目的 分析孤独症谱系障碍(ASD)儿童感觉异常现状及其相关因素,为ASD的临床诊断和行为矫正提供理论依据。方法 收集2015年8月—2016年1月在中山大学附属第三医院确诊的121例ASD儿童的孤独症诊断会谈量表(ADI-R)分析感觉异常情况;孤独症教育心理评核(第三版)(PEP-3)评估各方面能力;中国韦氏幼儿智力测试(简称智测)或Gesell量表评估智力或发育商,孤独症儿童进食行为量表(BAMBI)评估喂养问题;并分析感觉异常的相关临床特征的关联分析。结果 无感觉异常组23例(19.0%),轻度感觉异常组(简称轻度组)64例(52.9%),重度感觉异常组(简称重度组)34例(28.1%)。轻度组和重度组感觉异常种类显著多于无感觉异常组(χ2=88.042,P＜0.01),重度组感觉异常种类显著多于轻度组(P＜0.01)。在ADI-R中,无语言能力儿童重度感觉异常组A部分(社会互动异常)(19.59±4.67)和B部分(沟通异常)(12.36±1.76)均高于无感觉异常组(15.79±1.94、9.86±3.34,F=3.032、5.190,P＜0.05),且重度组B部分(沟通异常)高于轻度组(10.79±2.32,P＜0.05)。在PEP-3中,轻度组和重度组个人自理百分比得分均低于无感觉异常组(χ2=8.641,P＜0.01)。三组间智力测试和Gesell量表评估结果比较,差异无统计学意义(P＞0.05)。BAMBI评估显示,轻度组和重度组食物谱狭窄得分均高于无感觉异常组(χ2=6.806,P＜0.05)。无语言ASD儿童的感觉异常与ADI-R的A部分及B部分得分呈正相关(rs=0.260、0.359,P＜0.01),ASD儿童的感觉异常与个人自理百分比呈负相关(rs=-0.252,P=0.005),与食物谱狭窄得分呈正相关(rs=0.224,P=0.013)。结论 81.0%的ASD儿童有感觉异常,重度组感觉异常的种类较多。感觉异常程度严重的ASD儿童,社交能力较弱,饮食问题更多。ASD儿童的感觉异常与智力测试和Gesell量表评估结果不相关。感觉异常可能是ASD儿童社交能力的预测因子。
Abstract
Objective To investigate the sensory abnormalities in children with autism spectrum disorder (ASD) and the factors correlated with sensory abnormalities,so as to provide theoretical reference for the clinical diagnosis and behavior modification of ASD children. Methods A total of 121 ASD children were enrolled in this study from August,2015 to January,2016. The sensory abnormalities were evaluated by the Autism Diagnostic Interview-Revised (ADI-R). Psycho-Educational Profile-version 3 (PEP-3),WISC,Gesell test,Brief Autism Mealtime Behaviors Inventory (BAMBI) were used to assess other characteristics of ASD children. The correlation between sensory abnormalities and related factors was analyzed by spearman correlation analysis. Results Totally 19.0% (23/121) of ASD children had no-sensory abnormalities,mild- and severe-sensory abnormalities was detected in 64(52.9%) and 34(28.1%) children,respectively. The kinds of sensory abnormalities in mild- and severe-sensory abnormalities group were more than those in no-sensory abnormalities group (χ2=88.042,P<0.01),which were also much more in severe-sensory abnormalities group than that in mild-sensory abnormalities group (P<0.01). Part-A (scocial interaction) and B(communication) scores of ADI-R in severe-sensory abnormalities group with no language ability (19.59±4.67,12.36±1.76) were significantly higher than those in no-sensory abnormalities group (15.79±1.94,9.86±3.34,F=3.032,5.190,P＜0.05).Additionally,Part-B of ADI-R scored higher in severe-sensory abnormalities group than in mild-sensory abnormalities group (10.79±2.32,P<0.05). In PEP-3,the percentage of personal self-care in mild and severe-sensory abnormalities group was lower than that in no-sensory abnormalities group (χ2=8.641,P<0.01). As for full intelligence quotient(FIQ) and developmental quotient (DQ),there was no significant difference among three groups(P＞0.05). In BAMBI,mild- and severe-sensory abnormalities group had higher score on limited variety of food than no-sensory abnormalities group (χ2=6.806,P＜0.05). In non-verbal ASD children,sensory abnormalities were positively related to the part-A and B scores of ADI-R (rs=0.260,0.359,P<0.01).Moreover,sensory abnormalities of ASD children were negatively related with the percentage of personal self-care in PEP-3 (rs=-0.252,P=0.005),and positively related to the scores of food refusal in BAMBI (rs=0.224,P=0.013). Conclusions Sensory abnormalities are existed in 81.0% of ASD children,with a greater variety of sensory abnormalities in the severe group. ASD children with severe-sensory abnormalities are less socially competent and had more eating problems. Sensory abnormalities are not associated with intelligence test and Gesell assessment result. Sensory abnormalities may be a predictor of social competence in children with ASD.
关键词
孤独症谱系障碍 /
感觉异常 /
社交能力 /
儿童
Key words
autism spectrum disorder /
sensory abnormalities /
social ability /
children
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基金
广州市脑计划广州市科技计划项目重点领域研发计划(202007030011)
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