孤独症幼儿测试行为特点研究

探讨孤独症幼儿在发育诊断测验过程中的行为特点,以及婴幼儿测试行为量表（ITBRS）在孤独症的临床诊断中的价值。方法　研究对象为70例18～42个月的孤独症幼儿以及140名18～42个月的正常幼儿。研究工具为贝利婴幼儿发展量表（BSID）、0～4岁小儿发育诊断量表和ITBRS。结果　正常幼儿与孤独症幼儿在ITBRS的任务操作/目标定向、情绪调节、反应性和运动质量等4个因子上的得分以及量表总分上均存在显著性差异（P < 0.01）,表现为正常组得分明显高于孤独症组的得分。两组之间各条目得分比较显示,只有反应强度在两组间无统计学意义的差异外（P > 0.05）,其余条目都存在差异（P < 0.01或0.05）。孤独症组儿童量表总分100%处于异常测试行为范围。结论　孤独症婴幼儿存在明显的测试行为异常。在使用ITBRS评估婴幼儿存在明显测试行为异常时,高度提示他们患有孤独症的可能性。     

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′s α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。     

高功能孤独症青少年健康相关危险行为分析

目的探讨高功能孤独症青少年健康相关危险行为特点。方法 2017年4月至11月于北京大学第六医院门诊或病房诊治的高功能孤独症患儿50例,均符合《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,年龄12～18岁,智商均≥70分。选取同性别、年龄相匹配的正常青少年50名作为对照组。两组均完成青少年健康相关危险行为问卷(AHRBI)评定,同时由孤独症组家长完成青少年健康相关危险行为问卷父母版的评定。结果高功能孤独症组AHRBI自评问卷总分与自杀自伤行为、健康妥协行为、攻击与暴力行为及破坏纪律行为4项因子评分均高于正常对照组(P均0.05)。在所有条目中,高功能孤独症组欺负、威胁、恐吓伙伴,故意对他人打、挤、推、踢,不喝牛奶或豆浆,不参加任何体育活动,逃课或逃学,离家出走,伤害自己项目评分高于正常对照组(P均0.05)。高功能孤独症组健康妥协行为总分、自杀自伤行为总分以及不喝牛奶或豆浆行为、因节食而出现躯体不适、斗殴、随身携带武器、饮酒作乐或喝醉酒条目自评分均高于家长评定结果(P均0.05)。结论高功能孤独症青少年存在较多健康相关危险行为,除吸烟、饮酒和无保护性行为较少外,其他健康相关危险行为均多于正常青少年。     

不同发育水平孤独症谱系障碍患儿的语言状况

目的了解不同发育水平孤独症谱系障碍(ASD)患儿的语言状况。方法回顾性分析2018年1月至2020年12月于重庆医科大学附属儿童医院就诊的103例ASD患儿的临床资料。根据发育诊断性量表评估患儿发育水平, 分成发育或智力正常组和异常组(包括轻度异常、中重度异常);根据年龄分成2～3、4～6、7～8岁组。采用Pearson χ2或Fisher精确检验、独立样本t检验、方差分析或Kruskal-WallisH检验对比分析不同发育水平、不同年龄ASD患儿的语言情况, 用Pearson相关性检验分析语言能力与孤独症核心症状的关系。结果 103例ASD患儿中, 男86例、女17例, 年龄(5.5±1.5)岁, 正常组61例、异常组42例(轻度异常32例、中度异常10例)。3个年龄组间的发育测评分数、整体语言、听力理解、表达、句法和语义的分数差异均无统计学意义(均P>0.05)。正常组中语言能力异常的检出率显著低于发育异常组的检出率[49.2%(30/61)比100.0%(42/42), P<0.01]。正常组的听力理解、语言表达、语义、句法的分数均显著高于轻度、中重度异常组(89±1...     

