中文版《婴幼儿社会认知发展筛查量表》的信度和效度评价

目的对中文版《婴幼儿社会认知发展筛查量表》进行信度和效度评价。方法在广州市和佛山市选取无精神发育疾病、无重大生理疾病的正常婴幼儿843名,选取中山大学附属第三医院儿童发育行为中心确诊为孤独症的幼儿170例,对中文版《婴幼儿社会认知发展筛查量表》进行修订,并且评价量表的信度和效度。结果①信度分析：全量表及4个子量表的Cronbach′sα系数均〉0.7;全量表及4个子量表的分半信度系数为0.69-0.94;全量表及4个子量表的重测信度系数为0.79-0.95。②效度分析：各条目与全量表的相关系数为0.31-0.86;除认人子量表与所属条目n10的相关系数为0.40,各子量表与其他所属条目相关系数均〉0.5,但与其他子量表所属条目相关性不强;各子量表间、子量表与全量表间的相关系数均〉0.5。因子分析共提取6个公因子,解释总变异的60.63%,因子分析结果与原量表结构基本一致。2-3.5岁正常幼儿全量表和4个子量表得分都显著高于同年龄段孤独症幼儿。结论中文版《婴幼儿社会认知发展筛查量表》具有较好的信度和效度,且操作简便,可用于临床上评价0.5-3.5岁婴幼儿社会认知能力的发展情况。     

孤独症谱系商儿童版-中文版的效度和信度

目的:检验孤独症谱系商(AQ)儿童版-中文版的效度信度。方法:对符合美国精神障碍诊断与统计手册第4版(DSM-IV)孤独症诊断标准的门诊101例4～11岁孤独症儿童和124例年龄相匹配的正常儿童进行AQ儿童版-中文版评定。以两组间AQ儿童版-中文版总分及因子分比较确定区分效度;以DSM-IV诊断为金标准,以ROC方法确定界限分及灵敏度、特异度; 10例孤独症儿童和10例正常儿童的两位家长同时单独填写AQ儿童版-中文版以检验评分者信度; 10例孤独症儿童和10例正常儿童家长于首次评定2周后再次进行AQ儿童版-中文版评定,以检测重测信度;以Cronbach a系数检验内部一致性。结果:孤独症组AQ儿童版-中文版总分及各分量表分均高于正常对照组[如总分:(94. 2±15. 6)vs.(54. 4±13. 2),P 0. 001]; ROC曲线下面积为0. 98 (P 0. 01),界限分取73时,量表的灵敏度为0. 96,特异度为0. 90;量表总分评分者信度ICC和重测信度ICC分别为0. 80 (P 0. 001)和0. 92 (P 0. 001);量表内部一致性检验Cronbach a系数为0. 94 (P 0. 01),5个分量表的Cronbach a系数为0. 69～0. 89 (均P 0. 01)。结论:AQ儿童版-中文版的效度、信度较好,灵敏度、特异度较高,可用于儿童孤独症的临床筛查。     

改良婴幼儿孤独症量表中文版的信效度

目的:引进改良婴幼儿孤独症量表(Modified Checklist for Autism in Toddlers,M-CHAT),并检验信效度。方法:对93名符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准的门诊就诊的儿童孤独症患儿进行M-CHAT中文版评定,其中64名患儿同时评定儿童孤独症行为量表(ABC),56名患儿同时评定儿童孤独症评定量表(CARS),以检验其校标效度。53名患儿2～4周后再次进行M-CHAT中文版评定,以检验重测信度。对85名正常儿童进行M-CHAT中文版评定。共有117名被试(56名孤独症儿童,61名正常对照)的2位家长同时单独对被试进行M-CHAT中文版评定,以检验评分者信度。结果:M-CHAT中文版单项评分者信度Kappa值为0.24～1,总分评分者信度相关系数为0.79;单项重测信度Kappa值为0.27～1,总分重测信度相关系数为0.77(均P<0.01)。M-CHAT中文版内部一致性检验Cronbachα系数为0.85(P<0.01)。M-CHAT中文版各条目与总分之间的相关系数为-0.21～0.73;M-CHAT中文版总分与ABC、CARS总分之间的相关系数分别为0.34与0.53(均P<0.01)。M-CHAT中文版的灵敏度为0.96,特异度为0.60。结论:改良婴幼儿孤独症量表中文版的总体信度、效度较好,灵敏度较高,可用于我国儿童孤独症的早期筛查;但其特异度偏低,有待进一步修订完善。     

