孤独症谱系障碍与发育性语言延迟发病相关因素分析比较

【目的】 比较孤独谱系障碍(autism spectrum disorders, ASD)与发育性语言延迟(developmental language disorders, DLD)发病相关因素(风险因素和临床表现)之间的差异。 【方法】 应用自制发病相关因素调查表对46例ASD患儿和39例DLD患儿进行回顾性研究。 【结果】 ASD组与DLD组儿童,开始有意识叫妈妈(或其他带养人)的年龄差异有统计学意义(P=0.01),两组在首次诊断年龄、走路稳年龄、围生期危险因素(早产,胎次,生产方式,窒息缺氧,产重,产伤,头颅外伤,抽搐,重大疾病,带养人,父母生育年龄,家族史)方面差异无统计学意义(P>0.05)。ASD以语言交流障碍为首发症状35例(78.28%),以社会交流障碍为首发症状35例(78.28%),以行为问题(兴趣狭窄和行为刻板重复)为首发症状17例(36.57%),首次诊断平均年龄为39月龄。 【结论】 ASD患儿语言发育较晚。其核心症状中语言交流障碍和社会交流障碍易被家长察觉,但患儿首次就诊年龄偏大。     

Parents' reports of their involvement in an Iranian parent-based early intervention programme for children with ASD

Based on the findings of several preliminary studies on support and services for children with autism spectrum disorder (ASD) and their parents in Iran, an early intervention programme called Omid was established. This programme is based on the social model of disability. To promote the Omid resource kit, which is a component of the ‘Omid Early Intervention Programme’, a group of Iranian parents (N?=?39) of children with ASD at the first stage of diagnosis were recruited to ascertain their thoughts on parental engagement in the intervention programme. Parents' thoughts about the resource kit, the parent workshop and the professional visit at home were collected through notes which the parents presented to the researchers. Thematic analysis of the notes and comments showed that parental engagement in the early intervention process through a resource kit was welcomed within a society in which service provision for ASD is sparse and support for children with ASD and their parents is lacking.     

不同认知功能孤独症谱系障碍儿童在PEP-3中的反应特征

目的 探索不同认知功能孤独症谱系障碍(autism spectrum disorder, ASD)儿童在心理教育评估量表第3版(PEP-3)中反应特征, 为临床诊断和康复提供可循依据。方法 以智力测试结果为界定标准, 选择低功能ASD(LFA)、高功能ASD(HFA)和正常对照组儿童各26例, 各组性别、年龄相匹配各组男23例、女3例, 年龄在2~5岁间, 平均年龄分别为(40.92±9.60)、(40.07±7.60)、(40.12±9.31)月, 采用香港版PEP-3量表的功能发展量表对其进行测评分析。结果 LFA儿童在PEP-3所有功能领域的原积分和发展年龄均明显落后于对照组(P<0.001), HFA组的认知、大肌肉测验的原积分和发展年龄均低于对照组(P<0.05);LFA组的认知、语言表达、语言理解、模仿测验的原积分和发展年龄均明显低于HFA组(P<0.001), 小肌肉测验的原积分和发展年龄均低于HFA组(P<0.05)。LFA组在合成项沟通和体能的功能商数表现为“低-高”趋势(51.68±14.34 VS 75.08±9.00, P<0.001), HFA组则呈现“均衡”现象(91.40±12.93 VS 87.02±11.66, P=0.205)。结论 不同认知功能ASD儿童PEP-3评价结果反映了不同模式, 可作为辅助诊断和教育干预的参考。     

孤独症谱系障碍儿童早期诊断及干预的研究进展

孤独症谱系障碍(ASD)也称自闭症,是一种严重的神经发育障碍,近几年发病率逐年上升.ASD大多发病于儿童,往往持续终身,主要表现为在社会交流能力、语言能力、仪式化的刻板行为三个方面同时具有本质的缺损.临床中ASD没有特效的药物治疗,一部分患儿在早期筛查中容易被漏诊,而有些患儿虽然在早期经过干预治疗,但还是不能达到预期的...     

