天津市1.5～3岁儿童孤独症行为特征分析

目的:了解天津市1.5～3岁孤独症患者早期行为特征,为早期诊断和早期干预提供依据。方法:采用分层整群随机抽样,在天津市9个区县抽取1.5～3岁儿童8006名,采用儿童行为发育调查表进行筛查。用DSM-IV诊断标准和儿童孤独症评定量表(Childhood Autism Rating Scale,CARS)对筛出的432名可疑孤独症儿童进行诊断并评估症状程度,用儿童孤独症行为量表(Autism Behavior Checklist,ABC)分析其行为障碍特征。运用上述量表对21例已确诊的孤独症儿童、84名可疑阳性儿童、84名正常儿童的早期行为表现进行比较。结果:孤独症儿童和可疑性儿童在语言能力异常、无食指指灯、无假扮游戏行为、不会正常玩玩具、孩子与人无目光接触等9个项目检出率均高于正常儿童(如,无食指指灯,71.4%、54.8%vs.14.3%,P0.05);孤独症儿童在对所指物品无注意、孩子与人无目光接触、语言能力异常、不能接受简单指令、不用语言表达需要5个项目检出率高于可疑阳性组(如,对所指物品无注意,38.1%vs.2.4%,P0.05)。ABC量表评定结果表明重度孤独症儿童(CARS总分≥36分)在感觉和躯体功能上得分均高于轻中度孤独症儿童[(8.00±3.30)vs.(5.15±2.58),(12.00±6.12)vs.(6.15±3.26);均P0.05]。结论:孤独症患儿在婴幼儿期即出现明显发育、行为障碍,应引起重视。     

江门地区2-6岁儿童孤独症患病情况调查

目的了解江门市2-6岁儿童孤独症的患病情况以及影响因素,为早期发现、早期诊断提供治疗干预手段。方法采用整群抽样,用克氏孤独症行为量表进行初筛,用儿童孤独症家长评定量表进行复筛和确诊,并对计数资料的组间比较进行χ2检验。结果确诊为儿童孤独症的有97人,其中男65名,女32名。不同性别儿童孤独症患病率、城市和农村的儿童孤独症患病率、不同年龄组间的儿童孤独症患病率均存在明显差异。结论儿童孤独症往往预后不佳,早期发现和诊断意义重大,对于儿童孤独症的流行病学调查各地区应继续给予支持和重视。     

孤独症儿童睡眠问题及其相关因素

目的:了解孤独症儿童睡眠障碍情况,探讨孤独症儿童睡眠障碍的相关因素。方法:采用病例对照研究方法,入组198例符合美国精神障碍诊断与统计手册第4版(DSM-IV)诊断标准的孤独症儿童和233例性别、年龄匹配的正常儿童,收集所有儿童一般人口学资料和睡眠情况,对孤独症组进行孤独症儿童行为量表、Achenbach儿童行为量表,孤独谱系障碍筛查问卷评定,比较两组儿童睡眠情况,并对睡眠问题相关因素进行相关分析和回归分析。结果:孤独症组入睡困难、入睡前烦躁不安、入睡前要拍抱或摇晃、睡眠不安、间断睡眠、梦游、梦魇、夜惊、睡眠打鼾、夜间遗尿、睡眠呼吸暂停、用口呼吸、睡眠出汗评分均高于正常对照组(均P0.05),白天入睡时间固定的比例低于正常对照组(P0.05)。以睡眠状况得分为因变量,以儿童出生体质量、会走路月龄、会说话月龄、父亲年龄以及孤独症症状作为自变量进行线性回归分析,分析显示,孤独症组孤独症行为量表的感觉因子得分、躯体因子得分、自理因子得分与孤独症儿童的睡眠状况呈正向关联(β=0.21、0.21、0.29,P0.05),孩子出生时父亲的年龄对孤独症儿童的睡眠状况呈负性关联(β=-0.16,P0.05),而孤独症组孤独症行为量表的总分、交往因子分及语言因子分与睡眠状况总分无统计学关联(均P0.05)。结论:孤独症儿童与正常对照儿童比较,存在较多的睡眠问题,其睡眠问题与孤独症儿童的感觉因子得分、躯体因子得分、自理因子得分以及出生时父亲的年龄相关。     

