The transport mobility situation for children with autism spectrum disorders

In order to investigate the transport mobility situation for children with autism spectrum disorders, questionnaires from 1,631 parents were analysed. The results showed that almost 3 out of 4 parents were worried when their child was transported by school transport or by the Special Transport System. Transports in the family vehicle caused worry among almost half of the parents. The parents’ worries were justified by the fact that the children were not transported according to general safety recommendations. Moreover, it was common for the children to be transported with unfamiliar drivers, as well as with unknown passengers, which is known to be quite problematic. Transport mobility adaptation to this particular group of children with disabilities refers merely to implementation of knowledge and a specific, well-structured approach among the drivers towards the children during the ride, rather than to physical/mechanical adaptation of the vehicles.     

中国儿童孤独症谱系障碍患病率Meta分析

目的 采用Meta分析了解中国近16年孤独症谱系障碍(ASD)的患病率,掌握我国ASD的患病特征,进一步分析国内与国外ASD患病率存在差异的深层原因。方法 系统检索中国知网、维普、万方、Pubmed数据库2000年1月1日-2016年12月31日发表的中国儿童ASD患病情况的文献,采用R软件进行率值合并。结果 纳入30篇文献,中国儿童ASD患病率26.50/10 000;孤独症患病率为14.00/10 000。对发表年份、南北方等因素进行亚组分析,除南北方患病率间差异无统计学意义外,其余亚组患病率差异有统计学意义(P<0.05)。结论 尽管中国儿童ASD及孤独症患病率呈现递增趋势,但仍低于国外患病率报告;考虑限于调查人群、监测方法、筛查及诊断工具等因素影响,我国ASD患病率显然是被低估的。     

孤独症谱系障碍儿童睡眠障碍的评估和干预

睡眠障碍是孤独症谱系障碍(ASD)儿童最常见的共患障碍之一,不仅与ASD儿童核心症状存在显著相关,还会影响患儿的功能水平、生活质量以及干预康复效果,给父母造成巨大养育压力和经济负担。国际上已将睡眠障碍,特别是失眠纳入到ASD的综合诊治之中,但国内相关工作开展滞后,儿科专业人员对ASD儿童睡眠障碍的诊治能力有待提升。 因此,本研究将介绍ASD儿童睡眠障碍的评估和干预方法,为临床和研究工作提供依据。     

孤独谱系障碍患儿症状及行为学表现与父母情绪障碍相关研究

目的研究孤独谱系障碍(autism spectrum disorder,ASD)患儿的症状特点、心理问题及对父母情绪障碍的影响。方法分别使用孤独症行为量表和长处与困难问卷对593名患儿进行行为学表现和心理评估,同时使用抑郁自评量表、焦虑自评量表评估患儿父母的情绪障碍表现。结果在情绪及多动注意不能和困难总分方面,高年龄组的患儿表现出了更多的困难(F=4.361,P=0.013;F=16.029,P=0.000;F=9.638,P=0.013),同时在亲社会行为方面,高年龄组则表现更好(F=11.052,P=0.000);无论在焦虑或是抑郁障碍,母亲更易患情绪障碍(χ2=15.893,P=0.000;χ2=27.592,P=0.000);父母的抑郁,焦虑情绪与ASD患儿的多个行为学表现维度相关,并直接受症状严重程度的影响。结论ASD患儿行为学表现在不同年龄段表现不同,体现在情绪、多动注意不能及亲社会行为方面;母亲往往比父亲更易患有情绪障碍,父母亲的情绪障碍受ASD患儿的多个行为表现维度影响,应引起注意。     

