Table of Content

10 November 2025, Volume 33 Issue 11

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Professional Forum

The "Language-Social Communication-Cognition" three-dimensional language assessment and intervention model: Clinical application of Theory of Mind in language assessment and intervention

Xueman Liu, Jill de Villiers

2025, 33(11):  1170-1178.  DOI: 10.11852/zgetbjzz2025-1227

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This paper explores the establishment of a "Language-Social Communication-Cognition" three-dimensional model for children′s language assessment and intervention, grounded in the clinical reasoning framework for broadly defined language disorders.First, it lists the common language and communication issues in children with neurodevelopmental disorders and outlines evidence-based early language intervention approaches that align with this three-dimensional model.As children enter the preschool and school-age years, this model aids in the differential diagnosis process by analyzing the distinct root causes of language disorders, autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability.Neither early language intervention approaches nor linear language intervention processes are effective in advancing the critical skills these children need for academic learning and social participation.This paper emphasizes the crucial role of "Theory of Mind" ability within the three-dimensional model during this stage and dedicates a section to its detailed elaboration.Finally, the paper proposes a narrative-based language intervention system that implements the "Language-Social Communication-Cognition" model in practice, with three dimensions advancing together and synergistically, and explains its evidence-based foundation and clinical procedures.

New perspectives and appraisal on Chinese developmental dyslexia

JING Jin

2025, 33(11):  1179-1185.  DOI: 10.11852/zgetbjzz2025-1037

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Chinese developmental dyslexia (DD), characterized by its unique logographic writing system, exhibits distinct cognitive and neural mechanisms from dyslexia in alphabetic languages. Recent years have witnessed a significant broadening of research perspectives on Chinese DD, encompassing its cognitive underpinnings, cross-linguistic comparisons, objective biomarkers, and ecological support systems. These advances reveal the multidimensionality and complexity inherent in Chinese DD. This article provides an overview, concise evaluation, and recommendations regarding these research developments, aiming to offer insights for future studies on Chinese DD.

Original Articles

Development, reliability and validity analysis of the Children′s Phonological Awareness Assessment Scale

YAO Mengmeng, XU Qu, WANG Xiuhong, HU Wenxin, WANG Jingyu, HONG Qin, CHI Xia

2025, 33(11):  1186-1190.  DOI: 10.11852/zgetbjzz2025-0465

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Objective To develop a phonological awareness assessment scale suitable for Mandarin-speaking children aged 5-8 in China, and to examine its reliability and validity, so as to provide a scientific tool for the early clinical identification and intervention of children with reading difficulties. Methods The scale framework and items were constructed, followed by revisions through expert consultation, small-sample pilot testing, and preliminary predictive studies.Standardized audio recording processing and a playback program were also developed.Using a multi-stage sampling method, 298 children aged 5-8 were included to evaluate the scale′s reliability and validity. Results The final phonological awareness assessment scale consisted of 58 items across five dimensions.Reliability tests showed that the Cronbach′s α coefficients for each dimension ranged from 0.728 to 0.890, and test-retest reliability ranged from 0.632 to 0.760.Content validity was ensured through dual strategies of expert consultation and small-sample pilot testing.In terms of validity, construct validity analysis indicated that scores across all dimensions of the phonological awareness scale increased with age (Z=3.036, H values: 82.958-127.472, P<0.05).Using the rapid automatized naming test as the criterion tool, scores in syllable, onset, rime, and tone awareness showed significant negative correlations with naming time (r values:-0.343 to -0.617, P<0.05). Conclusions The Children′s Phonological Awareness Assessment Scale is suitable for Mandarin-speaking children aged 5-8, demonstrating good reliability and validity.It provides a theoretical basis for the early identification and intervention of children with reading difficulties.

