高功能孤独症患儿刻板重复行为与认知灵活性和抑制控制能力的关系研究
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摘要
背景刻板重复行为是孤独症患儿核心症状之一,与孤独症患儿的康复治疗和预后密切相关。国外研究发现认知灵活性和抑制控制能力可能与刻板重复行为的严重程度有关,而国内相关研究报道较少。积极探讨刻板重复行为的发生机制对研究更为有效的孤独症治疗干预方法,从而改善孤独症患儿的预后具有重要意义。目的探讨高功能孤独症(HFA)患儿刻板重复行为与认知灵活性和抑制控制能力之间的关系。方法选取2014年10月—2016年10月于北京大学第六医院门诊就诊的HFA患儿46例为研究对象,对所有被试进行认知灵活性(连线测验)、抑制控制能力(Stroop色词命名测验)检查,同时进行HFA谱系障碍筛查问卷(ASSQ)和异常行为量表(ABC)评定,分别对ASSQ局限性和重复行为因子和ABC刻板行为因子得分与连线测验和Stroop色词命名测验结果进行Spearman秩相关分析与多重线性回归分析。结果 Spearman秩相关分析显示,ASSQ条目9得分与B测验数字字母连线错误数呈正相关(P<0.05);ASSQ条目10得分与(3试)色字命字时间呈负相关(P<0.05);ASSQ条目18得分与B测验数字字母连线时间、B测验完成时间-A测验完成时间、(2试)色块命色时间、(3试)色字命字时间、(4试)色字命色错误数、颜色干扰时间呈正相关(P<0.05);ASSQ条目22得分与B测验数字字母连线错误数、(3试)色字命字错误数呈正相关(P<0.05);ASSQ条目23得分与(1试)汉字阅读时间、(2试)色块命色时间、(4试)色字命色时间、字义干扰时间呈负相关(P<0.05)。ABC条目17得分与B测验数字字母连线错误数呈正相关(P<0.05);ABC条目27得分与(1试)汉字阅读错误数、(3试)色字命字错误数呈正相关(P<0.05);ABC条目49得分与(1试)汉字阅读错误数、颜色干扰时间呈正相关(P<0.05);ABC刻板行为因子得分与B测验数字字母连线时间、B测验数字字母连线错误数、B测验完成时间-A测验完成时间呈正相关(P<0.05)。多重线性回归分析结果显示,连线测验中B测验数字字母连线错误数与ASSQ局限性和重复行为因子得分有回归关系(β=0.302,β'=0.397,t=2.330,P=0.027);Stroop色词命名测验中颜色干扰时间与ABC刻板行为因子得分有回归关系(β=0.162,β'=0.366,t=2.152,P=0.040)。结论 HFA患儿刻板重复行为与认知灵活性和抑制控制能力相关。认知灵活性越差,刻板重复行为越严重;抑制控制能力与刻板重复行为间存在复杂而矛盾的关系。
Background The repetitive and stereotyped behavior(RSB),one of the core symptoms of autism,is closely associated with the response to rehabilitation therapy and prognosis in children with autism.Foreign studies have found that cognitive flexibility and inhibitory control ability may be correlated with the severity of RSB,while related studies in China are very few.To improve the prognosis of children with autism,it is of great significance to explore highly effective interventions for autism on the basis of active discussion of the pathogenesis of RSB.Objective To investigate the relationship of RSB with cognitive flexibility and inhibitory control ability in children with high-functioning autism(HFA).Methods 46 outpatient pediatric patients with HFA(IQ ≥ 70) aged 6-17 years were recruited during October 2014 to October 2016 from Peking University Sixth Hospital.The Trail-Making Test(TMT) and Stroop color-word test were used to assess cognitive flexibility and inhibitory control ability,respectively.The high-functioning Autism Spectrum Screening Questionnaire(ASSQ) was adopted to identify HFA.Aberrant Behavior Checklist(ABC) was employed to assess the autistic behaviors.Spearman correlation and multiple linear regression analyses were performed to examine the correlation between results of ASSQ restricted and repetitive behavior subscale/ABC stereotypic behavior subscale and TMT/Stroop test.Results Spearman correlation analysis found that the score of item 9 in ASSQ was positively correlated with the number of errors made in connecting the numbers and letters in part B of TMT(P<0.05).The score of ASSQ item 10 was negatively correlated with the time used for naming the color of the words in experiment 3(P<0.05).The score of ASSQ item 18 was positively correlated with the time used for connecting numbers and letters in part B of TMT,the difference between the time used for completing part A and that for part B in TMT,time used for naming the color of the patches in experiment 2,time used for naming the color of the words in experiment 3,number of errors in naming the color of the words in experiment 4,and color interference time in performing the Stroop test(P<0.05).The score of item 22 of ASSQ was positively correlated with the number of number-letter connection errors in part B of TMT and the number of errors made in naming the color of the words in experiment 3 during performing the Stroop test(P<0.05).The score of ASSQ item 23 was negatively correlated with the time used for reading the written color names of the words in experiments 1,time used for naming the color of the patches in experiment 2,time used for naming the color of the words in experiment 4,and the semantic interference time(P<0.05).The score of ABC item 17 was positively correlated with the number of numberletter connection errors in completing part B of TMT(P<0.05).The score of ABC item 27 was positively correlated with the number of errors in reading the written color names of the words in experiment 1 and in naming the color of the words in experiment 3 during performing the Stroop test(P<0.05).The score of ABC item 49 was positively correlated with the number of errors in reading the written color names of the words in experiment 1 and the time of color interference of the Stroop test(P<0.05).The stereotypic behavior subscale score of ABC was positively correlated with the time used for connecting the numbers and letters in part B of TMT and the number of errors during the process,and the difference between the time used for completing part A and that for part B in TMT(P<0.05).Multiple linear regression analysis showed that the number of errors in completing part B of TMT was associated with the score of ASSQ restricted and repetitive behavior subscale(β=0.302,β'=0.397,t=2.330,P=0.027).The color interference time during the Stroop test was associated with the score of ABC stereotypic behavior subscale(β=0.162,β'=0.366,t=2.152,P=0.040).Conclusion RSB is associated with cognitive flexibility and inhibitory control ability in children with HFA.The worse the cognitive flexibility is,the more severe RSB becomes.But the relationship between inhibitory control ability and RSB is complex and contradictory.
