上海地区儿童综合性医院心理门诊来访者的特征及演变

目的分析上海地区儿童综合性医院心理门诊首次来访者的人口学特征、疾病分布,为探索心理卫生服务模式的发展方向提供理论基础。方法回顾2010-2014年复旦大学附属儿科医院心理科门诊病例资料完整的首诊病例共8 916例,对人口学特征、诊断归类进行统计,分析疾病分布特征。结果儿童心理门诊首诊人次逐年增加,平均幅度18.17%,就诊人群0~18岁,平均年龄为(6.64±3.47)岁,以0~6岁年龄段人数最多,男童多于女童,男女比例为2.79∶1。因各类精神障碍就诊比例为70.1%,按比例前五位依次为注意缺陷多动障碍、精神发育迟缓、广泛性发育障碍、言语及语言障碍、躯体形式障碍五大类。6岁组主要精神障碍依次为:广泛性发育障碍、精神发育迟缓以及注意缺陷多动障碍,6~12岁组儿童精神障碍依次为注意缺陷多动障碍、精神发育迟缓以及情绪障碍。青春期常见精神障碍为注意缺陷多动障碍、精神发育迟缓、情绪障碍、躯体形式障碍。结论综合性儿童医院心理门诊来访者呈快速上升趋势,儿童心理行为问题在不同年龄段和不同性别中呈现特点不同。     

儿童孤独症29例临床分析

目的:探讨儿童孤独症患儿临床特征性行为表现,孤独症儿童行为量表(ABC量表)及儿童期孤独症评定量表(CARS量表)在孤独症诊断中的价值。方法:对符合DSM-Ⅳ孤独症诊断标准的29例孤独症患儿进一步进行ABC量表及CARS量表评估,分析该组患儿的行为特征和ABC量表及CARS量表临床应用价值。结果:有关社会交往和言语交流障碍的项目出现频率最高。ABC量表及CARS量表测定结果与临床诊断的符合率均为93.10%,且阴性病人不重叠。结论:社会交往“质”的缺损和言语交流“质”的缺损是儿童孤独症突出表现,交会性注意障碍和想象性游戏障碍相结合可能显示孤独症或广泛性发展障碍(PDD)的高危性,ABC量表及CARS量表是很好的诊断工具,配合使用,减少漏诊。     

孤独症、精神发育迟滞的围生期危险因素及家族史的病例对照研究

【目的】 研究孤独症和精神发育迟滞的围生期危险因素及相关家族史之间的差异。 【方法】 分析在复旦大学附属儿科医院诊治的100例孤独症儿童、60例精神发育迟滞儿童以及80例发育正常儿童的围生期及家族史资料,应用方差分析、秩和检验以及χ²检验分析三组儿童围生期危险因素及家族史之间的差异。 【结果】 孤独症及精神发育迟滞儿童有家族史的比例显著高于正常儿童(35.0% vs 6.3%,P＜0.001;31.7% vs 6.3%,P=0.005),而孤独症组和精神发育迟滞组的家族史差异无统计学意义(P=0.362)。三组儿童有孕期疾病史的比例存在差异(28.00% vs 45.00% vs 26.25%,χ²=6.635,P=0.036),但两两比较后发现各组之间差异均不显著。孤独症组母亲的孕龄显著高于正常儿童组(P＜0.001),与精神发育迟滞组差异不显著,而精神发育迟滞组与正常儿童组之间的差异也不显著。三组儿童围生期缺氧或窒息史的比例不存在显著差异(8.00% vs 10.00% vs 2.50%,χ²=3.589,P=0.166)。在胎产次、孕周、生产方式、产重上,三组儿童之间差异也无统计学意义。 【结论】 1)孤独症与精神发育迟滞患儿家族史的阳性率不相上下,但均显著高于正常儿童;2)晚孕可能是孤独症的一个危险因素。     

