目的 采用Gesell发展诊断量表(GDDS)对18~42月孤独症谱系障碍(ASD)、发育性语言障碍(DLD)、全面发育迟缓(GDD)开展应用研究,分析这类儿童发育特点和差异性,为早期识别和鉴别诊断提供科学依据。方法 回顾性分析2021年9月—2022年4月于河南省儿童医院儿童保健科就诊的178例儿童病例资料,其中ASD29例,DLD45例,GDD104例。分析三组间非语言及语言发育水平差异,对儿童GDDS五大能区即大运动、精细动作、语言、适应性和个人-社交的DQ值进行组内比较分析。结果 1)ASD、DLD、GDD组间非语言发育水平两两比较差异均有统计学意义(H=-95.90、38.25、-57.65,P＜0.05),三组间语言能区DQ值两两比较差异均有统计学意义(H=-99.99、30.89、-69.11,P＜0.05);2)ASD、DLD、GDD组语言、个人-社交与大运动能区DQ值比较,差异有统计学意义(H=82.438、51.156;160.045、65.098;322.038、210.908,P＜0.001)。ASD、DLD组精细动作、适应性与大运动能区DQ值比较,差异无统计学意义(P＞0.05),而在GDD组差异有统计学意义(H=119.975、63.621,P＜0.05)。ASD组语言与个人-社交能区DQ值比较,差异无统计学意义(P＞0.05),而在DLD组差异有统计学意义(H=-94.946,P＜0.001)。结论 ASD、DLD、GDD儿童均存在发展不均衡,不同类疾病Gesell能区间差异不同;ASD儿童语言及非语言发育水平均显著落后于GDD、DLD儿童。GDDS用于评估语言相关的发育性疾病,有利于对此类疾病的早期识别和鉴别诊断。
Abstract
Objective To analyze the developmental characteristics and differences among autism spectrum disorder (ASD), developmental language disorder (DLD) and global developmental delay (GDD) by using Gesell Developmental Diagnostic Scale (GDDS), so as to provide scientific basis for early screening and differential diagnosis. Methods Clinical data of 178 children, involving 29 ASD children, 45 DLD children and 104 GDD children in the Department of Child Health care, Henan Children's Hospital from September 2021 to April 2022 were retrospectively analyzed. The developmental quotients (DQs) of the five dimensions of GDDS (gross motor, fine motor, language, adaptive behavior, personal-social behavior) of children in each group were analyzed and compared. The differences in the language development and nonverbal development levels (the average of gross motor, fine motor, adaptive behavior and personal-social behavior development) between the two groups were analyzed. Results 1) There were significant differences in the nonverbal development levels among ASD, DLD and GDD groups (H=―95.90, 38.25, ―57.65, P＜0.05), and also in the language functional area (H=―99.99, 30.89, ―69.11, P＜0.05). 2) There were significant differences in the DQs of language, personal-social behavior and gross motor development among ASD, DLD and GDD children (H=82.438, 51.156; 160.045, 65.098; 322.038, 210.908, P＜0.001). There were no significant differences among the DQs of fine motor, adaptive and gross motor in ASD and DLD groups (P>0.05). But there was a significant difference between the DQs of fine motor, adaptive and gross motor functional area in GDD groups (H=119.975, 63.621, P＜0.05). There was no significant difference between the DQs of language and personal-social dimension in ASD children(P＞0.05), but in the DLD group the difference was significant (H=-94.946, P＜0.001). Conclusions Children with ASD, DLD and GDD all have unbalanced development, with significant differences in GDDS dimensions in the different disease categories.The level of language development and nonverbal development of ASD children significantly lag behind GDD and DLD children. GDDS can be used to assess speech-related developmental disorders, and is helpful to facilitate the early identification and differential diagnosis of these disorders.
关键词
孤独症谱系障碍 /
发育性语言障碍 /
全面发育迟缓 /
Gesell发展诊断量表 /
儿童
Key words
autism spectrum disorder /
developmental language disorder /
global development delay /
Gesell Developmental Diagnosis Scale /
children
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 崔继华,章依文,黄敏辉,等.象征性游戏测试在儿童语言发育异常临床评估中的应用价值[J].中国儿童保健杂志,2016,24(1):78-81.
Cui JH,Zhang YW,Huang MH,et al.The application value of symbolic play test in the clinical evaluation of children's language development abnormalities[J].Chin J Child Health Care,2016,24(1):78-81.
[2] Georgiou N, Spanoudis G. Developmental language disorder and autism:Commonalities and differences on language[J].Brain Sci.2021,11(5):589.
[3] 张秀玲,李寄平,秦明镜,等.Gesell发展诊断量表3.5～6岁北京修订本的制定[J].中国临床心理学杂志,1994,2(3):148-150.
