2～6岁儿童广泛性发育障碍的3年后随访

A 3-year follow-up study of 2-6 years children with diagnosis of pervasive developmental disorder

目的:对2004年北京市2～6岁儿童广泛性发育障碍调查中诊断为广泛性发育障碍的儿童进行随访研究,了解广泛性发育障碍儿童的近期预后。方法:在3年后对2004年调查中确诊的广泛性发育障碍儿童进行随访,由儿童精神科医师根据美国精神障碍诊断与统计手册第4版进行诊断,随访时用儿童孤独症评定量表、Gesell发展诊断量表或中国修订韦氏儿童智力量表、Achenbach儿童行为量表、儿童感觉统合能力发展评定量表的评定及总体调查问卷、精神专业调查问卷进行调查。结果:2004年确诊的29名广泛性发育障碍儿童中共有26名儿童得到随访。随访时间间隔(38.1±0.9)个月。21名(80.8%)儿童诊断同前;另5名(19.2%)儿童的诊断发生变化,1名儿童孤独症诊断转变为不典型孤独症。2名孤独症诊断儿童及2名不典型孤独症诊断儿童不再符合广泛性发育障碍的诊断标准。疾病严重程度转归为显著好转、好转、无变化、加重者分别为4人(15.4%)、4人(15.4%)、15人(57.7%)、2人(7.7%),1名儿童转归无法确定。随访确诊广泛性发育障碍的儿童中,90.9%伴有精神发育迟滞,76.2%伴有感觉统合失调,52.4%伴有过度活动,18.2%伴有肢体残疾,18.2%伴有癫痫。患儿既往康复治疗明显不足,教育安置有限。结论:多数广泛性发育障碍儿童近期预后不良,少数患儿近期预后良好。

Objective： To investigate the short term prognosis and intervention of children with pervasive de- velopmental disorder （PDD） . Methods： The 29 children who were diagnosed as PDD in 2004 were diagnosed a- gain after （38.07 ± 0. 87） months according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-IV） and assessed with Childhood Autism Rating Scale, Gesell Developmental Schedule or Chinese- Wechsler Intelligence Scale for Children, Achenbach Child Behavior Checklist, Sensory Integrative Schedule, the self-made general condition questionnaire and questionnaire for psychiatric children. Results： Totally 26 children with PDD were followed up. Among them, 4 （ 15.4% ） cases got much improvement, 4 （ 15.4% ） got improvement, 15 （57.7%） got no improvement, 2 （7.7%） got worse. Twenty-one （80. 8% ） children had the same di- agnosis with 2004, 1 child＇s diagnosis changed from autism to atypical autism, 2 children with autism and 2 chil- dren with atypical autism in 2004 did not meet with diagnosis of PDD at follow up. The mhabititation intervention to these children was little. The education arrangement for these children was limited. The percentage of children co- morbid with mental retardation, sensory disintegration, hyperactivity, limb disability and epilepsy in children di- agnosed as PDD at follow up were separately 90.9%, 76. 2%, 52.4%, 18.2% and 18. 2%. Conclusion： It sug- gests that most of children with PDD have poor short term prognosis, and only small part of children with PDD have relatively good prognosis.