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。     

ASD儿童父母的亲职压力及心理影响因素研究

目的 探讨孤独症谱系障碍(ASD)儿童父母的亲职压力及心理影响因素.方法 选取2014至2015年由福建省福州儿童医院心理科和福建医科大学附属协和医院儿童神经专科高年资主治以上医师确诊、并其父母完成问卷调查的ASD儿童134例,采用亲职压力指标简表(包括父母困扰、亲子失功能及困难儿童3个分量表)、一般自我效能感量表、特质应对方式问卷对134名ASD儿童父母(实验组)进行调查,同时对115名正常儿童父母(对照组)施测,对结果进行分析.结果 实验组亲职压力总分及各维度得分均高于对照组(t =8.40 ～9.95,P＜0.05);实验组一般自我效能感低于对照组(t=-6.61,P＜0.05),且采用更多的消极应对方式和更少的积极应对方式(t值分别为6.39、-4.72,P＜0.05).相关分析显示:ASD儿童父母的亲职压力与消极应对呈正相关(r=0.328,P＜0.01),ASD儿童父母的亲职压力总分、父母困扰及困难儿童得分与患儿父母一般自我效能感均呈负相关(r值分别为-0.222、-0.251、-0.177,P＜0.05).结论 ASD儿童父母普遍存在较高水平的亲职压力,其亲职压力与家长的一般自我效能感及消极应对方式有关.     

孤独症谱系障碍儿童血清多不饱和脂肪酸水平的研究

目的 研究孤独症谱系障碍(ASD)儿童血清多不饱和脂肪酸(PUFAs)的表达水平,为ASD的诊治提供理论依据。方法 2020年12月—2021年6月在上海市儿童医院儿童保健科选取45例ASD儿童及30例对照组儿童为研究对象,通过液相-串联质谱法对其外周血血清进行PUFAs含量测定;通过简易孤独症饮食行为量表(BAMBI)及自制膳食调查问卷了解ASD儿童与对照组饮食行为习惯及饮食结构上的差异,进一步分析ASD儿童血清PUFAs表达水平的影响因素。结果 ASD组儿童血清中二十碳五烯酸(EPA)、二十二碳六烯酸(DHA)、花生四烯酸(AA)、亚油酸(LA)、总n-3 PUFAs及总n-6 PUFAs下降(t=2.81、2.04、2.94、2.33、2.11、2.63,P＜0.05),其中EPA及AA下降明显(P＜0.01)。ASD组儿童在拒食行为、与ASD特征相关喂养问题、食物谱狭窄及总分方面均高于对照组儿童(t=2.93、13.42、2.22、8.40,P＜0.05),ASD组儿童对饮食的总体兴趣低于对照组(t=2.70,P＜0.05),尤其对鱼类的兴趣偏低(t=5.03,P＜0.05)。结论 ASD儿童血清多数PUFAs含量比正常儿童低,可能与饮食行为及饮食偏好有关,补充PUFAs可能成为ASD儿童的辅助治疗手段之一。     

孤独症谱系障碍儿童睡眠障碍发生机制和治疗的研究进展

睡眠障碍是孤独症谱系障碍(autism spectrum disorder,ASD)儿童的常见共病,不仅可能加重ASD儿童自身的某些核心症状,还可能影响康复训练效果。ASD儿童睡眠障碍的确切发生机制目前暂不明确,可能与睡眠调控机制异常、ASD核心症状、共患病、躯体器质性病变、营养状况及用药等因素有关。ASD儿童的睡眠障碍目前暂无特殊有效治疗手段,家长培训联合行为干预是目前推荐的具有循证支持的干预方式。     

Participation of children on the autism spectrum in home,school, and community

Background

Children on the autism spectrum participate less frequently, and in a narrower range of activities, than their nonautistic peers, but little is known about exact participation patterns across contexts or how this is perceived by caregivers. This study aimed to document patterns of participation and caregiver views with regard to frequency and intensity of activities.

Method

Caregivers of children on the spectrum aged 5 (n = 90) and 9–10 years (n = 128) completed the Participation and Environment Measure for Children and Youth for home, school, and community. Caregivers reported on frequency of child's participation, level of involvement, and caregivers' desire for change in participation patterns.

Results

Item‐level analyses revealed similar patterns of participation across home, school, and community for both cohorts with some small age‐appropriate differences. Caregivers generally desired increased diversity, frequency, and involvement in activities but a decreased use of electronics (computers, games, TV, and DVDs).

