学龄前高功能孤独症谱系障碍儿童执行功能特征研究及与病情的相关性

Study on executive function characteristics of preschool children with high functioning autism spectrum disorder and the correlation with the disease

目的 探讨学龄前高功能孤独症谱系障碍(ASD)儿童执行功能特征及与病情的相关性。方法 选择2020年5月—2023年8月赣州市妇幼保健院治疗的78例高功能ASD儿童为高功能ASD组,体检的78例健康儿童为对照组。对两组儿童采用执行功能行为评定问卷(BREIF-P)评价,通过孤独症诊断评估量表(CARS)评估ASD症状,比较两组抑制、认知灵活性指数、转换、抑制自我调控指数、情感控制、组织计划、元认知指数、工作记忆评分,比较不同病情高功能ASD患儿抑制、认知灵活性指数、转换、抑制自我调控指数、情感控制、组织计划、元认知指数、工作记忆评分。分析高功能ASD儿童抑制、认知灵活性指数、转换、抑制自我调控指数、情感控制、组织计划、元认知指数、工作记忆评分与ASD严重程度的相关性。结果 高功能ASD组抑制、认知灵活性指数、转换、抑制自我调控指数、情感控制、组织计划、元认知指数、工作记忆评分[(32.65±5.54)分、(41.49±5.23)分、(20.31±3.35)分、(53.83±7.15)分、(21.18±3.57)分、(21.03±5.14)分、(56.30±9.06)分、(35.27±6.08)分]均高于对照组[(20.12±2.12)分、(26.74±3.52)分、(13.55±2.26)分、(33.31±5.45)分、(13.19±2.03)分、(11.72±2.26)分、(31.96±5.89)分、(21.24±3.07)分],差异均有统计学意义(均P<0.05)。重度ASD组抑制、认知灵活性指数、转换、抑制自我调控指数、情感控制、组织计划、元认知指数、工作记忆评分[(38.73±5.48)分、(50.25±6.48)分、(25.17±3.14)分、(63.81±9.15)分、(25.08±3.51)分、(25.91±3.52)分、(68.42±10.14)分、(42.51±6.16)分]均高于轻中度ASD组[(27.77±3.50)分、(27.70±4.50)分、(13.98±2.31)分、(41.59±5.28)分、(13.72±2.47)分、(14.28±2.50)分、(39.20±7.31)分、(24.92±3.29)分],差异均有统计学意义(均P<0.05)。Pearson分析显示:高功能ASD儿童抑制、认知灵活性指数、转换、抑制自我调控指数、情感控制、组织计划、元认知指数、工作记忆评分与ASD严重程度均呈正相关(r=6.852、5.534、7.314、7.053、5.210、5.866、8.328、6.885,均P<0.05)。结论 学龄前高功能ASD儿童存在执行功能损伤,存在抑制自我调控、认知灵活性、元认知缺陷,ASD病情与执行功能损伤程度呈正相关。

Objective To explore the characteristics of executive function in preschool children with high functioning autism spectrum disorder(ASD) and the correlation with the disease.Methods A total of 78 children with high-functioning ASD were selected from Ganzhou Maternal and Child Health Care Hospital from May 2020 to August 2023 as high-functioning ASD group,78 healthy children undergoing physical examination were selected as control group.The Executive Functional Behavior Assessment Questionnaire(BREIF-P) of preschool children in the two groups were evaluated,and ASD symptoms were assessed by Autism Diagnostic Assessment Scale(CARS).The scores of inhibition,cognitive flexibility index,conversion,inhibitory self-regulation index,affective control,organizational planning,metacognitive index,and working memory were compared between high-functioning ASD group and control group.The scores of inhibition,cognitive flexibility index,conversion,inhibitory self-regulation index,affective control,organizational planning,metacognitive index,and working memory were compared in the patients with different conditions of high functioning ASD.The correlations between inhibition,cognitive flexibility index,conversion,inhibitory self-regulation index,affective control,organizational planning,metacognitive index,working memory and ASD severity in high-functioning autistic children were analyzed.Results The scores of inhibition,cognitive flexibility index,conversion,inhibitory self-regulation index,affective control,organizational planning,metacognitive index,and working memory in high-functioning ASD group were(32.65±5.54),(41.49±5.23),(20.31±3.35),(53.83±7.15),(21.18±3.57),(21.03±5.14),(56.30±9.06),(35.27±6.08),respectively,which were statistically significantly higher than those in control group [(20.12±2.12),(26.74±3.52),(13.55±2.26),(33.31±5.45),(13.19±2.03),(11.72±2.26),(31.96±5.89),(21.24±3.07)](P<0.05).The scores of inhibition,cognitive flexibility index,conversion,inhibitory self-regulation index,affective control,organizational planning,metacognitive index,and working memory in severe ASD group were(38.73±5.48),(50.25±6.48),(25.17±3.14),(63.81±9.15),(25.08±3.51),(25.91±3.52),(68.42±10.14),(42.51±6.16),respectively,which were statistically significantly higher than those in mild to moderate ASD group [(27.77±3.50),(27.70±4.50),(13.98±2.31),(41.59±5.28),(13.72±2.47),(14.28±2.50),(39.20±7.31),and(24.92±3.29),respectively](P<0.05).Pearson analysis showed that the scores of inhibition,cognitive flexibility index,conversion,inhibitory self-regulation index,affective control,organizational planning,metacognitive index,and working memory were positively correlated with ASD severity in high-functioning autistic children(r=6.852,5.534,7.314,7.053,5.210,5.866,8.328,6.885,P<0.05).Conclusion Pre-school children with high functioning ASD have executive function impairment,including inhibitory self-regulation,cognitive flexibility,and metacognitive deficits.ASD is positively correlated with the degree of executive function impairment.