324例同龄儿童心理发育障碍的对照研究

目的:了解同年龄孤独症及精神发育迟滞儿童发育水平的异同点,为临床诊疗提供参考依据。方法:162例儿童孤独症患儿及162例精神发育迟滞患儿采用发育商量表(Gesell)检测智能发育水平。结果:孤独症组男女儿童智能发育水平无统计学差异;同年龄组孤独症及精神发育迟滞患儿除语言项以外,各项发育商水平差异均有统计学意义(P<0.05)。男童、女童分别进行发育商对比分析,各功能区发育水平男童的临床表现比女童明显。结论:孤独症患儿大多数伴有精神发育迟滞,发育水平损伤程度不同,孤独症男、女儿童发育损伤表现略有不同,男性患儿临床症状更为明显。     

汉族孤独症谱系障碍儿童脆性X基因突变研究

【目的】 采用优化的PCR体系对脆性X智力障碍基因-1(FMR-1)片段扩增,分析汉族孤独症谱系障碍(autism spectrum disorder, ASD)患儿FMR-1基因异常突变发生情况。 【方法】 以466例汉族ASD患儿为研究对象,其中典型孤独症433名,未分类广泛性发育障碍(PDD-NOS)33名。取患儿外周血3~5 mL提取DNA,采用优化的PCR体系对466例患儿DNA进行FMR-1基因片段扩增;对于扩增成功的PCR产物进一步采用短串联重复序列(short tanderm repeat, STR)荧光检测技术进行检测。 【结果】 466个ASD患儿中,464个ASD患者(99.57%)DNA样品PCR扩增成功;2个典型孤独症患者(0.43%)DNA样品PCR扩增失败(排除DNA质量和操作问题),推断FMR-1基因发生异常突变。对于扩增成功的PCR产物进一步采用STR荧光检测技术进行检测,结果显示PCR产物均小于500 bp,其(CGG)n重复个数属正常突变范围。 【结论】 研究采用优化的PCR体系对FMR-1基因片段扩增,进一步采用STR荧光检测技术准确推断出基因片段中三核苷酸(CGG)重复个数,优化后的PCR体系可适用于大样本孤独症谱系障碍儿童的FMR-1基因突变检测。检测结果显示汉族孤独症谱系障碍儿童FMR-1基因异常突变率为0.43%。     

碘缺乏病轻病区供应碘盐与否与儿童亚临床损伤的研究

目的：了解和比较未供应碘盐与供应碘盐IDD轻病区同期出生儿童的智商、亚临床损伤程度及儿童人群的亚克汀病患病率。方法：采用CRT－C2测验判定儿童智商，JPB、测听仪、X射线片、身高及体重判定儿童精神运动和听力障碍、骨龄和体格发育落后情况，按我国卫生行业标准诊断亚克汀病。结果：未供应碘盐轻病区儿童人群智商均值为96．8，轻度智力落后率7．5％；供应碘盐轻病区为100．9、3．5％。未供碘盐病区各智力水平儿童的精神运动和听力障碍率、骨龄和体格发育落后率均较供碘盐病区高。轻度智力落后儿童的亚临床损伤率，未供碘盐区为60．1％，供碘区为40．2％；定量计算儿童亚克汀病患病率，未供碘盐区为4．5％，供碘区为1．4％。结论：IDD轻病区供应碘盐后出生的轻度智力落后儿童亚临床损伤率及儿童人群亚克汀病患病率，均显著低于未供应碘盐轻病区，食用碘盐是预防子代亚临床损伤的有效措施。     

Gesell发育量表对2岁内孤独症谱系障碍患儿的应用研究

目的 探索Gesell发育量表对2岁以内孤独症谱系障碍(ASD)患儿的应用效果,为其早期诊断及干预提供科学依据。方法 对年龄在24月龄以内的55例ASD患儿、40例精神发育迟滞患儿及131名正常儿童,运用Gesell发育量表对其进行测评,并对3组儿童的发育商进行分析比较。结果 87.26%的ASD组患儿在Gesell发育量表中表现为不同程度的发育迟缓;ASD组患儿及精神发育迟滞组患儿在五个能区中的得分都低于正常对照组儿童,差异有统计学意义(P<0.05);ASD组患儿与精神发育迟滞组患儿在适应性行为及精细动作上的得分与其相当,差异无统计学意义(P>0.05);ASD组患儿在大运动能区的得分优于精神发育迟滞组患儿,在语言及个人-社交能区,ASD组得分低于精神发育迟滞组患儿,差异均有统计学意义(P均<0.05)。结论 2岁以内ASD患儿即有发育落后及发育不平衡的现象,以语言及个人-社交发育落后明显,大运动发育相对接近正常为特征,进行Gesell发育量表评估有利于对ASD患儿的早期发现。     