孤独症诊断观察量表模块1和儿童期孤独症评定量表的临床应用对比

目的 分析第二版孤独症诊断观察量表(ADOS-2)模块1与儿童期孤独症评定量表(CARS)对儿童孤独症谱系障碍(ASD)的诊断价值,为临床应用提供参考依据。方法 2019年1月—2022年3月在广东省妇幼保健院儿童神经康复医学科初次就诊,第一诊断为ASD、全面发育迟缓儿(GDD)及评估为正常的104例儿童为研究对象。其中ASD患儿60例(高、低功能各30例)为ASD组,24例全面发育迟缓患儿(GDD患儿)及正常儿20例为非ASD组,两组均采用ADOS-2模块1和CARS评估。比较两个量表与美国《精神疾病诊断与统计手册(第5版)》(DSM-5)中ASD诊断结果的一致性,对比两者诊断ASD的敏感性、特异性。结果 1)ADOS-2模块1与DSM-5的一致性好(Kappa=0.862),CARS与DSM-5的一致性为中等(Kappa=0.509),ADOS-2模块1与CARS间的一致性为好(Kappa=0.695)。2)ADOS-2模块1的敏感性优于CARS,差异有统计学意义(χ²=13.333,P<0.001)。ADOS-2模块1在诊断IQ≥70和IQ<70的儿童中的敏感性、特异性的对比差异无统计学意义(P>0.05)。CARS在诊断IQ<70的儿童的敏感性优于IQ≥70的儿童(χ²=7.500,P=0.006),特异性比较差异无统计学意义(P>0.05)。结论 ADOS-2 模块1、CARS均为辅助诊断ASD的重要工具,ADOS-2模块1在ASD儿童的早期诊断中具有更高的敏感性和特异性。临床工作中,对IQ≥70的儿童,建议降低CARS的诊断阈值,以提高CARS的诊断敏感性,降低漏诊率。     

孤独症谱系障碍儿童手势缺陷的研究进展

手势先于语言产生,促进语言的发展。孤独症谱系障碍(ASD)儿童手势的类型和功能存在非典型使用及发展,手势-语言轨迹发展缓慢,可以成为ASD儿童的一个关键早期行为标记。手势的发展与后期语言、认知、社交和ASD诊断显著相关,应对ASD儿童的早期手势功能进行评估和监测。针对手势特点进行个性化训练,增加儿童社会参与和学习潜能,以手势为中介促进语言、认知及社交发展,提高康复效果。     

Sex differences in the evaluation and diagnosis of autism spectrum disorders among children

BackgroundOne of the most consistent features of the autism spectrum disorders (ASDs) is the predominance among males, with approximately four males to every female. We sought to examine sex differences among children who met case definition for ASD in a large, population-based cohort with respect to age at first developmental evaluation, age of diagnosis, influence of cognitive impairment on these outcomes, and sex-specific behavioral characteristics.MethodsWe conducted a secondary analysis of data collected for a population-based study of the prevalence of ASD. The sample comprised 2,568 children born in 1994 who met the case definition of ASD as established by the Autism and Developmental Disabilities Monitoring (ADDM) Network for ASD surveillance. Children who had a history of developmental disability and behavioral features consistent with the DSM-IV-TR criteria for autistic disorder, Asperger's disorder, and Pervasive Developmental Disorder–Not Otherwise Specified in existing evaluation records were classified as ASD cases via two paths: streamlined and nonstreamlined. Streamlined reviews were conducted if there was an ASD diagnosis documented in the records. Data were collected in 13 sites across the United States through the ADDM Network, funded by the Centers for Disease Control and Prevention.ResultsMales constituted 81% of the sample. There were no differences by sex in average age at first evaluation or average age of diagnosis among those with an existing documented chart diagnosis of an ASD. Girls were less likely than boys to have a documented diagnosis (odds ratio [OR] = 0.76, p = .004). This analysis was adjusted for cognitive impairment status. In the logistic model, with the interaction term for sex and cognitive impairment, girls with IQ of 70 or less were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.70, 95% confidence interval [CI] = 0.50-0.97, p = .035). Boys with IQ greater than 70 were less likely than boys with IQ of 70 or less to have a documented diagnosis (OR = 0.60, 95% CI = 0.49-0.74, p < .001). This finding (less likely to have a documented diagnosis) was also true for girls with IQ greater than 70 (OR = 0.45, 95% CI = 0.32-0.66, p < .001). Girls were more likely to have notations of seizure-like behavior (p < .001). Boys were more likely to have notations of hyperactivity or a short attention span and aggressive behavior (p < .01).ConclusionsGirls, especially those without cognitive impairment, may be formally identified at a later age than boys. This may delay referral for early intervention. Community education efforts should alert clinicians and parents to the potential of ASDs in boys and girls.     

