高功能孤独症青少年健康相关危险行为分析
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摘要
目的探讨高功能孤独症青少年健康相关危险行为特点。方法 2017年4月至11月北京大学第六医院门诊或病房诊治的高功能孤独症患儿50例,均符合《美国精神障碍诊断与统计手册》第4版(DSM-Ⅳ)孤独症诊断标准,年龄12～18岁,智商均≥70分。选取同性别、年龄相匹配的正常青少年50名作为对照组。两组均完成青少年健康相关危险行为问卷(AHRBI)评定,同时由孤独症组家长完成青少年健康相关危险行为问卷父母版的评定。结果高功能孤独症组AHRBI自评问卷总分与自杀自伤行为、健康妥协行为、攻击与暴力行为及破坏纪律行为4项因子评分均高于正常对照组(P均<0.05)。在所有条目中,高功能孤独症组伤害自己行为分项目评分高于正常对照组(Z=-2.646,P<0.05)。高功能孤独症组健康妥协行为总分、自杀自伤行为总分以及不喝牛奶或豆浆行为、因节食而出现躯体不适、斗殴、随身携带武器、饮酒作乐或喝醉酒条目自评分均高于家长评定结果(Z=-2.921、-2.268、-2.497、-2.208、-2.000、-2.236、-2.064,P<0.05)。结论高功能孤独症青少年存在较多健康相关危险行为,除吸烟、饮酒和无保护性行为较少外,其他健康相关危险行为均多于正常青少年。
Objective To investigate the characteristics of health-related risky behaviors in adolescents with High Functioning Autism(HFA). Methods Fifty adolescents aged 12-18 years,IQ≥70 and meeting the criteria of autistic disorder in Diagnostic and Statistical Manual of MentalD isorders,Fourth Edition(DSM-Ⅳ)and 50 age-and gender-matched healthy controls were recruited. The health-related risky behaviors of all subjects were assessed with the Adolescents Health-related Risky Behavior Inventory(AHRBI). The parents of autistic subjects completed the Adolescents Health-related Risky Behavior Inventory for Paren(tAHRBI-P). Results HFA group had higher total scale score and four subscales' scores of AHRBI than controls,including Suicide and Self-Injury(SS),Health-Compromising Behavior(HCB),Aggression and Violence(AV)and Rule Breaking(RB)[e.g. Total Scores,49.5(39,81)vs. 47(38,60),P<0.05;SS scores,7(5,18)vs. 5(5,12),P<0.05]. HFA group had higher scores in the items of "Bully/Threaten/Intimidate partner", "Deliberately pushing and shoving others", "Do not drink milk/soy milk", "Do not participate in any form of physical activity", "Skip Class/Play truant", "Run away from home", "Bite/Scratch/Bump to hurt oneself" than controls[e.g. the scores of the item "Bully/Threaten/Intimidate partner",1(1,5)vs. 1(1,3),P<0.05]. Among all the subscales and items,the scores of HCB,SS, "Do not drink milk/soy milk", "Physical discomfort due to dieting", "Fighting and Arms-taking" and "Drinking" of selfassessment in HFA group were higher than those of parents' assessment[e.g. HCB scores,8(8,18)vs. 7(5,13),P<0.05]. Conclusion The adolescents with HFA have more health-related risky behaviors than the healthy adolescents except for Smoking and Drinking(SD)and Unprotected Sex(US).