杭州市1~3岁儿童父母亲孤独症相关信息知晓情况调查

目的:了解杭州市1~3岁儿童父母亲对孤独症相关信息知晓情况,为早期诊断及早期干预治疗提供科学依据。方法:采用横断面调查方法,在杭州市8个行政区内抽取7个社区卫生中心对5263名1~3岁儿童作为调查对象的父母亲中开展对孤独症信息知晓的现况调查。结果:父母亲对儿童孤独症三大症状的知晓主要表现在认为孤独症就是性格孤僻的有3004名(57.1%)、孤独症是一种严重的婴幼儿广泛发育障碍的有2578名(49.0%)、孤独症是语言发育障碍的有1800名(34.2%)。了解孤独症的渠道依次是报纸杂志、书籍、电视/电影、亲友邻居当中有自闭症、医生或专家介绍、其他。不同学历的父母亲对孤独症的了解差异显著(χ~2=105.86,129.27;P0.001)。结论:本研究的儿童父母亲对孤独症相关信息有一定的知晓,为进一步开展社区宣传教育提供了有利依据。     

儿童自闭症的分析和心理治疗

儿童自闭症又称儿童孤独症 ( Infantile autism) ,起病年龄在 30个月之前 ,以精神和心理发育的广泛性障碍为特征的一种疾病。美国儿童及成人孤独症学会顾问委员会认为孤独症儿童行为有以下 4个特征 :发育速度和顺序异常 ;对任何一种感觉刺激的反应异常 ;言语、语言认知及非言语性认知异常。与人、物和事的联系异常。自婴儿期起病 ,极度孤独 ,不能交往 ,对某些物体特殊依恋 ,预后欠佳[1 ] 。1　主要表现社会交往障碍。不能与他人 (包括父母 )建立正常的社会交往 ,社交缺陷是其核心症状。有的患儿早期就表现避免与他人目光接触 ,缺少面部表情…     

孤独症行为量表试测报告

采用孤独症行为量表 (Autism Behavior Checklist) 对国内60名孤独症儿童,157名精神发育迟滞儿童及108名正常儿童的试测,发现当量表总分≥31分作为孤独症筛查界限分时其信度、效度均为1,检验符合要求;当总分≥62分时,对诊断与鉴别诊断有较好的阳性率。量表项目出现频率提示,原量表项目在我国可以保留使用。性别、年龄因素对量表影响不大。     

2～6岁儿童广泛性发育障碍的3年后随访

目的:对2004年北京市2～6岁儿童广泛性发育障碍调查中诊断为广泛性发育障碍的儿童进行随访研究,了解广泛性发育障碍儿童的近期预后。方法:在3年后对2004年调查中确诊的广泛性发育障碍儿童进行随访,由儿童精神科医师根据美国精神障碍诊断与统计手册第4版进行诊断,随访时用儿童孤独症评定量表、Gesell发展诊断量表或中国修订韦氏儿童智力量表、Achenbach儿童行为量表、儿童感觉统合能力发展评定量表的评定及总体调查问卷、精神专业调查问卷进行调查。结果:2004年确诊的29名广泛性发育障碍儿童中共有26名儿童得到随访。随访时间间隔(38.1±0.9)个月。21名(80.8%)儿童诊断同前;另5名(19.2%)儿童的诊断发生变化,1名儿童孤独症诊断转变为不典型孤独症。2名孤独症诊断儿童及2名不典型孤独症诊断儿童不再符合广泛性发育障碍的诊断标准。疾病严重程度转归为显著好转、好转、无变化、加重者分别为4人(15.4%)、4人(15.4%)、15人(57.7%)、2人(7.7%),1名儿童转归无法确定。随访确诊广泛性发育障碍的儿童中,90.9%伴有精神发育迟滞,76.2%伴有感觉统合失调,52.4%伴有过度活动,18.2%伴有肢体残疾,18.2%伴有癫痫。患儿既往康复治疗明显不足,教育安置有限。结论:多数广泛性发育障碍儿童近期预后不良,少数患儿近期预后良好。     

