儿童孤独症谱系障碍社区监测模式效果评价

Evaluation of effect of community monitoring mode for autism spectrum disorders in children

目的通过对儿童孤独症谱系障碍（ASD）社区监测模式的研究,探讨ASD早期发现的管理流程,实现对ASD儿童的早期发现、早期诊断和早期干预。方法 2014年3月至2015年3月选择深圳市福田区6个社区为试点,建立以社区健康服务中心为网点、区级妇幼保健院和市级妇幼保健院为中心的三级监测网络。比较监测模式建立前后各项监测指标的变化情况。结果 ASD监测网络建立后,ASD的筛查率、阳性检出率、二级确诊及疑似阳性率均比上一年有明显增高,差异均有统计学意义（χ~2值分别为2 240.47、135.48、4.39,均P〈0.05）;初筛阳性儿童转诊到位率、二级确诊及疑似阳性儿童转诊到位率均比上一年有明显增高,差异均有统计学意义（χ~2值分别为162.02、4.92,均P〈0.05）。结论 ASD社区监测模式的建立提高了ASD儿童的系统管理率,有利于ASD儿童的早期发现和早期干预,可操作性强,适于在基层社区推广。

Objective To explore the process for early discovery of autism spectrum disorders （ASD） in children so as to achieve early detection, diagnosis and intervention of ASD by studying the community monitoring mode. Methods From March 2014 to March 2015 six communities were selected as experimental units in Futian District in Shenzhen. Three-leveled monitoring network was established based on community health service center, district leveled MCH and municipal leveled MCH. The changes of different monitoring indicators were compared before and after setup of monitoring mode. Results After ASD monitoring network was established, the screening rate, positive detection rate, two diagnosis and suspected positive rate rose obviously compared to those in previous year, and the differences were statistically significant （X2 value was 2 240.47, 135.48 and 4.39, respectively, all P 〈 0.05 ）. The referral rate of children with positive results in primary screening and that of two diagnosis and children with suspected positive results improved remarkably, and the differences were statistically significant （X2 value was 162.02 and 4.92, respeetively, both P 〈 0. 05 ）. Condusion Establishment of community monitoring mode for ASD improves systematic management rate of children with ASD, which is conducive to early detection and intervention for the cases. The maneuverability of the mode is strong and it is suitable for spread in grass-roots community.