Objective To investigate the characteristics of health-related risky behaviors in adolescents with High Functioning Autism(HFA). Methods Fifty adolescents aged 12-18 years,IQ≥70 and meeting the criteria of autistic disorder in Diagnostic and Statistical Manual of MentalD isorders,Fourth Edition(DSM-Ⅳ)and 50 age-and gender-matched healthy controls were recruited. The health-related risky behaviors of all subjects were assessed with the Adolescents Health-related Risky Behavior Inventory(AHRBI). The parents of autistic subjects completed the Adolescents Health-related Risky Behavior Inventory for Paren(tAHRBI-P). Results HFA group had higher total scale score and four subscales' scores of AHRBI than controls,including Suicide and Self-Injury(SS),Health-Compromising Behavior(HCB),Aggression and Violence(AV)and Rule Breaking(RB)[e.g. Total Scores,49.5(39,81)vs. 47(38,60),P<0.05;SS scores,7(5,18)vs. 5(5,12),P<0.05]. HFA group had higher scores in the items of "Bully/Threaten/Intimidate partner", "Deliberately pushing and shoving others", "Do not drink milk/soy milk", "Do not participate in any form of physical activity", "Skip Class/Play truant", "Run away from home", "Bite/Scratch/Bump to hurt oneself" than controls[e.g. the scores of the item "Bully/Threaten/Intimidate partner",1(1,5)vs. 1(1,3),P<0.05]. Among all the subscales and items,the scores of HCB,SS, "Do not drink milk/soy milk", "Physical discomfort due to dieting", "Fighting and Arms-taking" and "Drinking" of selfassessment in HFA group were higher than those of parents' assessment[e.g. HCB scores,8(8,18)vs. 7(5,13),P<0.05]. Conclusion The adolescents with HFA have more health-related risky behaviors than the healthy adolescents except for Smoking and Drinking(SD)and Unprotected Sex(US).
引文
[1]邹小兵,邓红珠.美国精神疾病诊断分类手册第5版“孤独症谱系障碍诊断标准”解读[J].中国实用儿科杂志,2013,28(8):561-563.
[2]季成叶.青少年健康危险行为[J].中国学校卫生,2007,28(4):289-291.
[3]王孟成,蚁金瑶,蔡琳,等.青少年健康相关危险行为问卷的编制及信效度检验[J].中国心理卫生杂志,2012,26(4):287-292.
[4]王建华.流行病学[M].7.北京:人民卫生出版社,2008:64.
[5]APA.American Psychiatric Assotiation.Diagnostic and Statistical Manual of Manual Disorders(DSM-Ⅳ)[M].Washingtom,DC:American Psychiatric Association,1994:44.
[6]龚耀先,蔡太生.中国修订韦氏儿童智力量表[J].中国临床心理学杂志,1994,2(1):1-6.
[7]龚耀生.中国修订韦氏成人智力量表手册[M].长沙:湖南地图出版社,1992:20.
[8]王慧,周娱菁,刘靖,等.青少年精神分裂症患者的健康相关危险行为[J].中国心理卫生杂志,2016,30(5):363-368.
[9]田野,李雪,刘靖,等.双相障碍青少年的健康相关危险行为[J].中国心理卫生杂志,2015,(4):267-272.
[10]张晓丽,齐军慧,刘靖,等.神经性厌食少年的健康相关危险行为[J].中国心理卫生杂志,2013,27(6):435-439.
[11]Paul AR,Mckechanie AG,Johnstone EC,et al.Brief report:the association of autistic traits and behavioural patterns in adolescents receiving special educational assistance[J].J Autism Dev Disord,2015,45(9):3055-3060.
[12]Samson AC,Phillips JM,Parker KJ,et al.Emotion dysregulation and the core features of autism spectrum disorder[J].JAutism Dev Disord,2014,44(7):1766-1772.
[13]Beighley JS,Matson JL,Rieske RD,et al.Food selectivity in children with and without an autism spectrum disorder:investigation of diagnosis and age[J].Res Dev Disabil,2013,34(10):3497-3503.
[14]Stanish HI,Curtin C,Must A,et al.Physical activity levels,frequency,and type among adolescents with and without autism spectrum disorder[J].J Autism Dev Disord,2017,47(3):785-794.
[15]Kiely B,Migdal TR,Vettam S,et al.Prevalence and correlates of elopement in a nationally representative sample of children with developmental disabilities in the United States[J].PLoSOne,2016,11(2):e0148337.
[16]Rattaz C,Michelon C,Baghdadli A.Symptom severity as a risk factor for self-injurious behaviours in adolescents with autism spectrum disorders[J].J Intellect Disabil Res,2015,59(8):730-740.