Association of natural transition of night wakings with emotional and behavioral problems in preschool children

YANG Zihan, DENG Yujiao, LIU Jieqiong, ZHU Qi, ZHAO Jin, ZHANG Yunting, WANG Guanghai, JIANG Fan

2025, 33(11):  1191-1195.  DOI: 10.11852/zgetbjzz2024-1350

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Objective To explore the natural transition of night wakings(NWs) problems in preschoolers and their association with emotional and behavioral problems, in order to provide theoretical basis for comprehensively promoting the sleep and mental health of preschool children. Methods Using the stratified cluster random sample method, a sample of preschoolers from 16 districts in Shanghai was recruited for baseline investigation in November 2016, and follow-up visit was in April 2019 before graduation.Children′s Sleep Habits Questionnaire was used to assess NWs and the natural transition, and the Strengths and Difficulties Questionnaire was used to assess children′s emotional and behavioral problems(EBPs) reported by primary caregivers.Logistic regression analysis was used to investigate the correlation between natural transition of NWs and EBPs. Results A total of 17 194 children completed both surveys.The prevalence of frequent NWs at entry and graduation years was 8.01% and 4.26%, respectively.Children were categorized into four groups based on their natural transition of NWs, including 88.63% in the no NWs group, 7.11% in the disappeared NWs group, 3.36% in the incident NWs group, and 0.90% in the persistent NWs group.Compared with the no NWs group, the disappeared NWs group (OR=1.43, 95%CI:1.21-1.69), the incident NWs group (OR=3.98, 95%CI:3.29-4.82) and the persistent NWs group (OR=2.66, 95%CI:1.82-3.88) exhibited a higher risk of EBPs (P＜0.001). Conclusion Persistent or incident NWs problems, are associated with the increase risk of EBPs, suggesting that early and comprehensive intervention should be carried out to promote the sleep and mental health.

Association between socio-emotional development levels and caregiver parenting stress in children aged 0-3

JIANG Jiajun, XIAO Jiayu, WANG Yifan, SONG Ruili, YAO Shaolan, TONG Lian

2025, 33(11):  1196-1200.  DOI: 10.11852/zgetbjzz2025-0142

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Objective To examine the association between caregiver parenting stress and social-emotional development in infants and toddlers, in order to provide scientific evidence for early childhood development promotion and the creation of a fertility-friendly society. Methods During November to December 2024, a stratified sampling method was employed to survey 487 primary caregivers of children aged 0-3 years in Sheyang County, Jiangsu Province.The Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2) and the Parenting Stress Index-Short Form (PSI-SF) were used to assess children′s social-emotional development and caregiver parenting stress, respectively. Results In this study, 13.1% and 6.8% of children scored close to or above the ASQ:SE-2 cutoff, respectively.ASQ:SE-2 scores increased with age (β=0.260, P<0.001).The average score of PSI-SF among caregivers was 79.13±26.62, with 24.6% reporting high parenting stress.Multiple linear regression analysis revealed that overall caregiver parenting stress (β=0.371, P<0.001) and the "difficult child" subscale (β=0.253, P=0.004) were significantly positively associated with poorer social-emotional outcomes in children, indicating that higher caregiver stress correlated with lower child social-emotional competence. Conclusions Infant and toddler social-emotional development is closely linked to caregiver parenting stress.Early screening for behavioral and psychological development should be implemented, along with interventions to alleviate caregiver stress and foster supportive rearing environments, thereby promoting high-quality population development.

Efficacy of virtual reality-based rehabilitation training for preschool-aged children with autism spectrum disorders