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。     

结构化教学法在孤独症谱系障碍儿童干预中的应用分析

目的 运用结构化教学法对孤独症谱系障碍儿童进行干预并观察其疗效,为孤独症谱系障碍儿童制定个体化康复训练方案及其早发现、早诊断、早期干预提供有效可靠的临床依据。方法 将梧州市妇幼保健院儿童保健科于2015年8月至2020年7月收治的孤独症谱系障碍儿童300人进行分组,接受结构化教学法干预150人作为干预组,未接受及不系统干预150人作为对照组,两组儿童训练前后采用《儿童孤独症诊疗康复指南》指定盖泽尔发展诊断量表进行智能评估。结果 干预组儿童在五大能区：大运动、语言、精细运动、适应能力、社交行为均高于对照组,差异有统计学意义（P<0.05）,干预后转归率也明显高于对照组,年龄越小,干预效果较明显。结论 结构化教学法运用于孤独症谱系障碍儿童的干预,可有效促进其个体化发育,明显改善其核心症状及智能发育水平,如尽早发现、精确诊断、及时干预可达到理想康复疗效,也为他们今后融入社会奠定坚实的基础。     

3～6岁儿童抚养人孤独症相关信息知晓现况调查

目的:探讨3～6岁儿童抚养人对孤独症相关信息知晓现状,为开展社区宣传教育提供依据.方法:采用横断面调查方法,在哈尔滨市8个行政区内抽取44所幼儿园,以其中所有3～6岁儿童的主要抚养人作为调查对象.采用自编问卷,从孤独症的症状识别、一般知识了解、病因、就诊态度等多方面评价对孤独症相关知识的知晓现况.共回收合格问卷4947份.结果:样本中,2786人(57.8％)能够准确识别孤独症的症状;3115人(64.8％)认为孤独症属于心理疾病;2484人(68.1％)认为应首选心理门诊就诊;1730人(36.4％)认为孤独症存在特殊能力或才能;2680人(67.0％)认为教育不当是导致孤独症发病的主要原因.多因素分析显示,居住在城市(OR=1.66)、女性(OR=1.34)、接触过孤独症(OR=1.50)、受教育水平较高(OR=2.04、5.39、9.12)的人群能更好的识别孤独症.结论:3～6岁儿童抚养人对孤独症的认识还存在很多误区,有必要积极开展社区宣传教育,提高家长对孤独症认知程度,改变错误认知,以早期识别孤独症儿童.     

Do children born after assisted conception have less risk of developing infantile autism?

BACKGROUND: A Danish population based matched case-control study of perinatal risk factors in children with infantile autism has provided some interesting and surprising observations regarding infantile autism and children born after assisted conception. METHODS AND RESULTS: The cases (461) consisted of all children born between 1990 and 1999 and diagnosed with infantile autism in the Danish Psychiatric Central Register before February 2001. Matched controls were identified in the Danish Civil Registration System. The main exposure measures included obstetric risk factors for infantile autism. We found a 59% decreased risk for developing infantile autism among children conceived after assisted conception (odds ratio [OR] 0.41, 95% [0.19-0.89]) and a 63% decreased risk after adjusting for known risk factors for assisted conception and infantile autism (OR 0.37, 95% [0.14-0.98]). CONCLUSION: We found that children born after assisted conception had a lower risk of developing infantile autism then their matched controls. Our observations could possibly be explained by the mother's health status before and during early pregnancy. Our findings require further investigation in larger studies.     

孤独症儿童与其他精神障碍儿童围生期危险因素比较

目的:比较孤独症与其他精神障碍儿童围生期危险因素之间的差异。方法:应用自制围生期危险因素调查表对197例孤独症儿童和93例其他精神障碍儿童进行回顾性调查。应用t检验和卡方检验分析两组儿童之间围生期危险因素的差异。结果:孤独症组围生期危险因素发生率高于其他精神障碍组(68%vs.51%,P=0.003),其母孕期感冒史及早产史发生率均高于其他精神障碍组(14.2%vs.6.5%,10.7%vs.3.2%;P=0.038,0.022);两组儿童在喂养方式上差异也有统计学意义(孤独症组母乳喂养、混合喂养、人工喂养的比例分别为67.7%、15.0%、17.3%,其他精神障碍组3种喂养方式的比例分别为48.3%、22.4%、29.3%;P=0.038)。结论:母孕期感冒、早产和喂养方式与孤独症发病可能有某种联系。     

