儿童神经心理行为检查量表2016版在孤独症谱系障碍幼儿中的临床应用

罗美芳; 肖博; 赵晓丽; 冯承芸; 彭琼玲; 姚小芳; 李秀银; 马丽亚

doi:10.7499/j.issn.1008-8830.2001035

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中国当代儿科杂志 ›› 2020, Vol. 22 ›› Issue (5) : 494-498. DOI: 10.7499/j.issn.1008-8830.2001035

论著·临床研究

儿童神经心理行为检查量表2016版在孤独症谱系障碍幼儿中的临床应用

罗美芳, 肖博, 赵晓丽, 冯承芸, 彭琼玲, 姚小芳, 李秀银, 马丽亚

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Application of the Children Neuropsychological and Behavioral Scale-Revision 2016 in young children with autism spectrum disorder

LUO Mei-Fang, XIAO Bo, ZHAO Xiao-Li, FENG Cheng-Yun, PENG Qiong-Ling, YAO Xiao-Fang, LI Xiu-Yin, MA Li-Ya

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摘要

目的分析比较孤独症谱系障碍（ASD）和单纯全面发育迟缓（GDD）患儿在儿童神经心理行为检查量表2016版（以下简称儿心量表2016版）中的表现特征及差异，探索儿心量表2016版对ASD的鉴别与提示作用。方法以18~30月龄ASD（n=260）和单纯GDD（n=371）患儿为研究对象，采用儿心量表2016版评估两组儿童在大运动、精细运动、适应能力、语言、社会行为等5大能区的发育水平，采用受试者工作（ROC）曲线分析儿心量表2016版新增的交流互动警示行为能区对ASD的鉴别意义。结果 ASD组患儿5大能区的发育商（DQ）均低于单纯GDD组（P < 0.05）。ASD组患儿语言能区及全量表DQ与交流互动警示行为能区分数呈中度负相关（分别r_s=-0.566、-0.552，P < 0.01）。ROC曲线分析显示，交流互动警示行为能区对ASD有诊断价值（P < 0.05），曲线下面积为0.835，最佳截断值为10.5，灵敏度为0.750，特异度为0.798。结论 18~30月龄ASD患儿较单纯GDD发育更差；儿心量表2016版新增的交流互动警示行为能区对于ASD和单纯GDD患儿中ASD的鉴别有一定的提示和参考价值。

Abstract

Objective To compare the assessment results of the Children Neuropsychological and Behavioral Scale-Revision 2016 (CNBS-R2016) between young children with autism spectrum disorder (ASD) and global developmental delay (GDD, without ASD) and to explore whether CNBS-R2016 could be helpful to early identification of ASD. Methods A total of 260 ASD and 371 GDD children aged 18-30 months were enrolled to finish the assessment of CNBS-R2016. The development quotients (DQs) of the five domains of CNBS-R2016 including gross motor, fine motor, adaptability, language and social behavior were compared between the two groups. The receiver operating characteristic (ROC) curve was used to evaluate the value of the autism-predicted domain in identifying ASD and GDD. Results The DQs of all the five domains in the ASD group were lower than those in the GDD group (P < 0.05). The language DQ and total DQ of the ASD group had a negative correlation with the score of the autism-predicted domain (r_s=-0.566, -0.552 respectively, P < 0.01). When the cut-off value of the autism-predicted domain was 10.5, the largest area under the ROC curve was 0.835, and the sensitivity and specificity for the diagnosis of ASD were 0.750 and 0.798 respectively. Conclusions The development of ASD children aged 18-30 months is worse than that of GDD children. CNBS-R2016 may be helpful to distinguish ASD from children with developmental delay.

导出引用

罗美芳, 肖博, 赵晓丽, 冯承芸, 彭琼玲, 姚小芳, 李秀银, 马丽亚. 儿童神经心理行为检查量表2016版在孤独症谱系障碍幼儿中的临床应用[J]. 中国当代儿科杂志. 2020, 22(5): 494-498 https://doi.org/10.7499/j.issn.1008-8830.2001035

LUO Mei-Fang, XIAO Bo, ZHAO Xiao-Li, FENG Cheng-Yun, PENG Qiong-Ling, YAO Xiao-Fang, LI Xiu-Yin, MA Li-Ya. Application of the Children Neuropsychological and Behavioral Scale-Revision 2016 in young children with autism spectrum disorder[J]. Chinese Journal of Contemporary Pediatrics. 2020, 22(5): 494-498 https://doi.org/10.7499/j.issn.1008-8830.2001035

