目的 分析第二版孤独症诊断观察量表(ADOS-2)模块1与儿童期孤独症评定量表(CARS)对儿童孤独症谱系障碍(ASD)的诊断价值,为临床应用提供参考依据。方法 2019年1月—2022年3月在广东省妇幼保健院儿童神经康复医学科初次就诊,第一诊断为ASD、全面发育迟缓儿(GDD)及评估为正常的104例儿童为研究对象。其中ASD患儿60例(高、低功能各30例)为ASD组,24例全面发育迟缓患儿(GDD患儿)及正常儿20例为非ASD组,两组均采用ADOS-2模块1和CARS评估。比较两个量表与美国《精神疾病诊断与统计手册(第5版)》(DSM-5)中ASD诊断结果的一致性,对比两者诊断ASD的敏感性、特异性。结果 1)ADOS-2模块1与DSM-5的一致性好(Kappa=0.862),CARS与DSM-5的一致性为中等(Kappa=0.509),ADOS-2模块1与CARS间的一致性为好(Kappa=0.695)。2)ADOS-2模块1的敏感性优于CARS,差异有统计学意义(χ2=13.333,P<0.001)。ADOS-2模块1在诊断IQ≥70和IQ<70的儿童中的敏感性、特异性的对比差异无统计学意义(P>0.05)。CARS在诊断IQ<70的儿童的敏感性优于IQ≥70的儿童(χ2=7.500,P=0.006),特异性比较差异无统计学意义(P>0.05)。结论 ADOS-2 模块1、CARS均为辅助诊断ASD的重要工具,ADOS-2模块1在ASD儿童的早期诊断中具有更高的敏感性和特异性。临床工作中,对IQ≥70的儿童,建议降低CARS的诊断阈值,以提高CARS的诊断敏感性,降低漏诊率。
Abstract
Objective To compare the diagnostic value between Autism Diagnostic Observation Schedule Second Edition(ADOS-2) Module-1 and Children Autism Rating Scale (CARS) for children with autism spectrum disorder (ASD), in order to provide reference for clinical application. Methods From January 2019 to March 2022, a total of 104 children who firstly visited and diagnosed in the Department of Neurological Rehabilitation, Guangdong Women and Children Hospital were enrolled in this study, including 60 ASD children (ASD group:30 cases of high function and 30 cases of low function,), 24 children with global developmental delay (GDD) and 20 normal children (non-ASD group). All children were assessed by ADOS-2 Module-1 and CARS. The consistency of diagnostic results between the two scales and the criteria of American Diagnostic and Statistical Manual of Mental Disorders-5(DSM-5) was evaluated, and the sensitivity and specificityof the two scales in the diagnosis of ASD were compared. Results 1) The consistency between ADOS-2 module 1 and DSM-5 was good (Kappa=0.862),as well as between ADOS-2 module 1 and CARS (Kappa=0.695).The consistency was medium between CARS and DSM-5 (Kappa=0.509), 2) The sensitivity of ADOS-2 module 1 was significantly better than that of CARS (χ2=13.333, P<0.001). There was no significant difference in the sensitivity and specificity between diagnosing children with IQ≥70 and children with IQ <70(P>0.05). The sensitivity of CARS in the diagnosis of children with IQ <70 was significantly better than that of children with IQ≥70 (χ2=7.500, P=0.006), but the specificity was not statistically significant (P>0.05). Conclusions ADOS-2 module-1 and CARS are both important tools to assist in the diagnosis of ASD, and ADOS-2 module-1 has higher sensitivity and specificity in the early diagnosis of ASD children. In clinical work, it is recommended to lower the diagnostic threshold of CARS for children with IQ ≥ 70 in order to improve the diagnostic sensitivity of CARS and reduce the rate of missed diagnosis.
关键词
孤独症 /
孤独症诊断观察量表 /
儿童孤独症评定量表
Key words
autism /
Autism Diagnostic Observation Schedule /
Children Autism Rating Scale
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基金
2021年广东省中医药局科研项目(20211047)。
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