以DSM系统和ABC量表角度来看孤独症症状变化  

Clinical characteristics of symptom of autism based on DSM criteria and ABC evaluation

作　　者：李改智 江文庆[1] 杜亚松[1] 姜凌霄 刘文文[1] 杨曹骅[1] 

机构地区：[1]上海交通大学医学院附属精神卫生中心,上海200030

出　　处：《中国儿童保健杂志》2015年第3期257-260,共4页Chinese Journal of Child Health Care

基　　金：国家重点基础研究发展计划(973)(2010CB529602);上海市科委重点项目(11411952401);上海交通大学医工交叉重点项目[多学科交叉项目培育(医工)](YG2013ZD0503);2013年上海市精神卫生中心特色专科建设项目(2013-YJTSZK-04)

摘　　要：目的了解孤独症患儿的症状特点,进一步理解DSM-Ⅴ的孤独谱系障碍(autism spectrum disorder,ASD)的诊断标准。方法对经DSM-Ⅳ诊断的466例孤独症患儿进行ABC评估,分析DSM-Ⅳ、ABC各个条目阳性率、不同性别及年龄段的阳性率。结果 1)466例孤独症患儿中,DSM-Ⅳ社交缺陷、言语缺陷、行为、功能延迟中,阳性率最高分别为95.3%,84.8%,79.8%,92.9%。5个条目存在年龄差异,2个条目存在性别差异,男性均高于女性。2)只有263名符合DSM-Ⅴ中社会交流和社会交往缺陷的标准。3)在ABC的57个条目中,阳性率最高的条目是38,占94%,最低的是条目34,占34.2%;男女生在第27条存在差异。结论使用DSM-Ⅴ之后,ASD诊断可能会下降,随着年龄增长,患者的社交和言语可能好转,但是行为问题表现更差,性别可能不是影响症状的原因。Objective To know the characteristics of symptoms in autism,and to understand the diagnostic criteria of autism spectrum disorder（ASD）in DSM-Ⅴ. Methods Children with autism were diagnosed using DSM-Ⅳ criteria and assessed by Autism Behavior Checklist（ABC）in Shanghai Mental Health Center.Then the positive rates of each item in DSM-Ⅳ and ABC,and the difference of every item in DSM-Ⅳ between gender/age were analysed. Results 1）Among 466 autistic children,the highest positive rates of qualitative impairment in social interaction,communication,restricted repetitive and stereotyped patterns of behavior,interest and activities,delays or abnormal functioning were 95.3%,84.8%,79.8%,92.9% respectively.There were differences among ages on marked impairment in the use of multiple nonverbal behaviors;marked impairment in the ability to initiate or sustain a conversation with others;stereotyped and repetitive use of language or idiosyncratic language;apparently inflexible adherence to specific,nonfunctional routines or rituals;delays or abnormal functioning in social interaction.There was difference between boys and girls in language as used in social communication,persistent preoccupation with parts of objects.2）263of 466 children diagnosed by DSM-Ⅳchildren met DSM-Ⅴ part A.3）The positive rates ranged from 34.2% ～94% in ABC,there was difference between genders on item 27. ConclusionsWith DSM-Ⅴ,the diagnosis of ASD may decrease,social communication and language may get better with age,but the behavior may get worse.Gender may be not the primary factor that affect the symptoms.

关 键 词：孤独症 DSM-Ⅳ DSM-Ⅴ AUTISM Behavior Checklist量表 

分 类 号：R749.94[医药卫生—神经病学与精神病学]