唐氏综合征儿童社会适应能力现状及影响因素研究

目的探讨唐氏综合征儿童的社会适应能力现状和影响因素。方法在2004年9月至2006年7月期间,采用家庭环境问卷,图片词汇测试和婴儿-初中学生社会生活能力量表对36例52～167个月的唐氏综合征儿童以及30名年龄20—65个月智龄匹配对照组、40名年龄43—144个月年龄匹配对照组儿童进行测试。两组儿童的性别、家庭一般环境状况匹配。结果在测试过程中,三组儿童的数据均进入结果分析。①唐氏综合征儿童在交往和参加集体活动能力得分与智龄匹配对照组差异无统计学意义,独立生活能力、运动能力、作业、自我管理得分均高于智龄匹配对照组儿童（20．0±4．8）分,（13．3±4．7）分,t=5．72,P=0．000;（7．5±1．4）分,（6．4±1．6）分,t=3．10,P=0．003;（8．2±2．4）分,（6．2±2．0）分,t=3．68,P=0．000;（5．9±2．6）分,（4．6±2．0）分,t=2．28,P=0．026。唐氏综合征儿童的社会生活能力各维度得分均低于年龄匹配对照组儿童,其中独立生活能力为（20．0±4．8）分vs（26．5±4．9）分（t=5．84,P=0．000）;运动能力为（7．5±1．4）分vs（11．4±3．3）分（t=6．76,P=0．ooo）;作业为（8．2±2．4）分vs（14．4±3．9）分（t=8．55,P=0．000）;交往为（8．3±3．6）分vs（18_3±4．8）分（t=10．38,P=0．000）;参加集体活动（9．6±2．3）分vs（17．1±4．2）分（t=9．76,P=0．000）;自我管理为（5．9±2．6）分vs（13．8±4．6）分（t=9．25,P=0．000）。②相关分析显示,图片词汇测试初分与生活能力各维度明显相关。即使在控制年龄因素后,各维度与图片词汇测试初分的相关性仍然有统计学意义。③多元逐步回归分析显示,维度独立生活能力选人家庭结构进入回归方程;维度运动能力有家庭结构和母亲文化水平两个维度进入回归方程;维度作业、交往、参加集体活动和自我管理有家庭结构和新生儿患病史两个维度进入回归方程。结论唐氏综合征儿童的社会生活能力落后于同年龄儿童但优于同智龄儿童认知发展水平,家庭环境因素和新生儿期病史对其有不同影响提示合理的干预方式有助于提高他们的社会适应能力。

A study on the social adjustment and its affective factors in Down syndrome children

OBJECTIVE: To explore the social adjustment status and affected factors thereof in Down syndrome children. METHODS: The family environment, cognitive development and social adjustment were examined in 36 Down syndrome children aged 52 - 167 months, 30 mental age-matched children aged 20 - 65 months, and 40 chronological age-matched children aged 43 - 144 months with questionnaire of family influential factors, Peabody Picture Vocabulary Test (PPVT) and Infants-Junior Middle School Students' Social-Life Abilities Scale from September 2004 to July 2006. The gender and general family environment were matched among the three groups. The information about the mode of delivery, history of newborn, family structure, income of family, and parents' education could be gathered from the questionnaire (used by parents). PPVT was adopted as research tool of cognitive development. Infants-Junior Middle School Students' Social-Life Abilities Scale was adopted as research tool of social adjustment. RESULTS: There were no differences between the Down syndrome children and mental age-matched group in communication and socialization. The Down syndrome children were better than the mental age-matched group in self-help [(20.0 +/- 4.8) vs (13.3 +/- 4.7), t = 5.72, P = 0.000]; locomotion [(7.5 +/- 1.4) vs (6.4 +/- 1. 6), t = 3.10, P = 0.003]; occupation [(8.2 +/- 2.4) vs (6.2 +/- 2.0), t = 3.68, P = 0.000], and self-direction [(5.9 +/- 2.6) vs (4.6 +/- 2.0), t = 2. 28, P = 0.026]. The chronological age-matched group were much better than the Down syndrome children in all factors of social-life abilities, including self-help [(20.0 +/- 4.8) vs (26.5 +/- 4.9), t = 5.84, P = 0.000]; locomotion [(7.5 +/- 1.4) vs (11.4 +/- 3.3), t = 6.76, P = 0.000]; occupation [(8.2 +/- 2.4) vs (14.4 +/- 3.9), t = 8.55, P = 0.000]; communication [(8.3 +/- 3.6) vs (18.3 +/- 4.8), t = 10.38, P = 0.000]; socialization [(9.6 +/- 2.3) vs (17.1 +/- 4.2), t = 9.76, P = 0.000], and self-direction [(5.9 +/- 2.6) vs (13. 8 +/- 4.6), t = 9.25, P = 0.000]. There was a relationship between the raw score of PPVT and social-life abilities in these children. Even after controlling effect of age, it was still associated with self-help (r = 0.70, P = 0.000), locomotion (r = 0.74, P = 0.000), occupation (r = 0.77, P = 0.000), communication (r = 0.86, P = 0.000), socialization (r = 0.80, P = 0.000), and self-direction (r = 0.76, P = 0.000). Multiple stepwise regression showed that the main factor influencing self-help was family structure. Family structure and mother's education influenced locomotion. Family structure and newborn history influenced occupation, communication, socialization and self-direction. CONCLUSION: Down syndrome children have better social adjustment than the mental age-matched group, yet worse than the chronological age-matched group. Cognition development, family environment and newborn history differently influence the Down syndrome child, which means proper intervention can improve their social adjustment.