Zhang XL,Li JP,Qin MJ,et al. Formulation of beijing revision of Gesell development diagnostic scale for 3.5-6 years old[J].Chin J Clin Psychol,1994,2(3):148-150.
[4] 梁静,王朝晖.S-S语言发育迟缓评价法与Gesell发育评估量表在幼儿语言评定应用中的对比[J].中国儿童保健杂志,2017,25(5):514-516.
Liang J,Wang ZH.Comparison between S-S language delay assessment and Gesell developmental assessment scale in the application of language assessment in children[J].Chin J Child Health Care,2017,25(5):514-516.
[5] American Psychiatric Association. Diagnostic and statistical manual of mental disorders[M].5th ed.Virginia:American psychiatric publishing,2013:55-59.
[6] WHO.ICD-11[EB/OL].(2018-06-18)[2020-10-30].http://icd.who.int/browsell/l-m/zh.
[7] 黎文倩,刘晓,代英,等.孤独症谱系障碍儿童的诊断年龄及其影响因素[J].中国当代儿科杂志,2018,20(10):799-803.
Li WQ,Liu X,Dai Y,et al.Diagnostic age of children with autism spectrum disorder and its influencing factors[J].Chin J Contemp Peditar,2018,20(10):799-803.
[8] 刘冬梅,邹时朴,龚俊,等.孤独症、全面发育迟缓及发育性语言延迟儿童早期语言发育特征[J].中国儿童保健杂志,2020,28(3):312-315.
Liu DM,Zou SP,Gong J,et al.Characteristics of early language development in children with autism spectrum disorders,general developmental delay and developmental language delay[J].Chin J Child Health Care,2020,28(3):312-315.
[9] Ellis Weismer S,Lord C,Esler A. Early language patterns of toddlers on the autism spectrum compared to toddlers with developmental delay[J].J Autism Dev Disord, 2010,40(10):1259-1273.
[10] 韦秋宏,刘晓,代英,等.语言相关的发育性疾病早期语言特征分析[J].中华实用儿科临床杂志,2022,37(4):279-283.
Wei QH,Liu X,Dai Y,et al.Analysis of early language characteristics of language-related developmental diseases[J].Chin J Appl Clin Pediatr,2022,37(4):279-283.
[11] Long C,Gurka MJ,Blackman J.Cognitive skills of young children with and without autism spectrum disorder using the BSID-Ⅲ[J].Autism Res Treat,2011,2011:759289.
[12] Visser JC,Rommelse N,Lappenschaar M,et al. Variation in the early trajectories of autism symptoms is related to the development of language,cognition,and behavior problems [J].J Am Acad Child Adolesc Psychiatry,2017,56(8):659-668.
[13] Lee SB, Song SH, Ham JH, et al. Idiom comprehension deficits in high-functioning autism spectrum disorder using a korean autism social language task[J].Yonsei Med J,2015,56(6):1613-1618.
[14] Wang H, Du Y, Mao Z, et al. Use of the Griffiths Mental Development Scale-Chinese in the assessment of children with autism spectrum disorder and global developmental delay/intellectual disability[J]. Medicine (Baltimore),2021,100(13):e25407.
[15] Özyurt G, Eliküçük ÇD. Comparison of language features,autism spectrum symptoms in children diagnosed with autism spectrum disorder, developmental language delay, and healthy controls[J].Noro Psikiyatr Ars,2018,55(3):205-210.
[16] Varanda CA, Mendes ECCS, Aulicino MG,et al. Linguagem e habilidades socioemocionais na infância o impacto de uma intervenşão na educaço infantil Capacomum-18-fevereiro 2021[M]. São Paulo:Appris,2020.
[17] Hage SVR, Sawasaki LY, Hyter Y, et al. Social communication and pragmatic skills of children with autism spectrum disorder and developmental language disorder[J]. Codas,2021,34(2):e20210075
[18] Löytömäki J,Ohtonen P,Laakso ML,et al. The role of linguistic and cognitive factors in emotion recognition difficulties in children with ASD,ADHD or DLD[J]. Int J Lang Commun Disord,2020,55(2):231-242.
[19] Shan L,Feng JY,Wang TT,et al.Prevalence and developmental profiles of autism spectrum disorders in children with global developmental delay[J]. Front Psychiatry,2022,12:794238
[20] Vig S, Jedrysek E. Autistic features in young children with significant cognitive impairment:Autism or mental retardation?[J]. J Autism Dev Disord, 1999,29(3):235-248.
基金
河南省医学科技攻关省部共建重点项目(SBGJ202102211)
PDF(491 KB)
