316例语言发育落后儿童的“五不”行为观察

Observation on“five no”behaviors of 316 children with language development retardation

目的探索"五不"行为,即不(少)看、不(少)应、不(少)指、不(少)语和不当在语言门诊中的应用。方法回顾山东大学齐鲁医院儿童保健及发育行为科以"语言发育落后"为主诉就诊的316例儿童的临床资料,根据DSM-5的诊断将儿童分为孤独症谱系障碍(ASD)组、全面发育迟缓(GDD)组、语言障碍(LD)组。对三组儿童首诊时观察到的"五不"行为进行比较,并将"五不"行为与孤独症行为量表(ABC)、儿童孤独症评定量表(CARS)、象征性游戏测试(SPT)、Gesell发育诊断量表(GDS)的得分进行相关性分析以及Logistic回归分析。结果ASD与GDD、LD组在不(少)看、不(少)应、不(少)指和不当行为差异均有统计学意义(P<0.001)。"五不"行为得分与ABC、CARS得分存在正相关性(P<0.001);与SPT、GDS应人能、应物能、言语能呈中度负相关(P<0.001)。回归分析结果示,月龄越小、GDS应人能得分越低、CARS得分越高的儿童,"五不"行为得分越高(P<0.05)。结论通过分析"五不"行为在ASD、GDD、LD三组儿童中的特征,发现"五不"行为是语言门诊中快速对语言发育落后儿童进行初步鉴别的有效方法。

Objective To explore the application of"five no"behaviors in language clinic,including no(less)seeing,no(less)responding,no(less)referring,no(less)language and inappropriateness.Methods The clinical data of 316 children complaining of"language retardation"in the Department of Child Health and Developmental Behavior,Qilu Hospital of Shandong University were reviewed.According to the DSM-5 diagnosis,the children were divided into autism spectrum disorder(ASD)group,general growth retardation(GDD)group and language disorder(LD)group.The"five no"behaviors observed at the first visit were compared among the three groups.Correlation analysis and Logistic regression analysis were conducted between the"five no"behaviors and scores of autism behavior scale(ABC),childhood autism rating scale(CARS),symbolic play ability test(SPT),and Gesell developmental diagnosis scale(GDS).Results There were statistically significant differences in no(less)seeing,no(less)responding,no(less)referring,and inappropriateness between ASD group and GDD group,LD group(P<0.001).There was a positive correlation between"five no"behaviors score with ABC and CARS scores(P<0.001),and a moderate negative correlation with SPT and GDS in coping with human ability,material ability and speech ability(P<0.001).Regression analysis showed that younger children with lower score of coping ability and higher score of CARS had higher score of"five no"behaviors(P<0.05).Conclusion By analyzing the characteristics of"five no"behaviors in ASD,GDD and LD children,we found that examining"five no"behaviors is an effective method to identify children with language development retardation in language clinic.