长春市0～6岁儿童孤独症的流行病学调查

目的了解长春市区所属十个区现住人口中0~6岁儿童孤独症患病情况。方法抽查长春市所属的十个区现住人口中0~6岁儿童10000人,采用孤独症行为量表(ABC)筛查。筛查阳性者进一步用儿童孤独症评定量表(CARS)及CCMD-3进行评定、确诊。结果筛查阳性者223人,确诊为儿童孤独症者15人,男性12人,女性3人。患病率为15.44/万。结论长春市区儿童孤独症的患病率接近国内报道的患病率,探索建立孤独症儿童早期筛查、早期诊断、早期康复训练的干预体系至关重要。     

宁波市1～6岁儿童孤独症谱系障碍调查

目的了解宁波市1~6岁儿童孤独症谱系障碍(ASD)分布特征及危险因素。方法采取分层整群抽样方法,对2014年6—12月宁波市5个县(市、区)1~6岁儿童进行ASD筛查。另选取在宁波市妇女儿童医院与康宁医院随访的46例ASD患儿及按年龄、性别(1∶3)匹配正常儿童进行病例对照研究,采用多因素条件Logistic回归分析ASD影响因素。结果共筛查12 123名1~6岁儿童,筛查阳性40例,筛查阳性率为3.30‰,最终确诊ASD儿童14例,患病率为1.15‰。多因素条件Logistic回归分析结果显示,1岁内户外活动时间少(OR=3.637,95%CI:1.069~12.404)、困难抚养型气质、独走出现的月龄大(OR=1.795,95%CI:1.302~2.474)和母亲生育年龄大(OR=7.973,95%CI:1.297~49.009)是ASD的危险因素。结论 ASD患病率相对偏高;应关注具有ASD发病因素的儿童,做到早筛查、早诊断、早干预,以改善ASD患儿的预后。     

无锡市1~6岁儿童孤独症患病现状调查

目的:了解无锡市1~6岁儿童孤独症患病情况,并进行干预性治疗。方法:采用整群随机抽样方法对无锡市25521名1~6岁儿童进行横断面调查,采用婴幼儿孤独症筛查表(CHAT)、克氏孤独症行为量表筛查,采用DSM-IV诊断标准和儿童孤独症评定量表(CARS)诊断,评估程度。结果:25 521名儿童中确诊孤独症25名,现患病率0.98‰,男女比例3.2∶1,城区患病率6.22‰,明显高于郊区患病率0.54‰(P<0.05),患病年龄高峰与3年心理行为门诊自然就诊患病年龄高峰相似。结论:无锡市1~6岁儿童孤独症患病率在国内外报道的患病率低范围内,家长、保健医生对孤独症的识别能力有待提高。     

孤独症谱系障碍儿童的早期诊断与识别

目的:在进行婴幼儿孤独症谱系障碍患病情况流行病学调查的同时早期诊断孤独症患儿,为早期干预做准备,并总结早期识别患儿的方法。方法:采用随机分层整群抽样方法,对连云港市8 532名0～3岁儿童进行横断面调查;应用婴幼儿孤独症筛查表(CHAT)筛查出可疑儿童,以儿童孤独症家长评定量表(ABC)、儿童期孤独症评定量表(CARS)及美国精神障碍诊断和统计手册(DSM-IV)的诊断依据进行确诊。结果:8 532名儿童中9名为孤独症阳性,阳性率为10.55/万,其中1岁内1例,1～2岁3例,2～3岁5例;男孩8例,女孩1例,男孩发病率高于女孩(P<0.05)。结论:加强对孤独症谱系障碍患儿的早期识别、早期诊断,对孤独症患儿的日后康复意义重大;总结出的早期识别孤独症谱系障碍儿童方法,为婴幼儿父母及医务工作者提供早期筛查孤独症患儿的依据。     

海南省0～6岁儿童孤独症谱系障碍的现况调查

目的 了解海南省0～6岁儿童孤独症谱系障碍的患病率、分布情况及差异。方法 抽查海南省18个市县0～6岁儿童37 862人,采用“儿童发育问题预警征象”调查表进行筛查,专科医师进行临床诊断。结果 海南省37 862名0～6岁儿童中诊断出235名孤独症儿童,孤独症患病率为6.2‰,其中男生为9.9‰,女生为1.7‰,性别差异具有显著统计学意义(χ²=101.91,P<0.001);不同年龄组儿童孤独症患病率差异有统计学意义(χ²=288.62,P<0.001),年龄越高孤独症患病率越高;城市显著高于其他地区(χ²=114.77,P<0.001)。结论 海南省0～6岁儿童孤独症谱系障碍的患病率居国内较高水平;且确诊年龄较大,需提高孤独症的早期诊断率。     

