应用移动端开展孤独症谱系障碍居家早期筛查的初步研究

doi:10.11852/zgetbjzz2022-1484

中国儿童保健杂志 ›› 2023, Vol. 31 ›› Issue (9): 963-968.DOI: 10.11852/zgetbjzz2022-1484

应用移动端开展孤独症谱系障碍居家早期筛查的初步研究

李亦诚¹, 张媛媛¹, 霍言言¹, 吴丹¹, 马玲¹, 仇晓艳¹, 马晨欢¹, 王健², 罗洁鸣³, 李天舒³, 徐敬⁴, 周洁⁵, 孙婷婷⁶, 沈红英⁷, 徐蕾⁸, 王瑜¹, 陈津津¹

1.上海交通大学医学院附属儿童医院上海市儿童医院儿童保健科,上海 200062;
2.上海市静安区妇幼保健所;
3.上海市黄浦区妇幼保健所;
4.上海市杨浦区妇幼保健所;
5.上海市普陀区妇婴保健院;
6.上海市杨浦区殷行社区卫生服务中心;
7.上海市闵行区虹桥社区卫生服务中心;
8.上海市黄浦区瑞金二路街道社区卫生服务中心

收稿日期:2022-12-09 修回日期:2023-03-12 发布日期:2023-08-31 出版日期:2023-09-10
通讯作者: 陈津津,E-mail:jjvoo@163.com
作者简介:李亦诚(1997-),女,上海人,住院医师,硕士研究生在读,主要研究方向为儿科学。
基金资助:
上海市卫健委老龄化和妇幼健康专项(2020YJZX0207);上海市2022年度“科技创新行动计划”技术标准项目(22DZ2203500);上海申康医院发展中心示范性研究型医师创新转化能力培训项目医企融合创新成果转化专项(SHDC2022CRD012);国家重点研发计划“生育健康及妇女儿童健康保障”重点专项(2022YFC2705200);上海申康医院发展中心市级医院新兴前沿技术联合攻关项目(SHDC12022114);上海申康医院发展中心临床三年行动计划资助(SHDC2020CR1047B);上海申康医院发展中心2021年临床科技创新项目(SHDC22021305-B)

Preliminary study on the application of mobile terminal in the early screening for autism spectrum disorder in children at home

LI Yicheng¹, ZHANG Yuanyuan¹, HUO Yanyan¹, WU Dan¹, MA Ling¹, QIU Xiaoyan¹, MA Chenhuan¹, WANG Jian², LUO Jieming³, LI Tianshu³, XU Jing⁴, ZHOU Jie⁵, SUN Tingting⁶, SHEN Hongying⁷, XU Lei⁸, WANG Yu¹, CHEN Jinjin¹

1. Department of Child Health Care, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062,China;
2. Shanghai Jing'an District Maternal and Child Health Care Institute;
3. Shanghai Huangpu District Maternal and Child Health Care Institute;
4. Shanghai Yangpu District Maternal and Child Health Care Institute;
5. Shanghai Putuo District Maternal and Child Health Care Hospital;
6. Yinhang Community Health Service Center, Yangpu District, Shanghai;
7. Hongqiao Community Health Service Center, Minhang District, Shanghai;
8. Community Health Service Center of Ruijin 2nd Road, Huangpu District, Shanghai

Received:2022-12-09 Revised:2023-03-12 Online:2023-09-10 Published:2023-08-31
Contact: CHEN Jinjin, E-mail: jjvoo@163.com

摘要/Abstract

摘要： 目的探究使用移动端在上海市0~36月龄婴幼儿中开展孤独症谱系障碍(ASD)早期筛查的临床应用价值,指导早期家庭干预。方法采取分层抽样的方式,在上海市随机抽取12家二、三级妇幼保健机构,选择建档常规体检的0～36月龄婴幼儿,应用修订的ASD早期筛查量表作为筛查工具,进行ASD居家线上筛查。分析首次和二次筛查率、筛查阳性率、阳性分布和相关影响因素等调查结果。结果参与社区ASD早期筛查的对象总计2 748人,累计筛查3 472人次,有效筛查3 317人次,有效筛查率为95.54%,二次筛查率为19.10%。筛查结果异常有308人,筛查阳性率为9.62%,其中男童的阳性率为12.44%,显著高于女童(6.51%)(χ²=33.45,P<0.05)。在筛查次数≥2次组中,有68名婴幼儿存在≥1次筛查结果异常,其中34名根据社区“健康促进指导”进行家庭干预随访结果正常,家庭干预有效率为50%。筛查能区未通过情况在各年龄组间分布有显著差异,大动作未通过者集中于12月龄前,语言及精细动作未通过者集中于18～24月龄,个人社交未通过者集中于24～30月龄。在“五不”行为阳性的婴幼儿中,“不语”行为的婴幼儿占大多数(65.17%)。结论应用移动端开展婴幼儿ASD居家早期筛查模式具有良好的临床应用价值。推动社区-家庭早期ASD干预,可调动养育者和基层儿童保健服务人员的主观能动性,提高基层妇幼保健机构早期识别能力和干预技能,引导养育者了解婴幼儿早期发展规律并提供回应性照护,更好地预防ASD的发生和发展。

