目的 分析改良婴幼儿孤独症检查表(M-CHAT)对疑似孤独症谱系障碍(ASD)婴幼儿的早期筛查结果及临床诊断随访情况之间的一致性,为临床诊疗提供参考依据,提高ASD早期识别率。方法 以2017年1月1日—2021年1月1日首次就诊于南京脑科医院儿童心理卫生研究中心的16~30月龄婴幼儿为研究对象,在基线期完成一般资料调查以及全面评估。并在2023年4—9月使用电话随访儿童的诊断情况,分析低于30月龄的高危ASD儿童筛查结果与随后的诊断随访之间的一致性。结果 M-CHAT筛查ASD的敏感度为0.937,特异度为0.514,阳性预测值(PPV)为0.929,阴性预测值(NPV)为0.545,曲线下面积(AUC)为0.726,筛查阳性率在16~23个月和24~30个月两个年龄组比较差异无统计学意义(83.8% vs.90.6%,χ2=2.824,P=0.113)。结论 M-CHAT在ASD患儿早期识别中具有良好的筛查效能,并表现出较好的诊断稳定性。
Abstract
Objective To analyze the consistency between the early screening Results of the Modified Checklist for Autism in Toddlers (M-CHAT) for infants and toddlers suspected of having autism spectrum disorder (ASD) and their subsequent clinical diagnosis, in order to provide reference for clinical practice and improve the early identification rate of ASD. Methods Infants and toddlers aged 16 to 30 months who first visited the Child Mental Health Research Center of Nanjing Brain Hospital between January 1st, 2017, and January 1st, 2021, were enrolled in the study. General data were collected and comprehensive assessments were completed at baseline. Between April and September 2023, telephone follow-ups were conducted to ascertain the diagnostic status of the children. The consistency between the M-CHAT screening outcomes for high-risk ASD children under 30 months and their later diagnostic follow-ups was analyzed. Results The M-CHAT showed a sensitivity of 0.937, specificity of 0.514, positive predictive value (PPV) of 0.929, negative predictive value (NPV) of 0.545, and an area under the curve (AUC) of 0.726. No statistically significant difference in the positive screening rate was observed between the two age groups of 16 - 23 months and 24 - 30 months old (83.8% vs.90.6%,χ2=2.824,P=0.113). Conclusion The M-CHAT demonstrates good screening efficacy in the early detection of ASD and exhibits a favorable diagnostic stability.
关键词
孤独症谱系障碍 /
早期筛查 /
早期诊断 /
改良婴幼儿孤独症量表 /
诊断稳定性
Key words
autism spectrum disorder /
early screening /
early diagnosis /
Modified Checklist For Autism in Toddlers /
diagnostic stability
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] American Psychiatric Association. Diagnostic and statistical manual of mental disorders[M], 5th ed. Arlington: American Psychiatric Association, 2013.
[2] Maenner MJ, Warren Z, Williams AR, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network[J]. MMWR Surveill Summ, 2023, 72(2): 1-14.
[3] Zhou H, Xu X, Yan W, et al. Prevalence of autism spectrum disorder in China: A nationwide multi-center population-based study among children aged 6 to 12 years[J]. Neurosci Bull, 2020, 36(9): 961-971.
[4] Pierce K, Gazestani VH, Bacon E, et al. Evaluation of the diagnostic stability of the early autism spectrum disorder phenotype in the general population starting at 12 months[J]. JAMA Pediatr, 2019, 173(6): 578-587.
[5] Hyman SL, Levy SE, Myers SM, et al. Identification, evaluation, and management of children with autism spectrum disorder[J]. Pediatrics, 2020, 145(1): e20193447.
[6] 中华医学会儿科学分会发育行为学组,中国医师协会儿科分会儿童保健专业委员会,儿童孤独症诊断与防治技术和标准研究项目专家组. 孤独症谱系障碍儿童早期识别筛查和早期干预专家共识[J]. 中华儿科杂志,2017,55(12):890-897.
