早期感觉统合训练对病毒性脑炎患儿的干预效应

目的 探讨早期感觉统合训练对病毒性脑炎患儿的干预效应。方法 回顾性分析2018年1月-2019年12月本院儿科住院部收治的重症病毒性脑炎恢复期患儿80例作为研究对象,根据康复干预方案将患者分为研究组(联合早期感觉统合训练,60例)和对照组(常规康复训练,20例),比较2组患儿治疗前和治疗3个月后运动能力、智力发育状况和感觉统合的差异。结果 治疗前2组粗大运动功能测试量表(Gross motor function measure,GMFM-88)、Peabody运动发育量表(Peabody developmental motor scale-Fine motor,PDMS-FM)、丹佛智力发育量表(Denver developmental screening test,DDST)及儿童感觉统合评分比较无明显差异(P>0.05); 治疗3个月后2组上述评分均明显高于治疗前(P<0.05),且研究组上述评分均明显高于对照组(P<0.05)。结论 早期感觉统合训练对病毒性脑炎患儿的干预效应满意,可明显改善运动功能、智力发育及感觉统合水平。     

儿童孤独症与感觉统合失调的相关分析

目的:探索儿童孤独症与感觉统合失调的关系.方法:对60例符合国际疾病分类第10版(ICD-10)诊断标准的儿童孤独症患儿(患者组)与60名健康儿童(对照组)填写儿童情况调查表,并分别进行感觉统合评定量表(SIS)、克氏孤独症行为量表(CBRS)及并儿童孤独症评定量表(CARS)评定孤独症患儿症状严重程度.结果:患者组伴感觉统合失调的占95.0%,而对照组存在感觉统合失调的仅占3.3%;患者组与对照组的感觉统合评定结果比较,差异具有显著性(P＜0.01);病程长短不同的患儿感觉统合失调严重度不同,差异具有显著性(P＜0.05);智力水平与感觉统合失调显著相关(P＜0.05);多元逐步回归分析结果:是否诊断为儿童孤独症与CBRS总分、本体感、母孕期有无高危因素、既往有重大疾病史、有无窒息史、母亲文化程度有关.结论:儿童孤独症患儿普遍存在感觉统合失调,在对儿童孤独症患儿进行个别化训练的同时应进行感觉统合训练.     

孤独症治疗评定量表中文版的信度和效度检验

目的 分析孤独症治疗评定量表（ATEC）中文版的信度和效度，并评价ATEC中文版评分与孤独症症状和发育水平的相关性。 方法 入组2016年6月-2018年12月在南京医科大学附属脑科医院就诊、符合《精神障碍诊断与统计手册(第5版)》（DSM-5）孤独症谱系障碍（ASD）诊断标准的77例儿童作为病例组，招募健康儿童71名作为对照组。采用ATEC中文版、孤独症行为量表（ABC）、儿童孤独症评定量表（CARS）、孤独症诊断访谈量表修订版（ADI-R）、Gesell发育量表评定病例组儿童的临床症状和发育水平；对照组儿童完成ATEC中文版评定。采用Cronbach’s α系数评估ATEC中文版的信度，采用ROC曲线评估其效度。 结果 ATEC中文版总量表及其各分量表的Cronbach’s α系数在0.750~0.787之间。ATEC中文版总量表及其分量表的敏感度在0.922~0.987之间，特异度在0.803~0.887之间，曲线下面积在0.924~0.972之间。ATEC中文版总评分与CARS和ABC总评分呈正相关（r=0.509、0.580，P均<0.01）；ATEC中文版的表达/语言/沟通、社交能力、感知/认知能力分量表评分与Gesell发育量表对应分量表的发育商均呈负相关（r=-0.677、-0.383、-0.332，P均<0.01）。 结论 ATEC中文版具有较高的信度和效度，且其评分能反映ASD症状的严重程度及患儿发育水平。     