关键词: 孤独症谱系障碍, 社区筛查, 早期筛查, 神经发育障碍, 移动端

Abstract: Objective To explore the clinical application value of using mobile terminal for early screening of autism spectrum disorder (ASD) in children aged 0 - 36 months in Shanghai, in order to guide early family intervention. Methods A stratified sampling method was used to randomly select 12 secondary and tertiary maternal and child health care institutions in Shanghai. Children aged 0 - 36 months who underwent routine community physical examination were selected. The revised ASD early screening scale was used as the screening tool to conduct ASD early screening online at home. The primary and secondary screening rate, screening positive rate, positivity distribution and related influencing factors were analyzed. Results A total of 2 748 infants and toddlers participated in the early screening of ASD in the community, with a total of 3 472 screenings and 3 317 valid screenings, representing a valid screening rate of 95.54% and a secondary screening rate of 19.10%. There were 308(9.62%) cases with abnormal screening results, among which the positive rate of boys was 12.44%, significantly higher than that of girls (6.51%) (χ²=33.45, P<0.05). Among those who were screened ≥2 times, 68 children had abnormal screening at least for 1 time, 34 children finally had normal follow-up result with home intervention based on the community health promotion guidance, and the effective rate of home intervention was 50%. There were significant differences in the distribution of screening dimension failures among different age groups. Failure in gross motor skills was concentrated before 12 months of age, failure in language and fine motor skills was concentrated between 18 and 24 months of age, and failure in personal social skills was concentrated between 24 and 30 months of age. The majority (65.17%) represented "no speech" behavior among children who failed in the "five no" screening test. Conclusions The mobile terminal has good clinical application value in early screening of ASD in children at home. Promoting early ASD intervention in community-family is helpful to mobilize the subjective initiative of home and community, improve the early identification capabilities of caregivers and primary care professionals, guide caregivers to understand the law of early development of children and provide responsive care, so as to better prevent ASD and reverse ASD outcomes effectively.

Key words: autism spectrum disorder, community screening, early screening, neurodevelopmental disorders, mobile device

中图分类号:

R749.94

李亦诚, 张媛媛, 霍言言, 吴丹, 马玲, 仇晓艳, 马晨欢, 王健, 罗洁鸣, 李天舒, 徐敬, 周洁, 孙婷婷, 沈红英, 徐蕾, 王瑜, 陈津津. 应用移动端开展孤独症谱系障碍居家早期筛查的初步研究[J]. 中国儿童保健杂志, 2023, 31(9): 963-968.

LI Yicheng, ZHANG Yuanyuan, HUO Yanyan, WU Dan, MA Ling, QIU Xiaoyan, MA Chenhuan, WANG Jian, LUO Jieming, LI Tianshu, XU Jing, ZHOU Jie, SUN Tingting, SHEN Hongying, XU Lei, WANG Yu, CHEN Jinjin. Preliminary study on the application of mobile terminal in the early screening for autism spectrum disorder in children at home[J]. Chinese Journal of Child Health Care, 2023, 31(9): 963-968.