GUO Naiqi, CHU Liting, YAO Yukai, MA Chenhuan, LU Dingjie, LI Xiaoqian, WANG Yu

2025, 33(11):  1201-1206.  DOI: 10.11852/zgetbjzz2024-1216

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Objective To evaluate the therapeutic efficacy of virtual reality (VR)-based rehabilitation training for children with autism spectrum disorder (ASD), in order to provide a theoretical foundation for digital interventions in ASD treatment. Methods From December 2023 to April 2024, a total of 60 children diagnosed with ASD at the Department of Child Health Medicine, Shanghai Children′s Hospital were randomly assigned to either an intervention group or a control group.The control group received early family intervention guided by a rehabilitation team, while the intervention group underwent VR-based rehabilitation training once a week for one hour per session additionally.Therapeutic outcomes were assessed before and after the intervention using the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Strengths and Difficulties Questionnaire (SDQ), and Social Responsiveness Scale (SRS). Results Before the intervention, there were no statistically significant differences in ABC, CARS, SDQ, and SRS scores between the intervention and control groups (P>0.05).After the intervention, the intervention group showed significantly lower scores in the sensory, social, and motor factors of the ABC, as well as in the total ABC and CARS scores, compared to the control group (t=2.253, 2.113, 2.162, 3.364, 2.742, P < 0.05).The SDQ revealed that the intervention group had significantly lower scores in hyperactivity/inattention, peer relationship problems, prosocial behavior, and total difficulties compared to the control group (t=2.084, 3.623, 2.591, 3.074, P < 0.05).The SRS results indicated that the intervention group outperformed the control group in social cognition, social communication, autistic mannerisms, and total scores after the intervention (t =2.012, 2.546, 2.126, 3.507, P<0.05). Conclusions VR-based rehabilitation training demonstrates positive effects on improving core symptoms and social functioning in children with ASD, highlighting its potential for clinical application.However, further research is needed to validate its long-term efficacy and generalizability.

Associative learning and visual perception deficits among children with Tourette Syndrome

ZENG Yanyun, SONG Wujing, ZHANG Juan, CHEN Lijun

2025, 33(11):  1207-1211.  DOI: 10.11852/zgetbjzz2024-1070

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Objective To investigate alterations in associative learning and visual perception in children with Tourette syndrome (TS), in order to provide foundational insights into the mechanisms underlying working memory and visual processing impairments in this population. Methods A total of 75 TS children in the pediatrics department of Dazu Hospital Affiliated to Chongqing Medical University from January 2021 to January 2024 were selected as the study subjects.The participants were stratified into three subgroups based on comorbidity profiles: Sample TS (n=37), TS with comorbid attention-deficit/hyperactivity disorder (TS+ADHD, n=17), and TS with comorbid obsessive-compulsive disorder/obsessive-compulsive behavior (TS+OCD/OCB, n=21).Seventy-five healthy children served as controls.The participants′ associative learning ability was assessed by the Rutgers Acquired Equivalence Test (RAET), and the number of acquisition trials (NAT), acquisition learning error ratio (ALER), retrieval error rate (RER), and generalization error rate (GER) were recorded.Other cognitive assessments included Cambridge Neuropsychological Test Automated Battery (CANTAB) evaluating spatial working memory (SWM),Beery Visual-Motor Integration (Beery VMI) assessing visual-motor integration, visual perception, and motor coordination. Results Compared with controls, TS children showed significantly increased NAT, ALER, and CANTAB total errors (Z=3.744, 4.011, 7.073, P<0.001), reduced visual motor integration score, visual perception score and motion coordination score (Z=6.272, 4.613, 3.608, P<0.001).No significant differences were observed in RER or GER (P>0.05).Compared with the control group, the total number of NAT, ALER and CANTAB errors in TS subgroups was significantly increased (P<0.05), while visual motor integration, visual perception and motion coordination score were significantly decreased (P<0.05).Negative correlations existed between CANTAB errors and VMI visual perception/motor coordination scores in TS children.(r=-0.330, -0.293, P<0.05). Conclusion TS children exhibit impaired associative learning during acquisition (basal ganglia-dependent phase) alongside visual perception and SWM deficits, while hippocampal-dependent retrieval/generalization phases remain intact.

