目的 探索和评价附后续访谈的改良版婴幼儿孤独症筛查量表(M-CHAT-R/F)联合年龄与发育进程问卷第三版(ASQ-3)筛查幼儿孤独症谱系障碍(ASD)的效果,为孤独症的早期识别提供指导。方法 以2016年8月-2017年3月在全国6家医院儿童保健科做常规保健,并且M-CHAT-R初筛阳性(筛查分数≥3分)的291名16~30月龄儿童为研究对象,由家长填写与儿童月龄相匹配的 ASQ-3问卷,测评儿童在沟通(C)、粗大动作(GM)、精细动作(FM)、解决问题(SP)、个人-社会(PS)等能区的发展水平。初筛阳性儿童由专科医师进一步根据DSM-5进行确诊。比较ASQ-3联合M-CHAT-R/F与单独使用M-CHAT-R/F对ASD筛查的阳性预测值(PPV)。结果 291例M-CHAT-R/F初筛阳性儿童中最终确诊ASD患儿53例,M-CHAT-R初筛对于ASD筛查的PPV为0.18。在初筛阳性、确诊者中,ASQ-3五大能区可疑发育迟缓率最高的均为C能区,其次为PS,将C和PS能区均不通过作为预测因子,其在M-CHAT-R初筛阳性群体中对于ASD筛查的PPV为0.43,在未做后续访谈前,可显著提高M-CHAT-R筛查ASD的PPV(0.43 vs 0.18,P<0.001)。结论 ASQ-3联合M-CHAT-R/F可提高对婴幼儿ASD筛查的阳性预测值,建议对M-CHAT-R/F筛查阳性的婴幼儿辅以ASQ-3评估。
Abstract
Objective To evaluate the efficacy of screening of autism spectrum disorders (ASDs) by using the Modified Checklist for Autism in Toddlers-Revised with Follow Up (M-CHAT-R/F) combined with the Ages and Stages Questionnaire-Third Edition(ASQ-3),in order to provide scientific basis for early identification of autism. Methods Totally 291 toddlers aged 16~30 months who have conducted routine health care in six hospitals and with positive screening Results of M-CHAT-R were enrolled in this study from August 2016 to March 2017,and the parents were invited to fill out ASQ-3 to assess the children's development of communication (C),gross motor (GM),,fine motor (FM),problem solving (SP),and personal-social (PS).Meanwhile,these children were referred to specialists for diagnostic evaluations according to DSM-5.The positive predictive value (PPV) for ASD of M-CHAT-R/F alone and that of M-CHAT-R/F combined with ASQ-3 were compared. Results A total of 53 of the 291 toddlers were diagnosed with ASD.The PPV for ASD of M-CHAT-R was 0.18.The communication domain of ASQ-3 had the highest suspicious developmental delay rate in both M-CHAT-R screening positive group and ASD group,followed by PS domain.The PPV for ASD detection could be increased to 0.43 using communication and PS domains as predictors on the basis of M-CHAT-R.Without follow-up interview,ASQ-3 could greatly improve the PPV of M-CHAT-R (0.43 vs.0.18,P<0.001). Conclusions M-CHAT-R combined with ASQ-3 could improve the screening effcacy of toddlerhood ASD.It is recommended to conduct assessment by ASQ-3 for toddlers with positive screening Results of M-CHAT-R.
关键词
筛查 /
孤独症谱系障碍 /
改良版婴幼儿孤独症筛查量表 /
年龄与发育进程问卷 /
阳性预测值
Key words
screening /
autism spectrum disorder /
Modified Checklist for Autism in Toddlers-Revised with Follow Up /
Ages and Stages Questionnaire /
positive predictive value
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