汉语发展性阅读障碍临床诊断实践

Clinical diagnostic practices for Chinese developmental dyslexia

目的探讨引入标准化评估工具对汉语发展性阅读障碍(DD)临床诊断的优化作用。方法采用横断面研究,于2023年5至12月从上海交通大学医学院附属儿童医院儿童保健科门诊招募130名存在语文成绩明显落后临床表现且筛查性量表筛查阳性的小学一至三年级儿童作为研究对象。筛查性量表采用中国小学生阅读障碍行为筛查量表(CDSBC),以儿童汉语阅读障碍筛查量表作为辅助。参照“汉语发展性阅读障碍诊断与干预的专家意见”的标准流程,对研究对象使用现代汉语发展性读写障碍评估工具(DDSSM)进行读写相关认知能力评价及诊断性评估,分为学习落后表现组和DD组。采用t检验和χ^(2)检验对比两组在智力、读写能力和注意缺陷多动障碍分布方面的差异。采用Spearman相关性分析分析DDSSM中各项认知能力得分与CDSBC得分的相关性。结果130名研究对象中男90名,年龄(8.3±1.0)岁;女40名,年龄(8.1±0.9)岁。最终诊断DD 59例,其中男41例。学习落后表现组与DD组的操作智商差异无统计学意义(101±15比100±15,t=0.53,P>0.05),DDSSM中字词读写能力差异有统计学意义(32±5比21±4,t=11.56,P<0.001)。学习落后表现组(71名)和DD组注意缺陷亚型注意缺陷多动障碍发生率差异无统计学意义[18名(25.4%)比16例(27.1%),χ^(2)=0.05,P>0.05]。DDSSM中口语词汇量、语素意识和正字法意识与CDSBC总分均负相关(r=-0.42、-0.32、-0.35,均P<0.01),但视觉空间知觉和快速自动化命名与CDSBC总分的相关性均无统计学意义(r=-0.09、-0.20,均P>0.05)。结论针对读写相关认知能力,CDSBC的评估作用不足,因此引入标准化DDSSM是对汉语DD临床诊断的优化,对实现精准诊断和干预具有至关重要的作用。

Objective To explore the optimization of the standardized assessment tool for clinical diagnosis of Chinese developmental dyslexia(DD).Methods A cross-sectional study was conducted from May to December 2023,in which 130 primary school children in grades 1 to 3 with clinical signs of literacy lag and positive screening results on the screening scales were recruited from the outpatient clinic of Child Health Care Medical Division,Shanghai Children′s Hospital,Shanghai Jiao Tong University School of Medicine.Chinese dyslexia screening behavior checklist for primary students(CDSBC)was used as the screening scales,and supplemented by dyslexia checklist for Chinese children.Referring to the standard procedure of the"expert advice on diagnosis and intervention of Chinese developmental dyslexia",the developmental dyslexia scale for standard mandarin(DDSSM)was used to evaluate the children′s literacy-related cognitive abilities and conduct the diagnostic assessment,and divided the children into learning backward group and the DD group.The t-test andχ^(2)test were used to compare the differences in the distribution of intelligence,literacy and attention deficit hyperactivity disorder between the two groups.Spearman′s correlation was used to analyze the correlation between the scores for each cognitive ability in the DDSSM and the CDSBC.Results Of the 130 children,90 were male,aged(8.3±1.0)years;40 were female,aged(8.1±0.9)years.A final diagnosis of DD was made in 59 cases,of which 41 were males.There was no statistically significant difference in operational intelligence quotient(101±15 vs.100±15,t=0.53,P>0.05)and statistically significant difference in literacy of DDSSM(32±5 vs.21±4,t=11.56,P<0.001)between the learning backward group and the DD group.Eighteen cases(25.4%)of the learning backward group were children with attention deficit subtype attention deficit hyperactivity disorder(ADHD-I),and 16 cases(27.1%)in DD group,the difference in incidence between the two groups was not statistically significant(χ^(2)=0.05,P>0.05).There were correlations between the DDSSM(for oral vocabulary,morphological awareness and orthographic awareness)and the CDSBC total score(r=-0.42,-0.32,-0.35,all P<0.01),but the correlations for visuospatial perception and rapid automatized naming with CDSBC total score were not statistically significant(r=-0.09 and-0.20,both P>0.05).Conclusion For literacy-related cognitive abilities,screening scales CDSBC are not sufficiently useful for assessment,so the introduction of standardized assessment tools DDSSM is an optimization of the clinical diagnosis of Chinese DD,which is crucial for achieving accurate diagnosis and intervention.