Causal role of mitochondrial-related genes in autism spectrum disorder

WANG Jian, LIU Chang, LIN lin, NIU Tingting, ZHANG Jianying

2025, 33(11):  1212-1217.  DOI: 10.11852/zgetbjzz2024-1255

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Objective To investigate the potential genetic mechanisms of mitochondrial-related genes in Autism Spectrum Disorder (ASD) using Summary-data-based Mendelian Randomization (SMR) and colocalization analysis based on multi-omics data. Methods Methylation quantitative trait loci (mQTLs), expression quantitative trait loci (eQTLs), and protein abundance quantitative trait loci (pQTLs) data were obtained from relevant QTL studies.The associations between mitochondrial-related genes and ASD were evaluated using SMR and colocalization analysis, and validated using datasets from FinnGen, UK Biobank (UKB), and the GWAS Catalog.The causal relationships between methylation, gene expression, and disease risk were further explored using SMR LocusPlot and SMR EffectPlot. Results The expression level of CHCHD3 was negatively associated with ASD risk (OR=0.27, 95%CI: 0.08-0.84).Lower methylation levels of NDUFA13 were associated with increased ASD risk, and upregulation of NDUFA13 expression increased ASD risk (OR=2.55, 95%CI: 1.03-6.28).Colocalization analysis further confirmed strong evidence for colocalization between the CHCHD3 methylation site (cg19918623) and multiple NDUFA13 methylation sites (cg03233793, cg07624705, cg25274157) with ASD risk (PP.H4 > 0.5). Conclusion Multi-omics evidence supports the potential association of mitochondrial-related genes CHCHD3 and NDUFA13 with ASD risk, providing new insights into the pathogenesis of ASD.

Two-sample Mendelian randomization study on the causal associationbetween neural cell adhesion molecule-L1 and autism spectrum disorder

CAI Mingxuan, WU Huiwen

2025, 33(11):  1218-1222.  DOI: 10.11852/zgetbjzz2024-1405

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Objective To analyze the causal relationship between neural cell adhesion molecule-L1 (NCAM-L1) and autism spectrum disorder (ASD) using Mendelian randomization (MR) analysis, in order to identify biological markers for early recognition of ASD in children. Methods Genetic variants of NCAM-L1 were selected as instrumental variables, analyzed in a two-sample MR analysis was performed on the ASD related genetic variation dataset obtained from the publicly available IEU Open GWAS database. Results The MR analysis revealed a negative correlation between NCAM-L1 and the relative risk of ASD using the inverse variance weighted (IVW) method (OR=0.933, 95%CI: 0.829-1.053, P=0.016).A similar association was observed using the weighted median method (OR=0.908, 95%CI: 0.786-1.034, P=0.046).No evidence of horizontal pleiotropy or heterogeneity was detected among the instrumental variables.Sensitivity analysis, including leave-one-out tests and scatterplot visualization, confirmed the robustness of the findings. Conclusion The two-sample MR analysis suggests a causal relationship between NCAM-L1 and ASD, indicating that lower levels of NCAM-L1 are associated with an increased risk of developing ASD.

Review

Advances in assessment tools for disorders of written expression in Chinese

WANG Ziyue, CHI Xia

2025, 33(11):  1223-1227.  DOI: 10.11852/zgetbjzz2025-0467

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Disorder of written expression is a common learning disability among school-age children, with a prevalence rate ranging from 3.8% to 8.6% in China.It significantly affects children′s academic achievement and social functioning.Currently, international researchers have made some progress in the study of written expression disorder, achieving important results in the development and application of assessment tools.However, there remains a lack of a well-constructed assessment system for this disorder in China.Therefore, this paper provides a systematic review of relevant assessment tools developed domestically and internationally.Based on the linguistic features, cognitive-neurological characteristics, and clinical diagnostic criteria, we propose a strategy for the development of assessment tools for disorders of written expression in Chinese, so as to provide a basis for early detection and precise intervention for children with this disorder.