Perinatal and early childhood stroke and thrombophilia

Perinatal and early childhood stroke are relatively frequent occurrences in Western populations compared with a number of more well publicised diseases of childhood. They have devastating consequences for the child and their family. Despite this, little remains known about the aetiology, pathophysiology and outcome of perinatal and childhood stroke. This review describes the epidemiology, known risk factors, clinical presentation and management of stroke in neonates and children. In particular, we focus on the mechanisms of stroke and the associations with different clinical conditions. There is an urgent need for coordinated research into perinatal and childhood stroke and the recently formed International Paediatric Stroke Study group (IPSS) will hopefully contribute much to improving our understanding and management of these children.     

Association between childhood sleep problems and perinatal factors, parental mental distress and behavioral problems

The aim of this study was to examine the effect of age, gender and perinatal risk factors on the risks for sleep problems, and investigate the relation between childhood sleep problems and children's behavioral syndromes and parental mental distress in early and middle childhood. We recruited a representative sample of 1391 children, ages 4-9, from nine kindergartens and three elementary schools by using a multistage sampling method. Parents of child participants completed a questionnaire including perinatal risk factors, sleep habits and problems, the Child Behavior Checklist (CBCL) and the Chinese Health Questionnaire (CHQ). A mixed model was used for data analysis to address cluster effect from the same classes and schools. Results showed that boys suffered from more sleep problems than girls. Early insomnia, sleep terrors and enuresis decreased with ages, but sleepwalking increased with ages. Perinatal exposure to alcohol, coffee and non-prescribed medication, vaginal bleeding, artificial delivery, first-born order and higher parental CHQ score (> or =4) were significantly associated with several childhood sleep problems. In addition, children with sleep problems had higher T-scores of the eight behavioral syndromes derived from the CBCL. Our findings indicated that the childhood sleep problems were associated with perinatal risk factors, parental psychopathology and children's behavioral problems.     

Reptilian behavioural patterns in childhood autism

Childhood autism may be caused by damage to three phylogenetically distinct regions of the brain, or their major pathways and connections. Injury to the neocortex results in loss of language and cognitive function, while injury to the limbic cortex results in autistic withdrawal and abolition of play behaviour. Injury to the more primitive striatal complex, mammalian counterpart of the brain of reptiles, results in a bizarre and truncated form of stereotyped and ritualistic behaviour. The causes of brain injury in childhood autism could be those common in the perinatal period including cerebral anoxia, haemorrhage, phenylketonuria, neurolipidoses , meningitis, toxoplasmosis, and congenital rubella. All these conditions have previously been shown to be associated with childhood autism.     

Viruses and autism: A Bi-mutual cause and effect

Autism spectrum disorder (ASD) is a group of heterogeneous, multi-factorial, neurodevelopmental disorders resulting from genetic and environmental factors interplay. Infection is a significant trigger of autism, especially during the critical developmental period. There is a strong interplay between the viral infection as a trigger and a result of ASD. We aim to highlight the mutual relationship between autism and viruses. We performed a thorough literature review and included 158 research in this review. Most of the literature agreed on the possible effects of the viral infection during the critical period of development on the risk of developing autism, especially for specific viral infections such as Rubella, Cytomegalovirus, Herpes Simplex virus, Varicella Zoster Virus, Influenza virus, Zika virus, and severe acute respiratory syndrome coronavirus 2. Viral infection directly infects the brain, triggers immune activation, induces epigenetic changes, and raises the risks of having a child with autism. At the same time, there is some evidence of increased risk of infection, including viral infections in children with autism, due to lots of factors. There is an increased risk of developing autism with a specific viral infection during the early developmental period and an increased risk of viral infections in children with autism. In addition, children with autism are at increased risk of infection, including viruses. Every effort should be made to prevent maternal and early-life infections and reduce the risk of autism. Immune modulation of children with autism should be considered to reduce the risk of infection.     