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。     

Prevalence of autism spectrum disorder among Nigerian children with intellectual disability: a stopgap assessment

The prevalence of autism spectrum disorder (ASD) among sub-Saharan African children with intellectual disability is about 0.7% more than three decades ago. During this period, the prevalence of ASD has been on the increase worldwide. Studies are not available in recent times addressing epidemiology of ASD among sub-Saharan African children. The present study assessed the prevalence of ASD among Nigerian children with intellectual disability. Forty four children with intellectual disability were assessed for diagnosis of childhood autism based on criteria specified in F84.0 section of International Classification of Diseases, Tenth Edition (ICD-10) Diagnostic Criteria for Research. Five (11.4%) of the children studied met the diagnostic criteria for childhood autism. Male/female ratio was 4:1. There is need for large scale epidemiological studies of ASD among sub-Saharan African children to clearly define the inter-relationship between ASD and intellectual disability in this population and to help in health care policy formulation.     

Pre-diagnostic and Diagnostic Stages of Autism Spectrum Disorder: A Parent Perspective

This study examined the experiences of parents receiving an autism spectrum disorder (ASD) diagnosis for their child. Mixed methods were used to give a detailed account of the sequence of events, parents’ experiences and actions associated with the ASD diagnosis. Parents waited nearly two and a half years (mean = 28.72 months) before receiving the ASD diagnosis. Parents with lower general and autism-specific social support, poorer physical health functioning and children with more severe communication problems reported longer wait times. Surprisingly, parents reported more positive than negative experiences from receiving the diagnosis. Paediatricians and psychologists were consulted most frequently; paediatricians and general physicians were rated most likely to neglect early ASD symptoms and least likely to make appropriate referrals. Qualitative analyses revealed seven themes describing the parent experience during the diagnostic process: “heightened awareness”, “initial search”, “dissatisfaction with medical or associated processionals”, “long process/delay”, “feeling uninformed”, “parent psychological and relational experiences” and “diagnosis goals”. A set of commonly experienced stages characterising the process of obtaining a diagnosis were identified and formulated into a six-stage model of diagnostic delay adapted from the patients’ health-seeking model.     

Accelerating early language development with multi-sensory training

This paper reports the outcome of a multi-sensory intervention on infant language skills. A programme titled ‘Rhyming Game and Exercise Club’, which included kinaesthetic–tactile mother–child rhyming games performed in natural joint attention situations, was intended to accelerate Finnish six- to eight-month-old infants’ language development. The participants were 20 infants (10 training group children and 10 control children). Their cognitive skills and both receptive and expressive language skills (Bayley Scales III) were tested three times (pre-, post- and follow-up assessments). The groups differed significantly in receptive language skills at the baseline, in favour of the controls. The results showed that the performance of the training group children in cognition and receptive language increased after the intervention. The training group girls showed more acceleration in receptive language skills than the boys. The results suggested that training consisting of rhyming games and kinaesthetic-tactile stimulation is a useful tool for accelerating early language development and for enriching mother–child interaction.     