Asperger综合征筛查量表的编制及信效度检验

目的:编制一套符合中国文化、具有较好的信度和效度的Asperger综合征(Asperger syn-drome,AS)筛查量表。方法:根据量表编制原理和程序编制成Asperger综合征筛查量表初版,经预调查条目分析调整形成量表终版,选取按照精神障碍诊断与统计手册第4版(DSM-Ⅳ)标准诊断的AS儿童67例(4～11岁)和小学1050名(5～11岁),由家长进行量表的填答,测算量表划界分并检验其信度和效度。结果:AS组儿童量表总得分高于正常组(P<0.05),用全量表总分对AS儿童进行筛查,ROC曲线下面积为0.98(P<0.01),划界分为49分。Asperger综合征筛查量表总分复测相关系数r为0.93,各条目复测相关系数r均在0.70以上,内部同质性检验Cronbach’sα系数为0.94。以DSM-Ⅳ为"金标准",量表筛查结果与其的关联系数r为0.72;探索性因子分析示KMO值为0.95,析出6个因子可解释总变异的50.00%;AS组各条目得分(除外2条)高于对照组(P<0.05)。结论:Asperger综合征筛查量表具有较好的信度和效度,值得推广使用。     

儿童孤独症筛查量表的编制与信度、效度分析

目的:编制儿童孤独症筛查量表,并对该量表进行信度和效度分析.方法:基于目前精神医学界对儿童孤独症临床表现和诊断的认识及孤独症诊断访谈量表的研究结果编制量表.选择儿童孤独症组、精神发育迟滞组和正常儿童组作为研究对象进行信度、效度检验.结果:该量表各项目的评定者信度和重测信度(Kappa值)分别为0.429-0.639(除一项外)和0.404-0.732.各因子的评定者信度和重测信度(相关系数)分别为0.944-0.988和0.840-0.984.量表总分的评定者信度和重测信度(相关系数)分别为0.933和0.986.量表的分半信度为0.969.同质性信度除一项外,其他各项目间的相关系数为0.444-0.855.P均<0.01.该量表各项目的鉴别诊断效度:三组间χ2值为20.658-108.152;各两组间Z值分别为2.186-9.264(除二项外).各因子的区分效度:三组间F值为138.227-468.368;各两组间组间均数差为2.916-14.542.量表总分的区分效度:三组间F值为562.563,各两组间组间均数差为10.91-34.64.p为0.029-0.000.量表的所有项目可聚为三个因子.筛查界限分为21分,诊断界限分为24分.结论:该量表具有较好的信度和效度,可用于儿童孤独症的筛查和诊断.     

老年人快速认知筛查量表筛查早期阿尔茨海默病性痴呆的试测

目的:考查老年人快速认知筛查量表(QCSS-E)筛查社区老年人轻度认知功能障碍(MCI)及轻中度阿尔茨海默病(AD)的性能。方法:在社区募集≥55岁老年人1298人,参照Peterson MCI诊断标准和DSM-5神经认知障碍AD诊断标准为金标准,将其分为正常对照(NC)组(n=629)、MCI组(n=573)及轻中度AD组(n=96)。计算量表总分及各维度得分筛查MCI和轻中度AD的阳性预测值、阴性预测值;采用ROC曲线分析检验量表总分的区分度。结果:量表总分筛查MCI的阳性预测值为67.6%,阴性预测值为83.9%;筛查轻中度AD的阳性预测值为64.2%,阴性预测值为96.9%。ROC曲线分析发现QCSS-E总分筛查正常与MCI、正常与轻中度AD、MCI与轻中度AD的AUC分别为83.5%、98.0%及85.6%。结论:QCSS-E总分及各维度得分在早期AD筛查中性能良好。     

