PDF(1599 KB)
PDF(1599 KB)
PDF(1599 KB)
儿童保健门诊语音障碍儿童初诊现状分析
Current status of initial diagnosis of speech sound disorder in a child healthcare clinic
目的 了解儿童保健科医生对语音障碍（SSD）的认识。方法 收集并分析2017年1月至2019年5月期间初次就诊并诊断为SSD的506例儿童的临床资料。结果 506例SSD儿童中，90.5% SSD儿童病史中描述发育行为相关表现；97.6%完善发育行为评估，以筛查性智能及发育测试为主（485/506，95.8%）。116例（22.9%）共患神经发育障碍性疾病，最常见的为语言障碍、全面发育迟缓和智力障碍，45.7%（53/116）发育行为相关病史中未记录异常表现。家属自觉听力异常儿童的神经发育障碍性疾病发生率高于家属自觉听力正常儿童，体查时对声源反应异常儿童的神经发育障碍性疾病发生率高于对声源反应正常儿童（P < 0.05）。506例SSD儿童中，病史中及体查时未关注听力的比例分别达33.2%、31.2%。92例（18.2%）完善诊断性听力测试，听力损失检出率为12%（11/92）。11例听力损失儿童病史中，3例既往听力筛查通过，3例家属自觉听力正常，7例体查时对声源反应正常。结论 SSD儿童易共患神经发育障碍性疾病，关注交流表现有助于其诊断，但病史询问易遗漏，应结合发育行为评估。SSD儿童的神经心理发育状况得到了儿童保健医师的关注，发育行为评估完成率高，但目前以筛查性智能发育测试为主。SSD儿童听力损失检出率高，儿童保健医生对其听力损失问题认识不足，诊断性听力测试未得到重视，临床不应以既往听力筛查结果或生活场景中儿童对声源的反应评估听力水平。
Objective To investigate the understanding of speech sound disorder (SSD) among child health practitioners. Methods The clinical data of 506 children with an initial diagnosis of SSD from January 2017 to May 2019 were retrospectively analyzed. Results Of the 506 SSD children, 90.5% had a description of developmental behavior in their medical records; 97.6% received a developmental-behavioral evaluation, mostly intellectual and developmental screening tests, which were given to 95.8% (485/506) of the total children. A total of 116 (22.9%) children also had neurodevelopmental disorders, commonly presenting with language disorder, global developmental delay, and intellectual disability; however, 53 (45.7%) of the 116 children had no history records of such abnormal developmental behavior. The incidence of neurodevelopmental disorders was significantly higher in the children with abnormal hearing reported by their families than in the children with normal hearing reported by their families (P < 0.001). The children with abnormal response to sound stimulation on physical examination had significantly more frequent neurodevelopmental disorders than those with normal response to sound stimulation (P < 0.05). Among the 506 children with SSD, hearing condition was ignored in 33.2% in history records, and in 31.2% on physical examination. Ninety-two children (18.2%) completed the diagnostic hearing test, 12% (11/92) of whom were diagnosed with hearing loss. Of the 11 children with hearing loss, three had passed a hearing screening, three had family-reported normal hearing, and seven had normal response to sound stimulation on physical examination. Conclusions SSD is frequently comorbid with neurodevelopmental disorders in children. Children's communication performance is a key to the diagnosis of neurodevelop-mental disorders. It's necessary to the diagnosis of SSD to perform a medical history collection about neuropsychological development and a developmental-behavior evaluation. There is a high proportion of children with SSD receiving the developmental-behavioral evaluation, suggesting that child health practitioners pay close attention to the neuropsychological development of SSD children, but mostly, the evaluation merely involves intellectual developmental screening tests. The detection rate of hearing loss in children with SSD is high. However, child health practitioners underestimate this problem, and have an insufficient understanding of the importance of the diagnostic hearing test. The diagnostic hearing test should be the preferred recommendation for assessing hearing ability rather than past hearing screening results or children's response to sound stimulation in life scenes.
Speech sound disorder / Hearing loss / Neurodevelopmental disorder / Child
[1] American Speech-Language-Hearing Association. Speech sound disorders:articulation and phonological process[DB/OL].[2019-11-19]. https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935321§ion=Overview.
[2] Black LI, Vahratian A, Hoffman HJ. Communication disorders and use of intervention services among children aged 3-17 years:United States, 2012[J]. NCHS Data Brief, 2015, (205):1-8.
