Дополнительные и альтернативные вмешательства при расстройствах аутистического спектра: обзор для родителей и клиницистов

Методы дополнительных и альтернативных вмешательств (Complementary and Alternative Therapy, CAT), применяемые в работе с детьми с расстройствами аутистического спектра (РАС), распространены в европейских странах и в Российской Федерации, однако их эффективность и безопасность обычно не рассматриваются клиницистами и родителями составлении рекомендаций и использовании. Данный аналитический обзор посвящен наиболее распространенным дополнительным и альтернативным вмешательствам, применяемым в работе с детьми с РАС. На основе анализа информации, представленной в мета-анализах, систематических обзорах и рандомизированных контролируемых исследованиях в базе данных PubMed, рассматриваются безопасность и эффективность каждого вида вмешательств. Обнаружено, что из всех рассмотренных методов только вмешательства с применением мелатонина можно считать безопасными и эффективными для детей с РАС с сопутствующими нарушениями сна. Методы, которые были классифицированы как безопасные, но не доказавшие свою эффективность, рекомендуется применять только в том случае, если они не противоречат терапии РАС «первой линии» – применению прикладного анализа поведения (Applied Behavioral Analysis, ABA). Методы, доказательств эффективности которых обнаружено не было, такие как терапия слуховой интеграции, биоакустическая коррекция, терапия сенсорной интеграции, микрополяризация, пет-терапия и диета, не должны рекомендоваться в качестве альтернативных методов терапии и могут использоваться только в дополнение к методам лечения на основе ABA-вмешательства. Не рекомендуется использовать хелатирование, гипербарическую кислородную терапию и холдинг- терапию по причине их установленного вредоносного психологического и физического воздействия. При выборе методов дополнительных и альтернативных вмешательств при РАС мы рекомендуем родителям и клиницистам использовать критерии, предложенные Н. Лофтхаусом и коллегами (2012): могут быть рекомендованы только безопасные, простые, экономные и разумные методы вмешательств, тогда как методы лечения, которые являются рискованными, трудно реализуемыми или дорогими, использовать не следует.

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