目的 比较2~5岁孤独症谱系障碍(ASD)、疑似ASD及全面发育迟缓(GDD)儿童的Gesell评估结果,了解其智能发育特征,为疾病的早期诊断和干预提供依据。方法 回顾性分析2018年7月—2022年8月在四川省妇幼保健院明确诊断为ASD(n=270)、疑似ASD(n=158)、GDD(n=218)的2~5岁儿童,运用Gesell发育量表进行评估,并对三组儿童5个能区发育水平分布情况进行统计描述及差异性分析。结果 1)三组儿童智能水平不同,且差异有统计学意义(P<0.05);ASD组在各能区得分均低于疑似ASD组,在精细和适应性上得分低于GDD组,差异有统计学意义(P<0.05)。2)不同年龄段三组儿童智能发育不同,差异有统计学意义(P<0.05);幼儿期,ASD儿童5个能区得分均低于疑似ASD组,GDD组除大运动外其余4个能区得分均高于ASD组,差异有统计学意义(P<0.05);学龄前期,ASD组仅在精细动作得分低于GDD组,在精细、适应性及语言能区得分低于疑似ASD组,差异有统计学意义(P<0.05)。3)各组儿童两年龄段发育商不同,ASD组学龄前儿童个人-社会能区发育水平高于ASD幼儿,差异有统计学意义(Z=2.45,P<0.05),疑似ASD组学龄前儿童在适应性及大运动能区得分低于疑似ASD幼儿,差异有统计学意义(Z=2.83、1.99,P<0.05),GDD组学龄前儿童语言、适应性及大运动能区发育水平低于GDD组幼儿,差异有统计学意义(Z=2.97、5.18、4.36,P<0.05)。结论 不同年龄段及不同发育问题儿童的神经发育特征具有一定的差异,在临床中可通过Gesell诊断量表明确其智能发育情况来识别ASD、疑似ASD及GDD,对疾病的早期诊断、训练计划的制定和预后具有重要意义。
Abstract
Objective To describe and compare the developmental levels of Gesell Developmental Scale(GDS) in children aged 2 - 5 years who were diagnosed with autism spectrum disorder (ASD), suspected ASD and GDD, and to know about the intelligence quotient, so as to provide reference for early diagnosis and early intervention. Methods A retrospective analysis was performed on children aged 2 - 5 years who were diagnosed with ASD (n=270), suspected ASD (n=158) and GDD (n=218) in Sichuan Maternal and Child Health Hospital from July 2018 to August 2022. The DQs of five domains of GDS were described and compared among the three groups. Results 1) The intelligence level of children in three groups was significantly different (P<0.05); The scores of ASD group were significantly lower than those of suspected ASD group in all five domains of GDS, and the scores of fine motor and adaptability were significantly lower than those of GDD group (P<0.05). 2) The intelligence development of the three groups at different ages was significantly different (P<0.05); For children aged 2 to 3 years, the scores in five domains of ASD children were lower than those of suspected ASD group, and the scores in four energy areas of GDD group were significantly higher than those of ASD group except for gross motor (P<0.05). For preschool children, the score of fine motor in ASD group was significantly lower than that in GDD group (P<0.05), and the score of fine motor, adaptability and language ability in ASD group was significantly lower than that in suspected ASD group. 3) The developmental quotient of children in each group was different between children aged 2 - 3 and preschool children. The development level of personal-social area of preschoolers in ASD group was significantly higher than that of ASD children (Z=2.45, P<0.05). The scores of adaptability and gross motor domain of preschoolers in the suspected ASD group were significantly lower than those of children with suspected ASD (Z=2.83, 1.99, P<0.05). The development levels of language, adaptability and gross motor area of preschool children in GDD group were significantly lower than those in the GDD group (Z=2.97, 5.18, 4.36, P<0.05). Conclusions There are certain differences in the neurodevelopmental characteristics of children with different age groups and developmental problems. In clinical practice, GDS can be used to clarify their intelligence development to identify ASD, suspected ASD and GDD, which is important for early diagnosis of the disease, the formulation of training programs and prognosis of the disease.
关键词
孤独症谱系障碍 /
全面发育迟缓 /
疑似孤独症 /
Gesell发育量表
Key words
autism spectrum disorder /
global developmental delay /
suspected autism /
Gesell Developmental Scale
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基金
四川省医学科研青年创新课题计划(Q17066)
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