高危孤独症谱系障碍婴幼儿探索性行为的特征研究

目的对比分析高危孤独症谱系障碍(HR-ASD)婴幼儿与正常发育(TD)婴幼儿探索性行为的差异, 并探讨其与ASD症状严重程度的关系。方法回顾性选取2019年1月至2020年8月在南京医科大学附属脑科医院儿童门诊就诊的31例6～23月龄HR-ASD婴幼儿为HR-ASD组及南京地区年龄、性别相匹配的TD婴幼儿37例为对照组(TD组), 采用《Gesell发育量表》评价2组发育水平, 并在自由游戏情境下测量探索性行为的深度及广度。使用《孤独症诊断观察量表》(ADOS)评估HR-ASD组的症状严重程度, 采用独立样本t检验及χ2检验分析2组间探索性行为的差异;采用Pearson相关分析探讨HR-ASD组探索性行为与症状严重程度之间的相关性;采用二元Logistic回归分析探索性行为在鉴别2组中的区分效能。结果与TD组相比, HR-ASD组的探索性行为的深度及广度显著降低(55.06±25.73比132.78±44.69、4.42±2.20比8.78±3.28), 差异均有统计学意义(t=-8.95、-6.53, 均P<0.01);非典型探索性行为及回避退缩性行为显著增加[18例(58.0...     

特发性矮小男童个性及心理行为研究

目的探讨特发性矮小男童的个性特征及心理行为有无异常。方法采用艾森克个性问卷(EPQ)及Achenbach儿童行为量表(CBCL)对学龄期特发性矮小男童32例及32例正常儿童进行测试。结果1.EPQ测试结果:特发性矮小组E分值明显低于对照组(P<0.01),N分值明显高于对照组(P<0.01);2.CBCL测试:特发性矮小男童组活动及社交能力均明显低于对照组(P<0.02,P<0.01),但学习情况无显著差异;行为问题中,除社交退缩、交往不良两组有显著差异外(P<0.01),特发性矮小组无其他行为障碍。结论学龄期特发性矮小男童性格偏内向、情绪较不稳定,存在交往不良、社交退缩现象。     

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目的探讨Tourette综合征(TS)患儿的情绪问题、社会适应能力和视感知功能。方法采用儿童社交焦虑量表(SAS)、儿童抑郁自评量表(DSRS)、儿童适应行为量表(SAB)和本顿视觉保持测验(BVRT),对2003年10月至2004年12月武汉市儿童医院收治的48例8~12岁TS患儿的焦虑、抑郁、适应行为和视感知功能进行测试,并与46名正常儿童相比较。结果TS组的SAS总分和DSRS总分均明显高于对照组儿童(P<0.01);在SAB测试中,TS组的独立功能因子及社会/自制因子T分明显低于对照组儿童(P<0.01),而适应行为商和认知功能因子T分与对照组相比差异无显著性意义(P>0.05);TS组的BVRT测试中所有正确得分及错误得分与对照组相比差异均无显著性意义(P>0.05)。结论TS患儿存在焦虑、抑郁和社会适应能力低下,其独立生活、社会交往及自制能力差,而视感知功能正常。     

婴幼儿期孤独症的临床诊断

目的分析婴幼儿期孤独症临床特征,为早期诊断提供依据。方法分析58例孤独症婴幼儿的早期症状,并采用0-6岁小儿神经心理发育检查表、婴幼儿孤独症筛查表（CHAT）及儿童孤独症评定量表（CARS）进行测评,分析各量表临床应用价值。结果婴幼儿期已存在明显临床表现,大多数发育商低下（88.2%）,且在智商5个能区里智能发育不平衡,CHAT及CARS量表测定结果阳性率分别为62.1%和96.6%。结论婴幼儿期孤独症患儿即出现明显发育、行为障碍,应引起重视。     

