高功能孤独症谱系障碍儿童适应性行为特点及其影响因素的研究

Characteristics of adaptive behavior of children with high-function autism spectrum disorder and their influencing factors

目的探究高功能孤独症谱系障碍(high-function autism spectrum disorder,HFASD)儿童的适应性行为特点及其相关影响因素。方法纳入中山大学儿童青少年心理行为发育研究中心自2017年4-7月招募的6~12岁HFASD儿童70例,对其适应性行为、智力水平、孤独症症状严重程度、执行功能、焦虑性情绪和干预情况等进行评估,分析HFASD儿童适应性行为的特点及其影响因素。结果25.7%的HFASD儿童的适应性行为处于低下水平,34.3%的患儿处于临界范围,仅40.0%的儿童具有中等及以上水平的适应性行为能力,其等级分布与智力水平等级分布的差异具有统计学意义(P<0.05);Logistic回归分析显示,总智力商数(full scale intelligence quotient,FSIQ)水平高是适应性行为的保护性因素(OR=1.21,95%CI:1.05~1.39),行为管理能力差(OR=0.86,95%CI:0.74~1.00)、社交动机缺乏(OR=0.79,95%CI:0.57~1.00)和有社交恐怖症状(OR=0.01,95%CI:0.00~0.33)则是适应性行为低下的危险因素。以FSIQ与一般适应综合分数(general adaptive composite,GAC)的差异分为因变量,进行多重线性回归分析,显示接受干预训练(β=0.27,P=0.02)尤其是结构化教学(β=0.25,P=0.02)能够减少GAC与智力水平的差异;社交知觉(β=0.29,P=0.01)损害程度大、存在社交恐怖(β=0.23,P=0.03)则会使得该差异增大。结论HFASD儿童的适应性行为与其智力水平不完全匹配,执行功能、症状严重程度以及焦虑症状均可能影响适应性行为。

Objective To explore the characteristics of adaptive behavior of children with high-function autism spectrum disorder( HFASD) and its influencing factors. Methods A total of 70 children with HFASD( aged 6-12 yeas)from the Research Center for Psycho-behavioral Development of Children and Adolescents of Sun Yat-sen University from April to July 2017 were recruited. The adaptive behavior,intelligence level,severity of ASD symptoms,executive function,anxiety and intervention therapy were assessed to determine characteristics and influencing factors of adaptive behavior in HFASD children. Results It revealed that 25. 7% HFASD children had a low level of adaptive behavior and 34. 3% a critical level. Only 40% children had adaptive behavior of medium level or above. The difference in the grade distribution between adaptive behavior and intelligence level was statistically significant( P < 0. 05). Logistic regression analysis showed that high level of full scale intelligence quotient( FSIQ) was a protective factor for adaptive behavior( OR = 1. 21,95% CI: 1. 05-1. 39),while poor behavioral regulation ability( OR = 0. 86,95% CI: 0. 74-1. 00),lack of social motivation( OR = 0. 79,95% CI: 0. 57-1. 00) and social phobia symptoms( OR = 0. 01,95% CI: 0. 00-0. 33) were risk factors for poor adaptive behavior. Multiple linear regression analysis was carried out,and FSIQ-GAC( full scale intelligence quotient-general adaptive composite) discrepancy scores were taken as dependent variables. It showed that intervention training( β = 0. 27,P = 0. 02),especially structured education( β = 0. 25,P = 0. 02),could reduce the FSIQ-GAC discrepancy scores and severely damaged social perception( β = 0. 29,P = 0. 01) and presence of social phobia( β = 0. 23,P = 0. 03) would exacerbate the discrepancy scores. Conclusion The study reveals that adaptive behavior of HFASD children does not match their intelligence level perfectly,and the executive function,severity of symptoms and anxiety symptoms may affect the adaptive behavior.