孤独症谱系障碍初筛阳性患儿康复训练后再评估的诊断研究

The diagnosis study of post-rehabilitation reevaluation of children with positive initial screening for autism spectrum disorders

摘要

目的 探讨孤独症谱系障碍(ASD)初筛阳性患儿康复训练后再评估的诊断情况及相关因素分析。方法 采用回顾性研究方法,选取2019年8月至2022年8月在聊城市人民医院儿童保健科行ASD初筛阳性患儿97例,将其分为≤24个月(12例)、>24~≤36个月(47例)、>36~≤72个月(38例)3个年龄段,再依据«美国精神障碍诊断统计手册第5版»(DSM-5)诊断标准将其分为ASD组(73例)与非ASD组(24例).收集患儿初诊时儿童孤独症评定量表(CARS)或修订的幼儿孤独症筛查量表-后续修订版(M-CHAT-R/F)量表和盖泽尔发育诊断(Gesell)量表各能区得分,分析ASD初筛阳性患儿康复训练后再评估诊断情况及相关因素。结果 有75.3%的ASD初筛阳性患儿康复训练后再评估符合ASD诊断,其中男患儿占71.8%,女患儿占100.0%.ASD初筛阳性患儿康复训练后再评估,ASD诊断符合率随年龄段增长呈依次上升趋势(χ²=10.032,P=0.002).康复训练后再评估,ASD组患儿的Gesell量表中适应性、大运动、精细动作、语言、个人-社交能区得分均明显低于非ASD组,差异均有统计学意义(t值分别为-3.268、-1.970、-2.472、-3.205、-3.570,P<0.05).康复训练后再评估,ASD诊断符合率与适应性(r=0.325)、大运动(r=0.229)、精细动作(r=0.241)、语言(r=0.286)、个人-社交(r=0.356)能区发育落后程度均呈正相关(P<0.05).ASD组≤24个月患儿的M-CHAT-R/F量表得分明显低于非ASD组(t=-4.950,P<0.05),ASD组>24~≤36个月患儿的CARS量表和M-CHAT-R/F量表得分均明显高于非ASD组(t值分别为2.166、2.151,P<0.05),ASD组>36~≤72个月患儿的CARS量表得分也明显高于非ASD组(t=2.695,P<0.05).对于>24个月的患儿,高CARS量表得分是康复训练后再评估诊断为ASD的危险因素(OR=1.367,95%CI:1.133~1.776,P<0.05),对于>24~≤36个月的患儿,高M-CHAT-R/F量表得分是康复训练后再评估诊断为ASD的危险因素(OR=1.623,95%CI:1.122~2.765,P<0.05)。结论 ASD初筛阳性患儿康复训练后再评估ASD诊断符合率较高,再评估ASD诊断符合率与患儿的性别、年龄、发育水平、初筛CARS量表或M-CHAT-R/F量表得分有关.

Abstract

Objective To explore the diagnosis and analysis of factors associated with post-rehabilitation reevaluation of children with positive initial screening for autism spectrum disorder(ASD). Methods A retrospective research analysis was used,97 cases children with positive initial screening for ASD were selected from August 2019 to August 2022 in the Department of Child Healthcare of Liaocheng People's Hospital,which were categorized into three age groups:≤24 months(12 cases),>24-≤36 months(47 cases),and >36-≤72 months(38 cases),and then,based on the diagnostic and statistical manual of mental disorders,fifth edition(DSM-5)of the United States,the children were divided into ASD group(73 cases)and non-ASD group(24 cases)according to the diagnostic criteria of the DSM-5.The Childhood Autism Rating Scale(CARS)or the Modified Childhood Autism Screening Scale-Revised/Further Revised(M-CHAT-R/F)scale and the Gesell Developmental Diagnostic Scale scores were collected at the time of the initial diagnosis of the children to analyze the diagnosis of the children with positive initial screening for ASD and the related factors after the reassessment of the diagnosis after the rehabilitation training. Results 75.3%children diagnosed as ASD after rehabilitation and the rate was 71.8%in male and 100%in female children respectively.In children with positive initial screening for ASD who were reevaluated after rehabilitation training,the compliance rate of ASD diagnosis increased sequentially with the age group(χ²=10.032,P=0.002).Reevaluated after rehabilitation training,children in the ASD group had significantly lower scores on the Gesell scale in adaptive,gross motor,fine motor,language,and personal-social competence areas than those in the non-ASD group,and the differences were all statistically significant(t=-3.268,-1.970,-2.472,-3.205 and -3.570,respectively,P<0.05).Reassessed after rehabilitation,the ASD diagnostic compliance rate was positively correlated with the degree of developmental lag in adaptive(r=0.325),gross-motor(r=0.229),fine-motor(r=0.241),language(r=0.286),and personal-social(r=0.356),ability areas(P<0.05).The children in the ASD group ≤24 months had significantly lower M-CHAT-R/F scale scores were significantly lower than those of the non-ASD group(t=-4.950,P<0.05),and the CARS scale and M-CHAT-R/F scale scores of the ASD group were significantly higher than those of the non-ASD group for children >24-≤36 months of age(t=2.166 and 2.151,respectively,P<0.05).The CARS scale scores of children in the ASD group(>36-≤72 months)were significantly higher than those in the non-ASD group(t=2.695,P<0.05).Higher CARS score was a risk factor for diagnosing as ASD for children older than 24 months.[OR=1.367,95%CI:1.133-1776,P<0.05].Higher M-CHAT-R/F score was a risk factor for diagnosing as ASD for children between 24 to 36 months.(OR=1.623,95%CI:1.122-2.765,P<0.05). Conclusion Reassessment of ASD diagnostic compliance after rehabilitation of children with initial positive ASD screening is high,and reassessment of ASD diagnostic compliance is related to the child's gender,age,developmental level,and score on either the initial screening CARS scale or the M-CHAT-R/F scale.

