三种儿童孤独症行为评定量表临床应用比较

目的　儿童孤独症的诊断缺乏特异性的生物学指标,量表评定有重要的临床指导价值,目前有多 种量表用于评定。该文对孤独症行为评定量表(ABC)、儿童期孤独症评定量表(CARS或卡氏量表)、克氏孤独症 行为量表(CABS或克氏量表)进行比较,以期为临床应用提供借鉴。方法　对28例孤独症患儿和34例对照组儿 童分别采用ABC、CARS和CABS进行评估和比较。结果　三种评估方法在病例组与对照组间的评定结果均有极 显著差异(P<0.01);DSM Ⅳ儿童孤独症诊断标准判断结果与CARS评估结果的一致性最好(Kappa=1),与ABC 也有较好一致性(Kappa=0.87),但与CABS的一致性稍差(Kappa=0.60)。应用受试者工作特性曲线(ROC)进行 综合比较,ABC取31为筛查界线分最好,其特异性为0.97、敏感性为0.89、一致率为0.94、阳性预测值为0.96、阴 性预测值为0.92,且更适合3岁以上儿童使用;CARS取30为诊断界线分最好,敏感性、特异性、一致性、阳性预测 值与阴性预测值均为1.0,且与年龄无关;CABS取6为筛查界线分更为理想,其特异性为0.91,敏感性为0.82、一 致率为0.87、阳性预测值为0.88、阴性预测值为0.86,且3岁以上儿童使用优于3岁以下。结论　ABC、CARS及 CABS是辅助诊断孤独症的重要评估工具,相互间具有较好的一致性;但如果同

Comparison of clinical application of three autism rating scale

Objective The incidence of autism is increasingly encountered in children, and more and more autism rating scales have come into use. This study clinically compared three autism rating scales: Autism Behavior Checklist (ABC), Clancy Autism Behavior Scale (CABS) and Childhood Autism Rating Scale (CARS), in order to provide a basis for selecting assessment method. Methods Twenty-eight cases with autism (Autism group), who all met the diagnostic standard of Diagnostic and Statistical Manual of Mental Disorders Ⅳ(DSM-Ⅳ, USA), were evaluated by ABC, CABS and CARS. The best cut-off score, specificity, sensitivity, accuracy, positive prognostic value (PPV) and negative prognostic value (NPV) of each rating scale in the diagnosis of autism were calculated. Thirty-four patients without autism served as the Control group. Results The scores evaluated by ABC, CARS and CABS in the Autism group were all significantly different from the Control group (P<0.01). The result of the CARS test had the highest coincidence to criteria of DSM-Ⅳ (Kappa=1), followed by that of the ABC test (Kappa=0.87) and that of the CABS test (Kappa=0.60). According to the receiver operator characteristic curve (ROC), the best cut-off score of ABC was 31, and its specificity, sensitivity, accuracy, PPV and NPV were 0.97, 0.89, 0.94, 0.96 and 0.92 respectively. It was more effective for children over 3 years. The best cut-off point of CARS was 30, and its specificity, sensitivity, accuracy, PPV and NPV were all 1.0. Its assessment efficacy was not associated with age. The best cut-off score of CABS was 6, and its specificity, sensitivity, accuracy, PPV and NPV were 0.91, 0.82, 0.87, 0.88 and 0.86 respectively. It was more effective for children over 3 years.Conclusions There was a high coincidence among ABC, CARS and CABS. CARS seems to be the best autism rating scale, followed by ABC and CABS.