孤独症谱系障碍儿童面孔识别的眼动研究

【目的】 探索孤独症谱系障碍儿童面孔注视模式。 【方法】 使用Tobii T60眼动仪记录眼动轨迹,比较孤独症谱系障碍儿童以及正常对照组观看陌生面孔、熟悉面孔以及自我面孔时注视模式的差异。 【结果】 孤独症谱系障碍儿童对面孔核心区域(包括眼睛、嘴巴以及鼻子)的注视时间比例均低于正常对照组儿童(P<0.05),对非核心区域的注视时间比例高于正常对照组(P<0.05)。 【结论】 孤独症谱系障碍儿童在眼睛以及嘴巴注视上均存在缺陷。面孔注视的缺陷可能与孤独症谱系障碍儿童社会性情感以及沟通功能缺失密切相关。     

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。     

听统刺激联合游戏疗法对孤独症儿童行为心理的干预

目的 探讨听觉统合训练联合游戏疗法对孤独症儿童行为心理的影响。方法 将孤独症患儿60例随机分为三组,A组(单纯的结构化教育治疗模式)、B组(结构化教育模式+游戏治疗)和C组(结构化教育治疗模式+游戏治疗+听觉统合治疗),每组各20例,治疗前后均采用儿童孤独症评定量表(CARS),孤独症儿童行为量表(ABC),Gesell发育诊断量表(社会适应性,个人社交,语言)进行评估。结果 三组患儿治疗6个月后的CARS、社会适应、语言、个人社交均有改善(P<0.05),其中在ABC及个人社交变化值方面,B组及C组较A组改善更为明显(P<0.05)。在语言变化值方面,C组变化值显著高于B组(P<0.05),同时B组变化值又显著高于A组(P<0.05)。结论 听觉统合训练联合游戏疗法在自闭症儿童行为心理治疗中,效果优于单纯结构化教育。     

0~3岁儿童心理行为发育预警征与Gesell发育评估一致性分析

目的 了解近三年北京市顺义区0~3岁儿童心理行为发育状况,评估预警征应用效果。方法 选取2018年9月—2021年9月在北京市顺义区妇幼保健院接受Gesell发育评估的儿童1 360例,检索相应儿童在社区体检中预警征的结果,对两种评估结果进行统计分析。结果 Gesell发育评估儿童1 360例中男童约占69.9%,女童约占30.1%,男童比例显著高于女童(χ² =214.412,P<0.05),男童语言及个人-社交能区显著低于女童(t＝4.201、2.186,P<0.05)。预警征筛查中12月龄以内的儿童阳性项目以大运动和精细动作发育落后为主,而12~36月龄儿童阳性项目以语言发育落后为主,各年龄段预警征阳性项目构成比差异有统计学意义(χ² ＝36.750、5.762、9.966、8.895、57.731、231.749、105.385、56.919,P<0.05)。经Kappa一致性检验,预警征与Gesell发育评估结果一致性为中等(Kappa=0.559,P<0.05)。预警征2项及以上阳性的儿童其适应性DQ值低于1项预警征阳性的儿童,差异有统计学意义(t=5.718,P<0.05)。结论 需关注男童心理行为发育,注重儿童早期发育促进,尤其重点关注婴儿的大运动及精细动作、幼儿的语言发育。     

孤独症谱系障碍男童注意能力及社交发展特征的初步研究

目的 了解孤独症谱系障碍(ASD)男童注意能力特征,探索注意能力与社交发展的关系。方法 收集2015年7月—2016年7月在上海交通大学医学院附属精神卫生中心儿少门诊就诊的ASD男童37例,采用孤独症行为量表(ABC)对男童症状进行评定,采用长处与困难问卷(SDQ)由父母对男童进行评定,运用孤独症诊断访谈量表修订版(ADI-R)中的社交发展和游戏部分,对ASD男童的自发性共同注意和社会特征进行评定。结果 ASD男童ABC量表的感觉能力、交往能力、运动能力、语言能力、自我照顾能力和症状严重度与SDQ量表的情绪问题、注意不能、同伴交往和总困难程度呈正相关(P<0.01);ADI-R社交发展和游戏部分的表情丰富程度、与同伴一起的想象性游戏、对其他儿童的兴趣、安慰他人、社会性主动提议和不恰当的面部表情得分和SDQ社会化行为因子分呈负相关(P<0.01)。结论 ASD男童在目光对视、社交性微笑、与同伴一起想像性游戏、引导别人注意等自发性共同注意能力存在缺陷,早期发现有助于ASD儿童的早期筛查、早期干预。     