[3] Flipsen P Jr. Emergence and prevalence of persistent and residual speech errors[J]. Semin Speech Lang, 2015, 36(4):217-223.
[4] Wren Y, Miller LL, Peters TJ, et al. Prevalence and predictors of persistent speech sound disorder at eight years old:findings from a population cohort study[J]. J Speech Lang Hear Res, 2016, 59(4):647-673.
[5] Lewis BA, Freebairn L, Tag J, et al. Heritability and longitudinal outcomes of spelling skills in individuals with histories of early speech and language disorders[J]. Learn Individ Differ, 2018, 65:1-11.
[6] Beitchman JH, Wilson B, Johnson CJ, et al. Fourteen-year follow-up of speech/language-impaired and control children:psychiatric outcome[J]. J Am Acad Child Adolesc Psychiatry, 2001, 40(1):75-82.
[7] Overby MS, Trainin G, Smit AB, et al. Preliteracy speech sound production skill and later literacy outcomes:a study using the Templin Archive[J]. Lang Speech Hear Serv Sch, 2012, 43(1):97-115.
[8] American Psychiatric Association. Diagnostic and statistical manual of mental disorders[M]. 5th ed. Arlington, VA:American Psychiatric Publishing, 2013:33-66.
[9] Alzahrani M, Tabet P, Saliba I. Pediatric hearing loss:common causes, diagnosis and therapeutic approach[J]. Minerva Pediatr, 2015, 67(1):75-90.
[10] 国家卫生和计划生育委员会新生儿疾病筛查听力诊断治疗组. 婴幼儿听力损失诊断与干预指南[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(3):181-188.
[11] 刘晓, 程茜, 李廷玉. 重庆方言儿童辅音发育特征的研究[J]. 重庆医学, 2012, 41(8):754-755.
[12] Eadie P, Morgan A, Ukoumunne OC, et al. Speech sound disorder at 4 years:prevalence, comorbidities, and predictors in a community cohort of children[J]. Dev Med Child Neurol, 2015, 57(6):578-584.
[13] Farquharson K, Hogan TP, Bernthal JE. Working memory in school-age children with and without a persistent speech sound disorder[J]. Int J Speech Lang Pathol, 2018, 20(4):422-433.
[14] Anggraeni R, Carosone-Link P, Djelantik B, et al. Otitis media related hearing loss in Indonesian school children[J]. Int J Pediatr Otorhinolaryngol, 2019, 125:44-50.
[15] 马晶, 徐芬, 万浪, 等. 黄石市2025例学龄前儿童听力筛查结果分析[J]. 听力学及言语疾病杂志, 2017, 25(5):465-467.
[16] Cai T, McPherson B. Hearing loss in children with otitis media with effusion:a systematic review[J]. Int J Audiol, 2017, 56(2):65-76.
[17] Liming BJ, Carter J, Cheng A, et al. International Pediatric Otolaryngology Group (IPOG) consensus recommendations:hearing loss in the pediatric patient[J]. Int J Pediatr Otorhinolaryngol, 2016, 90:251-258.
[18] 杨琨, 杨希林, 王燕, 等. 美国听力学会儿童听力筛查指南[J]. 听力学及言语疾病杂志, 2017, 25(2):119-136.
[19] Puschmann S, Daeglau M, Stropahl M, et al. Hearing-impaired listeners show increased audiovisual benefit when listening to speech in noise[J]. Neuroimage, 2019, 196:261-268.
[20] Farinetti A, Raji A, Wu H, et al. International consensus (ICON) on audiological assessment of hearing loss in children[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018, 135(1S):S41-S48.
[21] Hashemi N, Ghorbani A, Soleymani Z, et al. The Persian version of auditory word discrimination test (P-AWDT) for children:development, validity, and reliability[J]. Int J Pediatr Otorhinolaryngol, 2018, 110:93-99.
[22] 杨文竹, 赵云静, 张成惠. 功能性构音障碍儿童与正常儿童的音位对比式言语识别能力的研究[J]. 中国儿童保健杂志, 2015, 23(10):1027-1029.
[23] Boyce JO, Kilpatrick N, Morgan AT. Speech and language characteristics in individuals with nonsyndromic submucous cleft palate-a systematic review[J]. Child Care Health Dev, 2018, 44(6):818-831.