孤独症谱系障碍儿童胃肠问题与核心症状及预后的相关分析

目的旨在探讨孤独症谱系障碍(ASD)儿童胃肠问题与临床核心症状及预后的关系,为ASD的诊断和预后提供线索。方法纳入98例ASD儿童(ASD组)和103例发育正常的健康儿童(HC组)。评估两组儿童是否存在胃肠问题;ASD组根据是否存在胃肠问题分为胃肠道阳性组(GI+组)和胃肠道阴性组(GI-组),分别予以儿童孤独症评定量表(CARS)、孤独症儿童行为检查量表(ABC)评估患儿核心症状。经过行为康复治疗后,再次给予GI+组儿童以上量表进行评估。结果 ASD组胃肠问题的发生率明显高于HC组(P0.05);GI+组和GI-组CARS量表评分差异有统计学意义(P=0.005);胃肠症状好转的患儿治疗后儿童孤独症评定量表评分显著低于无好转者,也显著低于治疗前儿童孤独症评定量表评分(P0.05);胃肠症状加重时患儿精神症状多加重。结论 ASD组胃肠问题发生率较高,积极干预胃肠道症状可能有利于ASD的治疗,且胃肠道症状可作为预测ASD儿童病情变化的一个指标。     

感觉统合训练在缺氧缺血性脑病患儿早期干预中的疗效观察

目的探讨感觉统合训练在缺氧缺血性脑病(HIE)患儿早期干预中的使用价值。方法40例4～12个月伴有运动系统外症状如易激惹等的HIE恢复期患儿随机分成试验组和对照组,两组均接受神经发育疗法(NDP)训练,癫痫患者服用抗癫痫药。试验组增加感觉统合训练,包括视觉训练、听觉训练、口颈部按摩、全身皮肤擦刷、关节挤压、按摩棒振动肌肤、巴氏球上蹦跳、线性或弧线运动刺激,30 min/次,4次/d。治疗前、治疗后3个月、6个月分别用婴幼儿感觉功能测试及Peabody动作发展量表评估感觉功能及动作发育水平。结果试验组在3个月和6个月后感觉总分及总运动商数均明显高于对照组,在统计学上有显著差异(P＜0．01)。结论对感觉功能障碍的HIE患儿,早期积极的感觉统合训练有利于稳定患儿情绪,改善睡眠和进食能力,提高康复训练依从性,促进运动和认知行为等各方面功能的发育。     

感觉统合训练对精神发育迟滞儿童影响的对照研究

目的:探讨感觉统合训练对精神发育迟滞儿童感觉统合障碍影响。方法:将49例精神发育迟滞儿童患者随机分为对照组25例和研究组24例。研究组接受20周的感觉统合训练,对照组进行20周的观察,不作干预。干预前后对两组儿童进行儿童感觉统合评定量表(CSIRS)和儿童行为量表(CBCL)评定。结果:训练10周和20周后研究组和对照组在CSIRS3个分量表评分上差异均有统计学意义(P<0.05),而在CBCL评分上只有20周后在"社会能力"评分上两组差异有统计学意义。研究组和对照组智力评分差异无统计学意义。研究组CSIRS量表训练前后差异有统计学意义;训练20周前庭平衡失调小于训练10周水平(t=3.774,P=0.001),而触觉过分防御大于训练10周水平(t=3.868,P=0.000);本体感失调评分差异无统计学意义(t=0.634,P=0.221)。结论:感觉统合训练对精神发育迟滞儿童的感觉统合失调有效。     

