目的 了解孤独症患儿的症状特点,进一步理解DSM-Ⅴ的孤独谱系障碍(autism spectrum disorder,ASD)的诊断标准。方法 对经DSM-Ⅳ诊断的466例孤独症患儿进行ABC评估,分析DSM-Ⅳ、ABC各个条目阳性率、不同性别及年龄段的阳性率。结果 1)466例孤独症患儿中,DSM-Ⅳ社交缺陷、言语缺陷、行为、功能延迟中,阳性率最高分别为95.3%,84.8%,79.8%,92.9%。5个条目存在年龄差异,2个条目存在性别差异,男性均高于女性。2)只有263名符合DSM-Ⅴ中社会交流和社会交往缺陷的标准。3)在ABC的57个条目中,阳性率最高的条目是38,占94%,最低的是条目34,占34.2%;男女生在第27条存在差异。结论 使用DSM-Ⅴ之后, ASD 诊断可能会下降,随着年龄增长,患者的社交和言语可能好转,但是行为问题表现更差,性别可能不是影响症状的原因。

Objective To know the characteristics of symptoms in autism,and to understand the diagnostic criteria of autism spectrum disorder (ASD) in DSM-Ⅴ. Methods Children with autism were diagnosed using DSM-Ⅳ criteria and assessed by Autism Behavior Checklist (ABC) in Shanghai Mental Health Center.Then the positive rates of each item in DSM-Ⅳ and ABC,and the difference of every item in DSM-Ⅳ between gender/age were analysed. Results 1)Among 466 autistic children,the highest positive rates of qualitative impairment in social interaction,communication,restricted repetitive and stereotyped patterns of behavior,interest and activities,delays or abnormal functioning were 95.3%,84.8%,79.8%,92.9% respectively.There were differences among ages on marked impairment in the use of multiple nonverbal behaviors;marked impairment in the ability to initiate or sustain a conversation with others; stereotyped and repetitive use of language or idiosyncratic language;apparently inflexible adherence to specific,nonfunctional routines or rituals; delays or abnormal functioning in social interaction.There was difference between boys and girls in language as used in social communication,persistent preoccupation with parts of objects.2) 263 of 466 children diagnosed by DSM-Ⅳ children met DSM-Ⅴ part A.3) The positive rates ranged from 34.2%~94% in ABC,there was difference between genders on item 27. Conclusions With DSM-Ⅴ,the diagnosis of ASD may decrease,social communication and language may get better with age,but the behavior may get worse.Gender may be not the primary factor that affect the symptoms.