孤独症谱系障碍和发育性语言障碍儿童发育水平的差异研究

doi:10.11852/zgetbjzz2024-1421

中国儿童保健杂志 ›› 2025, Vol. 33 ›› Issue (4): 451-455.DOI: 10.11852/zgetbjzz2024-1421

孤独症谱系障碍和发育性语言障碍儿童发育水平的差异研究

杨逸凡¹, 肖雪斌¹, 谭亚飞¹, 王仕琼¹, 李瑞珍¹, 贾美香²

1.华中科技大学同济医学院附属武汉儿童医院(武汉市妇幼保健院),湖北武汉 430016;
2.北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心(北京大学第六医院)

收稿日期:2024-11-29 修回日期:2025-03-10 发布日期:2025-04-10 出版日期:2025-04-10
通讯作者: 贾美香,E-mail:fine_gf@163.com
作者简介:杨逸凡(1988—),男,主治医师,硕士学位,主要研究方向为儿童神经发育障碍性疾病和儿童心理卫生。
基金资助:
深圳深爱公益“孤独症专项研究基金”(SA202300108)

Developmental differences between children with autism spectrum disorder and developmental language disorders

YANG Yifan¹, XIAO Xuebin¹, TAN Yafei¹, WANG Shiqiong¹, LI Ruizhen¹, JIA Meixiang²

1. Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei 430016, China;
2. Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health(Peking University), National Clinical Research Center for Mental Disorders(Pecking University Sixth Hospital)

Received:2024-11-29 Revised:2025-03-10 Online:2025-04-10 Published:2025-04-10
Contact: JIA Meixiang, E-mail: fine_gf@163.com

摘要/Abstract

摘要： 目的比较孤独症谱系障碍(ASD)和发育性语言障碍 (DLD)儿童适应性、大运动、精细动作、语言、个人-社交能力发育水平的差异,为鉴别诊断和康复训练提供依据。方法选取2022年3月—2024年5月在武汉儿童医院儿童保健科就诊的268例ASD儿童和150例DLD儿童,对以上儿童均采用Gesell发育量表进行评估。结果 ASD和DLD组儿童在适应性、大运动、精细运动、语言、个人-社交5个领域的均值均低于正常水平,两者均为语言和社交领域的分值最低,且ASD组上述5个领域的发育水平均明显滞后于DLD组(t'=8.541、4.398、7.194、6.405、9.354,P＜0.001);语言商%×社交商%＜0.39时,鉴别诊断ASD的敏感性和特异性分别为69%和65%(OR=0.96,95%CI:0.94～0.97,P＜0.001)。结论 ASD和DLD儿童在5个领域的发育水平上均有受损,ASD组各能区受损更重,且两者均以语言和社交领域受损最重,这些差异有助于临床鉴别诊断和早期干预。

关键词: 孤独症谱系障碍, 发育性语言障碍, Gesell发育量表

Abstract: Objective To compare the differences in developmental levels of adaptive behavior, gross motor skills, fine motor skills, language, and personal-social abilities between children with autism spectrum disorder (ASD) and developmental language disorder (DLD), in order to provide a basis for differential diagnosis and rehabilitation training. Methods A total of 268 children with ASD and 150 children with DLD who visited the Child Health Department of Wuhan Children's Hospital from March 2022 to May 2024 were selected.All children were assessed using the Gesell Developmental Scale. Results The mean scores of children in both the ASD and DLD groups were below the normal level in the five domains of adaptive behavior, gross motor skills, fine motor skills, language, and personal-social abilities.Both groups scored the lowest in the language and social domains.The developmental levels in all domains were significantly more delayed in the ASD group compared to the DLD group (t'=8.541, 4.398, 7.194, 6.405, 9.354, P<0.001).When the product of language quotient (%) and social quotient (%) was less than 0.39, the sensitivity and specificity for diagnosing ASD were 69% and 65%, respectively (OR=0.96, 95% CI: 0.94-0.97, P<0.001). Conclusions Children with ASD and children with DLD both have impairments in the five developmental domains, with the ASD group showing more severe deficits.Both groups exhibit the most significant impairments in the language and social domains.These differences are helpful for clinical differential diagnosis and early intervention.