孤独谱系障碍2～3岁患儿杏仁核体积的研究

目的 分析2～3岁孤独谱系障碍(autism spectrum disorder,ASD)儿童与发育障碍儿童杏仁核体积的差异,并对ASD儿童杏仁核体积与社会情绪功能之间的相关性进行研究.方法 对46例ASD儿童(ASD组)和39例年龄、性别、发育商与之匹配的发育障碍儿童(对照组)进行磁共振扫描,手工勾画杏仁核,比较两组杏仁核体积的差异,利用婴幼儿沟通及象征性行为发展量表(Communication and Symbolic Behavior Scales Developmental Profile,CSBS-DP)评估患儿的社会交流能力,分析杏仁核体积与临床症状的相关性.结果 与对照组相比,2～3岁ASD儿童双侧杏仁核体积明显增大[左侧:(0.83 ±0.15) cm3与(0.72±0.13) cm3,t=3.55,P=0.001;右侧:(0.86±0.15)cm3与(0.77±0.12) cm3,t =2.83,P=0.006];在控制年龄和发育商后,ASD组儿童左侧杏仁核体积与社交领域中的手势项目(r=-0.331,P=0.042)及象征性行为领域中的游戏技巧项目均呈负相关(r=-0.333,P=0.041).结论 2～3岁的ASD儿童存在杏仁核体积增大,可能与患儿的社会情绪功能受损有关.     

感觉症状与Tourette综合征预后的关系

目的：分析Tourette综合征感觉症状对预后的影响.方法：随机选取Tourette综合征男性患儿120例,使用感觉性症状问卷进行评定,其中伴有感觉症状的患儿66例,不伴感觉症状的患儿54例,采用耶鲁抽动障碍严重程度量表（YGTSS）、抑郁自评量表（SDS）以及焦虑自评量表（SAS）评定,使用氟哌啶醇治疗4周后再次评定.结果：不伴有感觉症状的Tourette综合征患儿较伴有感觉症状的患儿抽动症状好转明显（P＜0.01）;抑郁自评、焦虑自评严重程度轻.结论：Tourette综合征常伴有各种感觉症状,重视感觉症状将对疗效可产生有利的影响.     

孤独症谱系障碍患儿父母生存质量与睡眠的相关研究

目的:探讨孤独症谱系障碍(ASD)患儿父母生存质量与睡眠质量以及两者之间的相关性。方法:使用世界卫生组织生存质量测定量表简表(WHOQOL-BREF)及匹兹堡睡眠质量指数量表(PSQI)对86例ASD患儿的父母(研究组)及83名性别、年龄均匹配的健康儿童父母(正常对照组)进行调查,比较两组WHOQOL-BREF及PSQI评分差异;采用多元线性回归分析睡眠质量对生存质量的影响。结果:ASD患儿父母的WHOQOL-BREF生理、心理、社会及环境各领域因子分值明显低于正常对照组(t=-4.903,t=-6.931,t=-4.300,t=-6.639;P均0.001);ASD患儿父母PSQI睡眠质量、入睡时间、日间功能障碍及总分显著高于正常儿童父母(t=4.547,t=2.545,t=2.508,t=3.479;P均0.01或P0.001)。多元回归分析显示睡眠质量对生存质量的各领域评分均存在显著负影响(t=-2.608~-5.661;P0.05或P0.001)。结论:ASD患儿父母生存质量及睡眠质量相对较差;且睡眠质量可能影响生存质量。     

孤独症谱系障碍儿童父母照顾负担及生活质量调查

目的调查评估孤独症谱系障碍(ASD)儿童父母的照顾负担及生活质量。方法使用Zarit护理负担量表(ZBI)评估父母照顾负担。使用简式健康状况问卷第二版(SF-36v2)评估父母生活质量。使用社交反应量表(SRS)评估儿童社交障碍。使用Sobel检验研究儿童社交障碍、父母照顾负担及生活质量三者的关系。结果与正常发育(TD)儿童家庭相比,ASD家庭母亲的照顾负担更重(P0.001);ASD儿童父母的生活质量低于TD儿童父母(P0.05);ASD儿童社交障碍对其母亲生活质量的影响是通过增加照顾负担来介导调节的(P0.001)。结论儿童孤独症谱系障碍给母亲带来了沉重的照顾负担,并严重影响了父母的生活质量。     