高功能孤独症青少年健康相关危险行为分析

目的 探讨高功能孤独症青少年健康相关危险行为特点。方法　2017年4月至11月于北京大学第六医院门诊或病房诊治的高功能孤独症患儿50例，均符合《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，年龄12～18岁，智商均≥70分。选取同性别、年龄相匹配的正常青少年50名作为对照组。两组均完成青少年健康相关危险行为问卷（AHRBI）评定，同时由孤独症组家长完成青少年健康相关危险行为问卷父母版的评定。结果　高功能孤独症组AHRBI自评问卷总分与自杀自伤行为、健康妥协行为、攻击与暴力行为及破坏纪律行为4项因子评分均高于正常对照组（P均＜0.05）。在所有条目中，高功能孤独症组欺负、威胁、恐吓伙伴，故意对他人打、挤、推、踢，不喝牛奶或豆浆，不参加任何体育活动，逃课或逃学，离家出走，伤害自己项目评分高于正常对照组（P均＜0.05）。高功能孤独症组健康妥协行为总分、自杀自伤行为总分以及不喝牛奶或豆浆行为、因节食而出现躯体不适、斗殴、随身携带武器、饮酒作乐或喝醉酒条目自评分均高于家长评定结果（P均＜0.05）。 结论　高功能孤独症青少年存在较多健康相关危险行为，除吸烟、饮酒和无保护性行为较少外，其他健康相关危险行为均多于正常青少年。     

初诊及长期无病生存白血病儿童情绪、自我意识及个性特征的调查分析

目的了解初诊及长期无病生存5年以上白血病儿童的情绪、自我意识特征及个性特征。方法选用儿童焦虑性情绪障碍筛查表、儿童抑郁障碍自评量表、Piers-Harris儿童自我意识量表和儿童版艾森克个性问卷分别对30例初诊白血病、20例长期无病生存5年以上白血病和50例正常对照儿童进行心理评估。结果三组儿童的焦虑总分以及躯体化/惊恐、广泛性焦虑、社交恐怖分量表评分差异有统计学意义(P均0.05),其中长期无病生存组患儿的焦虑总分以及躯体化/惊恐、广泛性焦虑和社交恐怖分量表评分均显著高于正常对照组(P均0.05);而初诊组患儿的社交恐怖分量表得分显著高于正常对照组(P0.05),学校恐怖分量表得分显著低于正常对照组(P0.05)。在抑郁评分方面,白血病患儿和正常对照组比较以及组间比较均无统计学意义(P均0.05)。三组儿童的自我意识总分以及行为、智力与学校情况和焦虑分量表评分差异有统计学意义,其中长期无病生存组患儿的自我意识总分及各分量表得分与正常对照组比较差异无统计学意义(P均0.05),而初诊组患儿的自我意识总分以及行为、智力与学校情况、焦虑分量表得分均显著低于正常对照组(P均0.05);总体白血病患儿与正常对照组比较,自我意识总分以及行为、焦虑分量表得分显著低于正常对照组(P均0.05)。长期无病生存组与初诊组患儿及正常对照组比较,性格普遍偏于内向(P0.01)。结论白血病儿童较正常儿童有更多的焦虑情绪,其自我意识降低,具有内向性格特征。在治疗儿童躯体疾病的同时,对白血病儿童进行社会心理干预非常必要。     

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??Objective??To study the family burden of children with thalassemia and their family members in Guizhou province. Methods??Family burden scale of disease??FBS?? and basic situation questionnaire were used to investigate 114 family members of children with thalassemia aged 0??14 who were diagnosed and treated in the Department of Pediatric Hematology and Oncology??Affiliated Hospital of Guizhou Medical University??from December 2016 to April 2018.
Results??The total score of FBS of family members of children with thalassemia was ??21.53±7.89??. The standardization scores of each dimension from high to low were family economic burden ??1.389±0.330????family entertainment activities ??0.914±0.530????family relationship ??0.807±0.530????mental health of family members??0.680±0.570????daily activities of the family ??0.679±0.390?? and physical fitness of family members ??0.442±0.440??. Univariate analysis??t/F test showed that the diagnosis typing of children with thalassemia??iron overload??medical insurance and monthly family income were the main factors affecting FBS??P??0.05??. Multivariate linear regression analysis showed that the effect of diagnostic typing??medical insurance??and monthly family income on FBS was statistically significant??P??0.05??. Conclusion??The family burden of children with thalassemia is widespread. It’s time that effective measures should be take to slove the problem according to family burden situation and its influencing factors.     