Conclusion

The possibility of autism‐specific participation patterns could inform future interventions aimed at enhancing social inclusion. This warrants further investigation through multiinformant designs that seek the perspectives of the child and caregivers.     

学龄前孤独症谱系障碍儿童诊疗相关问题及母亲心理健康状况的调查

目的 了解本地区学龄前孤独症谱系障碍(ASD)儿童诊疗中相关问题及母亲心理健康状况的特征,分析不同年龄段的差异,为开展进一步工作提供部分参考。方法 对诊断明确的235例学龄前ASD儿童按年龄段分为18～36月龄组(组1)98例,37～72月龄组(组2)137例,分别采用自拟调查问卷对两组儿童诊疗中相关问题进行调查,并使用症状自评量表(SCL-90)对其母亲进行心理健康的评定。结果 比较首诊主诉症状,两组ASD儿童家长均关注语言问题或以语言落后为主诉就诊,组2 较组1更多关注到社会交往障碍及行为异常(P<0.05);两组家长均把“语言进步”作为治疗首要目标,其次为行为改善(包括会理人、看人、刻板动作减少、听话好带等)(P>0.05);其它诸如:家庭如何开展训练、是否能上幼儿园及上学、病因及生第二胎患病几率、训练费用、是否成为特才、训练时间长短等,比较差异部分有统计学意义(P<0.05);两组儿童家长的SCL-90总分差异无统计学意义(P>0.05),均高于文献中正常健康儿童父母的SCL-90得分(P<0.05);各因子分中抑郁和焦虑因子得分组2高于组1(P<0.05)。结论 语言障碍或进步仍然是本地区学龄前期ASD儿童家长在诊疗中关注的首要问题,不同年龄段的ASD儿童诊疗及母亲心理健康状况存在差异。     

孤独症谱系障碍儿童的语言发育特征

孤独症谱系障碍(ASD)是儿童期常见的发育障碍性疾病,致残率高.语言障碍是ASD儿童的最常见共患病,其早期识别、诊断和早期针对性的干预措施,对改善ASD的预后具有重要意义.本文就孤独症谱系障碍儿童的语言发育特征进行综述.     

儿童孤独症谱系障碍运动功能评定分析

目的 了解孤独症谱系障碍(ASD)患儿运动功能发育情况,为ASD患儿的精准干预提供临床证据。方法 回顾性分析2017年3月-2019年12月在贵州省人民医院发育行为专科就诊的182例2～6岁ASD患儿认知和运动评估结果。结果 运动评估显示,ASD患儿粗大运动商平均为(69.9±13.7)分,精细运动商平均为(75.2±15.5)分,总运动商平均为(70.1±13.8)分。78.0%(142/182)ASD患儿存在粗大运动落后、61.5%(112/182)精细运动落后、75.8%(138/182)总运动落后。ASD患儿运动能力与智力发育水平呈明显正相关(r＝0.018~0.672, P＜0.01),精细运动各维度与智力发育水平的相关性最高。ASD女性患儿精细运动抓握能力维度优于男性患儿(P＜0.05),3岁以上患儿精细运动抓握能力维度落后明显(P＜0.05)。结论 ASD患儿存在明显的运动发育落后。对ASD患儿应尽早进行运动评估,便于制定精准化临床干预。     

儿童孤独症谱系障碍运动功能评定分析

目的 了解孤独症谱系障碍(ASD)患儿运动功能发育情况,为ASD患儿的精准干预提供临床证据。方法 回顾性分析2017年3月-2019年12月在贵州省人民医院发育行为专科就诊的182例2～6岁ASD患儿认知和运动评估结果。结果 运动评估显示,ASD患儿粗大运动商平均为(69.9±13.7)分,精细运动商平均为(75.2±15.5)分,总运动商平均为(70.1±13.8)分。78.0%(142/182)ASD患儿存在粗大运动落后、61.5%(112/182)精细运动落后、75.8%(138/182)总运动落后。ASD患儿运动能力与智力发育水平呈明显正相关(r＝0.018~0.672, P＜0.01),精细运动各维度与智力发育水平的相关性最高。ASD女性患儿精细运动抓握能力维度优于男性患儿(P＜0.05),3岁以上患儿精细运动抓握能力维度落后明显(P＜0.05)。结论 ASD患儿存在明显的运动发育落后。对ASD患儿应尽早进行运动评估,便于制定精准化临床干预。     