An MRI and proton spectroscopy study of the thalamus in children with autism

Thalamic alterations have been reported in autism, but the relationships between these abnormalities and clinical symptoms, specifically sensory features, have not been elucidated. The goal of this investigation is to combine two neuroimaging methods to examine further the pathophysiology of thalamic anomalies in autism and to identify any association with sensory deficits. Structural MRI and multi-voxel, short echo-time proton magnetic resonance spectroscopy ((1)H MRS) measurements were collected from 18 male children with autism and 16 healthy children. Anatomical measurements of thalamic nuclei and absolute concentration levels of key (1)H MRS metabolites were obtained. Sensory abnormalities were assessed using a sensory profile questionnaire. Lower levels of N-acetylaspartate (NAA), phosphocreatine and creatine, and choline-containing metabolites were observed on the left side in the autism group compared with controls. No differences in thalamic volumes were observed between the two groups. Relationships, although limited, were observed between measures of sensory abnormalities and (1)H MRS metabolites. Findings from this study support the role of the thalamus in the pathophysiology of autism and more specifically in the sensory abnormalities observed in this disorder. Further investigations of this structure are warranted, since it plays an important role in information processing as part of the cortico-thalamo-cortical pathways.     

Emotional and behavioral problems in preschool children with autism: Relationship with sensory processing dysfunction

This study aimed to investigate the sensory processing (SP) dysfunction and emotional and behavioral problems in preschool children with autism and then examine the relationship between the SP dysfunction and emotional and behavioral problems. The parents of 112 children aged 48–84 months (67 with autism; 45 age-matched typically developing) completed a demographic questionnaire, the Child Behavior Checklist-Chinese version (CBCL-C), and the Sensory Profile-Chinese version (SP-C). We found that 95.8% of children with autism who showed significant internalizing problems had at least one SP quadrant in the definite difference range, while 81.8% with significant externalizing problems had at least one SP quadrant in the definite difference range. Typically developing children showed lower percentages of 66.7% and 40.0%. Stepwise linear regression analysis revealed that in children with autism, avoiding and male gender were significant predictors of internalizing problems and sensitivity was a significant predictor of externalizing problems. In contrast, in typically developing children, avoiding was a significant predictor of internalizing problems and seeking was a significant predictor of externalizing problems. This study provided further understanding of the factors influencing emotional and behavioral problems in autism.     

A comparison of patterns of sensory processing in children with and without developmental disabilities

This study compared the patterns of sensory processing among children with autism spectrum disorder (ASD), attention deficit and hyperactivity disorder (ADHD), and children without disabilities. Parents reported on the frequency of sensory processing issues by completing the Chinese Sensory Profile (CSP). Children with disabilities (ASD or ADHD) exhibited significantly more sensory processing issues than children without disabilities. The results of GLM and discriminant analyses showed that the CSP effectively differentiated between children with and without developmental disabilities. But it failed to identify major differences in sensory processing issues between children with either ASD or ADHD. Sensory processing issues could be one of many criteria that characterize and differentiate the features of children with different developmental disabilities. Although no significant gender differences in sensory processing issues appeared, age was a significant cofounding factor in evaluating sensory processing. Children without disabilities showed some small decreases in sensory processing issues as they aged from 6 to 12 years old. Children with ASD showed some decrease in sensory processing issues over the span of their childhood, while children with ADHD showed a significant increase in auditory processing issues as well as small increases in many aspects of sensory processing.     

Developing a Chinese version of the Psychoeducational Profile (CPEP) to assess autistic children in Hong Kong

The Psychoeducational Profile (PEP) has been used to assess the developmental functioning and behavior of autistic children in the West. To examine its suitability for assessing autistic children in Hong Kong, the PEP was translated into Chinese and certain items were adapted for local conditions. The Chinese version of the PEP (CPEP) was administered to 23 autistic children and 40 children with normal development, ranging in age from 3 to 7 years. Some of the children were also given the Merrill-Palmer Scale of Mental Tests. Results indicated that CPEP scores correlated significantly with Merrill Palmer scores, demonstrating criterion-related validity. Significant positive correlations were also found between age and CPEP scores for children with normal development, verifying that the CPEP has properties of a developmental scale. There was also a significant difference between children with normal development and children with autism on the Pathology scale, suggesting that the scale has discriminant validity.     