精神活性物质使用问题筛查量表中文版的信效度

目的:初步评估精神活性物质使用问题筛查量表(Alcohol,Smoking,and Substance Use In-volvement Screening Test,ASSIST)中文版的信度与效度。方法:采用横断面研究的方法对122名精神疾病与药物依赖者进行ASSIST与DSM-IV轴I诊断用定式临床检查手册病人版(Structured Clinical Interview for DSM-IVAxisI Disorders-Patient Edition,SCID-I/P)访谈,其中73例进行两位评定者独立评估获取评定者间一致性信息,并在一周后由同一评定者对上述73例对象重新评估获取重测信度。用受试者工作特征曲线(ROC)分析确定ASSIST的预测临界值,并以SCID诊断结果作为效标,评定ASSIST的效度。结果:AS-SIST对筛查所涉及的10类精神活性物质评分者一致性较高(ICC内部相关系数均0.90),重测信度也较高(ICC内部相关系数0.90,Spearman等级相关系数0.80,Kappa值0.77)。采用ROC工作特征曲线法确定的诊断界值与ASSIST的分界值也具有较高的一致性,除酒精依赖外(Kappa值:0.56),ASSIST筛查结果与SCID物质依赖诊断一致性较高(Kappa值:0.94～1.00)。结论:精神活性物质使用问题筛查量表中文版在我国具有较好的信效度,可用于临床工作中对烟草、酒精及其他精神活性物质使用问题的筛查。     

异常行为量表中文版在儿童孤独症群体中的信效度

目的:引进并探讨异常行为量表(Aberrant Behavior Checklist,ABC)在我国儿童孤独症群体的适用性。方法:对206例孤独症儿童(1.5~14.0岁)进行ABC评定,其中49例患儿由父母分别填写ABC,30例患儿于2~4周后由同一位家长再次评定,以检验评定者信度和重测信度;根据适用年龄范围对部分患儿评定儿童孤独症评定量表、孤独症行为评定量表、Conner父母评定量表及Achenbach儿童行为量表,经比较检验ABC的校标效度;对ABC结构模型进行验证性因素分析以检验结构效度。结果:ABC中文版各因子的评定者信度(ICC)在0.820~0.898之间(P<0.001),重测信度(ICC)0.873~0.944(P<0.001),各因子及总量表的内部一致性系数为0.748~0.951;ABC中文版各因子与儿童孤独症评定量表、孤独症行为评定量表、Conner父母评定量表及Achenbach儿童行为量表的相应因子间呈正相关(r=0.27~0.67,均P<0.01);验证性因素分析检验了结构的有效性(χ2/df=1.91,RMSEA=0.060,GFI=0.704,NFI=0.62,CFI=0.77)。结论:异常行为量表中文版的信、效度较好,适用于儿童孤独症的量化评估,但仍需进一步修订完善。     

改良婴幼儿孤独症量表与婴幼儿孤独症量表临床应用比较

目的:比较改良婴幼儿孤独症量表(M-CHAT)与婴幼儿孤独症量表(CHAT)在广泛性发育障碍(PDDs)儿童的早期筛查中的适用性。方法:对69例符合美国精神障碍诊断和统计手册第4版(DSM-Ⅳ-TR)诊断标准的广泛性发育障碍儿童(PDDs组),和年龄、性别匹配的32名其他发育障碍儿童(对照组),同时运用M-CHAT和CHAT对被试进行临床评估,比较两种工具在临床筛查时的差异。结果:M-CHAT的灵敏度高于CHAT(0.99 vs.0.81,P0.01);而特异度则低于CHAT(0.16 vs.0.51,P0.01)。两种工具筛查阳性人数和阴性人数不一致[(95/6)vs.(72/29),P0.05]。年龄分层比较,在24月以下儿童中M-CHAT阳性数(17/0)和CHAT阳性数(15/2)均与临床诊断(12/5)一致;在36月以上儿童中,M-CHAT阳性数(6/1)和CHAT阳性数(3/4)均与临床诊断(6/1)一致,总体一致率为0.71(P0.05),两种工具筛查结果差异不具有统计学意义(P0.05);而在24～36月年龄组儿童中,M-CHAT阳性数比临床诊断高[(72/5)vs.(51/26),P0.05],M-CHAT与CHAT阳性数比临床诊断高[(72/5)vs.(54/23),P0.05)],而CHAT阳性数与临床诊断一致率为0.73,差异无统计学意义(P0.05)。结论:改良婴幼儿孤独症量表较婴幼儿孤独症量表灵敏度高,更适于正常人群的筛查;而婴幼儿孤独症量表运用在儿童发育障碍门诊时,与临床诊断的一致性较高。     

