不同角色评估孤独症谱系障碍儿童 核心症状一致性分析

Consistency Analysis of Core Symptoms in Children with Autism Spectrum Disorder Assessed by Different Roles

目的:探究ABC量表、CARS量表和GDS-C中个人社会和听力语言能区三种评估结果的一致性,为孤独症谱系障碍(ASD)患儿的临床诊断评估提供参考。方法:回顾性分析147例诊断为ASD儿童病例资料。临床医师根据诊室观察患儿行为表现及家长访谈完成CARS量表评定;嘱家长根据患儿日常表现完成ABC量表填写;由取得认证资格的专业评估师对患儿进行GDS-C评估,采用Kappa一致性分析对CARS、ABC得分以及GDS-C量表中的个人社会和听力语言发育商的一致性进行统计学检验;采用Spearman相关性分析探究三个评估工具结果的相关性。结果:CARS量表和ABC量表结果间一致性不高(κ=0.14,P=0.01<0.05);CARS得分与GDS-C听力语言发育商一致性差(κ=0.08,P=0.02<0.05)。CARS得分与GDS-C个人社会和听力语言能区发育商相关性较ABC得分与GDS-C个人社会和听力语言能区发育商大。结论:临床上,专业人员和家长对于孤独症儿童核心症状的评价虽然存在一致性和相关性,但一致性和相关性不强,故两者不能互相取代。CARS量表和ABC量表得分与患儿GDS-C个人社会和听力语言发育商不存在一致性,但存在一定程度相关性,故专业人士、家长、患儿自身表现方面的评价结果存在一定联系,在临床工作中应结合多方评价结果综合做出诊断,以提高诊断准确性,降低误诊风险。

Objective:This study aims to explore the consistency of the assessment of individual social and hearing language areas in ABC,CARS and GDS-C,so as to provide reference for the clinical diagnosis and assessment of children with ASD.Methods:The data of 147 children with ASD were retrospectively analyzed.The clinician completed the CARS scale according to the observation of children’s behavior in the clinic and the interview with parents.Parents were asked to complete the ABC scale according to the children’s daily performance.The children were evaluated by certified professional evaluators for GDS-C.Kappa consistency analysis was used to statistically test the consistency of CARS,ABC scores and individual social and hearing language development quotient in GDS-C scale.Spearman correlation analysis was used to explore the correlation between the three assessment tools.Results:There was consistency between CARS scale and ABC scale,but the consistency was poor(κ=0.14,P=0.01<0.05).CARS score was consistent with GDS-C hearing and language development quotient,but the consistency was poor(κ=0.08,P=0.02<0.05).The relationship between CARS score and development quotient of GDS-C social and listening language area was greater than that between ABC score and development quotient of GDS-C social and listening language area.Conclusion:Clinically,there is consistency and correlation between professionals and parents in the evaluation of core symptoms of children with autism,but the consistency and correlation are not strong,so the two can not replace each other.CARS scale and ABC scale scores and GDS-C personal hearing and language development in children with no consistency,but there is a certain degree of negative correlation,so the professionals,parents,the performance evaluation of the patients there is a certain link,in clinical work should be combined with various comprehensive diagnosis evaluation results,in order to improve the diagnostic accuracy,and decrease the misdiagnosis risk.