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孤独症谱系障碍患儿静止脸试验发声行为特征分析
翟梦瑶, 仇娜娜, 唐传高, 翁娇, 章丽丽, 封敏, 肖湘, 肖婷, 郑文明, 柯晓燕
中国当代儿科杂志 ›› 2020, Vol. 22 ›› Issue (4) : 361-367.
PDF(1632 KB)
PDF(1632 KB)
孤独症谱系障碍患儿静止脸试验发声行为特征分析
Characteristics of vocalization in children with autism spectrum disorder during the still-face paradigm
目的 研究孤独症谱系障碍（ASD）患儿2岁前静止脸试验（SFP）发声行为特征及其与确诊时ASD症状严重程度之间的相关性。方法 前瞻性纳入43例7~23月龄可疑ASD患儿（可疑ASD组）及37例正常对照儿童（TD组），测量两组静止脸试验（SFP）下发声行为的时长及频率，随访至2岁，确诊34例ASD（ASD组）。使用孤独症诊断观察量表（ADOS）评估ASD组患儿症状严重程度，分析ASD组患儿2岁前发声行为特征及其与ASD症状严重程度的关系。结果 与TD组相比，ASD组SFP下有意义语言及朝向人发声时长及频率降低，朝向物发声时长增加（均P < 0.05）。Spearman相关分析显示，ASD组总发声、非语言发声、呀呀学语、朝向人发声、朝向物发声时长及频率与ADOS语言和沟通维度呈负相关（均P < 0.05）；总发声、呀呀学语、朝向人发声时长及频率，朝向物发声时长与ADOS相互性社会互动维度呈负相关（均P < 0.05）；总发声频率及呀呀学语时长、朝向人发声时长及频率与ADOS游戏维度呈负相关（均P < 0.05）；总发声及非语言发声频率、朝向人发声时长及频率与ADOS刻板行为和局限兴趣维度呈负相关（均P < 0.05）。多元线性回归分析发现，总发声频率是ADOS语言和沟通维度的负向预测因子（P < 0.001）；朝向人发声时长是ADOS相互性社会互动维度的负向预测因子（P < 0.05）。结论 SFP可以更好地突出ASD患儿2岁前的发声行为异常，且这些异常能够早期预测ASD症状的严重程度。
Objective To study the characteristics of vocalization during the still-face paradigm (SFP) before the age of 2 years and their correlation with the severity of autism spectrum disorder (ASD) symptoms at diagnosis in children with ASD. Methods A total of 43 children aged 7-23 months, who were suspected of ASD, were enrolled as the suspected ASD group, and 37 typical development (TD) children, aged 7-23 months, were enrolled as the TD group. The frequency and durations of vocalization in the SFP were measured. The children in the suspected ASD group were followed up to the age of 2 years, and 34 children were diagnosed with ASD. Autism Diagnostic Observation Schedule (ADOS) was used to assess the severity of symptoms. The correlation of the characteristics of vocalization before the age of 2 years with the severity of ASD symptoms was analyzed. Results Compared with the TD group, the ASD group had significant reductions in the frequency and durations of meaningful vocalization and vocalization towards people and a significant increase in the duration of vocalization toward objects (P < 0.05). The Spearman correlation analysis showed that in the ASD group, the frequency and durations of total vocalization, non-speech vocalization, babbling, vocalization towards people, and vocalization towards objects were negatively correlated with the score of communication in ADOS (P < 0.05). The frequency and durations of total vocalization, babbling, and vocalization towards people and the duration of vocalization towards objects were negatively correlated with the score of reciprocal social interaction in ADOS (P < 0.05). The frequency of total vocalization, the duration of babbling, and the frequency and duration of vocalization towards people were negatively correlated with the score of play in ADOS (P < 0.05). The frequency of total vocalization and non-speech vocalization and the frequency and durations of vocalization towards people were negatively correlated with the score of stereotyped behaviors and restricted interests in ADOS (P < 0.05). The multiple linear regression analysis showed that the frequency of total vocalization was a negative predictive factor for the score of communication in ADOS (P < 0.001), and the duration of vocalization towards people was a negative predictive factor for the score of reciprocal social interaction in ADOS (P < 0.05). Conclusions SFP can better highlight the abnormal vocalization of ASD children before the age of 2 years, and such abnormalities can predict the severity of ASD symptoms early.
Autism spectrum disorder / Still-face paradigm / Vocalization / Child
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国家重点研发计划“重大慢性非传染性疾病防控研究”重点专项《儿童脑发育障碍的早期识别和综合干预》项目（2016 YFC1306205）；江苏省科教强卫工程医学重点人才项目（ZDRCA2016076）。