天津市2～6岁儿童孤独症调查

目的了解天津市儿童孤独症现患状况及可能的影响因素，为预防康复提供依据。方法采用分层整群抽样，在天津市两区县抽取2～6岁7316名儿童为对象，筛查和诊断儿童孤独症。结果天津市儿童孤独症现患率为1．1‰(8／7316)；男：女=7：1；城、乡患病率为1．4‰和0．8‰。孤独症患儿全部为智力低下者。结论应针对儿童孤独症的智力、精神和神经损伤及早采取康复措施。     

我国儿童孤独症患病情况分析

目的:了解我国儿童孤独症患病分布情况,为开展儿童孤独症的早期筛查和早期干预提供参考。方法:全面收集并分析我国现有已报道的10省市132 788名0～14岁儿童的孤独症患病调查数据。结果:搜集2000～2010年儿童孤独症患病率调查研究文献共16篇,地区分布为10个省市。实际调查132 788名儿童。我国10省市儿童孤独症患病率在0.28‰～25.0‰之间;福建省儿童孤独症患病率最低,安徽铜陵儿童孤独症患病率最高。132 788名儿童孤独症的总患病率为2.55‰,其中男、女患病率分别为3.37‰和1.62‰;城市、乡村患病率分别为3.35‰和0.84‰。结论:我国儿童孤独症的患病率具有明显的性别差异和地区差异。     

儿童孤独症发病危险因素的病例对照研究

目的 探讨儿童孤独症发病的相关危险因素, 为孤独症的防治提供理论依据。方法 采用成组病例对照研究, 对165例孤独症儿童和320例正常对照组儿童, 采用自编的孤独症危险因素调查表收集相关危险因素、家庭一般情况等资料, 用χ²检验分析两组儿童之间危险因素的差异。结果 病例组母亲高生育年龄(≥35岁)、有人工流产史、母孕期抑郁情绪史、母孕期被动吸烟史及父亲内向所占比例较正常组高(P<0.05), 进一步进行Logistic 回归分析显示母高育龄、孕期抑郁情绪、孕期被动吸烟、有人工流产史以及父亲性格内向为孤独症的危险因素。结论 母亲高龄生育、有人工流产史、孕期抑郁情绪、孕期被动吸烟以及父亲性格内向均可使儿童孤独症发病风险增高。     

石家庄市0~6岁儿童麻疹流行特征及发病危险因素研究

目的 探讨石家庄市0~6岁儿童麻疹流性特征及发病危险因素,为控制和消除麻疹提供科学依据。方法 选择0~6岁儿童麻疹实验室确诊病例,分析其流行特征,并采用成组病例-对照研究法探讨其发病危险因素。结果 石家庄市0~6岁儿童麻疹发病率为7.96/10万,发病率男（9.87/10万）高于女（6.23/10万）,农村（8.10/10万）高于城市（6.75/10万）。共有104组儿童纳入发病危险因素病例对照研究,结果显示,发病前7~21天的就诊史（OR=23.13, 95%CI: 3.56～150.39）及是否流动儿童（OR=18.39, 95%CI: 6.98～ 48.50）是石家庄市0~6岁儿童麻疹发病的危险因素,而麻疹疫苗免疫接种史（OR=0.059, 95%CI: 0.024～0.109）是麻疹发病的保护因素。结论 改进医院感染控制措施,提高适龄儿童麻疹疫苗接种率,尤其是加强流动儿童免疫规划管理,是控制消除麻疹的关键。     

2017-2019年永康市儿童孤独症患病情况及影响因素分析

目的统计2017-2019年永康市儿童孤独症患病情况,并初步探讨相关影响因素。方法采用横断面研究方法,选取2017-2019年永康市15 484名儿童进行筛查,采用自编问卷调查基本情况,筛查方法选择6个月以上的早期警示指标、孤独症行为量表(ABC)和改良婴幼儿孤独症量表(M-CHAT),统计2017-2019年永康市儿童孤独症患病情况,并采用多因素Logistic回归分析方法分析其患病相关影响因素。结果 2017-2019年永康市15 484名儿童中,共46名确诊患有孤独症,占0.30%。孤独症组与非孤独症组在性别、新生儿并发症、婴幼儿患病史、新生儿喂养方式、家庭月收入、父亲性格、母亲性格、主要抚养人、出生体质量、分娩方式、足月分娩、家族精神病史、母亲孕期是否服药、母亲孕期是否接触电脑工作、有无人流史及有无先兆流产等方面比较,差异均有统计学意义(均P0.05);在户籍、儿童年龄、父亲生育年龄、母亲生育年龄及产次等方面比较,差异均无统计学意义(均P0.05)。多因素Logistic回归分析结果显示,新生儿并发症、婴幼儿患病史、家族精神病史、母亲孕期服药、先兆流产是2017-2019年永康市儿童孤独症患病情况的危险因素(均P0.05)。结论 2017-2019年永康市儿童有一定孤独症患病率,新生儿并发症、婴幼儿患病史、家族精神病史、母亲孕期服药及先兆流产均是孤独症患病的危险因素,有效规避以上危险因素可能会减少孤独症患病率。     