[17]McElhanon BO,McCracken C,Karpen S,et al.Gastrointestinal symptoms in autism spectrum disorder:a meta-analysis[J].Pediatrics,2014,133(5):872-883.
[18]Volkmar F,Siegel M,Woodbury-Smith M,et al.Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder[J].J Am Acad Child Adolesc Psychiatry,2014,53(2):237-257.
[19]Suarez MA,Atchison BJ,Lagerwey M.Phenomenological examination of the mealtime experience for mothers of children with autism and food selectivity[J].Am J Occup Ther,2014,68(1):102-107.
[20]Memari AH,Ghaheri B,Ziaee V,et al.Physical activity in children and adolescents with autism assessed by triaxial accelerometry[J].Pediatr Obes,2013,8(2):150-158.
[21]Gowen E,Stanley J,Miall RC.Movement interference in autism-spectrum disorder[J].Neuropsychologia,2008,46(4):1060-1068.
[22]Anderson C,Law JK,Daniels A,et al.Occurrence and family impact of elopement in children with autism spectrum disorders[J].Pediatrics,2012,130(5):870-877.
[23]都萌萌,康传媛,李雪蓉,等.广泛性发育障碍儿童异常行为的发生率[J].中华行为医学与脑科学杂志,2015,24(11):1020-1022.
[24]Duerden EG,Oatley HK,Mak-Fan KM,et al.Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders[J].J Autism Dev Disord,2012,42(11):2460-2470.
[25]Storch EA,Sulkowski ML,Nadeau J,et al.The phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with autism spectrum disorders[J].J Autism Dev Disord,2013,43(10):2450-2459.
[26]Mangerud WL,Bjerkeset O,Holmen TL,et al.Smoking,alcohol consumption,and drug use among adolescents with psychiatric disorders compared with a population based sample[J].JAdolesc,2014,37(7):1189-1199.
[27]Sizoo B,van den Brink W,Gorissen van Eenige M,et al.Personality characteristics of adults with autism spectrum disorders or attention deficit hyperactivity disorder with and without substance use disorders[J].J Nerv Ment Dis,2009,197(6):450-454.
[28]Dewinter J,Vermeiren R,Vanwesenbeeck I,et al.Sexuality in adolescent boys with autism spectrum disorder:self-reported behaviours and attitudes[J].J Autism Dev Disord,2015,45(3):731-741.
[29]麻宏伟,李琳.儿童发育障碍相关疾病的病因鉴别和诊断[J].中国实用儿科杂志,2016,31(10):751-756.
[30]刘靖,李雪.儿童癫痫共患孤独症[J].中国实用儿科杂志,2017,32(4):252-256.
[2]季成叶.青少年健康危险行为[J].中国学校卫生,2007,28(4):289-291.
[3]王孟成,蚁金瑶,蔡琳,等.青少年健康相关危险行为问卷的编制及信效度检验[J].中国心理卫生杂志,2012,26(4):287-292.
[4]王建华.流行病学[M].7.北京:人民卫生出版社,2008:64.
[5]APA.American Psychiatric Assotiation.Diagnostic and Statistical Manual of Manual Disorders(DSM-Ⅳ)[M].Washingtom,DC:American Psychiatric Association,1994:44.
[6]龚耀先,蔡太生.中国修订韦氏儿童智力量表[J].中国临床心理学杂志,1994,2(1):1-6.
[7]龚耀生.中国修订韦氏成人智力量表手册[M].长沙:湖南地图出版社,1992:20.
[8]王慧,周娱菁,刘靖,等.青少年精神分裂症患者的健康相关危险行为[J].中国心理卫生杂志,2016,30(5):363-368.
[9]田野,李雪,刘靖,等.双相障碍青少年的健康相关危险行为[J].中国心理卫生杂志,2015,(4):267-272.
[10]张晓丽,齐军慧,刘靖,等.神经性厌食少年的健康相关危险行为[J].中国心理卫生杂志,2013,27(6):435-439.
