小于24个月龄孤独症谱系障碍行为与临床特征分析
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摘要
目的分析小于24个月龄ASD患儿的语言及非语言交流、社会交往缺陷以及重复刻板行为等临床特征,探讨ASD早期诊断可能存在的特异性临床表现。方法对确诊ASD的114例小于24个月龄患儿的病历资料进行回顾分析,并对其年龄分布、性别构成、不同亚型的构成、主要就诊原因及具体临床特征等指标进行统计描述,并分析不同组别之间的ASD患儿早期症状的关注核心和临床行为特征的突出表现。结果小于24个月龄ASD患儿确诊年龄呈偏态分布,50%病例于17~20个月龄获得诊断,主要的就诊原因是无语言(61.4%),但社交障碍仍是ASD早期诊断的核心障碍。在无目光对视、重复刻板的游戏方式、重复刻板的怪异行为合并手部动作这三方面男性患儿的表现比女性患儿更突出;孤独症组出现不听指令、独自玩耍、无互动性较PDD-NOS组更明显(P<0.05)。结论 ASD的早期核心表现仍是社交障碍,但语言落后更易受到关注,无目光注视和重复刻板行为特征在男性患儿中更突出,可能与女性ASD患儿早期漏诊率较高有关。社交障碍的严重程度可协助ASD早期诊断的分型。
Objective To analyze clinical characteristics( language and non-language communication,social interaction impairment,repetitive stereotyped behavior) of children with autism spectrum disorder( ASD) within 24 months,explore the probable and special clinical manifestations during early phase of ASD. Methods The clinical data of 114 children within 24 months diagnosed as ASD definitely was analyzed retrospectively; the distribution of age,sex composition,composition of subtypes,main causes for visiting a doctor,and specific clinical characteristics were described statistically,the core concerns of early symptoms and main manifestations of clinical behavioral characteristics of ASD children were compared among different groups. Results The diagnostic age of ASD children within 24 months showed a skewed distribution,50% of the children were diagnosed definitely during 17- 20 months after birth,the main chief complain was no speech( 61. 4%),but social interaction impairment was still the core disorder of ASD children during early diagnosis. Compared with girls,no eyeto-eye gaze,stereotyped and restricted game mode,stereotyped and restricted queer behaviors and hand movements were more common in boys. Compared with the children in PDD-NOS group,impairment on responding,contacting other kids,and interaction among the children in autism group were more common( P < 0. 05). Conclusion The early and core menifestation of ASD is still social interaction impairment,but language delay attracts more attention; no eye- to- eye gaze,stereotyped and restricted behaviors are more significant in boys,which may be correlated with high missed diagnostic rate of ASD girls during early phase. The severity of communication disorder may help to identify different subtypes of ASD.
Objective To analyze clinical characteristics( language and non-language communication,social interaction impairment,repetitive stereotyped behavior) of children with autism spectrum disorder( ASD) within 24 months,explore the probable and special clinical manifestations during early phase of ASD. Methods The clinical data of 114 children within 24 months diagnosed as ASD definitely was analyzed retrospectively; the distribution of age,sex composition,composition of subtypes,main causes for visiting a doctor,and specific clinical characteristics were described statistically,the core concerns of early symptoms and main manifestations of clinical behavioral characteristics of ASD children were compared among different groups. Results The diagnostic age of ASD children within 24 months showed a skewed distribution,50% of the children were diagnosed definitely during 17- 20 months after birth,the main chief complain was no speech( 61. 4%),but social interaction impairment was still the core disorder of ASD children during early diagnosis. Compared with girls,no eyeto-eye gaze,stereotyped and restricted game mode,stereotyped and restricted queer behaviors and hand movements were more common in boys. Compared with the children in PDD-NOS group,impairment on responding,contacting other kids,and interaction among the children in autism group were more common( P < 0. 05). Conclusion The early and core menifestation of ASD is still social interaction impairment,but language delay attracts more attention; no eye- to- eye gaze,stereotyped and restricted behaviors are more significant in boys,which may be correlated with high missed diagnostic rate of ASD girls during early phase. The severity of communication disorder may help to identify different subtypes of ASD.
引文
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[3]Lord C,Bishop SL.The autism spectrum:definitions,assessment and diagnoses[J].Br J Hosp Med(Lond),2009,70(3):132-135.
[4]Redcay E.The superior temporal sulcus performs a common function for social and speech perception:implications for the emergence of autism[J].Neurosci Biobehav Rev,2008,32(1):123-142.
[5]Baron-Cohen S.Empathizing,systemizing,and the extreme male brain theory of autism[J].Prog Brain Res,2010,48(186):167-175.
[6]Bennetto L,Pennington BF,Rogers SJ.Intact and impaired memory functions in autism[J].Child Dev,1996,67(4):1816-1835.
[7]邹小兵.孤独症谱系障碍的研究进展[J].临床儿科杂志,2010(8):715-717.
[8]Cantor RM,Yoon JL,Furr J,et al.Paternal age and autism are associated in a family-based sample[J].Mol Psychiatry,2007,12(5):419-421.
[9]Losh M,Childress D,Lam K,et al.Defining key features of the broad autism phenotype:a comparison across parents of multiple-and single-incidence autism families[J].Am J Med Genet B Neuropsychiatr Genet,2008,147B(4):424-433.