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孤独症谱系障碍儿童发育水平与核心症状的相关性研究

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目的 探讨不同发育水平孤独症谱系障碍儿童各发育水平与核心症状的相关性.方法 回顾性分析2021年1月至2023年10月在厦门大学附属妇女儿童医院儿童发育行为科首次确诊为孤独症谱系障碍(autism spectrum disorder,ASD)的儿童346例.采用0~6岁小儿神经心理检查评估ASD儿童的发育商,总发育商(developmental quotient,DQ)<70分归为低功能ASD组(n=285),总DQ≥70分归为高功能ASD组(n=61).采用孤独症行为量表(autism behavior checklist,ABC)和儿童孤独症评定量表(the child autism rating scale,CARS)评估ASD儿童的核心症状,分析不同发育水平组的核心症状差异及各能区发育商对核心症状的影响.采用SPSS 21.0统计软件进行t检验和多元线性回归分析.结果 (1)低功能ASD组儿童ABC总分[(60.71±22.61)分比(53.23±24.18)分,t=2.316,P=0.021]、感觉因子[(7.96±5.18)分比(6.36±4.60)分,t=2.233,P=0.026]、语言因子[(13.44±5.86)分比(10.46±5.52)分,t=3.641,P<0.001]、CARS 总分[(34.59±5.18)分比(31.07±5.72)分,t=4.731,P<0.001]、人际关系[(2.82±0.66)分比(2.57±0.67)分,t=2.604,P=0.01]、模仿[(3.01±0.76)分比(2.61±0.88)分,t=3.646,P<0.001]、情感反应[(2.33±0.77)分比(1.97±0.73)分,t=3.41,P<0.001]、躯体运用能力[(2.01±0.78)分比(1.77±0.72)分,t=2.249,P=0.025]、近处感觉反应[(1.52±0.70)分比(1.31±0.53)分,t=2.163,P=0.031]、语言交流[(3.19±0.64)分比(2.90±0.70)分,t=3.141,P=0.002]、非语言交流[(2.68±0.62)分比(2.20±0.60)分,t=5.595,P<0.001]、活动很大[(2.33±0.78)分比(2.10±0.83)分,t=2.108,P=0.036]、智力功能[(2.14±0.76)分比(1.77±0.72)分,t=3.499,P=0.001]、总的印象[(2.36±0.59)分比(2.13±0.50)分,t=2.891,P=0.004]均高于高功能ASD组儿童.(2)多元逐步线性回归分析显示,在高功能ASD组儿童中,语言和精细动作能区DQ能负向预测CARS总分(β=-0.383,-0.268;均P<0.05);在低功能ASD组儿童中,语言和大运动能区DQ能负向预测CARS总分(β=-0.233,-0.149,均P<0.01).结论 发育水平越低的ASD儿童核心症状越重,精细动作和语言能力对发育水平较高的ASD儿童的核心症状有影响,大运动和语言能力对发育水平低的ASD儿童的核心症状有影响,临床实践中可根据ASD儿童的发育水平来制定相应运动干预计划.
Correlation study between neurodevelopmental level and core symptoms in children with autism spectrum disorder
Objective To explore the correlation between neurodevelopmental levels and core symp-toms in children with autism spectrum disorder(ASD)at different developmental levels.Methods A retro-spective analysis was conducted on 346 children diagnosed with ASD for the first time at the Department of Child Developmental and Behavioral,Women and Children's Hospital,School of Medicine,Xiamen Universi-ty from January 2021 to October 2023.The developmental quotient(DQ)of ASD children was assessed u-sing the 0-6 years old children's neurodevelopmental assessment.A total DQ score less than 70 was classified as the low-functioning ASD group(n=285)and total DQ score more than 70 was classified as high-functio-ning ASD group(n=61).The core symptoms of ASD children were evaluated using the autism behavior checklist(ABC)and childhood autism rating scale(CARS).The analysis focused on comparing the core symptoms among different developmental levels and examining the impact of developmental quotient in vari-ous areas on these core symptoms.SPSS 21.0 statistical software was used for t-test and multiple linear re-gression analysis.Results(1)The total score of ABC((60.71±22.61)vs(53.23±24.18),t=2.316,P=0.021),sensory factor((7.96±5.18)vs(6.36±4.60),t=2.233,P=0.026),language factor((13.44±5.86)vs(10.46±5.52),t=3.641,P<0.001),the total score of CARS((34.59±5.18)v.s(31.07±5.72),t=4.731,P<0.001),relationship to people((2.82±0.66)vs(2.57±0.67),t=2.604,P=0.01),imitation((3.01±0.76)vs(2.61±0.88),t=3.646,P<0.001),emotional response((2.33±0.77)vs(1.97±0.73),t=3.41,P<0.001),body((2.01±0.78)vs(1.77±0.72),t=2.249,P=0.025),taste-smell-touch response and use((1.52±0.70)vs(1.31±0.53),t=2.163,P=0.031),verbal communication((3.19±0.64)vs(2.90±0.70),t=3.141,P=0.002),non-verbal communication((2.68±0.62)vs(2.20±0.60),t=5.595,P<0.001),activity level((2.33±0.78)vs(2.10±0.83),t=2.108,P=0.036),level and consistency of in-tellectual response((2.14±0.76)vs(1.77±0.72),t=3.499,P=0.001),and general impressions of chil-dren((2.36±0.59)vs(2.13±0.50),t=2.891,P=0.004)in the low-functioning ASD group were higher than those in the high-functioning ASD group.(2)Multiple stepwise linear regression analysis showed that children in high-functioning ASD group,language and fine motor domain DQ could negatively predict the total CARS score(β=-0.383,-0.268;both P<0.05).Children in low-functioning ASD group,language and gross motor domains DQ could negatively predict the total CARS score(β=-0.233,-0.149,both P<0.01).Conclusions The lower the development level,the more severe the core symptoms of ASD children.Fine motor and language ability have an impact on the core symptoms of ASD children with higher development level,while gross motor and language ability have an impact on the core symptoms of ASD children with low development level.In clinical practice,appropriate motor intervention plans can be formulated according to the development level of ASD children.

Autism disorder spectrumNeurodevelopmental levelCore symptomsChild

连琼霞、王毅娟、刘文龙

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厦门大学附属妇女儿童医院(厦门市妇幼保健院)儿童发育行为科,厦门 361102

孤独症谱系障碍 发育水平 核心症状 儿童

厦门市妇幼保健院林巧稚科研课题

FYLQZ2020007

2024

中华行为医学与脑科学杂志
中华医学会 济宁医学院

中华行为医学与脑科学杂志

CSTPCD北大核心
影响因子:1.472
ISSN:1674-6554
年,卷(期):2024.33(10)