孤独症谱系障碍与发育性语言障碍2~3岁儿童Gesell测评结果分析

目的 分析2~3岁儿童孤独症谱系障碍(ASD)与发育性语言障碍(DLD)的Gesell发育特征,为早期诊断和干预提供依据。方法 回顾性分析2020年3月—2021年3月,明确诊断为ASD(n=78)、DLD(n=80)的2~3岁儿童,通过Gesell婴幼儿发育量表对每个儿童进行发育水平测评,并对两组儿童5个能区发育水平分布情况进行统计,分析ASD、DLD儿童的Gesell发育特征。结果 1)ASD组儿童平均发育商得分均低于DLD组儿童。除大运动能区外,ASD组儿童适应性、精细运动、语言、个人-社交能区间发育水平均低于DLD组,差异有统计学意义(t=16.043、6.208、14.219、10.811,P＜0.001)。2)语言、个人-社交发育比较:ASD组儿童的语言发育水平以重度、中度障碍为主(48.72%、33.33%),DLD组儿童的语言发育水平以轻度障碍为主(77.5%)。ASD组儿童50%的个人-社交分布在轻度障碍区域,无1例正常;DLD组儿童的个人-社交发育商68.75%分布在轻度障碍区域,30%处于正常或边缘水平。结论 除大运动能区外,ASD儿童其余能区平均发育水平均低于DLD儿童。熟悉ASD、DLD儿童的Gesell发育特征,对ASD、DLD儿童的早期识别、康复及教育计划的制定和预后具有重要的意义。     

Mediators of preschoolers’ early mathematics concepts

The purpose of this study was to extend existing research relative to the predictors of early mathematics skills. Using Vygotskian theory as a framework, our primary goal was to determine whether social skills or letter awareness skills served as better mediators between receptive language and early mathematics concepts. The secondary goal was to examine possible differences in children’s early mathematics, language, letter awareness, and psychosocial skills for two different childcare settings, centre and family childcare. Participants included 109 children (48 girls) all of whom attended out‐of‐home childcare at least 13 hours each week and who would be attending kindergarten the following year. Sixty‐one children were enrolled in out‐of‐home family childcare and 48 in out‐of‐home centre childcare. Relative to our first goal, letter awareness fully mediated between receptive language and early mathematics (Sobel z‐value = 2.92, p = .003). This suggested that when children are able to understand a system of symbols for sounds and if they have sufficient receptive language skills, they are able to understand a system of symbols for number. Teaching early mathematics skills as frequently as letter awareness skills might reinforce more efficient acquisition of both. Relative to our second goal, children in centre‐based care outscored children in home‐based childcare on early mathematics and letter awareness skills. This suggested that some differential trainings for centre childcare providers versus home care providers might be appropriate so as to provide the highest quality environment for both groups of children.     

2～3岁儿童孤独症谱系障碍与发育性语言障碍的Gesell结果分析

目的比较2~3岁孤独症谱系障碍(autism spectrum disorders,ASD)和发育性语言障碍(developmental language disorder,DLD)的Gesell智能发育特征,为早期诊断和干预提供依据。方法对75例ASD儿童和71例DLD儿童用Gesell发育量表进行发育评估,将各组结果进行对比分析。结果 ASD儿童五个能区数值均低于正常,大运动能区和精细动作能区明显高于语言能区和个人-社交能区。ASD儿童各能区平均水平均低于发育性语言障碍组,且各能区间差异有统计学意义(P0.01)。结论 ASD儿童各项能力均低于DLD儿童。进行Gesell发育量表评估有利于ASD的辅助诊断。     

Examination of the relationship between gestures and vocabulary in children with autism spectrum disorder at different language stages

In this study, the relationship between vocabulary and gesture use is examined in children with autism spectrum disorder (ASD) at different language stages. A total of 72 children with ASD between the ages of 3.0 and 8.2 years participated in the study. Gesture use was assessed by using observation-based procedures, while the number of different words (NDW) and the mean length of utterance (MLU) was derived from conversational language samples. Significant differences were found in all gesture kinds among different language stages, in children with ASD. It was found that declarative deictic gestures and conventional/pantomime gestures meaningfully predict the NDW, while imperative deictic gestures do not. According to the findings of this study, gestures show different developmental features at different stages of language development in children with ASD. The findings show that declarative deictic gestures and conventional/pantomime gestures may play a significant role in vocabulary development in children with ASD.     

