孤独症筛查量表对学龄前儿童筛查效果与影响因素研究

Screening effect of autism among preschool children with screening and research on influencing factors

目的探讨孤独症筛查量表对学龄前儿童筛查效果与影响因素。方法采用随机多阶段分层抽样法选取350例正常儿童(对照组)与37例孤独症儿童(观察组),对全部儿童进行早期孤独症筛查量表(EASI)与孤独症婴幼儿筛查量表修订版(MCHAT)进行筛查及自拟影响因素问卷进行调查,比较2种筛查量表的筛查效果与分析孤独症的影响因素。结果 M-CHAT量表的特异度、阳性预测值、阴性预测值与粗符合率高达73.65%、95.08%、44.85%、94.07%,均显著高于EASI量表(81.23%、74.92%、17.25%、74.65%),差异有统计学意义(P<0.05);平行试验的灵敏度显著高于M-CHAT量表且系列试验的特异度与阳性预测值显著高于M-CHAT量表(均P<0.05);两组儿童无显著性频率差异的筛查条目有3例(13.04%),而具有显著性频率差异的筛查条目占86.96%(20/23),两组比较差异有统计学意义(P<0.05);单因素分析显示,学龄前儿童孤独症的影响因素有儿童的性别,父母的文化程度与性格特征,父母间的关系,母亲孕期是否有严重的妊娠反应、胎膜早破与贫血情况,母亲孕期情绪状况,父母对儿童的教育方式与教育态度等;多因素分析显示,性别、父母的文化程度、父母教育方式与态度为重要的影响因素。结论 M-CHAT量表具有较高的真实性、可区分性与可靠性,而联合试验在一定程度上可提高单独试验的灵敏度与特异度,学龄前儿童孤独症受儿童性别、父母的文化程度与父母教育方式与态度等影响。

Objective To study screening effect of autism among preschool children with screening and research on influencing factors.Methods 350 cases of normal children（control group）and 37 cases of children with autism（observation group）were selected randomly by using multi-stage stratified sampling method,all the children were given the early autism screening scale（EASI）and autistic infants screening scale revised（M-CHAT）to screening and the influencing factors of questionnaire investigation,two screening scale screening effect and analysis the influence factors of autism were compared and analysed.Results specific degree,positive predictive value,negative predictive value and the coincidence rate of the M-CHAT scale are as high as 73.65%,95.08%,44.85%,94.07%,significantly higher than that of EASI scale（81.23%,74.92%,17.25%,74.92%）（P〈0.05）;Parallel test sensitivity is significantly higher than the M-CHAT scale and series of experiments of specific and positive predictive value was significantly higher than that of the M-CHAT scale（all P〈0.05）;Two groups of children have no significant difference frequency screening items in 3cases（13.04%）,and has significant difference frequency screening items accounted for 86.96%（20/23）,the comparison is significant difference（P〈0.05）;Single factor analysis showed that the influence factors of preschool children with autism have a children′s gender,parents′educational level and personality characteristics,the relationship between parents,the mother during pregnancy to see if there is serious during pregnancy,premature rupture of membranes and anemia,pregnancy emotional state,parents to children′s education way and education attitude,etc.;Multi-factor analysis showed：gender,parents′education,parents education way and attitude is important influence factor.Conclusion distinguish,authenticity and reliability of M-CHAT scale are high,to a certain extent,joint test can improve the sensitivity and specific of separate test,autism among preschool children are influenced by children′s gender,parents′educational level and parental education patterns and attitudes,etc.