改良版婴幼儿孤独症筛查量表联合年龄与发育进程问卷筛查婴幼儿孤独症谱系障碍的效果及评价  

Efficacy evaluation of autism screening in toddlers by using the M-CHAT-R/F combined with Ages and Stages Questionnaire

作　　者：罗美芳 郭翠华[1] 曹牧青 王旭祥[1] 黄赛君[2] 静进[1] 

机构地区：[1]中山大学公共卫生学院妇幼系,广东广州510080 [2]佛山市妇幼保健院儿童保健科,广东佛山528000

出　　处：《中国儿童保健杂志》2018年第3期262-265,共4页Chinese Journal of Child Health Care

基　　金：国家自然科学基金(81573169)

摘　　要：目的探索和评价附后续访谈的改良版婴幼儿孤独症筛查量表(M-CHAT-R/F)联合年龄与发育进程问卷第三版(ASQ-3)筛查幼儿孤独症谱系障碍(ASD)的效果,为孤独症的早期识别提供指导。方法以2016年8月-2017年3月在全国6家医院儿童保健科做常规保健,并且M-CHAT-R初筛阳性(筛查分数≥3分)的291名16~30月龄儿童为研究对象,由家长填写与儿童月龄相匹配的ASQ-3问卷,测评儿童在沟通(C)、粗大动作(GM)、精细动作(FM)、解决问题(SP)、个人-社会(PS)等能区的发展水平。初筛阳性儿童由专科医师进一步根据DSM-5进行确诊。比较ASQ-3联合MCHAT-R/F与单独使用M-CHAT-R/F对ASD筛查的阳性预测值(PPV)。结果 291例M-CHAT-R/F初筛阳性儿童中最终确诊ASD患儿53例,M-CHAT-R初筛对于ASD筛查的PPV为0.18。在初筛阳性、确诊者中,ASQ-3五大能区可疑发育迟缓率最高的均为C能区,其次为PS,将C和PS能区均不通过作为预测因子,其在M-CHAT-R初筛阳性群体中对于ASD筛查的PPV为0.43,在未做后续访谈前,可显著提高M-CHAT-R筛查ASD的PPV(0.43vs 0.18,P<0.001)。结论 ASQ-3联合M-CHAT-R/F可提高对婴幼儿ASD筛查的阳性预测值,建议对M-CHAT-R/F筛查阳性的婴幼儿辅以ASQ-3评估。Objective To evaluate the efficacy of screening of autism spectrum disorders （ASDs） by using the Modi- fied Checklist for Autism in Toddlers-Revised with Follow Up （M-CHAT-R/F） combined with the Ages and Stages Ques- tionnaire-Third Edition（ASQ-3） ,in order to provide scientific basis for early identification of autism. Methods Totally 291 toddlers aged 16~30 months who have conducted routine health care in six hospitals and with positive screening results of M-CHAT-R were enrolled in this study from August 2016 to March 2017 ,and the parents were invited to fill out ASQ-3 to assess the children＇s development of communication （C）, gross motor （GM） ,, fine motor （FM）, problem solving （SP）, and personal-social （PS）. Meanwhile,these children were referred to specialists for diagnostic evaluations according to DSM- 5. The positive predictive value （PPV） for ASD of M-CHAT-R/F alone and that of M-CHAT-R/F combined with ASQ-3 were compared. Results A total of 53 of the 291 toddlers were diagnosed with ASD. The PPV for ASD of M-CHAT R was 0.18. The communication domain of ASQ-3 had the highest suspicious developmental delay rate in both M-CHAT-R screening positive group and ASD group,followed by PS domain. The PPV for ASD detection could be increased to 0.43 u- sing communication and PS domains as predictors on the basis of M-CHAT-R. Without follow up interview, ASQ-3 could greatly improve the PPV of M-CHAT-R （0.43 vs. 0. 18,P〈0. 001）. Conclusions M-CHAT-R combined with ASQ-3 could improve the screening effcacy of toddlerhood ASD. It is recommended to conduct assessment by ASQ-3 for toddlers with positive screening results of M-CHAT-R.

关 键 词：筛查 孤独症谱系障碍 改良版婴幼儿孤独症筛查量表 年龄与发育进程问卷 阳性预测值 

分 类 号：R179[医药卫生—妇幼卫生保健]