目的 探讨学龄前期孤独症谱系障碍(ASD)儿童智力结构特点及与症状严重程度的相关性,为临床诊断及有效干预提供参考。方法 纳入2020—2022年就诊于广州市妇女儿童医疗中心神经内科,符合DSM-5 ASD诊断标准的学龄前儿童。总智商(FSIQ)≥70分为高功能组,FSIQ<70分为低功能组,采用儿童孤独症评定量表(CARS)评估症状严重程度。对比不同性别、不同能力水平学龄前期ASD幼儿智力结构特点,并分析总智商与症状严重程度的相关性。结果 本研究符合纳入标准的ASD儿童共170例,年龄3.96(3.50,4.33)岁,其中男140例,女30例;男童FSIQ及视觉空间(VSI)得分显著高于女童(Z=2 612.0、2 600.5,P＜0.05);总体及男女童各自组别中针对言语理解(VCI)、VSI及工作记忆(WMI)的分数进行两两比较发现总体及男、女童均存在VSI较显著优势现象,总体及男童组VCI与WMI比较存在显著优势;总体及男女童各自组别的FSIQ分数与CARS评分均存在负相关(r=-0.556、-0.561、-0.563,P＜0.001)。低功能组患儿共137例,其中男114例,女23例,男童的FSIQ、VSI得分显著高于女童(Z=1 949.5、1 872.5,P＜0.001);低功能组总体及男、女童均存在显著VSI优势,男童还存在WMI劣势;低功能组总体及男童FSIQ分数与CARS评分均存在负相关(r=-0.292、-0.291,P＜0.05)。高功能组患儿33例,其中男26例,女7例;高功能组总体及男童均存在显著VSI优势,而女童VSI、VCI与WMI均无显著差异;高功能组总体及女童组FSIQ分数与CARS评分存在负相关(r=-0.368、-0.769,P＜0.05)。结论 相对于ASD女童,男童的总智商及视觉空间能力均较高,低功能组的ASD男童也有类似优势。学龄前期ASD男女童皆存在视觉空间优势。学龄前ASD男童的言语理解优于工作记忆,而ASD女童无类似优势。学龄前ASD患儿智商与孤独症症状严重程度无显著性别差异,总智商越高,孤独症症状越轻。
Abstract
Objective To explore the characteristics of intelligence structure in preschool boys and girls with autism spectrum disorder (ASD) and its correlation with the severity of autism, in order to provide reference for clinical diagnosis and intervention. Methods Preschool children who met the DSM-5 ASD diagnostic criteria and visited Neurology Department,Guangzhou Women and Children's Medical Center between 2020 and 2022, were included in the study. Children with Full Scale Intelligence Quotient (FSIQ) ≥70 were divided into high function group, while those with FSIQ<70 were divided into low function group. The severity of autism was assessed using the Child Autism Rating Scale (CARS).The structural characteristics of intelligence of preschool children with ASD were compared by gender and ability level, and the correlation between total IQ and symptom severity was analyzed. Results A total of 170 ASD children were recruited, with the medium age of 3.96 (3.50, 4.33) years old, including 140 boys and 30 girls. FSIQ and visual-spatial intelligence (VSI) scores of boys were significantly higher than those of girls (Z=2 612.0, 2 600.0, P<0.05); when comparing verbal comprehension intelligence (VCI), VSI, and working memory intelligence (WMI) across the overall ASD sample, boys group and girls group, there was a significant advantage in the VSI domain in all three groups; VCI scores of the overall sample and boys showed significant advantages over WMI; there was a negative correlation between FSIQ and CARS scores in the overall ASD sample, boys group and girls group (r =-0.556, -0.561,-0.563, P<0.001). Among the overall sample, 137 children were in the low-functioning group, including 114 boys and 23 girls; FSIQ and VSI scores of boys were significantly higher than those of girls (Z=1 949, 1 872, P<0.001); the overall sample and both boys and girls showed significant advantages in VSI, while boys also displayed disadvantages in WMI; there was a negative correlation between FSIQ and CARS scores in both the overall sample and boys (r=-0.292, -0.291, P<0.05). Among the overall sample, there were 26 boys and 7 girls in the high-functioning group; both boys and girls showed a significant advantage in VSI, while there were no significant differences in VSI, VCI, and WMI among the girls; there was a negative correlation between FSIQ and CARS scores in the overall sample and girls group (r＝－0.368,-0.769, P<0.05). Conclusions Boys with ASD may exhibit higher FSIQ and VSI compared to girls, and boys in the low-functioning group also display similar advantages. Both preschool boys and girls with ASD show VSI advantages. Boys with ASD have an advantage in VCI over WMI, while girls do not show a similar advantage. There is no sex difference in the relationship between the severity of autism and FSIQ. Higher FSIQ scores are associated with lower severity of autism.
关键词
孤独症谱系障碍 /
智力结构 /
学龄前儿童 /
性别 /
症状严重程度
Key words
autism spectrum disorder /
intelligence structure /
preschool children /
sex /
severity of autism
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基金
广州市科技计划项目(20210201232)
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