常用抑郁量表筛查我国青少年抑郁的效度和划界分

目的:检验常用抑郁量表即流调用抑郁量表(CES-D)和贝克抑郁量表第2版中文版(BDI-II-C)筛查我国青少年抑郁的效度和划界分。方法:5565名中学生(年龄:14.17±1.66)完成CES-D和BDI-II-C测试,其中634人[即CES-D总分≥20分(n=322)和20分(n=312)]进一步完成了学龄期儿童情感障碍和精神分裂症问卷(K-SADS)诊断访谈。对完成访谈的青少年以美国精神障碍诊断与统计手册第4版(DSM-IV)为标准做出抑郁障碍诊断,以此为效标,计算并比较CES-D和BDI-II-C在各自常规和最优划界分下筛查青少年抑郁症和所有抑郁障碍的效度。结果:1CES-D以总分≥29和≥24分为最优划界分,分别筛查青少年抑郁症和所有抑郁障碍的敏感度为94%-97%,特异度为74%-79%,阳性预测值为21%-30%,接受者操作特征(ROC)曲线下面积(AUC)为0.88-0.91;BDI-II-C以总分≥28和≥15分为最优划界分,分别筛查青少年抑郁症和所有抑郁障碍的敏感度为91%-95%,特异度为80%-83%,阳性预测值为23%-35%,AUC为0.88-0.91。2CES-D在常规划界分下筛查青少年抑郁症(≥24分)和所有抑郁障碍(≥20分)的特异度(55%-70%)和阳性预测值(16%-20%)均小于最优划界分;BDI-II-C在常规划界分下筛查青少年抑郁症(≥29分)和所有抑郁障碍(≥14分)结果与最优划界分相似,除筛查所有抑郁障碍的敏感度(99%)优于最优划界分(95%);3CES-D筛查抑郁症和所有抑郁障碍的特异度均小于BDI-II-C。结论:两常用抑郁量表筛查我国青少年抑郁具有较好的效标效度,建议CES-D选用最优划界分,BDI-II-C选用常规划界分。     

儿童佛罗里达强迫问卷的修订

目的:修订儿童佛罗里达强迫问卷(C-FOCI)并检验其信度和效度。方法:采用方便取样。选取小学四年级到高中三年级学生共4293名(年龄8～18岁)组成学校样本组;收集同期在中国医科大学盛京医院心理门诊就诊,按美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)标准诊断为强迫障碍的儿童40人(年龄9～18岁)组成强迫障碍组。所有样本完成C-FOCI,莱顿强迫问卷(儿童版)(LOI-CV)、儿童焦虑性情绪障碍筛查表(SCARED)、儿童抑郁量表(CDI)。利用学校样本进行内部一致性检验、探索性因素分析。利用学校样本分析C-FOCI和LOI-CV、SCARED、CDI的相关性,以检验平行效度。间隔4周后,79名在校高一学生再次完成C-FOCI以检验重测信度。利用所有样本制定C-FOCI的划界分。结果:C-FOCI分为症状清单和严重度量表两部分。强迫障碍组所有量表得分均高于学校样本组(P0.001)。C-FOCI症状清单包括17个条目,Cronbachα系数为0.81,重测信度0.70;C-FOCI严重度量表包括5个条目,Cronbachα系数为0.85,重测信度0.65,P0.001。对症状清单进行探索性因子分析析出4个因子,可解释总变异的45.8%。C-FOCI症状清单得分和严重度量表得分均与LOI-CV、SCARED、CDI得分呈正相关(r=0.34～0.55,均P0.001)。症状清单对强迫障碍儿童的诊断划界分为7分,灵敏度为67.5%,特异度为73.3%;严重度量表的诊断划界分为7分,灵敏度为90.0%,特异度为77.3%。结论:修订的儿童佛罗里达强迫问卷具有良好的信度和效度,可用于我国儿童强迫症状及严重程度的评估。     