广泛性发育障碍与感觉统合失调的关系

目的:探讨广泛性发育障碍(PDD)与感觉统合失调之间的关系.方法:对90例我院门诊的广泛性发育障碍患儿进行评估,以儿童感觉统合发展评定量表(SIS)评定感觉统合失调问题,以儿童期孤独症评定量表(CARS)评价病情的严重程度.结果:PDD中感觉统合轻-重度失调率为92.2%,儿童孤独症组与Asperger综合症组的感觉统合失调率比较差异无显著性(x2=1.87,P＞0.05).PDD的CARS总分与触觉过分防御(r=-0.34)、本体感失调(r=-0.21)呈负相关,差异均有显著性(P＜0.05).结论:感觉统合失调与PDD密切相关,这为PDD的治疗提供了新思路.     

CCMD-3与DSM-Ⅳ儿童孤独症两种诊断标准的比较

目的：比较中国精神疾病分类方案与诊断标准第三版（CCMD-3）与美国精神障碍诊断和统计手册第四版（DSM-Ⅳ）儿童孤独症诊断的一致性，探讨CCMD-3儿童孤独症诊断中存在的问题，确定诊断标准中各症状条目的出现频率。方法：运用CCMD-3和DSM-Ⅳ儿童孤独症诊断标准对连续首次就诊的255名可疑发育障碍儿童进行诊断。结果：两种诊断系统儿童孤独症、不典型孤独症、非孤独症诊断的总体一致率为96．08％；诊断差异主要来自于儿童孤独症和不典型孤独症的诊断不一致；个别症状在孤独症儿童中出现频率较低。结论：CCMD-3和DSM-Ⅳ儿童孤独症诊断标准具有较好的诊断一致性；为进一步提高诊断一致性，对CCMD-3中个别症状条目予以调整有所必要。     

Risk factors for asthma and atopy

PURPOSE OF REVIEW: The aim of this article is to provide information on risk factors associated with the development of atopy and asthma in childhood. RECENT FINDINGS: Several gene polymorphisms have been associated with susceptibility to asthma and allergy; complex gene-environmental interactions, however, appear to play a key role in the development of the disease. Early life sensitization to aeroallergens, presence of atopic dermatitis or allergic rhinitis, maternal smoking during pregnancy and children's environmental exposure to tobacco smoke, lower respiratory tract infections with respiratory syncytial virus and potentially with other viruses including rhinovirus and metapneumovirus, exposure to air pollutants, several perinatal factors other than maternal smoking, are among factors associated with an increased risk for development of chronic asthma. SUMMARY: The prevalence of asthma and allergic diseases is increasing progressively. Those who are involved in the care of young children should be prepared to recognize risk factors for development of these diseases and to appreciate the role of gene-environment interactions. Preventive measures established at an early age may modify the natural history of asthma and other allergic diseases.     

The incidence and prevalence of pervasive developmental disorders: a Danish population-based study

BACKGROUND: Based on prevalence studies and the few incidence studies of pervasive developmental disorders (PDDs) the prevalence and incidence of these disorders have been claimed to be increasing. METHOD: The annual and age-specific prevalence and incidence rates of childhood autism, atypical autism, Asperger's disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) in Denmark during the period 1971--2000 in children younger than 10 years were estimated using data from the Danish Psychiatric Central Register. RESULTS: A total of 2.4 million children younger than 10 years were followed and 2061 cases with the PDDs studied were identified. Generally, the prevalence and incidence rates of the PDDs studied were stable until the early 1990s after which an increase in the occurrence of all disorders was seen, until 2000. The annual incidence rate per 10000 children younger than 10 years was 2.0 for childhood autism, 0.7 for atypical autism, 1.4 for Asperger's disorder, and 3.0 for PDD-NOS in 2000. We calculated a 'corrected' prevalence of childhood autism at 11.8, atypical autism at 3.3, Asperger's disorder at 4.7, and PDD-NOS at 14.6 per 10,000 children younger than 10 years on 1 January 2001. CONCLUSIONS: We found that the estimated prevalences of the PDDs studied were probably underestimated. Furthermore, the increasing prevalence and incidence rates during the 1990s may well be explained by changes in the registration procedures and more awareness of the disorders, although a true increase in the incidence cannot be ruled out.