参考文献

[1] Baio J, Wiggins L, Christensen DL, et al. Prevalence of autism spectrum disorder among children aged 8 years-Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014[J]. MMWR Surveill Summ, 2018, 67(6):1-23.
[2] Sun X, Allison C, Matthews FE, et al. Prevalence of autism in mainland China, Hong Kong and Taiwan:a systematic review and meta-analysis[J]. Mol Autism, 2013, 4(1):7.
[3] 王馨, 杨文翰, 金宇, 等. 广州市幼儿园儿童孤独症谱系障碍患病率和相关因素[J]. 中国心理卫生杂志, 2011, 25(6):401-408.
[4] 张雅如, 邵智. 孤独症儿童语言障碍及其认知神经机制[J]. 中国妇幼保健, 2014, 29(4):647-650.
[5] Esposito G, Venuti P, Maestro S, et al. An exploration of symmetry in early autism spectrum disorders:analysis of lying[J]. Brain Dev, 2009, 31(2):131-138.
[6] Esposito G, Venuti P. Analysis of toddlers' gait after six months of independent walking to identify autism:a preliminary study[J]. Percept Mot Skills, 2008, 106(1):259-269.
[7] Bhat AN, Landa RJ, Galloway JC. Current perspectives on motor functioning in infants, children, and adults with autism spectrum disorders[J]. Phys Ther, 2011, 91(7):1116-1129.
[8] 郭翠华, 静进. 婴幼儿孤独症谱系障碍的早期筛查工具(综述)[J]. 中国心理卫生杂志, 2017, 31(9):704-709.
[9] 李瑞莉, 金春华, 张丽丽, 等. 《中国儿童发育量表》(4~6岁部分)信度与效度研究[J]. 中国儿童保健杂志, 2015, 23(9):934-936.
[10] 张丽丽, 金春华, 李瑞莉, 等. 《中国儿童发育量表》北京地区常模(0~4岁部分)修订与信度分析[J]. 中国儿童保健杂志, 2015, 23(6):573-576.
[11] 金春华. 儿童神经心理行为检查量表2016版[M]. 北京:北京出版社, 2016:37.
[12] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-fifth edition[M]. Arlington, VA:American Psychiatric Publishing, 2013:50-59.
[13] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders-fifth edition[M]. Arlington, VA:American Psychiatric Publishing, 2013:41.
[14] 中华医学会儿科学分会神经学组, 中国医师协会神经内科分会儿童神经疾病专业委员会. 儿童智力障碍或全面发育迟缓病因诊断策略专家共识[J]. 中华儿科杂志, 2018, 56(11):806-810.
[15] Ray-Subramanian CE, Huai N, Ellis Weismer S. Brief report:adaptive behavior and cognitive skills for toddlers on the autism spectrum[J]. J Autism Dev Disord, 2011, 41(5):679-684.
[16] 刘冬梅, 邹时朴, 龚俊, 等. 孤独症、全面发育迟缓及发育性语言延迟儿童早期语言发育特征[J]. 中国儿童保健杂志, 2020, 28(3):312-315.
[17] 马冬梅, 姜志梅, 庞伟, 等. 孤独症谱系障碍儿童语言功能评估探析[J]. 中国听力语言康复科学杂志, 2019, 17(3):175-178.
[18] 王建敏, 李侠, 农铮, 等. 监护人重视的首个儿童孤独症异常特征及与就诊时间关系的分析[J]. 中华流行病学杂志, 2015, 36(10):1077-1080.
[19] 周翔, 陈强, 曾彩霞, 等. 孤独症儿童能力发育特征探讨[J]. 中国儿童保健杂志, 2013, 21(4):364-366.
[20] 蒲元林, 张永芳, 赵继华, 等. 儿童全面发育迟缓的因素及预防[J]. 中国妇幼健康研究, 2018, 29(2):142-145.
[21] 柯海娟, 唐久来. 64例全面性发育迟缓患儿病因及疗效分析[J]. 中国儿童保健杂志, 2016, 24(6):658-661.
[22] Miller LE, Burke JD, Robins DL, et al. Diagnosing autism spectrum disorder in children with low mental age[J]. J Autism Dev Disord, 2019, 49(3):1080-1095.