81例儿童孤独症综合干预对行为异常的疗效分析

【目的】 探讨综合干预儿童孤独症在行为异常方面的临床疗效,为孤独症儿童的康复提供临床依据。 【方法】 采取病例对照研究方法,对81例儿童孤独症进行随机抽样,分为实验组和对照两组,两组在综合治疗的基础上,对实验组增加听觉统合训练干预,对患儿行为异常干预前后的临床症状变化进行比较。 【结果】 综合干预对两组行为异常症状包括对某些信息敏感、玩耍方式奇特、厌恶学习、注意力涣散、回避眼光接触、缺乏模仿性动作等均有改善,与对照组相比,实验组在玩耍方式奇特、缺乏模仿性动作、缺乏想象性游戏方面改善更为明显,差异有统计学意义(P<0.05)。 【结论】 综合训练干预可以改善孤独症患儿的部分异常行为,并有肯定的疗效。     

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。     

ASD与ADHD患儿基本面部表情识别特点研究

目的 测试孤独症谱系障碍(ASD)儿童、注意力缺陷多动障碍(ADHD)儿童和正常儿童对基本面部表情的识别能力,探讨孤独症谱系障碍儿童面部表情识别障碍特点。方法 采用计算机系统对32例ASD儿童和32例ADHD儿童和32例正常儿童进行测试, 以反应时长、正确率为分析指标,三组儿童在发展年龄上进行匹配。结果 1)ASD组和ADHD组相比,两组对高兴、愤怒情绪的注视时间差异无统计学意义(t=1.04、0.16,P>0.05);ASD组对悲伤、惊讶、恐惧的注视时间均短于对ADHD组,差异有统计学意义(t=1.83、1.79 、2.96,P<0.05)。ASD组和ADHD 组对各表情的平均注视时间均短于正常组,差异有统计学意义(P<0.05);2)ASD组对高兴、愤怒识别正确率与正常组比较差异无统计学意义(χ²=0.318、0.067,P>0.05 );ASD组的悲伤、惊讶、恐惧的识别率低于正常组(χ²=0.428、8.532、5.455 ,P<0.05);ADHD组仅对恐惧的识别率低于正常组(χ²=5.406,P<0.05);ADHD对其他几种情绪的识别率与正常组比较差异无统计学意义(P>0.05 )。结论 ASD儿童的面部表情识别障碍不仅仅源于视觉注意减少;ASD患儿的情绪识别障碍主要体现在对悲伤、惊讶、恐惧的情绪的识别中,对高兴、愤怒的识别率相对较高。     

孤独症儿童能力发育特征探讨

目的 探索孤独症儿童能力的自然发育特征,为临床诊治提供科学依据。方法 300例未经干预的孤独症儿童,其中男270例、女30例,年龄在12~96月之间,采用修订版心理教育评定量表(PEP-R)中的功能测验对其进行能力发育特征测评。结果 89.33%孤独症儿童总体发育商<70,且随着年龄的增长,其总体发育商有逐步下降的趋势(P<0.01);同一年龄段内,各个功能发育商发育明显不均衡(P<0.01),模仿及认知理解障碍最突出(P<0.01),认知理解与认知表达发育相分离(P<0.01),而大运动发育基本正常。 结论 未经干预的孤独症儿童能力发育进展和次序存在异常,随着年龄增长,这种异常有逐渐加重的趋势。     