Application of eye-tracking technique in the rehabilitation evaluation of children with autism spectrum disorder

ZHANG Yaru, SHAO Zhi, YANG Guang

2025, 33(11):  1228-1232.  DOI: 10.11852/zgetbjzz2024-0404

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Autism spectrum disorder (ASD) is a severe neurodevelopmental disorder characterized by persistent deficits in social communication and interaction, as well as limited and repetitive behavioral patterns. Due to the unknown etiology and high heterogeneity, the current evaluation of the rehabilitation effect of children with ASD is still mainly based on direct observation and assessment of children′s behaviors. Exploring a more objective evaluation method of rehabilitation effect is not only a powerful evidence to judge whether the treatment is effective, but also can provide more reference indicators for the formulation of intervention plans. Eye-tracking technology, with its non-invasive nature, high precision, ease of use, and high degree of freedom, shows considerable potential for evaluating the rehabilitation outcomes in children with ASD. This article reviews the research, specific advantages, and current applications of eye-tracking technology in assessing the rehabilitation outcomes in children with ASD, aiming to provide methods and perspectives for studying the physiological and psychological characteristics of these children and the objective evaluation of clinical interventions effects.

Comorbidity and differential diagnosis of autism spectrum disorder and attention-deficit/hyperactivity disorder

DUAN Cailing, ZHOU Xue, LIU Lijun, LIU Yinchi, GUO Lanmin

2025, 33(11):  1233-1239.  DOI: 10.11852/zgetbjzz2024-0822

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Autism spectrum disorder (ASD), as a neurodevelopmental disorder, often co-occurs with other psychiatric conditions. Approximately 96% of children with ASD have at least one comorbid condition, such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder, intellectual disability, anxiety disorders, bipolar disorder, depression, and tic disorders, among which ADHD is the most common. ASD and ADHD have a high overlap in genetics, immune system, intestinal microbiota, environmental exposure and behavioral manifestations, and there is a lack of clear distinguishing markers. Since the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which permits comorbid diagnosis of ASD and ADHD, there has been a lack of expert consensus and guidelines, making the clinical differential diagnosis of ASD, ADHD, and their comorbidities challenging. Therefore, this article elucidates the similarities and differences among ASD, ADHD, and their comorbidities in terms of pathogenic mechanisms and clinical symptoms, which has potential significance for future research on biomarkers of the three and development of cross-diagnostic assessment tools.

Research progress on family intervention for toddlers with autism spectrum disorder

YE Qinyi, LI Xueyan, XU Xiu

2025, 33(11):  1240-1245.  DOI: 10.11852/zgetbjzz2024-0699

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Autism spectrum disorder (ASD) is a neurodevelopmental disorder, and early scientific intervention can significantly improve the prognosis of children with ASD. Family intervention plays an important role in the early intervention of ASD in young children. An increasing number of research teams have developed parent-mediated intervention models based on naturalistic developmental behavioral intervention (NDBI). This review summarizes the primary evidence-based family intervention models, analyzes empirical research on these models in young children with ASD, and discusses methods to enhance the feasibility and effectiveness of interventions, so as to provide reference and insights for the better implementation of family intervention practices and research in China.

Research progress on microglia and triggering receptor expressed on myeloid cells 2 in autism spectrum disorder

LU Min, WEI Hua

2025, 33(11):  1246-1251.  DOI: 10.11852/zgetbjzz2024-0632

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Autism spectrum disorder (ASD) is a neurodevelopmental disorder in which the interaction between genetic and environmental factors plays a crucial role in its pathogenesis.In recent years, an increasing number of studies have focused on the role of neuroimmune alterations in the mechanism underlying ASD. Microglia, the immune cells in the central nervous system, have been implicated closely with ASD through numerous studies, which suggest an abnormal activation of microglia. The construction of neural networks and synaptic extension in ASD are also associated with the interactions between microglia and neurons. Triggering receptor expressed on myeloid cells 2 (TREM2), specifically expressed on microglia in the central nervous system, regulates microglia activation and function through multiple signaling pathways. It is recognized as a major pathologically induced immune signaling transduction hub in various neurodevelopmental disorders and represents a novel therapeutic target. Recent studies indicate that TREM2 may be involved in the pathogenesis and progression of ASD, although the specific mechanisms await further investigation. This article integrates domestic and international research progress to elucidate thecorrelation of microglia and TREM2 with the occurrence and development of ASD, as well as their possible mechanisms. Additionally, it discusses the potential of these factors as new therapeutic targets for ASD.

