孤独症谱系障碍儿童感觉异常症状的临床分析

Clinical analysis of sensory abnormalities in children with autism spectrum disorder

目的探讨孤独症谱系障碍(autism spectrum disorder,ASD)儿童的感觉异常表现。方法使用自制儿童感觉异常调查问卷收集研究资料,以照顾者填写的方式,对269例孤独症谱系障碍儿童(3岁以下为幼儿组,n=110;3~6岁为学龄前组,n=159)的感觉症状进行调查,与175例正常发育(typically developing,TD)儿童进行比较。采用SPSS 26.0软件统计分析;统计分析方法主要有描述性统计、t检验和χ2检验。结果ASD组感觉异常症状总发生率为95.17%,高于TD组的78.86%(χ2=28.224,P<0.001);ASD组多感觉域症状的发生率较高(84.77%),与TD组(63.77%)相比差异有统计学意义(χ2=22.608,P<0.001);ASD幼儿组感觉症状发生率为98.18%,与TD幼儿组的92.59%比较,差异无统计学意义(χ2=3.210,P=0.073);ASD幼儿组多感觉域症状的发生率较高(85.19%),与TD幼儿组(66.00%)相比差异有统计学意义(χ2=7.613,P=0.006)。在感觉症状的4个项目(听觉过度反应、听觉感觉寻求、触觉过度反应和触觉感觉寻求)严重程度调查中,前3项ASD组的中重度比例分别为66.67%、72.08%和61.54%,高于TD组的46.81%、56.36%和38.46%,差异有统计学意义(分别为χ2=9.652,P=0.002,χ2=7.822,P=0.005,χ2=4.631,P=0.031);而在感觉症状的4个项目严重程度调查中,ASD幼儿组与TD幼儿组比较,均差异无统计学意义(均P>0.05)。在感觉症状4个项目的功能损害调查中,ASD组的感觉症状导致的功能损害发生率(分别为68.55%,65.99%,63.25%和48.87%)均高于TD组(45.74%,28.18%,26.92%和27.12%)(χ2=12.814,P<0.001;χ2=40.456,P<0.001;χ2=11.429,P=0.001;χ2=7.930,P=0.005),ASD幼儿组在听觉感觉寻求、触觉过度反应两项中,功能损害发生率(分别为57.65%和55.56%)均高于TD幼儿组(分别为31.58%和0),其差异有统计学意义(P<0.05),其余两项的差异无统计学意义(P>0.05)。ASD组内的ASD幼儿组和ASD学龄前组在感觉症状发生率和多感觉域症状发生率比较,两者均差异无统计学意义(均P>0.05)。结论感觉异常症状在孤独症谱系障碍儿童中具有普遍性;其感觉症状多涉及两个或两个以上的感觉域;在幼儿期,ASD幼儿的感觉症状并不容易与典型发育幼儿区分,应全面关注ASD儿童的感觉症状的发生、数量、程度和功能损害等详细情况。

Objective To explore the abnormal sensory manifestations of children with autism spectrum disorder(ASD).Methods A total of 269 ASD children with sensory symptoms(ASD toddler group:under 3 years old(n=110),and ASD preschool children:3-6 years old(n=159))were investigated by self-made children's sensory abnormality questionnaire,and 175 typically developing(TD)children were compared.SPSS 26.0 software was used for statistical analysis,including descriptive statistics,t test andχ2 test.Results The incidence of sensory abnormalities in ASD group was 95.17%,which was higher than that in TD group(78.86%;χ2=28.224,P<0.001),and the incidence of multiple sensory domain symptoms in ASD group was 84.77%,which was higher than that in TD group(63.77%;χ2=22.608,P<0.001).The incidence of sensory symptoms in ASD toddler group was 98.18%,which was not statistically different from that in TD toddler group(92.59%)(χ2=3.210,P=0.073).The incidence of multiple sensory domain symptoms in ASD toddler group was higher(85.19%),which was statistically different from that in TD toddler group(66.00%)(χ2=7.613,P=0.006).In the four items of sensory symptoms(auditory hyperresponsiveness,auditory sensory seeking,tactile hyperresponsiveness and tactile sensory seeking),the proportion of moderate to severe of the first three items in ASD group were 66.67%,72.08%and 61.54%,which were higher than those in TD group(46.81%,56.36%and 38.46%)(χ2=9.652,P=0.002,χ2=7.822,P=0.005,χ2=4.631,P=0.031),but the proportion of moderate to severe of four items in ASD toddler group were not statistically different from that in TD toddler group at all(P>0.05).The incidence of functional impairment caused by four items of sensory symptoms in ASD group(68.55%,65.99%,63.25%and 48.87%)was higher than those in TD group(45.74%,28.18%,26.92%and 27.12%)(χ2=12.814,P<0.001;χ2=40.456,P<0.001;χ2=11.429,P=0.001;χ2=7.930,P=0.005).The incidence of functional impairment caused by auditory sensory seeking and tactile hyperresponsiveness in ASD toddler group(57.65%and 55.56%)was higher than that in TD toddler group(31.58%and 0)and the incidence of the other two symptoms in these two groups were not statistically different.There was no statistical difference in the incidence of sensory symptoms between ASD toddler group and ASD preschool group,neither the incidence of multiple sensory domain symptoms(P>0.05).Conclusion Sensory abnormalities are common in autistic children,and most of them involve two or more sensory domains.Attention should be paid to the occurrence,quantity,degree and functional impairment of their symptoms.