象征性游戏在孤独症谱系障碍早期识别诊断中的作用  

The role of symbolic play test in early diagnosis and identification of autism spectrum disorders

作　　者：季忆婷 沈春[2] 范云 张婷[2] 舒艳 陈亮亮 朱涛[2] 李斐[3,2] 徐明玉[3,2] JI Yiting;SHEN Chun;FAN Yun;ZHANG Ting;SHU Yan;CHEN Liangliang;ZHU Tao;LI Fei;XU Mingyu(Department of Developmental Behavioral Pediatrics,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Developmental and Behavioral Pediatric&Child Primary Care Department,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;MOE-Shanghai Key Laboratory of Children’s Environmental Health,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心发育行为儿童保健科,上海200127 [2]环境与儿童健康教育部重点实验室上海市重点实验室,上海200092 [3]上海交通大学医学院附属新华医院发育行为儿童保健科,上海200092

出　　处：《临床儿科杂志》2018年第9期674-677,共4页Journal of Clinical Pediatrics

基　　金：上海市教委高原高峰计划(研究型医师项目)(No.20152234);上海市申康三年行动计划项目(No.16 CR 2025 B);国家自然科学基金项目(No.81571031;No.81761128035;No.81781220701);上海市科委优秀学术带头人计划(No.17XD1403200);上海市卫生计生委系统项目(No.2017ZZ02026;No.2017EKHWYX-02;No.GDEK201709;No.2018 BR 33)

摘　　要：目的探索孤独症谱系障碍(ASD)儿童象征性游戏能力的影响因素,及其在疾病早期识别与诊断中的应用。方法回顾2015年4月到2017年8月就诊的123例发育行为儿保科门诊儿童的临床资料,其中66例发育迟缓(GDD)儿童包括ASD伴GDD 36例、单纯GDD 30例,57例不伴GDD儿童包括ASD不伴GDD 31例、原发性语言障碍(DLD)26例。比较各组间象征性游戏能力和Gesell婴幼儿发育水平,并探究象征性游戏能力的相关因素及对疾病的区分作用。结果在GDD儿童中,ASD伴GDD组象征性游戏检查(SPT)发展月龄低于单纯GDD组,且SPT发展月龄严重落后比例高于单纯GDD组。不伴GDD儿童中,ASD不伴GDD组SPT发展月龄低于DLD组,SPT发展月龄严重落后比例也高于DLD组;差异均有统计学意义(P<0.05)。在ASD儿童中,象征性游戏能力与儿童各能区的发育水平呈显著正相关(r=0.393~0.630,P<0.01),与ASD症状呈显著负相关(r=-0.390^-0.387,P<0.01)。二项逻辑回归分析发现,在GDD儿童中SPT发展月龄对单纯GDD和ASD伴GDD两类疾病具有区分效应(OR=0.39,95%CI:0.745~0.992,P=0.034);在不伴GDD的儿童中区分效应无显著性(P>0.05)。结论象征性游戏能力在ASD儿童中落后于发育水平相当的GDD和DLD儿童,且象征性游戏能显著区分伴有GDD的ASD,可为ASD早期识别提供线索。Objective To explore the influencing factors of symbolic play ability in children with autism spectrum disorder(ASD)and its application in the early diagnosis and identification of ASD.Method The clinical data of 123 children who visited developmental behavior pediatric clinic from April 2015 to August 2017 were reviewed.There were 66 cases of global developmental delay(GDD)including 36 cases of ASD with GDD and 30 cases of simple GDD,and 57 cases without GDD including 31 cases of ASD without GDD and 26 cases of developmental language disorder(DLD).The results of symbolic play test(SPT)and Gesell developmental scale(Gesell)among different groups were compared,and the related influencing factors of symbolic play ability and its role in classification of diseases were explored.Results In GDD children,the development month of symbolic play test(SPT)in ASD children with GDD was lower than that of the children with simple GDD,and the proportion of SPT development month retardation was higher than that of the children with simple GDD.In children without GDD,SPT development month in ASD children without GDD was lower than that of DLD children,and the proportion of SPT development month retardation was higher than that of DLD children,and there were statistical differences(P<0.05).In ASD children,the ability of symbolic play is positively correlated with the developmental quotients in the areas of Gesell(r=0.393~0.630,P<0.01),and had a significantly negative correlation with the ASD symptoms(r=?0.390~?0.387,P<0.01).Regression analysis showed that the symbolic play ability can distinguish between GDD and ASD combined with GDD independently in GDD children(OR=0.39,95%CI:0.745~0.992,P=0.034).But in ASD children without GDD,there was no significant difference(P>0.05).Conclusion There is a developmental delay of symbolic play ability in ASD children,compared with the GDD and DLD children at comparable development level.SPT could be used to differentiate ASD from GDD,and played an important role in early diagnosis and interven

关 键 词：孤独症谱系障碍 象征性游戏 早期筛查 

分 类 号：R749.94[医药卫生—神经病学与精神病学]