认知应物测验/临床语言、听力进程量表上海市的常模研究

目的为补充我国婴幼儿发育评价工具及精神发育迟滞（MR）与语言障碍鉴别工具不足,引进认知应物测验／临床语言、听力进程量表（CAT／CLAMS）。方法用CAT／CLAMS对1604名（16个月龄组、每个月龄组97～103名）上海市4个月～以上月龄组常模婴幼儿进行测试,对其中4个月～、6个月～、12个月～、18个月一和30个月～各20名共100名儿童同时用盖泽尔发育诊断量表（Gesell量表）测试。用Cronbach’s α模式对CAT／CLAMS进行信度分析,用皮尔逊相关分析分析同时效度。结果每例儿童CAT／CLAMS平均受试时间为10～20min。语言能、应物能及总量表三个分数均随年龄增长而增加,相关系数（r）分别等于0,96、0,98、0．98（P均〈0．01）。测试者间信度检验,三个分数的组内相关系数均≥0．96（P〈0．01）,Cronbach’s α系数均≥0．98;重测信度检验,三个分数的组内相关系数均≥0,95（P〈0．01）,Cronbach’sα系数均≥0．98;100名儿童的CAT／CLAMS与Gesell量表在语言能发育商（DQ）、应物能DQ、总量表DQ均呈明显正相关（r分别为0．517、0．703、0．613,P均〈0,01）,而且各个年龄组三个DQ之间均呈明显正相关（r=0．455～0．827,P〈0．05）。结论CAT／CLAMS是一个可以分别评价语言能、应物能及认知能力,结果精确量化、可靠、有效而且测试快速的婴幼儿发育筛查量表,值得推广应用。

Establishing the norm of cognitive adaptive test/clinical linguistic and auditory milestone scale in the children from 4 to 36 months of age in Shanghai, China

OBJECTIVE: To meet the need for instrument assessing the cognitive abilities of infants and young children as well as discriminating between global developmental delay and particular deficits in either language or problem-solving skills, we intended to introduce Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) into China. METHODS: CAT/CLAMS were administered to 1604 normative children aged 4-36 months (in 16 age groups, about 100 children per age group) in Shanghai during the period from December 2003 to June 2004. In the meantime, Gesell Developmental Diagnosis was applied for 100 of these children, respectively aged 4, 6, 12, 18 and 30 months (20 children per age group). Interclass correlation coefficients (ICC) were adopted to analyze data in terms of inter-rater reliability and re-test reliability of the scales of CAT/CLAMS. Cronbach alpha coefficients were calculated to assess the inter consistency of the scales. Pearson correlation coefficients(r) were adopted to analyze the concurrent validity of the scales. The normative percentile graphs of CAT/CLAMS in the children from 4 to 36 Months of age in Shanghai, China were adopted. RESULTS: Administrations of the CAT/CLAMS for each subject usually took 10-20 minutes. Individual scores (CLAMS, CAT, and CAT/CLAMS) increased with ages (Pearson correlation coefficients were 0.96, 0.98 and 0.98, respectively, P < 0.01 for all). ICCs (intraclass correlation coefficient) in terms of individual scores for the inter-rater reliability test and the re-test reliability test were respectively > or = 0.96 (P < 0.01) and > or = 0.95 (P < 0.01), all the Cronbach alpha coefficients were > or = 0.98; in 100 children of the 5 age groups, there was significantly positive correlation between CAT/CLAMS and Gesell Developmental Diagnosis in terms of language skill DQ and adaptive skill DQ, and Full Scale DQ (r = 0.517, 0.703, 0.613, respectively, P < 0.01 for all). Moreover, this significant positive correlation was observed in each of the 5 age groups (r = 0.455-0.827, P < 0.05). CONCLUSION: CAT/CLAMS is suitable for discriminating between global developmental delay and particular deficits in either language or problem-solving skills. It is a quick, reliable, and valid instrument, with refined and quantified results. It is a good tool for developmental surveillance and screening of infants and young children.