Parent-Professional Agreement on Diagnosis and Recommendations for Children With Developmental Disorders

Twenty-eight children with developmental disorders underwent an interdisciplinary assessment for diagnosis and recommendations about management. Following this assessment, the degree of agreement on diagnosis and recommendations between parents and the team was determined. There was substantial agreement for diagnosis of clearly identifiable conditions such as genetic disorders, autism, and mental retardation but less agreement for milder disorders such as learning disabilities, attention deficit disorder, and emotional disorders. Agreement on management varied, being higher for speech therapy and psychosocial interventions but lower for use of stimulant medication and diet. The parents identified additional diagnostic labels in their child and mentioned more recommendations than the clinicians prescribed. The results suggest the need for careful attention to patent perceptions following interdisciplinary assessment.     

404例智力低下儿童智力测试结果及病因探讨

目的:分析智力低下儿童智力测试结果及病因,为智力低下儿童的诊治提供依据。方法:2010年1月～2011年12月期间对1 332例儿童进行智力测试,其中4～6岁儿童采用中国修订的韦氏学龄前儿童智力量表(C-WYCSI)进行智商测定,7～17岁儿童采取韦氏学龄儿童智力量表(C-WISC)进行智商测定。结果:①确定为智力低下儿童404例,检出率为30.33%。其中轻度智力低下患儿155例(38.37%),中度智力低下患儿119例(29.46%),重度智力低下患儿76例(18.81%),极重度智力低下患儿54例(13.37%)。4～6岁238例,7～17岁166例。男性215例,女性189例。学龄前智力低下儿童与学龄儿童智力低下各级别分布构成、不同性别智力低下儿童智力各级别分布构成之间均无统计学差异(P>0.05)。②智力低下病因明确者288例(71.29%),病因不明者116例(28.71%);病因明确的智力低下患儿,导致智力低下的病因主要为先天性智力发育迟缓(17.08%)、染色体异常(10.64%)、脑积水(6.93%)为前三位原因。结论:4～17岁智力低下儿童以轻度智力低下为主,导致智力低下的病因较多,但以先天性智力发育迟缓、染色体异常及脑积水为最常见原因。     

Siblings off a child with autism, with mental retardation and with a normal development

A total of 60 children between 8 and 15 years of age participated in this project, 20 of whom had a sibling with autism, 20 a sibling with mental retardation and 20a non-disabled sibling. The children were questioned about their sibling relationship and their experiences of stress. The children with a sibling with autism also completed a questionnaire on their knowledge of the autistic syndrome. Analyses revealed that the three groups were basically similar in their ratings of the frequency of stressors involving their siblings. There was a trend for children with a disabled brother or sister to rate their relationship with the sibling more positively. Correlational analyses revealed an association between both stressor frequency and appraisal and the evaluation of the relationship with the brother or sister. Siblings of children with autism had a fair understanding of the autistic syndrome, in this group, there was also an association between the children's knowledge of the autistic disorder and the quality of the sibling relationship.     

Williams syndrome

Williams syndrome (WS) is a rare (2-5/100,000) genetic human disorder characterised by a typical facies and mental retardation with a deficit in the visuospatial cognitive function and a relative preservation of linguistic abilities in general, and spoken language in particular. This syndrome also includes morphological anomalies, metabolic functional impairments, and likely deficits in the pattern of brain ontogenesis. The genetic basis of WS, recently identified, are presented. A cognitive profile of the WS individuals is defined and compared to Down syndrome (DS) and autism cognitive profiles. Neuroanatomical features of WS, including a reduction in brain volume, preservation of cerebellum and frontal lobes, and a reduction of posterior cortical systems, are described. The possible role of NGF (nerve growth factor)--a neurotrophin involved in the development of brain cholinergic systems and the associated behavioural functions--in the aetiology of the typical mental retardation of WS patients, is critically discussed. Future research avenues, including the identification of potential neurobiological markers in order to precociously diagnose this syndrome, are reviewed.     