School district resources and identification of children with autistic disorder

OBJECTIVES: We estimated the effect of community and school district resources on the identification of children with autistic disorder. METHODS: Latent growth curve regression models were applied to school district-level data from one large state. RESULTS: The rate of identification of autistic disorder increased on average by 1.0 child per 10000 per year (P<.001), with statistically significant district variation. After adjustment for district and community characteristics, each increase in decile of school revenue was associated with an increase of 0.16 per 10000 children identified with autistic disorder. The proportion of economically disadvantaged children per district was inversely associated with autistic disorder cases. CONCLUSIONS: District revenue was associated with higher proportions of children identified with autistic disorder at baseline and increasing rates of identification when measured longitudinally. Economically disadvantaged communities may need assistance to identify children with autistic spectrum disorders and other developmental delays that require attention.     

BDNF基因二核苷酸多态性与儿童孤独症的关系

目的:探讨BDNF基因二核苷酸多态性的等位基因及基因型与儿童孤独症的关系。方法:按照ICD-10及CCMD-3的儿童孤独症诊断标准,以儿童孤独症评定量表、孤独症行为检查量表、儿童适应行为评定量表及儿童生长发育调查记录表作为评估、调查工具,在华西医院心理卫生中心门诊收集75例儿童孤独症患者的临床资料。根据儿童孤独症的神经发育障碍假说,以儿童孤独症为研究对象,进行神经发育相关的BDNF基因的二核苷酸重复多态性位点的检测,用SPSS11.0进行统计分析。结果:含二核苷酸重复多态性的A1(174bp)等位基因与儿童孤独症的社会交往因子呈负相关,而含A3(170bp)等位基因与之呈正相关,患者的适应水平也受到相应影响。结论:二核苷酸重复多态性的A1等位基因可能对孤独症的症状表达具有抑制作用,而A3等位基因对孤独症的症状表达有促发作用,并且影响儿童孤独症患者的社会适应水平。     

孤独症儿童气质特征分析

【目的】 分析孤独症儿童的气质特征,为孤独症早期防治提供依据。 【方法】 采1∶2病例对照研究,对40例孤独症患儿及80例正常儿童采用《3～7岁儿童气质问卷》、自制的家庭与环境因素调查表、《孤独症治疗评定量表》进行评估。 【结果】 40例孤独症组儿童的气质维度中适应性、反应强度、坚持性、反应阈分值与正常儿童组比较差异有统计学意义(P<0.05);孤独症组ATEC量表中语言交流、社会能力、感知认知意识三个分量表分值与气质维度存在相关性(P<0.05)。 【结论】 孤独症组儿童气质维度与正常儿童组存在差异;孤独症儿童的社交、语言和认知等障碍影响气质维度的发展。     

Association of autistic spectrum disorder and the measles, mumps, and rubella vaccine – A systematic review of current epidemiological evidence

The authors conducted a systematic review of the evidence for and against the existence of an association between autistic spectrum disorder and the measles, mumps and rubella (MMR) vaccine. Specifically, they tested four hypotheses: (1) that the rates of autistic spectrum disorder is higher in individuals who have received MMR than those who did not, (2) that an increase in autistic spectrum disorder may be occurring as a result of MMR, (3) that the development of autistic spectrum disorder is temporally associated with receiving the MMR, and (4) that a new variant form of autistic spectrum disorder may be associated with the MMR vaccine. The authors sought to identify all controlled epidemiological articles examining for an association between autistic spectrum disorder and the MMR vaccine. They extracted data from the articles on the characteristics and objectives of the study as well as evidence of an association. Twelve articles met the inclusion criteria. One study found no difference in the rates of autistic spectrum disorder and the MMR vaccine in children who were vaccinated and those who were not. Six studies examined for evidence of an increase in autistic spectrum disorder associated with an increase in the MMR vaccine coverage; none of the six showed evidence of an association. Four studies examined if a variant form of autistic spectrum disorder was associated with the MMR vaccine; none of the four showed evidence of an association. Eight studies attempted to determine if there was a temporal association between developing autistic spectrum disorder and receiving the MMR vaccine. Of these, one study identified an increase in parental concern in the 6‐month period following vaccination with MMR in one of its analyses. The results of all other studies showed no association between autistic spectrum disorder and the MMR vaccine. The authors concluded that the current literature does not suggest an association between autistic spectrum disorder and the MMR vaccine. The authors did note that the studies were not large enough even in aggregate to rule out a link between a rare variant form of autistic spectrum disorder and the MMR vaccine; they held, however, that given the real risks of not vaccinating and that the risks and existence of variant autistic spectrum disorder remain theoretical, current policies should continue to advocate the use of the MMR vaccine.     

