高功能孤独症儿童执行功能和心理推理能力特点及临床症状

目的:探讨高功能孤独症儿童执行功能和心理推理能力的神经心理特征及其与儿童孤独症-核心症状的关系。方法:对韦氏儿童智力量表、瑞文标准推理测试,智商≥70分、符合美国精神障碍诊断与统计手册第4版诊断标准的20名高功能孤独症儿童,及年龄、性别匹配的22名正常儿童进行执行功能(复杂图形记忆任务、Stroop色字命名任务、数字字母连线任务、数字广度任务、汉诺塔任务、言语流畅性任务)和心理推理能力(表征变化任务、错误信念任务)测查,比较两组差异;并对孤独症儿童进行孤独症诊断观察量表(ADOS)测查,将孤独症诊断观察量表评分与两组执行功能和心理推理能力差异进行相关分析。结果:高功能孤独症儿童复杂图形记忆任务中即时细节记忆(5.2±5.7)vs.(10.8±6.5)]、延时细节记忆(5.1±6.1)vs.(11.3±6.4)]、言语流畅性任务正确数(15.6±6.9)vs.(21.1±5.2)]、Stroop色字命名任务第1试耗时(24.8±17.3)s vs.(16.3±4.1)s]和第4试耗时(61.0±33.3)svs.(41.3±11.2)s]、汉诺塔完成情况(5/15)vs.(16/6)]和错误步骤数(3.7±2.2)vs.(0.8±0.9)]、表征变化任务中自我信念正确数/错误数(15/5)vs.(22/0)]和错误信念任务正确数/错误数(13/7)vs.(22/0)]的测试成绩均低于正常对照儿童(P0.05)。相关分析显示,复杂图形记忆任务成绩、言语流畅性任务成绩与孤独症诊断观察量表中言语交流、社会交往部分项目得分呈负相关(r=-0.45～-0.73,P0.05),Stroop色字命名任务、汉诺塔任务、表征变化任务、错误信念任务成绩与ADOS得分呈正相关(r=0.44～0.57,P0.05)。结论:高功能孤独症儿童可能存在执行功能及心理推理能力的缺陷;执行功能与儿童孤独症三大核心症状均相关,心理推理能力与儿童孤独症社会交往障碍、刻板行为和局限性兴趣相关。

Executive function,theory of mind,and symptom in children with high functioning autism

Objective:To explore the features of executive function and theory of mind in Chinese children with high functioning autism and the association between executive function,theory of mind and symptom of autism.Methods:Twenty children who were diagnosed as autism according to the criteria of Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-IV) and 22 normal controls were collected as samples.The groups were matched by age and gender.The Rey complex figure test,Stroop color-word task,digit span test,trail making test,tower of Hanoi,verbal fluency test were used to access executive function,and the representational change task and false belief task were used to assess their theory of minnd in these children.The autism children also were assessed with the Autism Diagnostic Observation Schedule(ADOS).Results:The performance of autism group were poorer than normal controls in test immediate memory detail score (5.2±5.7) vs.(10.8±6.5) ] and delay recalling detail score(5.1±6.1) vs.(11.3±6.4)] of Rey complex figure,verbal fluency test (15.6±6.9) vs.(21.1±5.2)],the first task (24.8±17.3) s vs.(16.3±4.1) s] and the fourth task(61.0±33.3) s vs.(41.3±11.2) s] of Stroop color-word task,the completion (5/15) vs.(16/6)] and the incorrect steps (3.7±2.2) vs.(0.8±0.9)] of tower of Hanoi,representational change task (15/5)vs.(22/0)] and false belief task(13/7)vs.(22/0)](P<0.05).Rey complex figure test and verbal fluency test were negatively associated with the scores of ADOS(r=-0.45——0.73,P<0.05).Stroop color-word task,tower of Hanoi,representational change task and false belief task were positively associated with the score of ADOS(r=0.44-0.57,P<0.05).Conclusion:It suggests that the children with high functioning autism may have impairments in executive function and theory of mind.The impairment of executive function and theory of mind may be correlated with severer symptoms of autism.