Short screening scales to monitor population prevalences and trends in non-specific psychological distress

BACKGROUND: A 10-question screening scale of psychological distress and a six-question short-form scale embedded within the 10-question scale were developed for the redesigned US National Health Interview Survey (NHIS). METHODS: Initial pilot questions were administered in a US national mail survey (N = 1401). A reduced set of questions was subsequently administered in a US national telephone survey (N = 1574). The 10-question and six-question scales, which we refer to as the K10 and K6, were constructed from the reduced set of questions based on Item Response Theory models. The scales were subsequently validated in a two-stage clinical reappraisal survey (N = 1000 telephone screening interviews in the first stage followed by N = 153 face-to-face clinical interviews in the second stage that oversampled first-stage respondents who screened positive for emotional problems) in a local convenience sample. The second-stage sample was administered the screening scales along with the Structured Clinical Interview for DSM-IV (SCID). The K6 was subsequently included in the 1997 (N = 36116) and 1998 (N = 32440) US National Health Interview Survey, while the K10 was included in the 1997 (N = 10641) Australian National Survey of Mental Health and Well-Being. RESULTS: Both the K10 and K6 have good precision in the 90th-99th percentile range of the population distribution (standard errors of standardized scores in the range 0.20-0.25) as well as consistent psychometric properties across major sociodemographic subsamples. The scales strongly discriminate between community cases and non-cases of DSM-IV/SCID disorders, with areas under the Receiver Operating Characteristic (ROC) curve of 0.87-0.88 for disorders having Global Assessment of Functioning (GAF) scores of 0-70 and 0.95-0.96 for disorders having GAF scores of 0-50. CONCLUSIONS: The brevity, strong psychometric properties, and ability to discriminate DSM-IV cases from non-cases make the K10 and K6 attractive for use in general-purpose health surveys. The scales are already being used in annual government health surveys in the US and Canada as well as in the WHO World Mental Health Surveys. Routine inclusion of either the K10 or K6 in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.     

社会技能训练对儿童行为问题的干预研究

目的:建立社会技能训练的方法,并探讨社会技能训练对儿童行为问题的干预效果.方法:应用社会技能训练对30例儿童行为问题患儿进行为期8周的干预,采用Rutter儿童行为问卷,Conners儿童行为问卷,Achenbach儿童行为量表进行干预前后评价,并进行临床疗效评定.结果:干预后,Rutter儿童行为问卷总分、A分和N分均较治疗前显著下降(P<0.001,P<0.05,P<0.01),临床评定总有效率达76.67%;Conners儿童行为问卷总分及因子分行为、学习、多动、多动指数较治疗前显著下降(P<0.05～0.01),总有效率63.33%;Achenbach儿童行为量表显示因子分违纪显著下降(P<0.05),总有效率60%.结论:社会技能训练的方法切实可行,并对儿童行为问题的改善有效.     

Identifying the behavioural phenotype in fetal alcohol spectrum disorder: sensitivity, specificity and screening potential

Summary Background: In most cases of Fetal Alcohol Spectrum Disorder (FASD), the pathognomonic facial features are absent making diagnosis challenging, if not impossible, particularly when no history of maternal drinking is available. Also because FASD is often comorbid with Attention Deficit Hyperactivity Disorder (ADHD), children with FASD are frequently improperly diagnosed and receive the wrong treatment. Since access to psychological testing is typically limited or non-existent in remote areas, other diagnostic methods are needed to provide necessary interventions. Objectives: To determine if a characteristic behavioural phenotype distinguishes children with FASD from typically developing children and children with ADHD and use this information to create a screening tool for FASD diagnosis. Methods: Parents and caregivers completed the Child Behavior Checklist (CBCL), a well-established standardized tool for evaluating children’s behavioural problems. Results from 30 children with Fetal Alcohol Syndrome or Alcohol-Related Neurodevelopmental Disability, 30 children with ADHD, and 30 typically developing healthy children matched for age and socioeconomic status with FASD were analyzed. Based on our previous work, 12 CBCL items that significantly differentiated FASD and control groups were selected for further analyses. Stepwise discriminant function analysis identified behavioural characteristics most strongly differentiating groups and Receiver Operating Characteristics (ROC) curve analyses determined sensitivity and specificity of different item combinations. Results: Seven items reflecting hyperactivity, inattention, lying and cheating, lack of guilt, and disobedience significantly differentiated children with FASD from controls. ROC analyses showed scores of 6 or higher on these items differentiated groups with a sensitivity of 86%, specificity of 82%. For FASD and ADHD, two combinations of items significantly differentiated groups with high sensitivity and specificity (i) no guilt, cruelty, and acts young (sensitivity = 70%; specificity = 80% (ii) acts young, cruelty, no guilt, lying or cheating, steals from home, and steals outside (sensitivity = 81%; specificity = 72%). These items were used to construct a potential FASD screening tool. Conclusions: Our findings identifying the behavioural characteristics differentiating children with FASD from typically developing children or children with ADHD have the potential for development of an empirically derived tool for FASD tool to be used in remote areas where psychological services are not readily available. This technique may speed up diagnosis and intervention for children without ready access to formal assessments.     