应用核磁共振成像研究孤独障碍脑结构的进展

应用核磁共振成像研究孤独障碍的脑结构异常可以阐明脑的神经解剖学与人的行为之间的关系.随着现代影像技术的发展,对孤独障碍脑结构像的研究报道越来越深入,并得出一些有意义的结论.该文不仅综述了近几年来应用核磁共振成像技术研究孤独障碍脑体积和灰白质的结果,而且分别从胼胝体、杏仁核、海马、基底节等与孤独障碍密切相关的皮层下结构的角度综述了其与孤独障碍的关系.     

孤独症儿童家长生存质量的研究

目的 分析孤独症患儿对其父母生存质量的影响,为有关机构展开工作提供参考依据。方法 采用普适性生存质量测定量表(SF-36),对90例孤独症患儿父母及120例正常儿童的父母进行评定。结果 1)孤独症组父母的生存质量总分及各领域评分均低于正常父母组(P＜0.01);2)低功能孤独症组的父母生存质量评分明显低于高功能孤独症组(P＜0.01);3)患儿家长的生存质量与患儿病情程度呈负相关,与智力水平呈正相关 (P＜0.01)。 结论 孤独症儿童对患儿父母生存质量有影响,低功能孤独症患儿则影响更大。     

Trends in autism

Leo Kanner described autism in 1943, and Hans Asperger described the syndrome in 1944. The term Pervasive Developmental Disorders (PDD) was first used in the 1980s to describe a class of disorders that include (1) Autistic disorder, (2) Rett disorder or syndrome, (3) Childhood Disintegrative Disorder, (4) Asperger's disorder or syndrome, and (5) Pervasive Developmental Disorder Not Otherwise Specified, or PDDNOS. Autism prevalence studies published before 1985 showed prevalence rates of 4 to 5 per 10,000 children for the broader autism spectrum, and about 2 per 10,000 for the classic autism definition. Since 1985 there have been higher rates of autism reported from several countries. From the UK a prevalence rate of 16.8 per 10,000 children for autistic disorder was reported, and 62.6 per 10,000 for the entire autistic spectrum disorders. Sweden reported a prevalence of 36 per 10,000 for Asperger and 35 per 10,000 for social impairment, or a total prevalence of 71 per 10,000 for suspected and possible cases. From the US, 40 per 10,000 in three to ten year old children for autistic disorder and 67 per 10,000 children for the entire autism spectrum was reported. From the north region in Israel for children born between 1989-93 in the Haifa area, an incidence rate of 10 per 10,000 was found for autism. In recent years concern has been shown about the possible increase in the prevalence of autistic spectrum disorders. Studies have shown an increase, but during these last twenty years diagnostic criteria and definition have also changed. Although many factors are at play, it is evident that there has been an increase.     

Perceptions of stigma: the parents of autistic children

This paper reports the findings of a qualitative study of courtesy stigma among 32 parents of autistic children. The results indicate that autism has uniquely stigmatising aspects because of the extremely disruptive nature of autistic symptoms, the normal physical appearance of autistic children, and the lack of public knowledge and understanding regarding the nature of autism. Most parents perceived themselves to be stigmatised by their child's disorder. There was a strong tendency for mothers to feel more stigmatised than fathers. Parents with more severely disabled children and children who were under the age of twelve were also somewhat more likely to perceive themselves to be stigmatised.     

Autistic spectrum disorder traits in children with attention deficit hyperactivity disorder

Background Current classification systems do not allow for comorbid diagnoses of attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). Children with ADHD are often screened for ASD during clinical assessment and when recruited to clinical trials. We predicted that children with ADHD would have more autistic traits than controls and that certain traits would be more prevalent. Methods The clinically referred sample consisted of 30 children with ADHD and 30 matched controls aged 9–15 years. Children were screened for ASD traits using the Social Aptitudes Scale (SAS) and the Social Communication Questionnaire (SCQ). Results We found that ASD traits were significantly higher in children with ADHD than controls. None of the children received a diagnosis of autism or ASD. However, a large proportion (28% using the SCQ and 62% using the SAS) of children with ADHD reached screening thresholds for a predictive diagnosis of ASD. Relative to controls, children with ADHD had significantly higher levels of communication and social deficits, but not repetitive behaviours. Conclusion Further work is needed to establish whether autistic‐like communication and social difficulties in children with ADHD are part of the broader ASD phenotype or are specific to ADHD.