参考文献

[1] 儿童孤独症诊疗康复指南(卫办医政发〔2010〕123号)[J]. 中国儿童保健杂志, 2011, 19(3):289-294.
[2] Maenner MJ, Shaw KA, Bakian AV, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years-Autism and developmental disabilities monitoring network, 11 sites, United States, 2018[J]. MMWR Surveill Summ, 2021, 70(11):1-16.
[3] Blumberg SJ, Bramlett MD, Kogan MD, et al. Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011-2012[J]. Natl Health Stat Report, 2013 (65):1-11.
[4] Zylstra RG, Prater CD, Walthour AE, et al. Autism: Why the rise in rates?[J]. J Fam Pract, 2014, 63(6):316-320.
[5] Blenner S, Augustyn M. Is the prevalence of autism increasing in the United States?[J]. BMJ, 2014, 348: g3088.
[6] 刘贤, 林穗方, 陈文雄, 等. 中国儿童孤独症谱系障碍患病率Meta分析[J]. 中国儿童保健杂志, 2018, 26(4):402-406, 429.
Liu X, Lin SF, Chen WX, et al.Prevalence of autism spectrum disorders among children in China:A systematic review and meta-analysis[J].Chin J Child Health Care, 2018, 26(4):402-406, 429. (in Chinese)
[7] Poon KK, Sidhu DJ. Adults with autism spectrum disorders: A review of outcomes, social attainment, and interventions[J]. Curr Opin Psychiatry, 2017, 30(2):77-84.
[8] Zwaigenbaum L, Bauman ML, Fein D, et al. Early screening of autism spectrum disorder: Recommendations for practice and research[J]. Pediatrics, 2015, 136(Suppl 1):41-59.
[9] Sanchack KE, Thomas CA. Autism spectrum disorder: Primary care principles[J]. Am Fam Physician, 2016, 94(12):972-979.
[10] 中华医学会儿科学分会发育行为学组, 中国医师协会儿科分会儿童保健专业委员会, 儿童孤独症诊断与防治技术和标准研究项目专家组. 孤独症谱系障碍儿童早期识别筛查和早期干预专家共识[J]. 中华儿科杂志, 2017, 55(12):890-897.
DevelopmentalBehaviour Group of the Paediatrics Branch of the Chinese Medical Association, Child Health Care Committee of the Paediatrics Branch of the Chinese Medical Association, Research Group on Techniques and Standards for the Diagnosis and Prevention of Childhood Autism. Consensus on early identification screening and early intervention for autism spectrum disorder[J]. Chin J Pediatrics, 2017, 55(12):890-897. (in Chinese)
[11] Thabtah F, Peebles D. Early autism screening: A comprehensive review[J]. Int J Environ Res Public Health, 2019, 16(18):3502.
[12] Salomone E, Charman T, Mcconachie H, et al. Child's verbal ability and gender are associated with age at diagnosis in a sample of young children with ASD in Europe[J]. Child Care Health Dev, 2016, 42(1):141-145.
[13] Sheldrick RC, Maye MP, Carter AS. Age at first identification of autism spectrum disorder: An analysis of two US surveys[J]. J Am Acad Child Adolesc Psychiatry, 2017, 56(4):313-320.
[14] 黎文倩, 刘晓, 代英, 等. 孤独症谱系障碍儿童的诊断年龄及其影响因素[J]. 中国当代儿科杂志, 2018, 20(10):799-803.
Li WQ, Liu X, Dai Y, et al.Age of diagnosis of autism spectrum disorder in children and factors influencing the age of diagnosis[J].Chin J Contemp Pediatr, 2018, 20(10):799-803. (in Chinese)
[15] 戴琼, 徐海青, 汪鸿, 等. 2000-2016年中国儿童孤独症谱系障碍患病率Meta分析[J]. 中国儿童保健杂志, 2017, 25(12):1243-1246.
Dai Q,Xu HQ, Wang H, et al.Prevalence of autism spectrum disorder in Chinese children from 2010 to 2016:A meta-analysis[J]. Chin J Child Health Care, 2017, 25(12):1243-1246. (in Chinese)
[16] 骆名进, 宋海东, 刘健, 等. 儿童孤独症社区早期综合干预现况及可行模式探讨[J]. 中国康复医学杂志, 2017, 32(1):82-84.
[17] 郭翠华, 罗美芳, 王旭祥, 等. 三甲医院和社区孤独症谱系障碍早期筛查的结果比较[J]. 中国儿童保健杂志, 2018, 26(4):372-375.
Guo CH,Luo MF,Wang XX, et al. Comparison of the early screening results for autism spectrum disorder in Grade Ⅲ level A hospitals and community health services[J].Chin J Child Health Care, 2018, 26(4):372-375. (in Chinese)
[18] Maenner MJ, Shaw KA, Baio J, et al. Prevalence of autism spectrum disorder among children aged 8 years - Autism and developmental disabilities monitoring network, 11 sites, United States, 2016[J]. MMWR Surveill Summ, 2020, 69(4):1-12.

应用移动端开展孤独症谱系障碍居家早期筛查的初步研究

Preliminary study on the application of mobile terminal in the early screening for autism spectrum disorder in children at home

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