贵州地区儿童孤独症82例临床特征及康复现状

目的:探讨儿童孤独症患儿的临床特征。方法:对82例孤独症患儿临床资料进行分析。结果:在82例病例中,平均就诊年龄明显大于发病年龄,症状以语言障碍和社会交往障碍最为突出。结论:急需提高父母和基层医生对儿童孤独症的认识,以达到早期发现、早期诊断和康复的目的。     

我国儿童孤独症药物治疗的现状分析

儿童孤独症是起病于婴幼儿时期的一种严重的广泛性发育障碍。该病以社会交往障碍、语言交流障碍和重复刻板行为的三联征为临床特点,并伴有不同程度的智力低下、感知觉障碍和情绪、情感异常等表现,常预后不良。儿童孤独症主要采用综合性治疗,包括特殊教育训练、行为矫正、辅助性物理治疗及药物治疗。该病尚无特异性药物治疗方案,目前采用的治疗药物包括抗精神病药物、抗抑郁药物、心境稳定剂和儿童注意缺陷及多动障碍治疗药物等。上述药物主要针对患儿的伴随精神症状进行对症治疗,从而提高患儿生存质量。笔者通过归纳我国儿童孤独症的治疗药物及其作用机制和应用疗效,旨在为进一步探索儿童孤独症的药物治疗提供参考。     

孤独症谱系障碍儿童的早期诊断与识别

目的:探讨连云港市婴幼儿孤独症谱系障碍患病的早期诊断及识别方法。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研究,用婴幼儿孤独症筛查表(CHAT)筛查出可疑儿童,进一步应用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)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1例,1～2岁3例,2～3岁5例;男孩7例,女孩2例。结论:加强对孤独症谱系障碍患儿的早期识别能力,做到早期诊断孤独症患儿,对孤独症患儿的日后康复工作意义重大。     

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。     

早产儿脑瘫类型及并发症与胎龄和出生体重的关系

目的 分析早产儿脑性瘫痪(简称脑瘫)类型及并发症与胎龄和出生体重的关系, 为临床制定康复计划提供参考依据。方法 对135例脑瘫早产儿进行脑瘫分型、智力测定、语言评估、眼科学检查、脑干听觉诱发电位测试及脑电图检查等, 采用SPSS 11.5软件统计分析。结果 1)各类并发症共计284个, 平均每例患儿合并并发症(2.10±1.33)个。2)<32周组脑瘫构成比、痉挛型四肢瘫、智力低下、语言障碍、视觉障碍、继发性肌肉骨骼障碍、癫痫发生率及并发症个数均明显高于32~33周组和/或34~36周组。3)<1 500 g组脑瘫构成比、痉挛型四肢瘫、智力低下、语言障碍、视觉障碍、继发性肌肉骨骼障碍、癫痫发生率及并发症个数均明显高1 500~2 499 g组和/或≥2 500 g组。结论 小胎龄早产儿和极低出生体重儿痉挛型四肢瘫的发生率较高, 合并症发生率增加。降低小胎龄早产儿和极低出生体重儿的出生率是减少脑瘫发生的重要措施。     

智力低下儿童与染色体脆性部位相关性的研究

目的:探讨智力低下儿童与染色体脆性部位表达率的相关性。方法:采用低叶酸、低小牛血清、较高PH值和G显带技术方法,对20例智力低下儿童和20例正常儿童的外周血淋巴细胞染色体畸变和脆性部位表达率进行分析。结果:智力低下儿童染色体畸变率为15·3%,对照组为3·7%;脆性部位发生率为26·95%,对照组为5·6%,两组的染色体畸变率和脆性部位表达率有明显的差异(P<0·01)。结论:智力低下儿童与染色体畸变率和脆性部位表达率有一定的相关性。     

