目的 探讨学龄前发育性语言障碍(developmental language disorder, DLD)儿童听处理 (auditory processing, AP)、工作记忆与语言功能的关联,分析工作记忆的中介作用。 方法 采用前瞻性横断面设计,选取42例DLD儿童(设为DLD组)及45例正常儿童(设为正常对照组)为研究对象,采用梦想普通话听力理解和表达能力标准化评估(Diagnostic Receptive and Expressive Assessment of Mandarin‑Comprehensive, DREAM‑C)、学龄前儿童听处理评估量表(Preschool Auditory Processing Assessment Scale, PAPAS)、韦氏智力量表第4版及Conners父母用症状问卷(Conners Parent Symptom Questionnaire, PSQ)对所有儿童进行评估,分析量表间相关性,并分析听觉解码、工作记忆与整体语言的关系及工作记忆的中介效应。 结果 DLD组PAPAS各维度得分及AP异常风险比例高于正常对照组(P0.001)。所有儿童DREAM‑C各维度得分与PAPAS各维度得分呈负相关(P0.05)。DLD组工作记忆得分与PAPAS总分、听觉解码、听觉注意、沟通交流维度得分呈负相关(P0.05);PSQ品行问题、学习问题和多动指数得分与PAPAS总分、听觉解码、听觉注意、沟通交流、多动-冲动维度得分呈正相关(P0.05),冲动-多动得分与PAPAS总分、听觉注意、多动冲动维度得分呈正相关(P0.05),焦虑得分仅与沟通交流维度得分呈正相关(P0.05)。控制混杂因素后,听觉解码得分(b'=-0.431,P=0.009)、工作记忆得分(b'=0.437,P0.001)与DREAM‑C整体语言维度得分独立相关。工作记忆在听觉解码与整体语言间起部分中介作用,效应占比40%。 结论 学龄前DLD儿童AP与语言、认知及行为问题密切相关;听觉解码不仅直接影响语言功能,还通过工作记忆发挥间接效应。PAPAS可作为简便筛查工具在临床中推广应用。
Objective To investigate associations among auditory processing (AP), working memory, and language function in preschool children with developmental language disorder (DLD), and to analyze the mediating role of working memory. Methods A prospective cross-sectional design was adopted. Forty-two children with DLD (DLD group) and 45 typically developing children (normal control group) were enrolled. The Diagnostic Receptive and Expressive Assessment of Mandarin-Comprehensive (DREAM-C), Preschool Auditory Processing Assessment Scale (PAPAS), Wechsler Intelligence Scales (Fourth Edition), and Conners Parent Symptom Questionnaire (PSQ) were used for evaluation. Correlations among scales were analyzed. The relationships among auditory decoding, working memory, and overall language function, as well as the mediating effect of working memory, were examined. Results Scores on all PAPAS dimensions and the proportion of children at risk for AP abnormalities were significantly higher in the DLD group than in the control group (P0.001). In all children, DREAM-C dimension scores were negatively correlated with PAPAS dimension scores (P0.05). In the DLD group, working memory was negatively correlated with total PAPAS score and scores for auditory decoding, auditory attention, and communication (P0.05). PSQ scores for conduct problems, learning problems, and hyperactivity index were positively correlated with total PAPAS score and scores for auditory decoding, auditory attention, communication, and hyperactivity-impulsivity (P0.05). The impulsivity-hyperactivity score was positively correlated with total PAPAS score and scores for auditory attention and hyperactivity-impulsivity (P0.05). The anxiety score was positively correlated only with the communication score (P0.05). After controlling for confounders, the auditory decoding score (b'=-0.431, P=0.009) and the working memory score (b'=0.437, P0.001) were independently associated with the DREAM-C overall language score. Working memory partially mediated the association between auditory decoding and overall language ability, accounting for 40% of the total effect. Conclusions Auditory processing in preschool children with DLD is closely associated with language, cognitive, and behavioral problems. Auditory decoding directly affects language function and indirectly influences it through working memory. PAPAS may serve as a convenient screening tool for clinical use.