孤独症谱系障碍儿童症状转归及其影响因素的随访研究

Follow-up study on symptom outcome and its influencing factors of children with autism spectrum disorder

目的对孤独症谱系障碍(autistic spectrum disorder,ASD)儿童进行随访,了解其症状转归情况并探讨可能的影响因素。方法在2013~2017年确诊的ASD儿童中随机抽取175例通过电话预约,进行随访和评估。共90例应答,应答率51.43%。评估方法包括0~6岁儿童神经心理发育量表(DQ)、婴儿-初中生社会生活能力量表(S-M)、孤独症行为量表(ABC)和儿童孤独症评定量表(CARS),并由家长填写自拟的康复训练情况调查问卷。结果样本随访时的发育商(DQ)明显高于初诊时(75.52±23.01 vs 64.93±13.69),ABC、CARS总分明显低于初诊(ABC:47.74±30.95 vs 68.04±33.15;CARS:28.96±5.59 vs 31.65±5.04)时,差异均有统计学意义(P<0.001),S-M得分前后未见显著性差异;前后两次DQ评价结果显示,随访时DQ<70分比例从初诊时的75.61%降低到36.59%,ABC筛查阳性率由50.51%降低到24.71%,CARS大于诊断界值分比例由72.79%降低到56.63%,S-M标准分低于正常的比例由75.9%下降到58.6%,差异均有统计学意义(P<0.05);线性回归分析结果显示,是否进行康复训练对患儿DQ、ABC得分改善有显著影响(P<0.05)。结论 ASD儿童进行二次随访评估时大部分儿童转归较好,康复训练可以显著提高ASD儿童的发育水平,并明显改善ASD儿童的症状的严重程度。

Objective To investigate the outcome of children with autism spectrum disorder ( ASD) and explore the possibly influencing factors. Methods A random sample of 175 ASD children diagnosed in 2013 ~ 2017 were followed up and evaluated by telephone reservation. A total of 90 cases responded with a response rate of 51. 43%. Assessment methods included the Neuropsychological Development Scale for children aged 0 ~ 6 ( DQ),the Infant-Junior Middle School Social Life ability scale ( S-M),the Autism Behavior Scale ( ABC),and the Child Autism Rating Scale ( CARS),and their parents filled out a self-designed rehabilitation training questionnaire. Results At the time of follow-up,the development quotient ( DQ) was signifi-cantly higher than that at first time ( 75. 52 ± 23. 01 vs 64. 93 ± 13. 69). The total scores of ABC and CARS were significantly lower than that at first time ( ABC: 47. 74 ± 30. 95 vs 68. 04 ± 33. 15;CARS: 28. 96 ± 5. 59 vs 31. 65 ± 5. 04),the difference was statistically significant ( P < 0. 05);At the time of follow-up,the results of twice evaluation showed that the propor- tion of DQ < 70 points decreased from 75. 61% to 36. 59%,the positive rate of ABC screening decreased from 50. 51% to 24. 71%,and the proportion of CARS greater than the diagnostic boundary value decreased from 72. 79% to 56. 63%,the proportion of S-M standard scores de- creased from 75. 9% to 58. 6%,and the difference was statistically significant ( P < 0. 05);The results of linear regression analysis showed that whether rehabilitation training had signifi- cant effect on DQ and ABC score improvement ( P<0. 05). Conclusion Most children with ASD have a better outcome in the second follow-up assessment. Rehabilitation training can significantly improve the developmental level of children with ASD and improve the severity of symptoms in children with ASD.