Developmental Behavioral Group of Pediatrics Branch of Chinese Medical Association, Child Health Professional Committee of Pediatrics Branch of Chinese Medical Doctor Association, child autism diagnosis and prevention technology and standards research project expert group.Expert consensus on early identification, screening and early intervention of children with autism spectrum disorder[J]. Chinese Journal of Pediatrics,2017,55(12):890-897. (in Chinese)
[7] Hirota T, King BH. Autism spectrum disorder: A review[J]. JAMA, 2023, 329(2): 157-168.
[8] Lord C, Elsabbagh M, et al. Autism spectrum disorder[J]. Lancet, 2018, 392(10146): 508-520.
[9] Carbone PS, Campbell K, Wilkes J, et al. Primary care autism screening and later autism diagnosis[J]. Pediatrics, 2020, 146(2): e20192314.
[10] Guthrie W, Wallis K, Bennett A, et al. Accuracy of autism screening in a large pediatric network[J]. Pediatrics, 2019, 144(4): e20183963.
[11] Begus K, Southgate V. Infant pointing serves an interrogative function[J]. Dev Sci, 2012, 15(5): 611-617.
[12] Bilszta JL, Sunita. Early identification of autism: A comparison of the Checklist for Autism in Toddlers and the Modified Checklist for Autism in Toddlers[J]. J Paediatr Child Health, 2013, 49(6): 438-444.
[13] 邱婷, 卫雅蓉, 肖婷, 等. 改良婴幼儿孤独症量表和婴幼儿孤独症量表-23在孤独症谱系障碍早期筛查中的临床适应性比较[J]. 临床精神医学杂志, 2020, 30(1): 44-46.
Qiu T, Wei YR, Xiao T, et al. A comparison study on modified checklist for autism in toddlers and checklist for autism in toddlers-23 for early screening of autism spectrum disorder[J]. J Clin Psychiatry, 2020, 30(1): 44-46. (in Chinese)
[14] 龚郁杏, 刘靖, 李长璟, 等. 改良婴幼儿孤独症量表中文修订版的信效度[J]. 中国心理卫生杂志, 2012, 26(6): 476-480.
Gong YX, Liu J, Li CJ, et al. Reliability and validity of the Chinese revised version of the Modified Checklist for Autism in Toddlers[J]. Chin J Ment Health, 2012, 26(6): 476-480. (in Chinese)
[15] Zou B, Li X, Huang X, et al. Telephone follow-up design and practice for advanced cancer pain patients[J]. J Cancer Educ, 2020, 35(4): 751-759.
[16] 魏星, 张崎, 高心, 等. 临床研究电话随访方法探索[J]. 中国胸心血管外科临床杂志, 2023, 30(9): 1235-1239.
Wei X, Zhang Q, Gao X, et al. Method exploration of telephone follow-up in clinical research[J]. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(9): 1235-1239. (in Chinese)
[17] Chlebowski C, Robins DL, Barton ML, et al. Large-Scale use of the modified checklist for autism in low-risk toddlers[J]. Pediatrics, 2013, 131(4): e1121-e1127.
[18] Kim SH, Joseph RM, Frazier JA, et al. Predictive validity of the Modified Checklist for Autism in toddlers (M-CHAT) born very preterm[J]. J Pediatr, 2016, 178: 101-107.
[19] Pierce K, Gazestani VH, Bacon E, et al. Evaluation of the diagnostic stability of the early autism spectrum disorder phenotype in the general population starting at 12 months[J]. JAMA Pediatr, 2019, 173(6): 578-587.
[20] Toh TH, Tan VW, Lau PS, et al. Accuracy of Modified Checklist for Autism in Toddlers (M-CHAT) in detecting autism and other developmental disorders in community clinics[J]. J Autism Dev Disord, 2018, 48(1): 28-35.
[21] Hatch B, Iosif A-M, Chuang A, et al. Longitudinal differences in response to name among infants developing asd and risk for ADHD[J]. J Autism Dev Disord, 2021, 51(3): 827-836.
[22] Yama B, Freeman T, Graves E, et al. Examination of the properties of the modified checklist for autism in toddlers (M-CHAT) in a population sample[J]. J Autism Dev Disord, 2012, 42(1): 23-34.
基金
国家自然科学基金项目(81971282);南京医科大学孤独症专病队列(NMUC2022010A)
PDF(761 KB)
