目的 通过总结分析徐汇区2012—2020年开展社区(初级卫生保健机构)早期孤独症(ASD)筛查工作以来,登记确诊的徐汇区ASD儿童的就诊时间、确诊年龄,旨在为更早更快地识别孤独症儿童提供依据。方法 徐汇区妇幼保健所及13家社区卫生服务中心儿保门诊体检的18~24月龄儿童常规筛查阳性者、18~24月龄筛查阴性和非18~24月龄儿童体检时医生怀疑有社交沟通技能问题并结合年龄段筛查量表或丹佛发育筛查Ⅱ(DenverⅡ)异常者,均通过绿色通道定向转诊至复旦大学附属儿科医院儿保科发育行为专科门诊进行确诊,确诊的ASD儿童作为研究对象,将他们分为年龄段筛查阳性确诊、非年龄段筛查阳性确诊、年龄段筛查假阴性确诊3种不同就诊原因进行分析。采用单因素方差分析(ANOVA)进行组间比较、差异有统计学意义时用LSD法进行组间两两比较。结果 确诊的121例ASD儿童,82例为年龄段筛查阳性确诊、18例为非年龄段筛查阳性确诊、21例为年龄段筛查假阴性确诊,平均确诊月龄为(26.34±9.08)个月。年龄段筛查阳性确诊、非年龄段筛查阳性确诊、年龄段筛查假阴性确诊年龄不同,差异有统计学意义(F=21.22,P<0.001)。年龄段筛查假阴性确诊中的医生转诊与家长自行就诊、非年龄段筛查阳性确诊中的系统体检转诊与入园入托转诊,4种就诊原因的确诊年龄差异无统计学意义(F=1.746,P=0.176)。结论 徐汇区儿童保健系统管理和常规体检的儿童中ASD儿童,确诊年龄普遍提前,年龄段筛查阳性的确诊时间更早。
Abstract
Objective To summarize and analyze the treatment time and diagnosis months of children with autism spectrum disorder (ASD) registered and diagnosed in Xuhui District since the early autism screening in communities(primary health care institutions) was carried out from 2012 to 2020, so as to provide basis for identifying ASD children earlier and faster. Methods Children aged 18 to 24 months with positive results in routine screening, and children who were suspected with social interaction problems and with abnormal results of the age screening scale or Denver Ⅱ during the physical examination of 18 to 24 months with negative screening and non 18 - 24 month old children in Xuhui District Maternal and child health care center and 13 community health service centers, were referred through the green channel to the developmental behavior specialist clinic of the Child Healthcare Department of the Pediatric Hospital Affiliated to Fudan University for diagnosis. Children diagnosed with ASD were enrolled in this study, and were divided into three different reasons for consultation: Diagnosis in 18 to 24 months old with a positive screening result, diagnosis beyond 18 to 24 months old with a positive screening result, diagnosis in 18 to 24 months old with a false negative screening result. One way ANOVA was used for inter-group comparison and LSD method was used to compare the two groups when the difference was statistically significant. Results Among 121 children diagnosed with ASD, 82 cases aged 18 to 24 months with a positive screening result were diagnosed, 18 cases aged beyond 18 to 24 months with a positive screening result were diagnosed, 21 cases aged 18 to 24 months with a false negative screening result were diagnosed, with an average age of (26.34±9.08) months. The age of diagnosis was significantly different among the three groups (F=21.22, P<0.001). There was no significant difference in the age of diagnosis for the four reasons for consultation among doctor referrals and parental self-referrals in children aged 18 to 24 months with a false negative screening result, referrals for systematic medical examinations and referrals for school and nursery admissions for children beyond 18 to 24 months with a positive screening result (F=1.746, P=0.176). Conclusions The age of diagnosis is generally earlier for children managed by the child health care system and routinely screened in Xuhui District. Diagnosis is confirmed earlier for children aged 18 to 24 months with a positive screening result.
关键词
孤独症谱系障碍 /
社区 /
就诊原因 /
确诊年龄
Key words
autism spectrum disorder /
community /
reason for visit /
age of diagnosis
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