儿童自闭症101例的高危因素配对分析

目的 探讨儿童自闭症发生的危险因素, 为自闭症儿童的早期预防和干预提供理论基础。方法 2010年6月-2011 年12月在上海市儿童医院儿童保健所就诊的儿童, 经3名主治医师以上的专业医师共同确诊, 符合美国精神障碍诊断和统计手册(The Diagnostic and Statistical Manual of Mental Disorders-IV, DSM-IV)诊断标准的自闭症儿童101例, 同时收集正常对照儿童101例, 性别和年龄分别与自闭症组匹配, 由监护人填写儿童家庭社会环境调查问卷。应用t检验和χ²检验进行单因素分析, 应用Logistic回归进行多因素分析。结果 Logistic回归分析进入方程的变量中, 性别(OR=10.640, P<0.01)、6个月前非母乳喂养(OR=2.952, P<0.01)、孕期患感染性疾病(OR=2.042, P<0.01)、出生时有高危因素(OR=1.189, P<0.01)及父母每天陪宝宝说话或者游戏的时间(OR=0.179, P<0.05)5个变量有统计学意义。结论 性别为男性、6个月前非母乳喂养、母孕期患感染性疾病、出生时有高危因素是儿童患自闭症的主要危险因素, 父母每天陪宝宝说话或者游戏的时间>1 h是保护因素。     

Arrival time behavior of two-year-olds in child care

Twenty two-year-old children enrolled in a full day child care program were observed as they entered each morning to determine their behavior as they separated from their parents. Over 50% of the entrances involved children showing signs of contentment by waving and smiling. Fifty-five percent of the separations involved children using materials that were available in the classroom, most often sensory materials such as sand, water, and playdoh. The second most frequent separation aid was the use of transitional objects such as stuffed animals, blankets, and other toys brought from home. As a result of the observations, recommendations are made to assist caregivers in making arrival time easier for children, parents, and teachers.     

天津市1.5～3岁儿童孤独症相关行为调查

目的:分析婴幼儿期孤独症临床特征,从而探索孤独症早期征象。方法:采用自行编制的"儿童行为发育调查表"对天津市9个区1.5～3岁儿童进行孤独症相关行为调查。结果:7439例儿童中,检出孤独症可疑患儿424例,男孩检出率高于女孩。可疑孤独症儿童与初步筛查正常的儿童在"无假扮游戏"、"不向他人显示所感兴趣东西"、"开始微笑月龄>6"等26项检出率差别有统计学意义。结论:"无假扮游戏"、"不向他人显示所感兴趣东西"、"开始微笑月龄>6"等26项症状可能是孤独症的早期征象。     

Early detection of childhood autism: a review of screening instruments and rating scales

Summary The detection and diagnosis of autism may be delayed until middle childhood, 3–4 years after its onset. This is more likely in high-functioning autism and in cases of co-morbidity with mental retardation. Such delays have serious effects on children and their families as well as on the provision of clinical and educational resources. In addition to greater awareness among professionals and to the development of comprehensive services, early detection could be facilitated by screening for early signs and symptoms of autism. The instruments that have been developed to rate autistic behaviours, particularly in pre-school children, are reviewed in this paper. Although the majority of these observational or informant-based measures were not initially designed for screening purposes, previous research findings from their application could be useful in the future development of such a screening instrument. Relevant research findings are discussed and suggestions are made for further evaluation in appropriate populations.     

OBSERVATIONS OF YOUNG NORMAL AND HANDICAPPED CHILDREN

Summary An observational study was made of 1–2-year-old children, and of mentally handicapped children functioning at a similar level, to determine the extent to which they involved themselves in play with toys and other objects and the extent to which their day was 'empty'. Observations of normal children were made in their homes and in day nurseries; observations of mentally handicapped children were made at home, in day care centres (special schools) and in the schools and wards of subnormality hospitals. In no setting were children interacting with adults for more than 20% of their non-routine time. These findings seem to justify concern over independent play with toys and other objects. The handicapped children in all settings had 'emptier' days than the normal children, this being accounted for by greater amounts of inattentive handling of objects and self-stimulation and lesser amounts of social interaction and attentive play. However, attentive play scores for the handicapped children varied markedly with setting. In appropriate circumstances, there can be as much spontaneous contact with objects in handicapped children as in normal children at a similar development level. Despite current concern over the effects of day care on the development of very young children, normal children in day nurseries did not differ from normal children at home, either in attentive play scores or in the proportion of non-routine time spent interacting with adults.     