自闭症儿童的家庭治疗

目的采用家庭治疗促进自闭症儿童心理康复。方法遵循随机抽样的原则,在正在接受结构化教育、感觉综合训练、听觉统合训练的自闭症儿童中,随机选择1/2比例（5名）儿童同时进行家庭治疗。结果与对照组相比,实验组的感觉能力（t=3.769,P=0.003）、交往能力（t=2.567,P=0.039）、躯体运动能力（t=2.687,P=0.035）、总分（t=2.719,P=0.033）的得分显著改善,其他项目也存在着下降的趋势。结论家庭治疗可以促进自闭症儿童心理康复,提升患儿的感觉能力、人际交往能力、躯体运动能力。     

Are abilities abnormally interdependent in children with autism?

We propose that stronger than usual correlations between abilities indicate which cognitive processes are impaired in autism. Study 1 compared partial correlations (controlling age) between intelligence and social cognition in children with autism (n = 18), mental retardation (MR; n = 34), or no psychological disorder (n = 37). Correlations were stronger in the autism group. Study 2 compared correlations between measures of perceptual organization and verbal comprehension, receptive and expressive language, fine and gross motor coordination, and theory of mind, emotion recognition, and emotion understanding abilities in children with autism (n = 30) or MR (n = 24) and in a large representative sample of children (n = 449). Results indicate that autism is marked by stronger correlations between all ability domains, and MR is marked by stronger correlations between motor coordination tasks and other ability measures.     

Selecting immunohistochemical cut-off scores for novel biomarkers of progression and survival in colorectal cancer

BACKGROUND: Cut-off scores for determining positivity of biomarkers detected by immunohistochemistry are often set arbitrarily and vary between reports. AIMS: To evaluate the performance of receiver operating characteristic (ROC) curve analysis in determining clinically important cut-off scores for a novel tumour marker, the receptor for hyaluronic acid mediated motility (RHAMM), and show the reproducibility of the selected cut-off scores in 1197 mismatch-repair (MMR) proficient colorectal cancers (CRC). METHODS: Immunohistochemistry for RHAMM was performed using a tissue microarray of 1197 MMR-proficient CRC. Immunoreactivity was scored using a semi-quantitative scoring method by evaluating the percentage of positive tumour cells. ROC curve analysis was performed for T stage, N stage, tumour grade, vascular invasion and survival. The score with the shortest distance from the curve to the point with both maximum sensitivity and specificity, i.e. the point (0.0, 1.0), was selected as the cut-off score leading to the greatest number of tumours correctly classified as having or not having the clinical outcome. In order to determine the reliability of the selected cut-off scores, 100 bootstrapped replications were performed to resample the data. RESULTS: The cut-off score for T stage, N stage, tumour grade and vascular invasion was 100% and that for survival 90%. The most frequently selected cut-off score from the 100 resamples was also 100% for T stage, N stage, tumour grade, and vascular invasion and 90% for survival. CONCLUSIONS: ROC curve analysis can be used as an alternative method in the selection and validation of cut-off scores for determining the clinically relevant threshold for immunohistochemical tumour positivity.