目的 研究孤独症谱系障碍(ASD)早期诊断的影响因素,为相关政策及研究提供科学依据。方法 对207例于深圳市妇幼保健院确诊的6岁以下ASD儿童的带养人进行现场或电话调查。依据诊断月龄分为早期诊断组(n=48,23.19%)和非早期诊断组(n=159,76.81%),采用调查表、盖瑟尔发育诊断量表(GDDS)、婴儿-初中学生社会生活能力量表(S-M)进行评估,运用单因素分析和逐步Logistic回归探讨影响因素。结果 两组的早期筛查、主要带养人等11个变量有统计学差异(P<0.05)。进行早期筛查有利于早期诊断(OR=4.296,95%CI:1.959~9.423);生活能力水平(OR=0.380,95%CI:0.207~0.698)、粗大运动水平(OR=0.323,95%CI:0.185~0.564)越低,越不利于早期诊断。结论 早期筛查对早期诊断至关重要,应完善当前的ASD早期筛查程序。
Abstract
Objective To investigate factors affecting the early diagnosis of autism spectrum disorders (ASD) in order to provide evidence for further research and policy. Methods Totally 207 ASD cases under six years old diagnosed at Shenzhen Maternity and Child Health care Hospital were recruited,and their caregivers were asked to finish a field survey or telephone survey.According to the diagnostic months,participants were divided into early diagnosis group(n=48,23.19%) and later diagnosis group(n=159,76.81%).Univariate analysis and stepwise Logistic regression analysis were used to compare the influencing factors on questionnaire,results of Gesell Development Diagnosis Scales (GDDS) and Baby-junior high school students ability of social life scale(S-M) between the two groups. Results The two groups were different in 11 factors,such as an early screening of ASD,the main caregivers.Multivarite Logistic analysis showed that early screening of ASD was an favorable factor(OR=4.296,95%CI:1.959~9.423).The more seriously disabled degree of ability for social life(OR=0.380,95%CI:0.207~0.698)and gross motor skill(OR=0.323,95%CI:0.185~0.564),the worse it was for early diagnosis. Conclusion Since the early screening plays a crucial role at early diagnosis,the process of early screening for ASD should be improved.
关键词
孤独症谱系障碍 /
早期诊断 /
早期筛查
Key words
autism spectrum disorders /
early diagnosis /
early screening
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参考文献
[1] Association AP.Diagnostic and statistical manual of mental disorders[M].5 th edition(DSM-Ⅴ).Washington DC:American Psychiatric Publishing,2013.
[2] Lai MC,Lombardo MV,Baron-Cohen S.Autism[J].Lancet,2014,383(9920):896-910.
[3] Christensen DL,Baio J,Van Naarden BK,et al.Prevalence and characteristics of autism spectrum disorder among children aged 8 years--autism and developmental disabilities monitoring network,11 sites,United States,2012[J].MMWR Surveill Summ,2016,65(3):1-23.
[4] 韦臻,任路忠,翁丽芬,等.深圳市18～24月龄婴幼儿孤独症谱系障碍筛查及3年随访研究[J].中国儿童保健杂志,2012,20(4):354-357.
[5] Mandell DS,Novak MM,Zubritsky CD.Factors associated with age of diagnosis among children with autism spectrum disorders[J].Pediatrics,2005,116(6):1480-1486.
[6] Steiner AM,Goldsmith TR,Snow AV,et al.Practitioner's guide to assessment of autism spectrum disorders in infants and toddlers[J].J Autism Dev Disord,2012,42(6):1183-1196.
[7] Young RL,Brewer N,Pattison C.Parental identification of early behavioral abnormalities in children with autistic disorder[J].Autism,2003,7(2):125-143.
[8] 黎海芪.实用儿童保健学[M].北京:人民卫生出版社,2016.
[9] 张致祥,左启华,雷贞武,等.“婴儿-初中学生社会生活能力量表”再标准化[J].中国临床心理学杂志,1995,3(1):12-15.
[10] 黄敏施,林艳,何慧静,等.婴幼儿沟通和象征性行为发展量表应用研究[J].中国实用儿科杂志,2016,31(10):770-773.
[11] Johnson CP,Myers SM.Identification and evaluation of children with autism spectrum disorders[J].Pediatrics,2007,120(5):1183-1215.
[12] 徐强,孙晓勉.儿童孤独症谱系障碍社区监测模式效果评价[J].中国妇幼健康研究,2016,27(9):1069-1070.
[13] 周翔,陈强,陈红,等.Gesell发育量表对2岁内孤独症谱系障碍患儿的应用研究[J].中国儿童保健杂志,2016,24(12):1329-1331.
[14] 万国斌.孤独谱系障碍的临床诊断及其影响因素[J].中国儿童保健杂志,2015,23(9):897-899.
[15] Bickel J,Bridgemohan C,Sideridis G,et al.Child and family characteristics associated with age of diagnosis of an autism spectrum disorder in a tertiary care setting[J].J Dev Behav Pediatr,2015,36(1):1-7.
[16] 蒋秋静.儿童孤独症的早期特征与影响异常情况发现时间的因素分析[D].武汉:华中科技大学,2011
基金
深圳市三名工程项目(SZSM201512009);深圳市科技计划项目(JCYJ2016042719200185)
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