婴幼儿孤独症筛查量表(CHAT-23)探索性因子分析及应用

Analysis on the Checklist for Autism in Toddler:common factor and application in autism screening among small children

目的对婴幼儿孤独症筛查量表(CHAT-23)进行探索性因子分析,并且对CHAT-23量表筛查出的阳性儿童进行相关因素调查分析。方法在天津市中心城区随机抽取2个辖区,对辖区内22个社区卫生服务中心正在接受常规健康体检儿童中符合条件并知情同意的2358名儿童进行CHAT-23量表筛查,采用主成分分析法和Promax旋转法进行探索性因子分析;并对其中基本信息填写完整的1238名儿童进行相关因素分析。结果探索性因子分析显示,CHAT-23问卷共提取出4个公因子,分别为儿童的反应、与家长/陌生人的互动、指向动作、互动游戏,共解释了50.87%的变异。CHAT-23问卷筛查出阳性儿童121人,筛查阳性率5.13%(121/2358)。1238名儿童χ~2检验显示筛查阳性组与筛查正常组在儿童性别(χ^2=4.77,P=0.03)、母孕期先兆流产史(χ^2=4.02,P=0.05)、母孕期服药史(χ^2=6.17,P=0.01)差异均有统计学意义;回归分析显示,男童(OR=1.92,95%CI=1.08~3.42)、母孕期服药史(OR=2.66,95%CI=1.01~6.70)是筛查阳性组儿童的危险因素。结论CHAT-23具有良好的结构效度,可作为初级医疗保健机构有利的筛查工具。

Objective To conduct exploratory factor analysis on the Checklist for Autism in Toddler(CHAT-23)and to carry out autism screening among small children with CHAT-23.Methods We recruited 2358 children aged 16-36 months and having routine physical examination at 22 community healthcare centers in two randomly selected central urban districts of Tianjin city and carried out autism screening with CHAT-23 between February and October 2013.Principal component analysis and Promax rotation method were used in exploratory factor analysis on CHAT-23.Results The exploratory factor analysis revealed 4 common factors in CHAT-23,namely children’s response,interaction with parents/strangers,pointing movement,and interactive game,which explained 50.87% of the total variation of the scale.Of the 2358 children screened,121 were positive for autism,with a screening positive rate of 5.13%.Among the 1238 children with complete demographic information,there were significant differences between the autism positive and negative children in sex ratio(χ^2=4.77,P=0.03),maternal history of threatened abortion(χ^2=4.02,P=0.05),and maternal history of taking medicine during pregnancy(χ^2=6.17,P=0.01).Regression analysis reveal that being a boy(odds ratio[OR]=1.92,95% confidence interval[95%CI]:1.08-3.42)and with history of taking medicine during pregnancy(OR=2.66,95%CI:1.01-6.70)were risk factors of autism positive.Conclusion CHAT-23 is of good structural validity and could be used as a screening tool in primary health care institutions.