孤独症、全面发育迟缓及发育性语言延迟儿童早期语言发育特征

目的 分析孤独症谱系障碍(ASD)、全面发育迟缓(GDD)及发育性语言延迟(DLD)儿童的语言发育特征及差异,为早期识别与干预提供依据。方法 选取2017年3月-2018年12月确诊的18~36月龄的ASD、GDD、DLD儿童为研究对象,其中ASD组155例、GDD组92例、DLD组162例。测试者与家长共同完成《早期语言发育进程量表》,评估3组儿童语言发育水平。结果 1)ASD、GDD与DLD语音和语言表达差值(P₇₅-A分)、听觉感受和理解差值(P₇₅-B分)、与视觉相关的理解和表达差值(P₇₅-C分)及全量表总分差值(P₇₅-总分)中位数分别为:17、10、3、31;16、9、1、26;14、7、0、21。2)除GDD与DLD组女童P₇₅-A分差异无统计学意义(H=5.503,P=0.057),不同性别间ASD与DLD、GDD与DLD的各部分差值比较,差异均有统计学意义(P<0.05)。3)不同性别间ASD和GDD组内四部分差值比较,差异均无统计学意义(P>0.05),而DLD组内P₇₅-A分和P₇₅-总分存在性别差异(Z=-2.117、-2.010,P<0.05)。结论 语言发育受损程度由重到轻为ASD、GDD、DLD;在听觉感受和理解及与视觉相关的理解与表达能力上ASD和GDD较DLD落后;DLD组内女童语言发育比男童好。     

Proposed Changes to the American Psychiatric Association Diagnostic Criteria for Autism Spectrum Disorder: Implications for Young Children and Their Families

The American Psychiatric Association has revised the diagnostic criteria for their DSM-5 manual. Important changes have been made to the diagnosis of the current (DSM-IV) category of Pervasive Developmental Disorders. This category includes Autistic Disorder (autism), Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). The DSM-5 deletes Asperger’s Disorder and PDD-NOS as diagnostic entities. This change may have unintended consequences, including the possibility that the new diagnostic framework will adversely affect access to developmental interventions under Individuals with Disabilities Education Act (IDEA) programs, Early Intervention (for birth to 2 years olds) and preschool special education (for 3 and 4 years olds). Changing the current diagnosis of PDD-NOS to a “Social Communication Disorder” focused on language pragmatics in the DSM-5 may restrict eligibility for IDEA programs and limit the scope of services for affected children. Young children who meet current criteria for PDD-NOS require more intensive and multi-disciplinary services than would be available with a communication domain diagnosis and possible service authorization limited to speech-language therapy. Intensive behavioral interventions, inclusive group setting placements, and family support services are typically more available for children with an autism spectrum disorder than with diagnoses reflecting speech-language delay. The diagnostic distinction reflective of the higher language and social functioning between Asperger’s Disorder and autism is also undermined by eliminating the former as a categorical diagnosis and subsuming it under autism. This change may adversely affect treatment planning and misinform parents about prognosis for children who meet current criteria for Asperger’s Disorder.     

“And I look down and he is gone”: Narrating autism,elopement and wandering in Los Angeles

