目的 探讨基于线上模式的自研量表在孤独症谱系障碍(ASD)早期筛查方面的可行性。方法 参考国外的线上筛查系统、已有的筛查量表和精神障碍诊断与统计手册(第5版)(DSM-5)诊断标准,编制自研筛查量表,分为两个年龄段量表,合计11个条目。基于该量表开发出线上筛查系统——“小小启明星”。2019年12月—2020年2月,在心理门诊招募了1 073名适龄儿童,平均(18.19±4.6)月龄,进行线上筛查。对线上筛查系统的筛查效能以及与改良版婴幼儿孤独症筛查(M-CHAT-R/F)量表的一致性进行分析。结果 使用12月龄段量表进行筛查,共有568例儿童,平均(13.6±1.2)月龄,灵敏度为0.83,特异度为0.98。使用18、24月龄段量表进行筛查,共有505例儿童,平均(21.3±2.6)月龄,灵敏度为0.77,特异度为0.81。自研量表与M-CHAT-R/F的一致性达到75.8%,Kappa值为0.422。结论 “小小启明星”作为一个本土化的ASD线上筛查系统具有良好的信效度,但部分条目仍需进一步修订与基于社区群体验证。线上筛查模式具有可行性和临床价值,值得在ASD早期筛查领域进一步推广使用。
Abstract
Objective To explore the feasibility of a self-developed scale based on an online platform for early detection of autism spectrum disorder (ASD). Methods By referring to overseas online screening systems, existing screening scales, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5) diagnostic criteria, a self-developed screening scale was compiled, with two age-specific versions with a total of 11 items. Based on this scale, an online screening system named "Xiaoxiaoqimingxing" was developed. From December 2019 to February 2020, 1 073 eligible children with an average age of (18.1±4.6) months were recruited from psychological clinics to take online screening. The screening effectiveness of the online system and its consistency with the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) Scale were analyzed. Results When screening using the 12-month age-specific scale, a total of 568 children with an average age of (13.6±1.2) months were involved, yielding a sensitivity of 0.83 and a specificity of 0.98. When screening using the 18- and 24-month age-specific scale, a total of 505 children with an average age of (21.3±2.6) months participated, resulting in a sensitivity of 0.77 and a specificity of 0.81. The consistency between the self-developed scale and the M-CHAT-R/F scale reached 75.8%, with a Kappa value of 0.422. Conclusions "Xiaoxiaoqimingxing", as a localized online screening system for ASD, demonstrates good reliability and validity, although some items require further revision and community-based validation. The online screening mode exhibits feasibility and clinical value, warranting further promotion and use in early ASD screening.
关键词
孤独症谱系障碍 /
早期筛查 /
线上模式 /
本土化
Key words
autism spectrum disorder /
early screening /
online mode /
localization
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参考文献
[1] American PA. Diagnostic and statistical manual of mental disorders. 5th ed[M]. Washington DC, USA: American Psychiatric Publishing, 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, 11 Sites, United States, 2020[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] Mukherjee D, Bhavnani S, Lockwood EG, et al. Digital tools for direct assessment of autism risk during early childhood: A systematic review[J]. Autism, 2024, 28(1): 6-31.
[5] 涂顺顺, 张蓓华, 肖永涛, 等. ASD儿童早期筛查与社交干预模式的研究进展[J]. 心理月刊, 2024, 19(13): 234-236,240.
Tu SS, Zhang BH, Xiao YT, et al. Research progress on early screening and social intervention model for children with autism spectrum disorder[J]. Psychologies Magazine, 2024, 19(13): 234-236,240. (in Chinese)
[6] 韦秋宏, 谢小芬, 戴婧婧, 等. 孤独症筛查量表在早期识别孤独症谱系障碍中的临床价值[J]. 中国当代儿科杂志, 2021, 23(4): 343-349.
Wei QH, Xie XF, Dai JJ, et al. Value of autism screening checklists in the early identification of autism spectrum disorder[J]. Chin J Contemp Pediatr, 2021, 23(4): 343-349. (in Chinese)
[7] 邱婷, 章恒. 线上筛查模式在孤独症谱系障碍早期筛查中的临床运用[J]. 临床精神医学杂志, 2022, 32(2): 136-138.