Key words: autism spectrum disorder, developmental language disorders, Gesell Developmental Scale

中图分类号:

R749.94

杨逸凡, 肖雪斌, 谭亚飞, 王仕琼, 李瑞珍, 贾美香. 孤独症谱系障碍和发育性语言障碍儿童发育水平的差异研究[J]. 中国儿童保健杂志, 2025, 33(4): 451-455.

YANG Yifan, XIAO Xuebin, TAN Yafei, WANG Shiqiong, LI Ruizhen, JIA Meixiang. Developmental differences between children with autism spectrum disorder and developmental language disorders[J]. Chinese Journal of Child Health Care, 2025, 33(4): 451-455.

参考文献

[1] 杨逸凡,李瑞珍,陈磊,等.孤独症谱系障碍儿童肉碱代谢特点及辅助诊断价值[J].中国心理卫生杂志,2020,34(12):1016-1021.
Yang YF, Li RZ, Chen L, et al.Characteristics of carnitine metabolism and its auxiliary diagnostic value in children with autism spectrum disorders[J].Chin Ment Health J, 2020,34(12):1016-1021.(in Chinese)
[2] 美国精神医学学会.精神障碍诊断与统计手册(第5版)[M].张道龙,刘春宇,童慧琦,等译.北京:北京大学出版社, 2014:19-20.
[3] Lord C, Brugha TS, Charman T, et al.Autism spectrum disorder[J].Nat Rev Dis Primers,2020,6(1):5-23.
[4] Maenner MJ, Warren Z, Williams AR, et al.Prevalence and characteristics of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network,11 sites,United States,2020[J].MMWR Surveill Summ, 2023,72(2):1-14.
[5] 赵亚楠,李智文,李琳,等.中国0～6岁儿童孤独症谱系障碍筛查患病现状[J].中国生育健康杂志,2023,34(5):423-428.
Zhao YN, Li ZW, Li L, et al.The prevalence of ASD screening in children aged 0-6 years old in China[J].Chin J Rep Health, 2023,34(5):423-428.(in Chinese)
[6] 干凯滟,黄安琪,张子一,等.M-CHAT筛查阳性对孤独症谱系障碍早期诊断稳定性的前瞻性研究[J].中国儿童保健杂志, 2024,32(10):1076-1079,1105.
Gan KY, Huang AQ,Zhang ZY,et al.Prospective study of the stability of early diagnosis of autism spectrum disorder with positive screening results of modified checklist for autism in toddlers[J].Chin J Child Health Care, 2024,32(10):1076-1079,1105.(in Chinese)
[7] 康倩倩,叶华,盛誉,等.孤独症谱系障碍儿童发现与确诊的特点[J].中国心理卫生杂志,2022,36(6):481-483.
Kang QQ, Ye H, Sheng Y, et al.Characteristics of detection and diagnosis of children with autism spectrum disorder[J].Chin Ment Health J, 2022,36(6):481-483.(in Chinese)
[8] Buescher AV, Cidav Z, Knapp M, et al.Costs of autism spectrum disorders in the United Kingdom and the United States[J].JAMA Pediatr, 2014,168(8):721-728.
[9] Posar A, Visconti P.Long-term outcome of autism spectrum disorder[J].Turk Pediatri Ars, 2019,54(4):201-212.
[10] Georgiou N, Spanoudis G.Developmental language disorder and autism: Commonalities and differences on language[J].Brain Sci, 2021,11(5):589-590.
[11] Feltner C, Wallace IF, Nowell SW, et al.Screening for speech and language delay and disorders in children 5 years or younger[J].JAMA, 2024,331(4):335-351.
[12] America CDC.Language and speech disorders in children[EB/OL].(2022-10-14)[2023-02-24].https://doi.org/10.2147/NDT.S331987.
[13] O'Hare A, Bremner L.Management of developmental speech and language disorders: Part 1[J].Arch Dis Child,2016,101(3):272-277.
[14] Norbury CF, Gooch D, Wray C, et al.The impact of nonverbal ability on prevalence and clinical presentation of language disorder: Evidence from a population study[J].J Child Psychol Psychiatry, 2016,57(11):1247-1257.
[15] Wu SS,Zhao J, Villiers J, et al.Prevalence, co-occurring difficulties, and risk factors of developmental language disorder:First evidence for Mandarin-speaking children in a population-based study[EB/OL].(2023-2-17)[2024-9-15].https://doi.org/10.1016/j.lanwpc.2023.100713.
