目的 探究使用移动端在上海市0~36月龄婴幼儿中开展孤独症谱系障碍(ASD)早期筛查的临床应用价值,指导早期家庭干预。方法 采取分层抽样的方式,在上海市随机抽取12家二、三级妇幼保健机构,选择建档常规体检的0～36月龄婴幼儿,应用修订的ASD早期筛查量表作为筛查工具,进行ASD居家线上筛查。分析首次和二次筛查率、筛查阳性率、阳性分布和相关影响因素等调查结果。结果 参与社区ASD早期筛查的对象总计2 748人,累计筛查3 472人次,有效筛查3 317人次,有效筛查率为95.54%,二次筛查率为19.10%。筛查结果异常有308人,筛查阳性率为9.62%,其中男童的阳性率为12.44%,显著高于女童(6.51%)(χ2=33.45,P<0.05)。在筛查次数≥2次组中,有68名婴幼儿存在≥1次筛查结果异常,其中34名根据社区“健康促进指导”进行家庭干预随访结果正常,家庭干预有效率为50%。筛查能区未通过情况在各年龄组间分布有显著差异,大动作未通过者集中于12月龄前,语言及精细动作未通过者集中于18～24月龄,个人社交未通过者集中于24～30月龄。在“五不”行为阳性的婴幼儿中,“不语”行为的婴幼儿占大多数(65.17%)。结论 应用移动端开展婴幼儿ASD居家早期筛查模式具有良好的临床应用价值。推动社区-家庭早期ASD干预,可调动养育者和基层儿童保健服务人员的主观能动性,提高基层妇幼保健机构早期识别能力和干预技能,引导养育者了解婴幼儿早期发展规律并提供回应性照护,更好地预防ASD的发生和发展。
Abstract
Objective To explore the clinical application value of using mobile terminal for early screening of autism spectrum disorder (ASD) in children aged 0 - 36 months in Shanghai, in order to guide early family intervention. Methods A stratified sampling method was used to randomly select 12 secondary and tertiary maternal and child health care institutions in Shanghai. Children aged 0 - 36 months who underwent routine community physical examination were selected. The revised ASD early screening scale was used as the screening tool to conduct ASD early screening online at home. The primary and secondary screening rate, screening positive rate, positivity distribution and related influencing factors were analyzed. Results A total of 2 748 infants and toddlers participated in the early screening of ASD in the community, with a total of 3 472 screenings and 3 317 valid screenings, representing a valid screening rate of 95.54% and a secondary screening rate of 19.10%. There were 308(9.62%) cases with abnormal screening results, among which the positive rate of boys was 12.44%, significantly higher than that of girls (6.51%) (χ2=33.45, P<0.05). Among those who were screened ≥2 times, 68 children had abnormal screening at least for 1 time, 34 children finally had normal follow-up result with home intervention based on the community health promotion guidance, and the effective rate of home intervention was 50%. There were significant differences in the distribution of screening dimension failures among different age groups. Failure in gross motor skills was concentrated before 12 months of age, failure in language and fine motor skills was concentrated between 18 and 24 months of age, and failure in personal social skills was concentrated between 24 and 30 months of age. The majority (65.17%) represented "no speech" behavior among children who failed in the "five no" screening test. Conclusions The mobile terminal has good clinical application value in early screening of ASD in children at home. Promoting early ASD intervention in community-family is helpful to mobilize the subjective initiative of home and community, improve the early identification capabilities of caregivers and primary care professionals, guide caregivers to understand the law of early development of children and provide responsive care, so as to better prevent ASD and reverse ASD outcomes effectively.
关键词
孤独症谱系障碍 /
社区筛查 /
早期筛查 /
神经发育障碍 /
移动端
Key words
autism spectrum disorder /
community screening /
early screening /
neurodevelopmental disorders /
mobile device
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基金
上海市卫健委老龄化和妇幼健康专项(2020YJZX0207);上海市2022年度“科技创新行动计划”技术标准项目(22DZ2203500);上海申康医院发展中心示范性研究型医师创新转化能力培训项目医企融合创新成果转化专项(SHDC2022CRD012);国家重点研发计划“生育健康及妇女儿童健康保障”重点专项(2022YFC2705200);上海申康医院发展中心市级医院新兴前沿技术联合攻关项目(SHDC12022114);上海申康医院发展中心临床三年行动计划资助(SHDC2020CR1047B);上海申康医院发展中心2021年临床科技创新项目(SHDC22021305-B)
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