关键词

孤独症谱系障碍 / 筛查阳性 / 康复训练 / 诊断

Key words

autism spectrum disorder / screened positive / rehabilitation / diagnosis

参考文献

[1] 美国精神医学学会. 精神障碍诊断与统计手册[M].5版. 北京: 北京大学出版社, 2015: 46-55.

[2] Troisi J, Autio R, Beopoulos T, et al. Genome,environment,microbiome and metabolome in autism(GEMMA)study design:biomarkers identification for precision treatment and primary prevention of autism spectrum disorders by an integrated multi-omics systems biology approach[J]. Brain Sci, 2020, 10(10): 743.

[3] Zheng F, Liu G, Dang T, et al. GABA Signaling pathway-associated gene PLCL1 rare variants may be associated with autism spectrum disorders[J]. Neurosci Bull, 2021, 37(8): 1240-1245.

[4] Morales HP, Voltas MN, Canals SJ, et al. Autism spectrum disorder prevalence and associated sociodemographic factors in the school population:EPINED study[J]. Autism, 2021, 25(7): 1999-2011.

[5] Elsabbagh M, Divan G, Koh YJ, et al. Global prevalence of autism and other pervasive developmental disorders[J]. Autism Res, 2012, 5(3): 160-179.

[6] Wang F, Lu L, Wang SB, et al. The prevalence of autism spectrum disorders in China:a comprehensive meta-analysis[J]. Int J Biol Sci, 2018, 14(7): 717-725.

[7] 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.

[8] Woolfenden S, Sarkozy V, Ridley G, et al. A systematic review of the diagnostic stability of autism spectrum disorder[J]. Res Autism Spect Dis, 2012, 6(1): 345-354.

[9] Kadam A, Patni B, Pandit A, et al. Stability of the initial diagnosis of autism spectrum disorder by DSM-5 in children:a short-term follow-up study[J]. J Trop Pediatr, 2021, 67(1): fmaa104.

[10] Giserman-Kiss I, Cater AS. Stability of autism spectrum disorder in young children with diverse backgrounds[J]. J Autism Dev Disord, 2020, 50(9): 3263-3275.

[11] Bieleninik Ł, Posserud MB, Geretsegger M, et al. Tracing the temporal stability of autism spectrum diagnosis and severity as measured by the autism diagnostic observation schedule:a systematic review and meta-analysis[J]. PLoS One, 2017, 12(9): e0183160.

[12] 黄敏施, 韦臻, 冯哲, 等. 孤独症谱系障碍跨时间诊断一致性研究[J]. 中华精神科杂志, 2019, 52(1): 57-61.

[13] Lord C, Rutter M, DiLavore PC, et al. Autism diagnostic observation schedule,second edition[M].Torrance: Western Psychological Services publish, 2012: 3-429.

[14] 杨玉凤, 王惠珊, 洪琦, 等. 儿童发育行为心理评定量表[M]. 北京: 人民卫生出版社, 2016: 131-134.

[15] Robins DL, Casagrande K, Barton M, et al. Validation of the modified checklist for Autism in toddlers,revised with follow-up(M-CHAT-R/F)[J]. Pediatrics, 2014, 133(1): 37-45.

[16] Guo C, Luo M, Wang X, et al. Reliability and validity of the chinese version of modified checklist for autism in toddlers,revised,with follow-up(M-CHAT-R/F)[J]. Pediatrics, 2014, 133(1): 37-45.

[17] Gabrielsen TP, Farley M, Speer L, et al. Identifying autism in a brief observation[J]. Pediatrics, 2015, 135(2): e330-e338.

[18] Li HH, Feng JY, Wang B, et al. Comparison of the children neuropsychological and behavior scale and the Griffiths mental development scales when assessing the development of children with autism[J]. Psychol Res Behav Manag, 2019, 12: 973-981.

[19] 李洪华, 温和花, 杨丽娟, 等. 不同性别和年龄孤独症谱系障碍儿童症状严重程度及发育水平的差异分析[J]. 中华行为医学与脑科学杂志, 2021, 30(1): 27-32.

[20] 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.

[21] Nah YH, Young RL, Brewer N. Using the autism detection in early childhood(ADEC)and childhood autism rating scales(CARS)to predict long term outcomes in children with autism spectrum disorders[J]. J Autism Dev Disord, 2014, 44(9): 2301-2310.

基金资助

全民健康科技发展专项基金项目(Z2020LSD021)

聊城市重点研发计划政策引导类项目(2022YDSF34)