Sensory processing abilities and their relation to participation in leisure activities among children with high-functioning autism spectrum disorder (HFASD)

Children with autism may have atypical sensory processing abilities, which are known to impact child's performance and participation. However, lack of information exists regarding the expression of these abilities in specific groups on the spectrum, as children with high-functioning autism spectrum disorder (HFASD). This study aimed to characterize the sensory processing abilities of children with HFASD and examine their relationship to participation in leisure activities. Participants were 50 children aged 6–11 years: 25 children with HFASD and 25 with typical development. Sensory processing abilities were examined by the short sensory profile (SSP). Participation was assessed by the children's assessment of participation and enjoyment (CAPE). Children with HFASD had atypical sensory processing abilities. They also had lower participation in leisure activities expressed in limited range of activities, performed less often, mainly alone and at home. Their atypical sensory processing patterns were correlated with lower participation, specifically in social, physical and informal activities. In conclusion, children with HFASD may have atypical sensory processing abilities and restricted participation. Intervention should refer to each of these parameters and to the relationship between them in order to enable optimal inclusion of children with HFASD in society.     

A retrospective review of the effectiveness of aripiprazole in the treatment of sensory abnormalities in autism

Although sensory deficits are frequently observed in autistic individuals, pharmacologic interventions targeting these abnormalities are lacking. The goal of this investigation was to assess the effectiveness of aripiprazole in targeting sensory deficits in children and adolescents with autism. Using an outpatient clinic registry for pervasive developmental disorder, 13 individuals who had received aripiprazole for treating disruptive behaviors and had completed behavioral rating scales (aberrant behavior checklist [ABC] and sensory profile questionnaire [SPQ]) were identified. Mean treatment duration was 24.4 weeks with a mean final aripiprazole dosage of 10.8 mg. Aripiprazole yielded improvements in the total ABC and in several items of the SPQ including registration, inattention/distractibility, auditory processing, and modulation of visual input affecting emotional responses and activity level, suggesting that aripiprazole might be beneficial in targeting sensory abnormalities in autism.     

Sensory Responsiveness as a Predictor of Social Severity in Children with High Functioning Autism Spectrum Disorders

This study examines the relationship between sensory responsiveness and social severity in children with high functioning autism spectrum disorders (HFASD; N = 36) and age-matched controls (N = 26) between 6 and 10 years old. Significant relationships were found between social responsiveness scale scores and each of the six sensory profile sensory system scores for children with HFASD and controls. Multivariate regression analyses revealed atypical scores from multisensory responsiveness, and responsiveness of the proximal senses of oral sensory/olfactory and touch as the strongest predictors of greater social impairment in the participants. Findings suggest that the relationship between sensory responsiveness and other autistic traits is more important than previously recognized and addressing sensory modulation issues in children with HFASD may be more critical than previously understood.     

Describing the Sensory Abnormalities of Children and Adults with Autism

Patterns of sensory abnormalities in children and adults with autism were examined using the Diagnostic Interview for Social and Communication Disorders (DISCO). This interview elicits detailed information about responsiveness to a wide range of sensory stimuli. Study 1 showed that over 90% of children with autism had sensory abnormalities and had sensory symptoms in multiple sensory domains. Group differences between children with autism and clinical comparison children were found in the total number of symptoms and in specific domains of smell/taste and vision. Study 2 confirmed that sensory abnormalities are pervasive and multimodal and persistent across age and ability in children and adults with autism. Age and IQ level affects some sensory symptoms however. Clinical and research implications are discussed.