家庭社交行为干预对家族性高风险孤独症谱系障碍婴幼儿发展与结局观察

A Randomized Controlled Study on the Development and Outcome of Family Social Behavior Intervention in Infants and toddlers with Familial High Risk Autism Spectrum Disorder

目的观察家庭社交行为干预对家族性高风险孤独症谱系障碍(autism spectrum disorder,ASD)婴幼儿社交行为,神经发育轨迹及结局的影响。方法将在清远市妇幼保健院儿童康复科招募的110名年龄为6个月的家族性高风险ASD婴儿(ASD患儿的年幼同胞)作为研究组,同期在儿童群体保健科招募58名年龄为6个月的家族性低风险ASD婴儿(正常发育儿童的年幼同胞)作为对照。将研究组按随机数表法分为研究组A和研究组B,研究组A采用家庭社交行为干预,研究组B和对照组则采用常规养育方法,持续追踪至24个月,在6月,12月,18月大时研究组和对照组均采用婴儿孤独症观察量表(autism observation scale for infants,AOSI),盖泽尔发展量表(gesell developmental scale,GDS)分别评估其社交行为及神经发育功能。在24个月大时则采用GDS,儿童孤独症评定量表等工具评估幼儿神经发育和ASD核心症状,同时依据美国《精神疾病诊断与统计手册(第5版)》中相关诊断标准对三组幼儿的发育结局进行判断。结果组内比较,三组研究对象AOSI总分和GDS各能区得分与评估时间均呈线性关系,不同时间点得分相比较,差异具有统计学意义(P<0.05);组间比较,AOSI总分和GDS各能区得分,均为对照组优于研究组A,研究组A优于研究组B,差异具有统计学意义(P<0.05)。对照组在幼儿2岁时诊断为ASD的比例为1.7%,语言障碍1.7%,ASD高危儿1.7%,语言行为异常共3例(5.2%);研究组A在幼儿2岁时诊断为ASD的比例为5.5%,语言障碍5.5%,ASD高危儿3.6%,语言行为异常共8例(14.5%);研究组B在幼儿2岁时诊断为ASD的比例为16.4%,语言障碍18.2%,ASD高危儿5.5%,语言行为异常共22例(40%)。结论与家族性低风险ASD儿相比,家族性高风险ASD儿在婴幼儿期存在更多的ASD样行为,其神经发育也相对落后;且更容易发展为ASD或存在不同程度的语言行为问题。从婴儿期开始家庭社交行为干预可以有效促进家族性高风险ASD儿的语言-社交行为发展和神经发育,进而减少ASD或语言行为异常的发生。

Objective Uncovering the effects of a family social behavior intervention on social behavior,neurodevelopmental trajectories,and outcomes in infants and toddlers with familial high-risk autism spectrum disorder(ASD).Method One hundred and ten familial high-risk ASD infants(young siblings of children with ASD)aged 6 months old recruited in the Department of Child Rehabilitation of Qingyuan Maternal and Child Health Hospital were used as the study group,and 58 familial low-risk ASD infants(young siblings of normal-developing children)aged 6 months old were recruited in the Department of Children's Group Health Care at the same period of time were used as controls.The study group was divided into Study Group A and Study Group B according to random number table method.Study Group A was treated with family social behavioral intervention,while Study Group B and control group were treated with conventional parenting methods and followed up until 24 months of age.At 6,12 and 18 months of age,the study group and the control group were assessed by the autism observation scale for infants(AOSI)and the gesell developmental scale(GDS),respectively,for social behavior and neurodevelopmental functioning.At 24 months of age,the neurodevelopmental and core symptoms of ASD were assessed using the GDS and the Childhood Autism Scale,and the developmental outcomes of the three groups were judged according to the relevant diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders(5th edition).Results In intra-group comparison,the AOSI total score and GDS scores in each functional area of the three study groups were linearly related to the time of assessment,and the differences were statistically significant when comparing the scores at different time points(P<0.05).In intergroup comparison,the AOSI total scores and the GDS scores in each functional area of the three study groups were better for the control group than for study group A,and study group A was better for study group B,and the differences were statistically significant(P<0.05).The proportion of children diagnosed with ASD at the age of 2 in the control group was 1.7%,with language disorders being 1.7%,high-risk children with ASD being 1.7%,and 3 cases(5.2%)of language and behavior abnormalities;The proportion of children diagnosed with ASD in study group A at the age of 2 was 5.5%,with language disorders being 5.5%,high-risk children with ASD being 3.6%,and a total of 8 cases(14.5%)with abnormal language and behavior;The proportion of children diagnosed with ASD in study group B at the age of 2 was 16.4%,language disorders were 18.2%,high-risk children with ASD were 5.5%,and a total of 22 cases(40%)had abnormal language and behavior.Conclusion Compared with children with familial low-risk ASD,children with familial high-risk ASD have more ASD-like behaviors in infancy and childhood,and their neurodevelopment is relatively backward;they are more likely to develop ASD or have different degrees of language-behavior problems.Family social behavior intervention from infancy can effectively promote language-social behavior development and neurodevelopment in children with familial high-risk ASD,thereby reducing the incidence of ASD or languagebehavior abnormalities.