Advances in mechanisms underlying autism spectrum disorder in offspring induced by maternal immune activation

WANG Jin, SHEN Kexin, CHEN Jie, DING Yuan

2025, 33(11):  1252-1255.  DOI: 10.11852/zgetbjzz2024-0784

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Autism spectrum disorder(ASD) is a neurodevelopmental disorder primarily characterized by social impairments and repetitive, stereotyped behaviors, resulting from the combined effects of genetic and environmental factors. Maternal immune activation (MIA) has been recognized as one of the significant risk factors for the occurrence of ASD in offspring. Recent studies have implicated MIA in metabolic disorder, disrupted gut microbiota, epigenetic alterations, and neuroinflammation associated with ASD. However, the specific underlying mechanisms remain elusive. Therefore, this study aims to provide theoretical support for the etiology research of ASD by comprehensively reviewing the mechanisms pertaining to the elevated risk of ASD associated with MIA.

Clinical Research

Characteristics of speech evoked auditory brainstem response in 120 preschool children

CHEN Bilan, LIU Panting, SUN Yuying, YU Xinyue, ZHOU Jia, LI Tingyu,XU Yaqin, MENG Liping, ZHANG Lei,QIAN Jun, CHI Xia, HONG Qin

2025, 33(11):  1256-1260.  DOI: 10.11852/zgetbjzz2024-1410

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Objective To analyze the characteristics and influencing factors of speech-evoked auditory brainstem response (speech-ABR) in typically developed preschool children of different ages and genders, and to understand the development of auditory processing abilities in this population. Methods A total of 120 typically developed preschool children participating in the Nanjing norm study of the Preschool Auditory Processing Assessment Scale in August 2021 were selected for speech-ABR testing.Age and gender differences in speech-ABR parameters, as well as their influencing factors, were analyzed. Results 1) Statistically significant differences in the amplitude of the C-wave were observed among the 4-, 5-, and 6-year-old groups (H=6.950, P<0.05).Post-hoc pairwise comparisons revealed a significant difference between the 5- and 6-year-old groups (P=0.012).2) Boys exhibited prolonged latencies in waves V (Z=3.449), A (Z=2.845), D (Z = 2.111), F (Z=3.450), and O (Z=2.856) compared to girls (P<0.05).Wave amplitudes showed no significant gender-based differences (P>0.05).3) Stepwise multiple linear regression analysis indicated that male gender was associated with longer V-wave latency (β=0.290).Maternal pregnancy age at 25-29 years old (reference:≥35 years old) was associated with shorter V-wave latency (β =-0.219).Preterm birth<37 weeks (reference:≥37 weeks) was associated with shorter C-wave latency (β=-0.254).Higher maternal education level of bachelor′s degree or above (reference: college-educated group) was associated with greater V-wave amplitude (β =-0.200) (all P<0.05). Conclusions Speech-ABR responses in preschool children show significant gender-based differences, with minimal age-related variations.Maternal age at pregnancy, gestational age, and maternal education level may influence brainstem encoding abilities.

Mendelian randomization study on the relationship between inflammatory circulation factors and the risk of tic disorder

ZHANG Lili, SHANG Lili, CUI Heqing, ZHOU Bingyuan, WU Anqi

2025, 33(11):  1261-1269.  DOI: 10.11852/zgetbjzz2024-1112

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Objective To explore the potential causal relationship between inflammatory factors and Tourette′s disorder (TD), and to investigate the mechanisms for treating TD based on these findings. Methods This Mendelian randomization (MR) study utilized genome-wide association study (GWAS) data on inflammatory factors and TD. Independent genetic loci significantly associated with 91 inflammatory factors were selected as instrumental variables based on predefined thresholds. The inverse-variance weighted (IVW) method was primarily used for MR analysis, with results evaluated using odds ratios (ORs) and 95% confidence intervals (CIs). Sensitivity analysis, including leave-one-out analysis, heterogeneity testing, and horizontal pleiotropy testing, were conducted to validate the stability and reliability of the results. Results The analysis revealed statistically significant associations for CCL25 (OR＝1.331, 95%CI: 1.014-1.747, P＝0.040), CD40 (OR＝1.677, 95%CI: 1.025-2.744, P=0.040), and IL-17C (OR＝0.480, 95%CI: 0.269-0.858, P＝0.013). Conclusion CCL25 and CD40 are associated with an increased risk of TD, while IL-17C is associated with a reduced risk of TD.

