ki se je ohranilo tudi tri mesece po zaključku programa. Nekaj manjših sprememb je bilo mogoče opaziti tudi na področju težavnega vedenja otrok, tj. na ravni starostne primerjave (ko smo skupine razdelili na šolske in predšolske otroke). Oblikovana psihoedukativna intervencija se je tako na slovenskem vzorcu staršev otrok z MAS izkazala kot učinkovit in praktičen način zmanjševanja težav s spanjem pri otrocih z MAS ter se lahko brez večjih težav vključi v slovenski sistem javnega zdravstva. Izvedena raziskava ob tem odpira tudi nova področja raziskovanja, predvsem splošne prevalence spalnih motenj v Sloveniji pri otrocih, mladostnikih, mladih odraslih in odraslih z MAS; prilagoditve naše intervencije drugim starostnim skupinam ter hkrati posploševanja naših ugotovitev na že omenjene skupine. Autism spectrum disorder (ASD) is a developmental neurological disorder that often co-occurs with other conditions. Sleep disorders in children with MAS are very common (prevalence ranges from 40 to 80%), among which behavioral insomnia is the most common, however, evidence on the effectiveness of behavioral interventions to resolve these problems is limited. Sleep is important for cognitive functioning, mood, mental health, and cardiovascular, cerebrovascular, and metabolic health. In this doctoral dissertation, we designed and studied the effectiveness of a psychoeducational intervention for parents of children with autism who had associated behavioral insomnia. We designed the intervention according to the principles of the behavioral-cognitive paradigm. We hypothesized that within the framework of the psychoeducational group there would be a reduction in the general sleep problems of children with autism (fewer night awakenings, longer sleep time, shorter time falling asleep) and that it would have a positive impact on parents' mental health, parental stress and on the reduction problematic behavior of children with MAS. A total of 26 children with MAS and their parents participated in the research, who were divided into an intervention group and a control group. The inclusion criteria were as follows - a confirmed diagnosis of MAS according to the ICD-10, made by a suitably qualified expert (e.g. clinical psychologist, paediatrician, a specialist in child and adolescent psychiatry), the child's age from 2 to 11 years, problems must be related to sleep to falling asleep in the evening or frequent night awakenings or a combination of both (i.e. behavioural insomnia) and last for at least 3 months. The exclusion criteria were the following - the presence of behavioural signs of obstructive sleep apnea (OSA), epilepsy, sensory disorders - deafness, an associated disorder in mental development, receiving melatonin to regulate sleep disorders or other forms of pharmacological treatment, parents of children with autism with poor knowledge of Slovenian language, which could affect the understanding of individual measures, filling out questionnaires. The intervention group consisted of six consecutive weekly sessions lasting 60 minutes. To measure changes in the sleep domain in children with MAS, we used the modified Children's Sleep Habits Questionnaire (CSHQ-A). After completing the program, parents of children in the intervention group reported a statistically significant reduction in sleep anxiety, night awakenings/parasomnias, and overall sleep problems, which were maintained 3 months after the program was completed. Some minor changes could also be observed in the area of children's problematic behavior, namely at the level of age comparison (when we divided the groups into school and preschool children). The designed psycho-educational intervention proved to be an effective and practical way to reduce sleep problems in children with MAS in the Slovenian case of parents of children with MAS and has the potential to be integrated into the Slovenian public health system without major problems. The conducted research also opens up new areas of research, namely what is the general prevalence of sleep disorders in Slovenia among children, adolescents, young adults and adults with MAS, adapting our intervention for other age groups and at the same time generalizing our findings to the aforementioned groups. motnje avtističnega spektra motnje spanja otroci psihoedukacija autism spectrum disorders sleep disorders children psychoeducation true true false A. Demšar Slovenski jezik Angleški jezik Doktorsko delo/naloga 2024-03-02 20:45:21 2024-12-05 13:07:20 2024-12-06 03:20:50 0000-00-00 00:00:00 2024 0 Maribor 0 Maribor 1 spletni vir (1 datoteka PDF (195 str.)) 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 159.963.273:616.896(043.3) 217839875 DOK_Demsar_Ajda_2024.pdf DOK_Demsar_Ajda_2024.pdf 1 59F3B1D9942E0B2CADB85C4996614CDF 299c8f27e819323195d1bc498554b3900f8b61221e7cf182afb098a8924b5a09 212c17b1-b301-11ef-9aff-00155d000105 https://dk.um.si/Dokument.php?lang=slv&id=187133 Filozofska fakulteta 0 0 0