‘Wandering’ and ‘elopement’ have been identified as common in autism, affecting half of all diagnosed children ages four to ten, yet families rarely receive advice from practitioners even after the fact. Family perspectives have been missing from the literature as well as from public health and policy debates on how and when to respond to this problem. The problem of ‘wandering’ and ‘elopement’ reveals a complex intersection of larger issues encountered by families of children with autism. To consider these issues, this article examines ‘wandering’ and ‘elopement’ from the perspectives of African American mothers of children with autism, an underrepresented group in autism research. We consider how the mothers experience these behaviors and the response to these behaviors by professionals, such as service coordinators and law enforcement personnel working within various jurisdictions that become involved with the problem. We analyze the mothers' narratives about ‘wandering’ and ‘elopement’ drawn from ethnographic interviews that were collected between October 1, 2009 and August 31, 2012. These interviews were part of a larger project on disparities in autism diagnosis and services that followed a cohort of 25 four to ten-year old children. Drawing on narrative, phenomenological and interpretive traditions, we trace the mothers' developing understandings of ‘wandering’ and ‘elopement’ over time, and show how these understandings become elaborated and transformed. This article provides a nuanced, moment-to-moment and longitudinal picture of the mothers' experiences of ‘wandering’ and ‘elopement’ that enriches the cross-sectional view of large-scale surveys about the problem and contributes unique insights at the family and community levels. Implications for professional awareness, clinical practice and service provision are also suggested.     

孤独症与语言发育迟缓儿童在年龄与发育进程问卷中的表现特征及差异

目的 了解孤独症谱系障碍(ASD)与语言发育迟缓 (LR)儿童在中文版年龄与发育进程问卷(ASQ)中的表现特征及其差异,为孤独症的早期筛查与鉴别提供指导。方法 以2016年9月-2017年2月就诊于佛山市妇幼保健院与广东省妇幼保健院儿童心理门诊并确诊为ASD和LR的16~30月龄儿童为研究对象,其中ASD儿童44例,LR儿童25例。研究人员与家长共同完成ASQ-3与ASQ-SE,筛查评估两组儿童在沟通、粗大动作、精细动作、解决问题、个人-社会、社交-情绪等能区的发展水平。结果 ASD儿童在ASQ-3五大能区及ASQ-SE中的筛查不通过率均高于LR,其中大动作、精细动作、个人-社会能区的差异有统计学意义(P<0.05)。调整性别、年龄等混杂因素后,ASD组在大动作(OR=2.52,95%CI:1.24~5.11)和个人-社会(OR=2.15,95%CI:1.18~3.94)能区的表现仍较LR组更差。结论 16~30月龄的ASD儿童,其大动作和个人-社会能区的发育比LR儿童更差。当存在语言发育迟缓的儿童在ASQ-3筛查中合并有大动作和个人-社会能区发育落后时,建议对其进行特异性的孤独症筛查与诊断评估。     

Parent-Reported Prevalence of Autism Spectrum Disorders in US-Born Children: An Assessment of Changes within Birth Cohorts from the 2003 to the 2007 National Survey of Children’s Health

The prevalence of autism spectrum disorders (ASD) from the 2007 National Survey of Children’s Health (NSCH) was twice the 2003 NSCH estimate for autism. From each NSCH, we selected children born in the US from 1990 to 2000. We estimated autism prevalence within each 1-year birth cohort to hold genetic and non-genetic prenatal factors constant. Prevalence differences across surveys thus reflect survey measurement changes and/or external identification effects. In 2003, parents were asked whether their child was ever diagnosed with autism. In 2007, parents were asked whether their child was ever diagnosed with an ASD and whether s/he currently had an ASD. For the 1997–2000 birth cohorts (children aged 3–6 years in 2003 and 7–10 years in 2007), relative increases between 2003 autism estimates and 2007 ASD estimates were 200–600 %. For the 1990–1996 birth cohorts (children aged 7–13 years in 2003) increases were lower; nonetheless, differences between 2003 estimates and 2007 “ever ASD” estimates were >100 % for 6 cohorts and differences between 2003 estimates and 2007 “current ASD” estimates were >80 % for 3 cohorts. The magnitude of most birth cohort-specific differences suggests continuing diagnosis of children in the community played a sizable role in the 2003–2007 ASD prevalence increase. While some increase was expected for 1997–2000 cohorts, because some children have later diagnoses coinciding with school entry, increases were also observed for children ages ≥7 years in 2003. Given past ASD subtype studies, the 2003 “autism” question might have missed a modest amount (≤33 %) of ASDs other than autistic disorder.