Screening and Surveillance for Autism Spectrum Disorder in Research and Practice

Several research studies have attempted to prospectively identify children with autism spectrum disorder (ASD) using screening instruments. While it has been possible to pick up unrecognised cases using screens, no instrument has yet proved sufficiently robust to recommend universal screening. However, autism screens can play an important role in improved surveillance for ASD and other developmental disorders. There are important differences between the development of screening instruments in research studies and the use of screens as part of routine clinical surveillance. Screening for a developmental disorder raises clinical issues for parents and professionals, including those relating to the concept of 'risk status', certainty of diagnosis, advice about management and the availability of appropriate services. One positive by-product of screening studies will be improvements in the training and knowledge of primary care health practitioners about early signs of ASD, hopefully leading to improved clinical decision-making about appropriate referral. Future developments in the field should include consideration of a broader approach to the identification of children with developmental and language disorders alongside the identification of children with ASD, and appropriate research designs to test the specific benefits of early intervention.     

家庭因素与儿童孤独症的病例对照研究

目的:探讨家庭因素在儿童孤独症发生中的作用。方法:符合DSM-Ⅳ孤独症诊断标准的80名儿童孤独症者为病例组,具有可比性的160名正常儿童为对照组,进行1∶2配对病例对照研究。结果:与对照组儿童比较,病例组儿童父母的文化程度和职业层次较高,家庭的亲密度、娱乐性得分较低,而矛盾性得分较高(P<0.05);单亲或重组家庭,主要由(外)祖父母照顾、过分溺爱、放任自流、让孩子独自玩耍、家长不予理睬是儿童孤独症的促进因素,而经常与孩子玩耍、带孩子看书、讲故事,让孩子和其他小朋友一起玩耍是儿童孤独症的抑制因素。结论:儿童孤独症的发生与家庭诸多因素有关,应加强对儿童抚养人孤独症防治知识的普及,创造和谐稳定的生活环境,采取适当的教养方式,减少儿童孤独症的发生。     

Screening and Surveillance for Autism Spectrum Disorder in Research and Practice

Several research studies have attempted to prospectively identify children with autism spectrum disorder (ASD) using screening instruments. While it has been possible to pick up unrecognised cases using screens, no instrument has yet proved sufficiently robust to recommend universal screening. However, autism screens can play an important role in improved surveillance for ASD and other developmental disorders. There are important differences between the development of screening instruments in research studies and the use of screens as part of routine clinical surveillance. Screening for a developmental disorder raises clinical issues for parents and professionals, including those relating to the concept of 'risk status', certainty of diagnosis, advice about management and the availability of appropriate services. One positive by-product of screening studies will be improvements in the training and knowledge of primary care health practitioners about early signs of ASD, hopefully leading to improved clinical decision-making about appropriate referral. Future developments in the field should include consideration of a broader approach to the identification of children with developmental and language disorders alongside the identification of children with ASD, and appropriate research designs to test the specific benefits of early intervention.     