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??Objective??To explore the effect of group training of parents’ behavioral management skills in the treatment of preschoolers’ externalizing problem behaviors. Methods??The two kindergartens in Shenzhen were screened with Child Behavior Scale Chinese scale??CBSC???? each kindergarten was selected as externalizing problem behaviors intervention group??15 person?? and the control group??10 person??. The parent of the intervention group had 8 sessions of group training sessions about behavioral management skills?? and no intervention was given to the control group. Compare the CBSC scores in two groups before and after the intervention?? and the satisfaction of parents was investigated. Results??There were 23 effective data in intervention group and 18 in control group. After the parents received the group training?? their children’s attention scores??12.30±5.30????restlessness scores??10.96±4.76????and the externalizing problem scores??24.13±8.65??were significantly lower than before???16.13±5.35??????13.35±4.16??????30.78±5.81????P??0.05??. The aggression score was significantly lower than before???0.87±0.87?? vs. ??2.67±2.95????P??0.05??. The satisfaction survey showed that 100% of the parents were satisfied with the training??with 73.91% of the parents who thought the training helped a lot. Conclusion??Parent behavioral management skills group training is an effective and feasible way to treat the externalizing problem behaviors in preschool children. Further improvement and exploration of standardized parental training methods can help to meet the needs of children’s psychological clinical and health care development??and the demand for health service of children.     

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??Objective To understand the dynamic changes of early clinical curative effect in children with asthma and allergic rhinitis who received the dust mite specific immunotherapy??and to discuss the influencing factors of the efficacy. Methods A total of 70 cases with mild or moderate persistent asthma combined with allergic rhinitis who received the dust mite specific immunotherapy combined with drug therapy between February 2012 and November 2012 in Beijing Children’s Hospital were adopted in the case-self-control study. Results Totally 54 cases completed treatment of 12 months. The clinical response rates to SIT ??effective cases?? at 3??6??9 and 12 months after SIT were 72.2%??39????75.9%??41????81.5%??44?? and 87.0%??47???? respectively. After one year of treatment??the average daily SMS and VAS score were all decreased ??5.28±2.28 vs. 2.87±1.96??5.59±3.35 vs. 4.04±3.68?? P??0.05??. PEF% pred was improved???95.41±15.18?? vs. ??99.24±16.24????P??0.05??. Conclusion The effective rate of SIT increases gradually with prolonged treatment. When children with asthma and allergic rhinitis received immunotherapy combined with drug therapy??the patients with higher baseline SMS??shorter asthma history and lower PEF%pred respond more effectively to SIT.     