[16] Norbury C, Griffiths S, Goh SKY, et al.Developmental language disorder: A hidden condition[J].Lancet Child Adolesc Health, 2024,8(7):473-475.
[17] Conti-Ramsden G, Durkin K, Toseeb U, et al.Education and employment outcomes of young adults with a history of developmental language disorder[J].Int J Lang Commun Disord, 2018,53(2):237-255.
[18] Clegg J, Hollis C, Mawhood L, et al.Developmental language disorders-a follow-up in later adult life.Cognitive, language and psychosocial outcomes[J].J Child Psychol Psychiatry, 2005,46(2):128-149.
[19] Hage SVR, Sawasaki LY, Hyter Y, et al.Social communication and pragmatic skills of children with autism spectrum disorder and developmental language disorder[EB/OL].(2021-12-17)[2024.10.15].https://doi.org/10.1590/2317-1782/20212021075.
[20] 邹小兵,邓红珠.儿童孤独症谱系障碍[J].中国实用儿科杂志,2013,28(8):561-563.
Zhou XB, Deng HZ.Childhood autism spectrum disorder[J].Chin J Pract Pediatr, 2013,28(8):561-563.(in Chinese)
[21] Zampella CJ, Wang LAL, Haley M, et al.Motor skill differences in autism spectrum disorder: A clinically focused review[J].Curr Psychiatry Rep, 2021,23(10):64-75.
[22] Visscher C, Houwen S, Scherder EJ, et al.Motor profile of children with developmental speech and language disorders[J].Pediatrics, 2007,120(1):158-163.
[23] 李丽芳,李晶,张长杰.孤独症谱系障碍儿童的语言障碍特点及提升其语言能力的康复干预模式[J].中国儿童保健杂志, 2025,33(1):97-102.
Li LF, Li J, Zhang CJ.Characteristics of language disorders in children with autism spectrum disorder and rehabilitation intervention mode to improve their language ability[J].Chin J Child Health Care, 2025,33(1):97-102.
[24] Vogindroukas I, Stankova M, Chelas EN, et al.Language and speech characteristics in autism[J].Neuropsychiatr Dis Treat, 2022,18(9):2367-2377.
[25] Reindal L, Nærland T, Weidle B, et al.Structural and pragmatic language impairments in children evaluated for autism spectrum disorder (ASD)[J].J Autism Dev Disord, 2023,53(2):701-719.
[26] Levy SE, Giarelli E, Lee LC, et al.Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States[J].J Dev Behav Pediatr, 2010,31(4):267-275.
[27] Simms MD, Jin XM.Autism, language disorder, and social (pragmatic) communication disorder: DSM-V and differential diagnoses[J].Pediatr Rev, 2015,36(8):355-363.
[28] Reichow B, Hume K, Barton EE, et al.Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD) (Review)[EB/OL].(2018-5-9)[2024-9-15].https://doi.org/10.1002/14651858.CD009260.pub3.
[29] Holloway JM, Long TM, Biasini F.Relationships between gross motor skills and social function in young boys with autism spectrum disorder[J].Pediatr Phys Ther, 2018,30(3):184-190.
[30] Choi B, Leech KA, Tager-Flusberg H, et al.Development of fine motor skills is associated with expressive language outcomes in infants at high and low risk for autism spectrum disorder[J].J Neurodev Disord, 2018,10(14):1-11.

孤独症谱系障碍和发育性语言障碍儿童发育水平的差异研究

Developmental differences between children with autism spectrum disorder and developmental language disorders

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