Current Literature: 5

Background A tertiary neurodisability centre at a major London teaching hospital (Guy's and Thomas’). Aim To review the outcome after 4 years of a cohort of children with severe language delay/disorder and some features of autism, but not sufficient at the time to confirm a diagnosis of autism. Methods The notes of 227 children assessed at the centre between the age of 2 and 5 were examined to select cases. This resulted in 40 children with severe receptive language delay as the primary diagnosis and a nonverbal IQ above 70. One hundred and eight children were excluded as another diagnosis, including autism, had been made and in 79 cases original clinical notes were insufficient for re‐analysis. However further exclusions due to lack of formal IQ scores, changed addresses, refusals and re‐assessment delays left a total of 18 children who participated in the study. Standard measures of performance were used to assess intellectual and language functioning, in addition to clinical evaluation. Results Follow‐up at a mean age of 8 years and 7 months showed that five children now showed sufficient language and social impairments for a diagnosis of childhood autism and the other 13 met criteria for atypical autism although nine of these showed some recovery in their language skills. The severity of social communication impairments and repetitive behaviours in the original notes were associated with the severity of autism when re‐assessed. From parental questionnaires, none of the children was considered to have developed ‘true friendships’ with reciprocal interaction, sharing and coinitiation of activities. Some tried but didn’t succeed while others were ‘loners’ who preferred their own company. All 18 children had a statement. Ten children attended specialist educational provision (six in a language unit, two in an MLD school and two in an autism unit) and the others had help in mainstream. Conclusions The authors thought they would find two groups of children at follow‐up: one with ‘true autism’ and one where improvement had occurred; ‘true language delay’. Instead, they found that all could be given a diagnosis of autism when re‐assessed. They discuss the continuing difficulties of defining childhood developmental disorders at an early age and the difficulties of separating autism from ‘a receptive language disorder with secondary socio‐emotional problems’ as required by ICD‐10. They comment on the apparent importance of repetitive behaviours and the prognosis of children who show impairments in all three ASD areas in the preschool years, even if they are not sufficient to diagnose an ASD at the time. They also comment on the risk to effective education and health support if a diagnosis of autism is not given.     

Parent–infant interactions looking for instances of volitional social gaze versus reflexive gaze – an observational study

ABSTRACT

Very early precursors of disrupted social behaviours are significant to understanding the possibility of mitigating or changing behaviours through interventions. Spontaneous play situations between infant and parent in two groups of infants aged 8.5–9 months were observed. First, a large number of videos were analysed to develop an observational schedule of play behaviour. Second, 135 videos were used in the comparison of atypical (AT; n?=?23) and typically developed (TD; n?=?22) infants. Frequency and duration of infants’ orientation towards the parent’s eye zone was significantly higher among TD infants than AT, indicating a stronger social gaze behaviour. Both groups were as competent at screening the surroundings, grabbing, and looking at toys. Finding may indicate an equal competence at reacting to reflexive stimuli. The quality of gaze behaviour provides important information for child healthcare professionals and parents when deciding whether to start supportive intervention or diagnostic investigation.     

Accumulation of chlorpyrifos on residential surfaces and toys accessible to children.

Quantitative examination of major pathways and routes of exposure to pesticides is essential for determining human risk. The current study was conducted in two apartments and examines the accumulation of the pesticide chlorpyrifos in childrens' toys after the time suggested for reentry after application. It has been established for the first time that a semivolatile pesticide will accumulate on and in toys and other sorbant surfaces in a home via a two-phase physical process that continues for at least 2 weeks postapplication. A summation of the above for a 3-6-year-old child yielded an estimated nondietary total dose of 208 microg/kg/day. Potential exposure from the inhalation pathway was negligible, while dermal and nondietary oral doses from playing with toys contributed to 39 and 61% of the total dose, respectively. If children with high frequency mouthing behavior are considered as candidates for acute exposure to chlorpyrifos residues, the estimated acute dose could be as high as 356 microg/kg/day. Routine reapplication of pesticides could lead to continued accumulation in toys and other sorbant surfaces, e.g., pillows, with large sorbant reservoirs, which can become a long-term source of exposure to a child. Estimates of a child's nondietary exposure to chlorpyrifos associated with toys and other sorbant surfaces for a period of 1 week following application appear to be of public health concern, and studies of actual childhood exposure from this pathway are warranted in the home environment. The above information should be used to determine if current procedures for postapplication reentry are sufficient and to evaluate the need for procedures to store frequently used household toys, pillows, and other sorbant objects during insecticidal application.