Qiu T, Zhang H. Early screening of autism spectrum disorders by online screening mode[J]. J Clin Psychiatry, 2022, 32(2): 136-138. (in Chinese)
[8] 陈雯珺, 余英, 黄立鹤. 数字技术在欧美国家孤独症儿童早期筛查中的应用[J]. 中国特殊教育, 2022, 29(7): 52-61.
Chen WJ, Yu Y, Huang LH. The application of digital technology in the early screening of autism in children in Europe and the United States[J]. Chinese Journal of Special Education, 2022,29(7): 52-61. (in Chinese)
[9] Barbaro J, Yaari M. Study protocol for an evaluation of ASDetect - a Mobile application for the early detection of autism[J]. BMC Pediatrics, 2020, 20(1): 21.
[10] 罗美芳, 郭翠华, 曹牧青, 等. 改良版婴幼儿孤独症筛查量表联合年龄与发育进程问卷筛查婴幼儿孤独症谱系障碍的效果及评价[J]. 中国儿童保健杂志, 2018, 26(3): 262-265.
Luo MF, Guo CH, Cao MQ, et al. Efficacy evaluation of autism screening in toddlers by using the M-CHAT-R/F combined with ages and stages questionnaire[J], Chin J Child Health Care, 2018, 26(3): 262-265. (in Chinese)
[11] Koh HC, Lim SH, Chan GJ, et al. The clinical utility of the modified checklist for autism in toddlers with high risk 18-48 month old children in Singapore[J]. J Autism Dev Disord, 2014, 44(2): 405-416.
[12] Salisbury LA, Nyce JD, Hannum CD, et al. Sensitivity and specificity of 2 autism screeners among referred children between 16 and 48 months of age[J]. J Dev Behav Pediatr, 2018, 39(3): 254-258.
[13] Magán-maganto M, Canal-bedia R, Hernández-fabián A, et al. Spanish cultural validation of the modified checklist for autism in toddlers, revised[J]. J Autism Dev Disord, 2020, 50(7): 2412-2423.
[14] Wong CM, Mohd ZN, Fan HH, et al. A direct comparison of three screening methods for autism spectrum disorder in a high-likelihood sibling population[J]. J Autism Dev Disord, 2024.
[15] 郭雯, 朱国伟, 周兆娥, 等. CHAT-23量表在社区早期筛查儿童孤独症的应用研究[J]. 中国妇幼保健, 2013, 28(32): 5308-5311.
Guo W, Zhu GW, Zhou ZE, et al. Study on the application of CHAT-23 Scale in early screening of childhood autism in communities[J]. Maternal and Child Health Care of China, 2013, 28(32): 5308-5311. (in Chinese)
[16] 陈碧媛, 梁亚勇, 邓红珠, 等. 小于24个月龄孤独症谱系障碍行为与临床特征分析[J]. 中国妇幼保健, 2016, 31(13): 2634-2637.
Chen BY, Liang YY, Deng HZ, et al. Analysis on behaviors and clinical characteristics of children with autism spectrum disorder within 24 months[J]. Maternal and Child Health Care of China, 2016, 31(13): 2634-2637. (in Chinese)
[17] 王志丹, 邢冰冰, 彭子函. 孤独症谱系障碍儿童呼名反应和应答性微笑的影响因素研究[J]. 陕西教育学院学报, 2021, 37(8): 1-7.
Wang ZD, Xing BB, Peng ZH. Study on the influencing factors of response to name and responsive smile in children with autism spectrum disorder[J]. Journal of Shaanxi Xueqian Normal University, 2021, 37(8): 1-7. (in Chinese)
[18] Barbaro J, Wang C, Wang J, et al. A pilot investigation of the social attention and communication surveillance (SACS) tool for the early identification of autism in tianjin, China (SACS-C)[J]. Front Neurol, 2020, 11: 1-11
[19] Thabtah F, Peebles D. Early autism screening: A comprehensive review[J]. Int J Environ Res Public Health, 2019, 16(18): 3502.
基金
2023年深圳市卫生经济学会科研项目(2023156);广东省重点领域研发计划资助(2019B030335001);深圳市医学重点学科(SZXK071);深圳市科技计划资助(JCYJ20220530155204009);深圳市孕产疾病与母婴健康重点实验室(ZDSYS20230626091559006)
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