改良婴幼儿孤独症量表与婴幼儿孤独症量表临床应用比较

A Comparative study on the clinical application of Modified Checklist for Autism in Toddlers(M-CHAT) and Checklist for Autism in Toddlers(CHAT)

目的:比较改良婴幼儿孤独症量表(M-CHAT)与婴幼儿孤独症量表(CHAT)在广泛性发育障碍(PDDs)儿童的早期筛查中的适用性。方法:对69例符合美国精神障碍诊断和统计手册第4版(DSM-Ⅳ-TR)诊断标准的广泛性发育障碍儿童(PDDs组),和年龄、性别匹配的32名其他发育障碍儿童(对照组),同时运用M-CHAT和CHAT对被试进行临床评估,比较两种工具在临床筛查时的差异。结果:M-CHAT的灵敏度高于CHAT(0.99 vs.0.81,P<0.01);而特异度则低于CHAT(0.16 vs.0.51,P<0.01)。两种工具筛查阳性人数和阴性人数不一致[(95/6)vs.(72/29),P<0.05]。年龄分层比较,在24月以下儿童中M-CHAT阳性数(17/0)和CHAT阳性数(15/2)均与临床诊断(12/5)一致;在36月以上儿童中,M-CHAT阳性数(6/1)和CHAT阳性数(3/4)均与临床诊断(6/1)一致,总体一致率为0.71(P>0.05),两种工具筛查结果差异不具有统计学意义(P>0.05);而在24～36月年龄组儿童中,M-CHAT阳性数比临床诊断高[(72/5)vs.(51/26),P<0.05],M-CHAT与CHAT阳性数比临床诊断高[(72/5)vs.(54/23),P<0.05)],而CHAT阳性数与临床诊断一致率为0.73,差异无统计学意义(P>0.05)。结论:改良婴幼儿孤独症量表较婴幼儿孤独症量表灵敏度高,更适于正常人群的筛查;而婴幼儿孤独症量表运用在儿童发育障碍门诊时,与临床诊断的一致性较高。

Objective： To compare the application of Modified Checklist for Autism in Toddlers （M-CHAT） and that of Checklist for Autism in Toddlers （CHAT） in the clinical screening. Methods： Sixty-nine children with pervasive developmental disorders （PDDs） according to the Diagnostic and Statistical Manual of Mental Disorders- IV （DSM-IV-TR）criterion and 32 age- and gender-matched children with other developmental disorder were includ- ed. All subjects were evaluated with M-CHAT and CHAT. Results： The sensitivity of M-CHAT was higher than that of CHAT （0. 99 vs. 0. 81, P 〈0. 01）, the specificity was lower （0. 16 vs. 0. 51, P 〈0. 01）, and there was signif- icant difference between CHAT and M-CHAT in screening results [ （95/6） vs. （72/29）, P 〈 0. 05 ]. In the childrenyounger than 24 months, both the positive screening result of M-CHAT （17/0） and that of CHAT （15/2） were consistent with the clinical diagnosis （12/5）, and the children older than 36 months, both the positive screening re- sult of M-CHAT （6/1）and that of CHAT （3/4） were consistent with the clinical diagnosis （6/1）, the concordance rate was 0. 71 （P 〉 0.05）, and no significant difference between the positive screening result of M-CHAT and that of CHAT （P 〉0. 05） ; but in the children aged 24 -36 months, there was significant difference between the posi- tive screening result of M-CHAT and the gold standard [ （72/5） vs. （51/26）, P 〈 0. 05 ], and there was also signifi- cant difference between the positive screening result of M-CHAT and that of CHAT [（72/5） vs. （54/23）, P 〈 0. 05], but no significant difference between the clinical diagnosis and CHAT, and the concordance rate was 0. 73 （P 〉0. 05）. Conclusion： It suggests that the sensitivity of M-CHAT is higher than that of CHAT, and it is a prom- ising screening instrument for PDDs in normal toddlers. Applying in the clinic of child developmental disorder, the screening results of CHAT are consistent with clinical diagnosis.