改良婴幼儿孤独症量表中文修订版的信效度

目的:在引进改良婴幼儿孤独症量表(M-CHAT)基础上,对该量表的评分方法进行修订,检验修订评分方法后量表的信效度。方法:保留量表原来所有条目内容,将其中的22个条目的 "是/否"二级评分改为"从不/偶尔/有时/经常"四级评分,分值相应地设定为3、2、1、0分。条目11、18、20、22为逆向条目,分值设置方向相反;条目16评分"是/否",设定为0、1分,从而形成M-CHAT中文修订版。对93名符合美国精神障碍诊断与统计手册第4版诊断标准的孤独症患儿进行M-CHAT中文修订版评定,其中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。52名患儿2～4周后再次进行M-CHAT中文修订版评定,以检测重测信度。对85名正常儿童进行M-CHAT中文修订版评定。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中文修订版评定,以检测评分者信度。结果:M-CHAT中文修订版单项评分者信度的组内相关系数(ICC)为0.41～1,总分评分者信度相关系数为0.89(P均0.01)。单项重测信度ICC为0.15～1,总分重测信度相关系数为0.83(均P0.01,项目10除外)。内部一致性检验Cronbachα系数为0.90(P0.01)。M-CHAT中文修订版有2个条目与总分间相关系数分别为-0.35、-0.13;其余21个条目与总分间相关系数在0.13～0.84之间(均P0.01)。M-CHAT中文修订版总分与CARS量表总分之间相关系数为0.49(P0.01)。当总分界限分定为17分时,M-CHAT中文修订版灵敏度为0.91,特异度为0.81。结论:M-CHAT中文修订版的信、效度均优于M-CHAT中文版,更适用于儿童孤独症的早期筛查。

Reliability and validity of the Chinese revised version of the Modified Checklist for Autism in Toddlers

Objective: To revise the scoring method of the Chinese Version of the Modified Checklist for Autism in Toddlers(M-CHAT),and investigate its reliability and validity.Methods: The Chinese revised version of M-CHAT included all questions of the Chinese version of M-CHAT,but the answers of 22 items changed from "yes / no" to" never / occasionally / sometimes / often".The score of these items correspondingly changed from "1/0" to "3/2/1/0"except for items 11,18,20 and 22 which scores were adverse.The score of item 16 was still "0/1".Ninety-three outpatient children diagnosed as autistic disorder according to the Diagnostic and Statistical Manual of Mental Disorders-IV(DSM-IV) were included,all of them were evaluated by the Chinese revised version of M-CHAT,fifty-six of them were evaluated by the Childhood Autism Rating Scale(CARS) to investigate the criterion validity,fifty-two of them were re-evaluated by the Chinese revised version of M-CHAT again 2~4 weeks later to investigate the test-retest reliability.Eighty-five normal children were evaluated by the Chinese revised version of M-CHAT.Two caregivers of 117 subjects,including 56 autistic children and 61 normal children,fulfilled the Chinese revised version of M-CHAT separately at the same time to investigate the inter-rater liability.Results: The single itemis intraclass correlation coefficients(ICC) of inter-rater reliability ranged from 0.41 to 1.The inter-rater reliability correlation coefficient of total score was 0.89,P<0.01.The single item’ s ICC of test-retest reliability ranged from 0.15 to 1,and the correlation coefficient of test-retest reliability of total score was 0.83(Ps<0.01 except item 10).The internal consistency coefficient of the scale was 0.90,P<0.01.All correlation coefficients of the content validity were positive except two which were-0.35 and-0.13,and the coefficients ranged from 0.13 to 0.84,P<0.01.The criterion validity coefficients of M-CHAT with CARS was 0.49,P<0.01.When the cutoff point was set at 17,the sensitivity was 0.91,and the specificity was 0.81.Conclusions: The reliability and validity of the Chinese revised version of M-CHAT are superior to that of the Chinese version of M-CHAT and it is more suitable for the early screening of autism.