不同年龄孤独症谱系障碍儿童症状与整体发育水平的相关性

Correlation between severity of symptoms and overall development level of children with autism spectrum disorder at different ages

目的探讨不同年龄孤独症谱系障碍(autism spectrum disorder,ASD)儿童症状严重程度与整体发育水平的相关性。方法选取2016年5月—2019年5月首次诊断为ASD的503例儿童作为研究对象,其中≤3岁组272例,>3岁组231例。采用孤独症行为评定量表(autism behavior checklist,ABC)和儿童期孤独症评定量表(childhood autism rating scale,CARS)评估ASD症状,格塞尔(Gesell)发育量表(Gesell developmental schedule,GDS)评估发育商(developmental quotient,DQ)。应用Mann-Whitney U检验和Spearman相关性分析方法进行统计学分析。结果2组ABC总分的差异无统计学意义(P>0.05),>3岁组CARS总分低于≤3岁组(P<0.05);2组GDS个人-社交能区DQ分布的差异有统计学意义(P<0.05)。503例ASD儿童GDS适应性和语言能区的DQ与CARS总分均呈显著负相关(r=-0.095,P<0.05;r=-0.141,P<0.05),≤3岁组ABC总分与GDS适应性能区的DQ呈显著负相关(r=-0.137,P<0.05),>3岁组CARS总分与GDS语言能区的DQ呈显著负相关(r=-0.181,P<0.01)。结论首次诊断年龄大的ASD儿童症状较轻,但个人-社交能力受损更明显。不同年龄ASD患儿其症状严重程度与发育水平的相关性不同,3岁以前症状严重者适应性水平低,3岁以后症状严重者语言能力差。

Objective To investigate the association between the severity of symptoms and overall development level of children with autism spectrum disorder(ASD)at different ages.Methods A total of 503 children(2 groups including 272≤3 years old and 231>3 years old)first diagnosed as ASD from May 2016 to May 2019 were enrolled.The core symptoms of ASD were assessed by autism behavior scale(ABC)and childhood autism rating scale(CARS).The Chinese version of the Gesell developmental schedule(GDS)was used to test the development of quotient(DQ).Mann-Whitney U test and Spearman’s correlation analysis were performed for statistical analyses.Results There was no significant difference in the total ABC score between the two groups.The total CARS score of the>3 years old group was significantly lower than that of the≤3 years old group(P<0.05).There was significant difference in the distribution of personal social DQ between the two groups(P<0.05).The CARS score of all enrolled children was negatively correlated with DQ of adaptive performance(r=-0.095,P<0.05)and language(r=-0.141,P<0.05).The total ABC score was negatively correlated with DQ of adaptive performance in the≤3 years old group(r=-0.137,P<0.05)and negatively correlated with DQ of language in the>3 years old group(r=-0.181,P<0.01).Conclusion Children with an older age at diagnosis have mild ASD symptoms and an even worse personal-social ability.The correlation between symptom severity and developmental level of children with ASD at different ages is different.Under 3 years old,the children who have poor adaptability DQ are associated with severer symptoms.Older than 3 years old,the children who have poor language DQ are associated with severer symptoms.