Unmet Need and Problems Accessing Core Health Care Services for Children with Autism Spectrum Disorder

To investigate the health care experiences of children with autism spectrum disorder, whether they have unmet needs, and if so, what types, and problems they encounter accessing needed care. We address these issues by identifying four core health care services and access problems related to provider and system characteristics. Using data from the 2005?C2006 National Survey of Children with Special Health Care Needs (NS-CSHCN) we compared children with autism spectrum disorder with children with special health care needs with other emotional, developmental or behavioral problems (excluding autism spectrum disorder) and with other children with special health care needs. We used weighted logistic regression to examine differences in parent reports of unmet needs for the three different health condition groups. Overall unmet need for each service type among CSHCN ranged from 2.5% for routine preventive care to 15% for mental health services. After controlling for predisposing, enabling and need factors, some differences across health condition groups remained. Families of children with autism spectrum disorder were in fact significantly more at risk for having unmet specialty and therapy care needs. Additionally, families of children with autism spectrum disorder were more likely to report provider lack of skills to treat the child as a barrier in obtaining therapy and mental health services. Disparities in unmet needs for children with autism suggest that organizational features of managed care programs and provider characteristics pose barriers to accessing care.     

Birth Weight and Health and Developmental Outcomes in US Children, 1997�C2005

The primary goal of this study was to assess the association between the full birth weight distribution and prevalence of specific developmental disabilities and related measures of health and special education services utilization in US children. Using data from the 1997?C2005 National Health Interview Survey (NHIS) Sample Child Core, we identified 87,578 children 3?C17 years of age with parent-reported information on birth weight. We estimated the prevalences of DDs (attention-deficit/hyperactivity disorder [ADHD], autism, cerebral palsy, hearing impairment, learning disability without mental retardation, mental retardation, seizures, stuttering/stammering, and other developmental delay) and several indicators of health services utilization within a range of birth weight categories. We calculated odds ratios adjusted for demographic factors (AOR). We observed trends of decreasing disability/indicator prevalence with increasing birth weight up to a plateau. Although associations were strongest for very low birth weight, children with ??normal?? birth weights of 2,500?C2,999 g were more likely than those with birth weights of 3,500?C3,999 g to have mental retardation (AOR 1.9 [95% CI: 1.4?C2.6]), cerebral palsy (AOR 2.4 [95% CI: 1.5?C3.8]), learning disability without mental retardation (AOR 1.2 [95% CI: 1.1?C1.4]), ADHD (AOR 1.2 [95% CI: 1.1?C1.3]), and other developmental delay (AOR 1.3 [95% CI: 1.1?C1.5]) and to receive special education services (AOR 1.3 [95% CI: 1.2?C1.5]). While much research has focused on the health and developmental outcomes of low and very low birth weight children, these findings suggest that additional study of a continuous range of birth weights may be warranted.     

Psychiatric disorders among American Indian and white youth in Appalachia: the Great Smoky Mountains Study.

OBJECTIVES: This study examined prevalence of psychiatric disorders, social and family risk factors for disorders, and met and unmet needs for mental health care among Appalachian youth. METHODS: All 9-, 11-, and 13-year-old American Indian children in an 11-county area of the southern Appalachians were recruited, together with a representative sample of the surrounding population of White children. RESULTS: Three-month prevalences of psychiatric disorders were similar (American Indian, 16.7%; White, 19.2%). Substance use was more common in American Indian children (9.0% vs 3.8% in White children), as was comorbidity of substance use and psychiatric disorder (2.5% vs 0.9%). American Indian poverty, family adversity (e.g., parental unemployment, welfare dependency), and family deviance (parental violence, substance abuse, and crime) rates were higher, but the rate of family mental illness, excluding substance abuse, was lower. Child psychiatric disorder and mental health service use were associated with family mental illness in both ethnic groups but were associated with poverty and family deviance only in White children. Despite lower financial barriers, American Indian children used fewer mental health services. CONCLUSIONS: This study suggests that poverty and crime play different roles in different communities in the etiology of child psychiatric disorder.