Clinical characteristics and polysomnography analysis of children with tic disorder

GUO Yingying, ZHANG Tao, JING Yali, WANG Jing, YANG Changhong, MA Duting, XUE Yongxin, YANG Lin, ZHANG Jing

2025, 33(11):  1270-1274.  DOI: 10.11852/zgetbjzz2024-1033

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Objective To explore the sleep characteristics of children with tic disorder (TD), in order to enhance clinicians′ understanding of sleep issues in these patients. Methods A convenience sampling method was used to select 50 TD children who visited the pediatric outpatient department of the Second Affiliated Hospital of Xi′an Jiaotong University from June 2022 to June 2023. Polysomnography (PSG) monitoring for over 15 hours was conducted, and clinical and PSG characteristics were analyzed. Results The prevalence of comorbid sleep disorders in TD children was 70%. Among the 50 cases, reduced sleep efficiency was observed in 23 cases (46%), prolonged sleep latency in 19 cases (38%), and fragmented sleep in 35 cases (70%). Slow-wave sleep (SWS) was reduced in 7 cases, normal in 25 cases, and increased in 18 cases, with an abnormal proportion of 50%. Hypoxemia was present in 27 cases (54%), abnormal arousal index in 10 cases (20%), reduced total sleep time in 5 cases (10%), and decreased REM sleep percentage in 16 cases (32%). Abnormal EEG findings were observed in 18 cases (36%), with 16 cases showing frontal lobe discharges and 2 cases showing central lobe discharges. Reduced SWS was associated with the severity of TD, with severe TD more likely to exhibit reduced SWS, showing statistical significance (χ²＝7.103, P<0.05). Tourette syndrome showed more significant abnormalities in arousal index, with statistical significance (χ²=9.828, P<0.05). Conclusions The prevalence of comorbid sleep disorders in children with TD is as high as 70%. TD not only disrupts sleep architecture but also impairs sleep quality, adversely affecting the physical and mental health development of these children. Clinicians should pay greater attention to sleep problems in children with TD.

Mediating role of behavioral problems and family function in the relationship between core symptoms of autism spectrum disorder and parenting stress

ZHAI Tianyu, YAN Wenjie, DU Yasong, LIU Wenwen, ZHANG Linna, LYU Tao, LI Gaizhi, YANG Caohua

2025, 33(11):  1275-1280.  DOI: 10.11852/zgetbjzz2024-1156

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Objective To investigate the mediating roles of behavioral problems and family function in the relationship between core symptoms of autism spectrum disorder (ASD) and parenting stress, in order to provide insights from both the child and family perspectives to inform strategies for alleviating parenting stress. Methods From February 2012 to August 2018, a cross-sectional continuous study was conducted.A total of 300 children with ASD were assessed using the Autism Behavior Checklist (ABC) and the Strengths and Difficulties Questionnaire (SDQ).Parents were evaluated using the Family Assessment Device (FAD) and the Parenting Stress Index-Short Form (PSI-SF). Results Emotional problems (95%CI: -0.057 6 to -0.017 9) and hyperactivity problems (95%CI: -0.052 9 to -0.019 0) from the SDQ exhibited parallel mediating effects on the relationship between ABC total scores and PSI-SF total scores.Role functioning from the FAD (95%CI: -0.030 6 to -0.000 1) demonstrated a simple mediating effect on the relationship between ABC total scores and PSI-SF total scores. Conclusions Emotional and hyperactivity problems in children with ASD play parallel mediating roles in the impact of ASD symptoms on parenting stress, while family role functioning serves as a simple mediator in this relationship.