[11]Paul AR,Mckechanie AG,Johnstone EC,et al.Brief report:the association of autistic traits and behavioural patterns in adolescents receiving special educational assistance[J].J Autism Dev Disord,2015,45(9):3055-3060.
[12]Samson AC,Phillips JM,Parker KJ,et al.Emotion dysregulation and the core features of autism spectrum disorder[J].JAutism Dev Disord,2014,44(7):1766-1772.
[13]Beighley JS,Matson JL,Rieske RD,et al.Food selectivity in children with and without an autism spectrum disorder:investigation of diagnosis and age[J].Res Dev Disabil,2013,34(10):3497-3503.
[14]Stanish HI,Curtin C,Must A,et al.Physical activity levels,frequency,and type among adolescents with and without autism spectrum disorder[J].J Autism Dev Disord,2017,47(3):785-794.
[15]Kiely B,Migdal TR,Vettam S,et al.Prevalence and correlates of elopement in a nationally representative sample of children with developmental disabilities in the United States[J].PLoSOne,2016,11(2):e0148337.
[16]Rattaz C,Michelon C,Baghdadli A.Symptom severity as a risk factor for self-injurious behaviours in adolescents with autism spectrum disorders[J].J Intellect Disabil Res,2015,59(8):730-740.
[17]McElhanon BO,McCracken C,Karpen S,et al.Gastrointestinal symptoms in autism spectrum disorder:a meta-analysis[J].Pediatrics,2014,133(5):872-883.
[18]Volkmar F,Siegel M,Woodbury-Smith M,et al.Practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder[J].J Am Acad Child Adolesc Psychiatry,2014,53(2):237-257.
[19]Suarez MA,Atchison BJ,Lagerwey M.Phenomenological examination of the mealtime experience for mothers of children with autism and food selectivity[J].Am J Occup Ther,2014,68(1):102-107.
[20]Memari AH,Ghaheri B,Ziaee V,et al.Physical activity in children and adolescents with autism assessed by triaxial accelerometry[J].Pediatr Obes,2013,8(2):150-158.
[21]Gowen E,Stanley J,Miall RC.Movement interference in autism-spectrum disorder[J].Neuropsychologia,2008,46(4):1060-1068.
[22]Anderson C,Law JK,Daniels A,et al.Occurrence and family impact of elopement in children with autism spectrum disorders[J].Pediatrics,2012,130(5):870-877.
[23]都萌萌,康传媛,李雪蓉,等.广泛性发育障碍儿童异常行为的发生率[J].中华行为医学与脑科学杂志,2015,24(11):1020-1022.
[24]Duerden EG,Oatley HK,Mak-Fan KM,et al.Risk factors associated with self-injurious behaviors in children and adolescents with autism spectrum disorders[J].J Autism Dev Disord,2012,42(11):2460-2470.
[25]Storch EA,Sulkowski ML,Nadeau J,et al.The phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with autism spectrum disorders[J].J Autism Dev Disord,2013,43(10):2450-2459.
[26]Mangerud WL,Bjerkeset O,Holmen TL,et al.Smoking,alcohol consumption,and drug use among adolescents with psychiatric disorders compared with a population based sample[J].JAdolesc,2014,37(7):1189-1199.
[27]Sizoo B,van den Brink W,Gorissen van Eenige M,et al.Personality characteristics of adults with autism spectrum disorders or attention deficit hyperactivity disorder with and without substance use disorders[J].J Nerv Ment Dis,2009,197(6):450-454.
[28]Dewinter J,Vermeiren R,Vanwesenbeeck I,et al.Sexuality in adolescent boys with autism spectrum disorder:self-reported behaviours and attitudes[J].J Autism Dev Disord,2015,45(3):731-741.
[29]麻宏伟,李琳.儿童发育障碍相关疾病的病因鉴别和诊断[J].中国实用儿科杂志,2016,31(10):751-756.
[30]刘靖,李雪.儿童癫痫共患孤独症[J].中国实用儿科杂志,2017,32(4):252-256.