不同发育水平孤独症谱系障碍患儿的语言状况

Analysis of language of children with autism spectrum disorder at different developmental levels

目的了解不同发育水平孤独症谱系障碍(ASD)患儿的语言状况。方法回顾性分析2018年1月至2020年12月于重庆医科大学附属儿童医院就诊的103例ASD患儿的临床资料。根据发育诊断性量表评估患儿发育水平,分成发育或智力正常组和异常组(包括轻度异常、中重度异常);根据年龄分成2~3、4~6、7~8岁组。采用Pearsonχ^(2)或Fisher精确检验、独立样本t检验、方差分析或Kruskal-WallisH检验对比分析不同发育水平、不同年龄ASD患儿的语言情况,用Pearson相关性检验分析语言能力与孤独症核心症状的关系。结果103例ASD患儿中,男86例、女17例,年龄(5.5±1.5)岁,正常组61例、异常组42例(轻度异常32例、中度异常10例)。3个年龄组间的发育测评分数、整体语言、听力理解、表达、句法和语义的分数差异均无统计学意义(均P>0.05)。正常组中语言能力异常的检出率显著低于发育异常组的检出率[49.2%(30/61)比100.0%(42/42),P<0.01]。正常组的听力理解、语言表达、语义、句法的分数均显著高于轻度、中重度异常组(89±13比76±11、71±8,80±12比66±8、58±7,92±14比78±14、71±11,83±10比71±8、64±5,F=18.61、29.69、17.26、29.35,均P<0.01)。异常组的语言能力同孤独症的核心症状之间均无相关关系(r=-0.02~0.58,均P>0.05);正常组的语言能力与社会互动、重复刻板及局限兴趣行为均无相关关系(r=0~-0.22,均P>0.05);正常组的整体语言、听力理解、语义、语言表达能力与沟通交流均呈负相关(r=-0.28~-0.36,均P<0.05),句法与沟通交流无显著相关关系(r=-0.24,P>0.05)。结论大部分ASD患儿有语言发育障碍,以表达落后和句法异常为主;发育水平越差语言障碍程度越重,即使发育水平正常的ASD患儿中也会存在语言发育障碍;ASD患儿的语言能力同核心症状间的相关性较小。

Objective To explore the language characteristics of children with autism spectrum disorder(ASD)at different developmental levels.Methods The clinical data of 103 children with ASD who attended the Children′s Hospital of Chongqing Medical University from January 2018 to December 2020 was analyzed retrospectively.They were divided into typical development and abnormal development(including mild and moderate or severe)groups based on developmental diagnostic scale results,and also devided into 2-3,4-6,and 7-8 years of age groups based on age.The language characteristics of children with ASD at different developmental levels and different ages were compared by Pearson′s chi-square or Fisher′s exact probabilty test,t test,analysis of variance,or Kruskal-Wallis H test.The relationship between language ability and core symptoms of ASD was analyzed by Pearson correlation test.Results Among 103 children with ASD,86 were males and 17 were females,with an age of(5.5±1.5)years.A total of 61 children were charactered as typical development and 42 as abnormal(32 mild and 10 moderate or severe).There were no significant differences in developmental scale,overall language,receptive,expressive,syntax,and semantics scores among the three different age groups(all P>0.05).The detection rate of abnormal language ability in the typical development group was significantly lower than that in the abnormal development group(49.2%(30/61)vs.100.0%(42/42),P<0.01).Receptive,expressive,semantics,and syntax scores of the typical development groups were significantly higher than those of the mildly and moderately or severely abnormal group(89±13 vs.76±11 vs.71±8,F=18.61,P<0.01;80±12 vs.66±8 vs.58±7,F=29.69,P<0.01;92±14 vs.78±14 vs.71±11,F=17.26,P<0.01;83±10 vs.71±8 vs.64±5,F=29.35,P<0.01).Within the abnormal development group,there were no significant correlations between language ability and the core symptoms of ASD(r=-0.02-0.58,all P>0.05).Within the typical development group,there were no significant correlations between language ability and social interaction,repetitive stereotypes,and limited interests(r=0--0.22,all P>0.05).However,overall language,receptive,semantics,and expressive language abilities were negatively correlated with communication(r=-0.28--0.36,all P<0.05),and there was no significant correlation between syntax and communication(r=-0.24,P>0.05)in typical developmental group.Conclusions The majority of children with ASD manifest language development disorders,mainly in the aspects of expressive and syntax language.Children with ASD with more delayed developmental level have more severe language disorder.About half children with ASD with normal development have language development disorders.The language ability of children with ASD is minimally correlated with ASD core symptoms.