孤独症谱系障碍儿童常见共患病研究进展

孤独症谱系障碍(ASD)是一组发生于生命早期的神经发育障碍性疾病,ASD儿童常伴有注意缺陷多动障碍(ADHD)、癫痫、睡眠障碍、胃肠道问题、免疫异常、焦虑、情感障碍等共患病,本文重点对目前研究较多的ASD共患ADHD、癫痫、睡眠障碍、胃肠道问题,分别从流行病学特点、对ASD儿童临床症状的影响、治疗方法方面进行综述。     

儿童孤独症脑磁共振波谱的病例-对照研究

【目的】探讨孤独症儿童脑部神经代谢产物的改变及其与行为表现的关系,为临床诊治提供参考。【方法】应用无创性磁共振波谱,分别测量24名孤独症患儿和10名同龄健康儿童额叶、小脑蚓部内的N-乙酰天冬氨酸(NAA)、含胆碱复合物(Cho)与肌酸(Cr)的比值,进行对照研究,并分析病例组代谢产物与孤独症治疗评估量表(ATEC)得分的关系。【结果】孤独症组额叶、小脑蚓部NAA/Cr比值、小脑蚓部Cho/Cr比值低于对照组(P<0.05);孤独症组额叶NAA/Cr比值与ATEC说话/语言评分负相关(r=-0.494,P=0.023),额叶Cho/Cr比值与健康/行为评分负相关(r=-0.405,P=0.049);孤独症组小脑蚓部NAA/Cr比值女童低于男童(P<0.05);孤独症组小脑蚓部NAA/Cr、Cho/Cr比值与年龄呈正相关(P<0.05)。【结论】孤独症儿童额叶皮质、小脑蚓部存在神经元丢失或功能下降,其严重程度与语言障碍、认知障碍等临床表现相关;小脑蚓部存在细胞膜的代谢异常、髓鞘发育不良;孤独症儿童小脑蚓部神经功能存在性别差异,且随着年龄的增长有所改善。     

A longitudinal study of autism spectrum disorders in individuals diagnosed with a developmental language disorder as children

Background   A number of studies have shown that the diagnosis of developmental language disorder (DLD) can be unstable over time, such that young children with a diagnosis of DLD may show symptoms more characteristics of autism spectrum disorder (ASD) at a later date.
Method   To estimate the types and prevalence of ASD 469 individuals with a DLD, consecutively assessed in the same clinic during a period of 10 years, and 2345 controls from the general population were screened for ASD through the nationwide Danish Psychiatric Central Register (DPCR). The mean length of observation was 34.7 years, and the mean age at follow-up 35.8 (range: 28.3–46.7) years.
Results   At follow-up, 10 (2.1%) in the DLD group and two (0.09%) in the comparison group were known in the DPCR with a diagnosis of any ASD ( P < 0.0001; odds ratio = 25.5; 95% confidence interval 5.5–116.9).
Conclusion   Our results provide additional support to the notion that DLD is a marker of increased vulnerability to the development of ASD.     

