不同语言评估工具在12月龄高危儿语言发育评估中的应用价值

Application value of different language assessment tools in language development assessment of 12-month-old high-risk infants

目的 探讨不同语言评估工具在12月龄高危儿语言发育评估中的应用价值,筛选出简便有效的语言评估工具。方法 选取2022年3月—2023年5月在贵阳市妇幼保健院儿童保健科高危儿门诊随访的11~13月龄的217例高危儿作为研究对象,分别使用早期语言发育进程量表(ELMS)、汉语沟通发展量表-普通话版本(PCDI)和年龄与发育进程量表-第三版(ASQ-3)进行语言评估,并以Gesell发育量表作为金标准,计算三种评估工具的受试者工作特征曲线下面积(AUC)、灵敏度、特异度、正确率、阳性预测值、阴性预测值、约登指数、Kappa值;应用Spearman相关分析不同语言评估方法之间的相关性;采用逼近理想解的排序(TOPSIS)对三种评估工具进行综合评价。结果 1)217例高危儿中最多是早产儿78例(35.94%),Gesell、ELMS、PCDI-理解、PCDI-会说及ASQ-3检出语言发育迟缓的比例分别为5.5%、7.8%、36.4%、30.0%、11.5%;2)ASQ-3与Gesell相关性最强(r_(s)=0.607,P<0.01),ASQ-3的AUC最大(AUC=0.812,P<0.05),ASQ-3与Gesell评估一致性中等(Kappa=0.56,P<0.01),ASQ-3的灵敏度(91.7%)、正确率(93.1%)、阴性预测值(99.5%)和约登指数(0.85)最高,ELMS的特异度(94.6%)最高;3)采用TOPSIS对三种评估工具进行综合评价,ASQ-3最优,ELMS次之,PCDI-理解最差。结论 ASQ-3在11~13月龄高危儿语言筛查中的应用价值较好,未来可能需要拓展年龄范围和建立ELMS和PCDI的全国性常模。

Objective To explore the application value of different language assessment tools in the assessment of language development of 12-month-old high-risk infants,and to screen out simple and valid language assessment tools.Methods A total of 21711-to 13-month-old high-risk infants who were followed up at the outpatient service for high-risk infants at the child health clinic of Guiyang Maternal and Child Health Hospital from March 2022 to May 2023 were selected as the study subjects.Their language was evaluated by Early Language Milestone Scale(ELMS),Putonghua Communicative Development Inventory(PCDI)and Ages and Stages Questionnaire-Third Edition(ASQ-3).With Gesell as the gold standard for the assessment of language,the area under receiver operating characteristic curve(AUC),sensitivity,specificity,accuracy,positive predictive value,negative predictive value,Youden index and Kappa value of the three tools were calculated.Spearman correlation analysis was used to analyze the correlation between the different language assessment scales.The Technique for Order Preference by Similarity to Ideal Solution(TOPSIS)was used to evaluate the three tools.Results 1)Among 217 high-risk infants,78 preterm infants was the most(35.94%).The rate of delayed language development detected by Gesell,ELMS,PCDI-comprehension,PCDI-expression,ASQ-3 were 5.5%,7.8%,36.4%,30.0%and 11.5%,respectively.2)ASQ-3 had the strongest correlation with Gesell language region(r_(s)=0.607,P<0.01)and it had the most AUC(AUC=0.812,P<0.05).The consistency between ASQ-3 and Gesell was moderate(Kappa=0.56,P<0.01).ASQ-3 had the highest sensitivity(91.7%),accuracy(93.1%),negative predictive value(99.5%)and Youden index(0.85),and ELMS had the highest specificity(94.6%).3)Comprehensive evaluation of three tools by the TOPSIS indicated that ASQ-3 was the best,followed by ELMS and PCDI-comprehension was the worse.Conclusion Among the three assessment tools,ASQ-3 has the highest value in assessing the language development of 11-to 13-month-old high risk infants,and it may be necessary to expand the age range and establish a national norm of ELMS and PCDI in the future.