指物动作对儿童孤独症的识别意义及与功能发展的关系  

The recognition significance of pointing gestures in children with autism spectrum disorder and its relationship with functional development

作　　者：马扬[1] 熊妮娜 赵明 纪文静[1] 沈瑞云[1] 陈艳杰 李世杰 黄鸿眉 魏庄[1] 张晚霞 梁爱民[1] Ma Yang;Xiong Nina;Zhao Ming;Ji Wenjing;Shen Ruiyun;Chen Yanjie;Li Shijie;Huang Hongmei;Wei Zhuang;Zhang Wanxia;Liang Aimin(Children’s Health Care Center,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院保健中心,北京100045

出　　处：《中华行为医学与脑科学杂志》2023年第11期981-986,共6页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：北京市卫生健康委员会项目(儿童健康防治结合策略)(2-1-1-1-69)。

摘　　要：目的探讨指物动作对孤独症谱系障碍(autism spectrum disorder,ASD)儿童的识别价值及指物动作与功能发展的关系。方法 2020年12月至2021年11月,对1 099名北京儿童医院保健中心门诊就诊的儿童(ASD儿童942例,正常儿童157例)进行指物动作测试,同时收集其中800名1.0~5.9岁儿童神经心理行为检查量表的测评数据。采用SPSS 20.0软件进行统计分析。用趋势检验分析指物动作测试灵敏度在ASD儿童中的分布,用方差分析探讨指物动作测试得分与各功能发展领域的关系。结果指物动作在1.0~10.0岁ASD儿童中灵敏度为83.5%,其中1.0~4.9岁ASD儿童灵敏度为76.3%~93.1%,1.0~2.9岁ASD儿童灵敏度为93.1%~95.1%;随年龄增长,指物动作在ASD儿童中的灵敏度(线性和线性组合检验值为164.889,P<0.001)及约登指数有下降趋势;指物动作有较好的阳性预测值(91.53%~100.00%)和阴性预测值(75.36%~91.84%)。指物动作测试在1.0~10.0岁轻度ASD儿童中灵敏度为44.9%,其中1.0~3.9岁轻度ASD儿童灵敏度为46.5%~65.9%;指物动作测试在1.0~10.0岁中度ASD儿童中灵敏度为81.5%,其中1.0~3.9岁中度ASD儿童灵敏度为87.3~97.8%;指物动作测试在1.0~10.0岁重度ASD儿童中灵敏度为97.2%,其中1.0~3.9岁重度ASD儿童灵敏度为100.0%。轻度、中度、重度ASD儿童指物动作测试灵敏度均有随年龄增长而下降的趋势(线性和线性组合检验值分别为16.725,64.232,66.732,均P<0.001)。重度ASD儿童指物动作测试主要得2分(80.3%,419/522);中度ASD儿童指物动作测试主要得1分(64.2%,170/265)。不同指物动作测试得分ASD儿童间在各功能发展领域有明显差异,指物动作测试0分ASD儿童功能发展评分明显高于指物动作测试1分、2分ASD儿童(均P<0.05)。结论指物动作在ASD儿童中有较好灵敏度(特别是1.0~4.9岁),可以作为一个可客观观察的筛查方法。ASD儿童指物动作测试得分越好,其功能发展越好。Objective To understand the identification value of pointing gestures in children with autism spectrum disorder(ASD)and its relationship with functional development.Methods From December 2020 to November 2021,1099 children from Children’s Health Care Center of Beijing Children’s Hospital were tested by pointing gestures test,including 942 ASD children and 157 typical developed children.And the data of children's neuropsychological development scale from 800 children aged 1.0-5.9 were collected.SPSS 20.0 was used for statistical analysis.Trend test was used to analyze the distribution of pointing gestures test sensitivity in autistic children,and ANOVA was used to analyze the relationship between pointing gestures test scores and functional development fields.Results The sensitivity of pointing gestures was 83.5%in children aged 1.0-10.0 years,76.3%-93.1%in children aged 1.0-4.9 years,and 93.1%-95.1%in children aged 1.0-2.9.With the increase of age,the sensitivity of pointing gestures in autistic children(linear-by-linear association=164.889,P<0.001)and the Yoden index had a decreasing trend.The positive predictive value(91.53%-100.00%)and negative predictive value(75.36%-91.84%)were found in the children aged 1.0-10.0 years.The sensitivity of pointing gestures test was 44.9%in children with mild autism aged 1.0-10.0 years and 46.5%-65.9%in children with mild autism aged from 1.0-3.9 years.The sensitivity of pointing gestures test was 81.5%in children with moderate autism aged from 1.0-10.0 years and 87.3%-97.8%in children with moderate autism aged 1.0-3.9 years.The sensitivity of the pointing gestures test was 97.2%in children with severe autism aged 1.0-10.0 years,and 100.0%in children with severe autism aged 1.0-3.9 years.The sensitivity of the pointing gestures in mild,moderate and severe autism children decreased with age(linear-by-linear association values were 16.725,64.232,66.732 respectively,all P<0.001).The children with severe autism mainly scored 2 points(80.3%,419/522)on the pointing gestures test

关 键 词：指物动作 孤独症谱系障碍 识别 功能发展 儿童 

分 类 号：R749.94[医药卫生—神经病学与精神病学]