Impact of comorbid autism spectrum disorders on stimulant response in children with attention deficit hyperactivity disorder: a retrospective and prospective effectiveness study

BACKGROUND: In the recent past, psychiatrists and paediatricians have avoided prescribing stimulant medication, such as methylphenidate and dexamphetamine to patients with autism spectrum disorders (ASD) because of both doubts about efficacy and concern that these medications make stereotypies worse. Recently, a number of small trials have suggested that methyphenidate does have a role in the management of hyperactivity in children with autistic spectrum disorders. METHODS: Children with ASD and attention deficit hyperactivity disorder (ADHD), and children with ADHD without ASD received standard treatment with methyphenidate from one specialist centre. A combination of standardized and novel outcome tools was used to allow both an exploratory retrospective study of 174 children and then a prospective study of a further 52 children to be carried out. RESULTS: After treatment with stimulants, the subjects in both groups showed statistically significant improvements in target symptoms of 'hyperactivity', 'impulsivity', 'inattention', 'oppositionality', 'aggression' and 'intermittent explosive rage'. The Clinical Global Impression-Improvement and efficacy index measures also improved in each group. In both the retrospective and the prospective studies, there was no statistically significant difference in the degree of improvements between each group. Importantly, neither tics nor repetitive behaviours worsened in either group. Children in the 'ADHD-only' group who were prescribed stimulants experienced significant 'nausea', 'giddiness', 'headaches' and 'sleep difficulties', whereas sleep difficulties were the only side effect that emerged in children in the ASD with ADHD group. CONCLUSIONS: Both studies presented here support previous findings from smaller studies that show children with autism and ADHD can respond as well to stimulants as children with ADHD alone. Although randomized controlled trials remain the gold standard for efficacy studies, systems like this that allow clinicians to continue rigorous and consistent monitoring for many years have a valuable role to play. Furthermore, such monitoring systems which now exist electronically can easily accumulate large data sets and reveal details about long-term effectiveness and long-term side effects of medication that are unlikely to be discovered in short-term trials.     

婴儿期社会性反应评估对18月龄孤独症行为预测作用队列研究

目的 识别孤独症在婴幼儿早期的行为发育特点,为早期干预赢得时机。方法 采用前瞻性队列研究的方法建立队列,记录各阶段研究对象的生长发育状况,分阶段填写适当的《婴儿社会性反应问卷》并计算得分,在儿童18个月龄时,用《CHAT-23问卷》进行孤独症行为的筛查,计算3、6、9、12个月龄儿童社会性反应得分,并根据百分位数P₂₅和P₇₅将其划分为低分组、中分组及高分组,采用χ²方法分析18个月龄儿童的孤独症行为在各月龄不同分组中的分布情况,利用二元logistic回归模型分析12月龄内婴儿的社会性反应与18月龄孤独症行为的关联效应。结果 本研究共纳入3月龄（3个月±7 d）的婴儿1 207人,截止到18月龄,追踪到队列儿童共1 085人,筛查出孤独症行为儿童99人,检出率9.1%; 3、6、9、12月龄的低分组孤独症行为检出率依次为16.1%、13.3%、13.7%和14.5%;单因素分析结果显示,各月龄社会性反应得分中低分组的孤独症行为检出率均高于高分组,且各月龄差异均有统计学意义（P<0.05）;二元logistic回归分析显示,低分组是发生孤独症谱系障碍（ASDs）的危险因素,3、6、9和12月龄的RR值（95%CI）分别为2.94（1.50~5.75）、3.28（1.32~8.09）、2.38（1.16~4.88）和4.90（2.08~11.49）。结论 虽然孤独症行为的机制目前尚不明确,但是在儿童12月龄内某些特定行为对ASDs具有预测作用,可为早期干预提供依据。     

Promoting the social inclusion of children with autism spectrum disorders in community groups

Children with autism spectrum disorders (ASDs) are not easily included in mainstream youth activities provided by the community and voluntary sector (CVS) such as scouts, sports organisations and youth clubs. Two studies were undertaken. First, a survey of over 200 personnel from CVS groups to ascertain their previous experience of these children and reactions to their enrolment. Second, in light of the findings, a short, two-hour introductory training course on ASD targeted at youth leaders was devised and evaluated with nearly 400 participants. Most participants reported changes in their attitudes and perceptions as well as citing a range of information they had gained from attending. Further research is needed into the reasons why CVS groups are disinclined to enrol children with ASD and in targeting awareness raising and training opportunities more specifically within this sector.