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??Abstract??Objective??To investigate the working memory profiles in children with Attention Deficit Hyperactivity Disorder ??ADHD??. Methods??We investigated 39 children with ADHD ??DSM-IV???? including ADHD combined type??ADHD-C????n = 14????ADHD inattentive type ??ADHD-I?? ??n = 14?? and ADHD hyperactive/ impulsive type??ADHD-HI?? ??n = 11???? and 19 normal controls matched for age?? sex?? handedness?? and intelligence during a working memory task. Prefrontal brain activity was measured by concentration changes of oxygenated haemoglobin ??oxyHb??. Functional near-infrared spectroscopy ??NIRS?? was used to obtain the oxyHb. Results The results of working memory task?? ??1??ADHD children had more total errors ??3.51±3.025?? and comparison errors??2.41±2.149??than controls??P < 0.05??.??2??There was no significant difference in reaction time between ADHD and control group ??P??0.05??.??3??ADHD-C patients had more reaction errors??1.71±2.016??than ADHD-HI’s??P < 0.05?? ??on comparison errors??ADHD-HI children had more than ADHD-C’s??P < 0.05????and ADHD-I children also had more than ADHD-C’s??P < 0.05??.But there was no significant difference between ADHD-I and ADHD-HI group.??4?? ADHD-HI group had longer reaction time than ADHD-I’s ??P < 0.05??.The results of NIRS?? ??1?? There was no significant difference in concentration changes of oxygenated haemoglobin ??oxyHb?? between ADHD and control group when they performed working memory task.??2??Concentration levels of oxyHb in ADHD-C decreased in the left-down prefrontal cortex area during performing reaction commission than ADHD-I???-2.46±9.62 ??×10-4 vs.??10.47±14.18??×10-4 P < 0.05??.Conclusion??There are significant deficiencies in working memory in children with ADHD??ADHD subtypes differ in working memory profile.     

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??Objective??To evaluate sleep habits and related affecting factors in children with epilepsy aged from 7 to 14 years old. Methods??By asking parents and guardians?? the children's sleep habit questionnaire was used to evaluate sleep habits of 162 children with epilepsy and 162 normal controls. Results??The mean score on the sleep questionnaire for children with epilepsy was 32.4±3.6 ??P < 0.01???? whereas for the normal control group it was 58.8±3.3 ??P < 0.01??. In children with epilepsy?? neuropsychomotor developmental delay had higher scores??49.9±7.3?? than that of appropriate development ??43.5±8.1??P < 0.01??. The group under polytherapy ??54.3±5.7?? had a higher score than that under monotherapy??42.9±6.3??. In addition?? the mean score for patients with daytime seizures was 44.1±7.6??and for those with nocturnal seizures it was 52.3±5.7 ??P < 0.01??. The mean score for children with partial seizures was 41.6±4.9??and for those with generalized seizures it was 47.4±8.7 ??P < 0.01??. Conclusion??Children with epilepsy are prone to have sleep disorders. Many factors?? such as neuropsychomotor development??seizure type??seizure frequency and therapy of seizures?? can affect their sleep habits.     

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??Objective analyze the current status of bone metabolism and bone mineral density??BMD?? in moderate/severe hemophilia children??to provide data for improving the life quality of Chinese children with hemophilia. Methods Bone metabolism and BMD data were analyzed for 28 cases of moderate/severe hemophilia children diagnosed in Hemophilia Center of Beijing Children Hospital from October 2014 to February 2015. Results ??1??The median age of 28 cases of hemophilia children was 12.9??range 6 to 18 years?? years old??hemophilia A 22 was in cases??78.6%????hemophilia B 6 cases??21.4%???? Severe hemophilia children was in 19 cases??67.9%????moderate hemophilia children 9 cases??32.1%??. The mean of BMD was ??151.86±25.93?? g/L??which was significantly lower than the normal children???191.48±20.36?? g/L???P??0.05. There was no relationship in Age??time of the first bleeding, as well as frequency of bleeding with BMD??P??0.05??. But significant correlation was found between BMD and outdoor activities/school activities participation??P??0.0002 and 0.0016??. Conclusion BMD of hemophilia children without bone metabolic abnormalities is significantly lower than that of the normal children in China. Reducing joint bleeding and increasing the outdoor activities??rather than supplement calcium blindly will be the key point to improve the life quality of hemophilia children.     

