孤独症谱系障碍线上早期筛查模式的探索与临床应用  

Exploration and clinical application of online mode for early screening of autism spectrum disorder

作　　者：陈杰荣 万国斌[1,2] 韦臻 黄敏施[1,2] CHEN Jierong;WAN Guobin;WEI Zhen;HUANG Minshi(Department of Child Psychiatry and Rehabilitation,Shenzhen Maternity and Child Healthcare Hospital,Southern Medical University,Shenzhen,Guangdong 518028,China;Shenzhen Key Laboratory of Maternal and Child Health and Diseases)

机构地区：[1]南方医科大学深圳妇幼保健院儿童心理与康复科,广东深圳518028 [2]深圳市孕产疾病与母婴健康重点实验室

出　　处：《中国儿童保健杂志》2025年第4期456-460,共5页Chinese Journal of Child Health Care

基　　金：2023年深圳市卫生经济学会科研项目(2023156);广东省重点领域研发计划资助(2019B030335001);深圳市医学重点学科(SZXK071);深圳市科技计划资助(JCYJ20220530155204009);深圳市孕产疾病与母婴健康重点实验室(ZDSYS20230626091559006)。

摘　　要：目的探讨基于线上模式的自研量表在孤独症谱系障碍(ASD)早期筛查方面的可行性。方法参考国外的线上筛查系统、已有的筛查量表和精神障碍诊断与统计手册(第5版)(DSM-5)诊断标准,编制自研筛查量表,分为两个年龄段量表,合计11个条目。基于该量表开发出线上筛查系统——“小小启明星”。2019年12月—2020年2月,在心理门诊招募了1073名适龄儿童,平均(18.19±4.6)月龄,进行线上筛查。对线上筛查系统的筛查效能以及与改良版婴幼儿孤独症筛查(M-CHAT-R/F)量表的一致性进行分析。结果使用12月龄段量表进行筛查,共有568例儿童,平均(13.6±1.2)月龄,灵敏度为0.83,特异度为0.98。使用18、24月龄段量表进行筛查,共有505例儿童,平均(21.3±2.6)月龄,灵敏度为0.77,特异度为0.81。自研量表与M-CHAT-R/F的一致性达到75.8%,Kappa值为0.422。结论“小小启明星”作为一个本土化的ASD线上筛查系统具有良好的信效度,但部分条目仍需进一步修订与基于社区群体验证。线上筛查模式具有可行性和临床价值,值得在ASD早期筛查领域进一步推广使用。Objective To explore the feasibility of a self-developed scale based on an online platform for early detection of autism spectrum disorder(ASD).Methods By referring to overseas online screening systems,existing screening scales,and the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition(DSM-5)diagnostic criteria,a self-developed screening scale was compiled,with two age-specific versions with a total of 11 items.Based on this scale,an online screening system named"Xiaoxiaoqimingxing"was developed.From December 2019 to February 2020,1073 eligible children with an average age of(18.1±4.6)months were recruited from psychological clinics to take online screening.The screening effectiveness of the online system and its consistency with the Modified Checklist for Autism in Toddlers,Revised with Follow-up(M-CHAT-R/F)Scale were analyzed.Results When screening using the 12-month age-specific scale,a total of 568 children with an average age of(13.6±1.2)months were involved,yielding a sensitivity of 0.83 and a specificity of 0.98.When screening using the 18-and 24-month age-specific scale,a total of 505 children with an average age of(21.3±2.6)months participated,resulting in a sensitivity of 0.77 and a specificity of 0.81.The consistency between the self-developed scale and the M-CHAT-R/F scale reached 75.8%,with a Kappa value of 0.422.Conclusions"Xiaoxiaoqimingxing",as a localized online screening system for ASD,demonstrates good reliability and validity,although some items require further revision and community-based validation.The online screening mode exhibits feasibility and clinical value,warranting further promotion and use in early ASD screening.

关 键 词：孤独症谱系障碍 早期筛查 线上模式 本土化 

分 类 号：R749.94[医药卫生—神经病学与精神病学]