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??Objective To investigate the clinical characteristics and treatment of hypereosinophilic syndrome??HES?? in children. Methods The clinical manifestations?? laboratory examinations??gastroscopy and imaging features??pathological results and therapy experience in 13 HES children admitted in Beijing Children’s Hospital??Capital Medical University from January 2009 to February 2016 and related literatures were analyzed retrospectively. Results Of the 13 patients evaluated?? 7 were male??54%?? and 6 were female??46%??. The median age at diagnosis was 9.6 years old??ranging 3 to 14 years old??. The median course of disease was 23 months??ranging 1 to 72 months??. The peripheral eosionophil counts ranged ??4.5—29.2??×109/L??mean 13.5×109/L??. Gastrointestinal tract was the most commonly involved organ?? and was reported in 92%??12/13?? of patients. It was followed in frequency by urinary system??84%????pulmonary??53%????cardiac??23%????and skin??8%?? and liver??8%??. A total of 2 sites were involved in 6 patients??3 sites were involved in 5 patients and 4 sites were involved in 2 patients. Treatment of oral prednisone therapy was given and follow-up of 10 patients had no clinical symptoms??2 patients had stopped prednisone??. But eosionophil counts still increased to varying degrees. Three patients were lost to follow-up. Conclusion HES in children is more common in school age and adolescent children. Gastrointestinal tract??urinary system and pulmonary involvement are more common. Glucocorticoid treatment is effective??which requires to be maintained in small dose in the long term.     

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??Objective The intellectual profiles of children with AS were studied in order to better interpret their behavioral characteristics.Methods Totally 114 children of 6.08~14.24 years old with AS were examined by the China-Wechsler Intelligence Scale for Children ??C-WISC?? and all subtests were administrated.Results The level of intelligence of chidren ranged from mildly impaired to very superior??the average verbal intelligence quotient????VIQ????performance intelligence quotient??PIQ??and full intelligence quotient??FIQ?? were respectively 101.52±18.72??88.30±17.40 and 94.90±17.75??There was statistically significant difference between the VIQ and PIQ among children with AS and a tendency of VIQ??PIQ was showed??P??0.01??. The differences between scores on three Kaufman factors was significant??P??0.01??. Children with AS scored the highest on similarity??vocabulary and information subtests and scored the lowest on picture completion??picture arrangement and coding subsets in full scale??score on comprehension subtest was the lowest in the verbal scale and scores on block design and object assembly subtest were the highest in performance scale.Conclusion The intelligence structures of children with AS are not balanced??which is characterized by a combination of assets and deficits.     

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??Objective??To observe the efficacy and safety of multi-target immunosuppressive therapy in treatment of children with steroid-resistant nephritic syndrome??SRNS??. Methods??A total of 48 children with SRNS were enrolled in this multicenter prospective study. Based on the same comprehensive treatment??the children were randomly divided into two groups?? ??1??observation group?? they were orally given CSA??3??4 mg/??kg·d???? and MMF??20 mg/??kg·d???? multi-target immunosuppressive therapy????2??control group??they were orally given CSA??4??6 mg/??kg·d????. The side effects were closely observed. The plasma concentrations of CSA??urine protein to creatinine ratios??liver and kidney function??blood routine and urine β2-microglobulin were respectively compared between the two groups after 2 weeks??1 month??3 months and 6 months of treatment. Results??The average plasma concentrations of CSA in the observation group was ??88.86±16.94?? μg/L??and in the control group it was ??152.96±19.20?? μg/L??P??0.001??. The urine protein to creatinine ratios in the observation group after 1 month and 3 months of treatment were lower than the control group in the same time period??P??0.05??. The serum albumin in the observation group after 1 month and 3 months of treatment was higher than the control group in the same time period??P??0.05??. The urine β2-microglobulin in these two groups had no differences during the treatment??P??0.05??. The overall remission rate of the observation group was 88%??and in the control group it was 87%. The remission rate of the observation group after 2 weeks and 1 month of treatment was better than the control group??P??0.05??. The main side effect during therapy was infection??gastrointestinal reaction??crinosity??hypertension and leukocyte decrease. The side effect of the observation group was less than the control group??P??0.05??. Conclusion??The multi-target therapy in children with SRNS by CSA and MMF results in early remission and can keep long-term remission with mild side effect.