Background The repetitive and stereotyped behavior(RSB),one of the core symptoms of autism,is closely associated with the response to rehabilitation therapy and prognosis in children with autism.Foreign studies have found that cognitive flexibility and inhibitory control ability may be correlated with the severity of RSB,while related studies in China are very few.To improve the prognosis of children with autism,it is of great significance to explore highly effective interventions for autism on the basis of active discussion of the pathogenesis of RSB.Objective To investigate the relationship of RSB with cognitive flexibility and inhibitory control ability in children with high-functioning autism(HFA).Methods 46 outpatient pediatric patients with HFA(IQ ≥ 70) aged 6-17 years were recruited during October 2014 to October 2016 from Peking University Sixth Hospital.The Trail-Making Test(TMT) and Stroop color-word test were used to assess cognitive flexibility and inhibitory control ability,respectively.The high-functioning Autism Spectrum Screening Questionnaire(ASSQ) was adopted to identify HFA.Aberrant Behavior Checklist(ABC) was employed to assess the autistic behaviors.Spearman correlation and multiple linear regression analyses were performed to examine the correlation between results of ASSQ restricted and repetitive behavior subscale/ABC stereotypic behavior subscale and TMT/Stroop test.Results Spearman correlation analysis found that the score of item 9 in ASSQ was positively correlated with the number of errors made in connecting the numbers and letters in part B of TMT(P<0.05).The score of ASSQ item 10 was negatively correlated with the time used for naming the color of the words in experiment 3(P<0.05).The score of ASSQ item 18 was positively correlated with the time used for connecting numbers and letters in part B of TMT,the difference between the time used for completing part A and that for part B in TMT,time used for naming the color of the patches in experiment 2,time used for naming the color of the words in experiment 3,number of errors in naming the color of the words in experiment 4,and color interference time in performing the Stroop test(P<0.05).The score of item 22 of ASSQ was positively correlated with the number of number-letter connection errors in part B of TMT and the number of errors made in naming the color of the words in experiment 3 during performing the Stroop test(P<0.05).The score of ASSQ item 23 was negatively correlated with the time used for reading the written color names of the words in experiments 1,time used for naming the color of the patches in experiment 2,time used for naming the color of the words in experiment 4,and the semantic interference time(P<0.05).The score of ABC item 17 was positively correlated with the number of numberletter connection errors in completing part B of TMT(P<0.05).The score of ABC item 27 was positively correlated with the number of errors in reading the written color names of the words in experiment 1 and in naming the color of the words in experiment 3 during performing the Stroop test(P<0.05).The score of ABC item 49 was positively correlated with the number of errors in reading the written color names of the words in experiment 1 and the time of color interference of the Stroop test(P<0.05).The stereotypic behavior subscale score of ABC was positively correlated with the time used for connecting the numbers and letters in part B of TMT and the number of errors during the process,and the difference between the time used for completing part A and that for part B in TMT(P<0.05).Multiple linear regression analysis showed that the number of errors in completing part B of TMT was associated with the score of ASSQ restricted and repetitive behavior subscale(β=0.302,β'=0.397,t=2.330,P=0.027).The color interference time during the Stroop test was associated with the score of ABC stereotypic behavior subscale(β=0.162,β'=0.366,t=2.152,P=0.040).Conclusion RSB is associated with cognitive flexibility and inhibitory control ability in children with HFA.The worse the cognitive flexibility is,the more severe RSB becomes.But the relationship between inhibitory control ability and RSB is complex and contradictory.
引文
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[14]闫俊,王玉凤,崔玉华.强迫性障碍患者的执行功能研究[J].中国心理卫生杂志,2007,21(7):492-495.DOI:10.3321/j.issn:1000-6729.2007.07.020.YAN J,WANG Y F,CUI Y H.Executive function in obsessivecompulsive disorder[J].Chinese Mental Health Journal,2007,21(7):492-495.DOI:10.3321/j.issn:1000-6729.2007.07.020.
[15]EHLERS S,GILLBERG C,WING L.A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children[J].J Autism Dev Disord,1999,29(2):129-141.
[16]GUO Y Q,TANG Y,RICE C,et al.Validation of the Autism Spectrum Screening Questionnaire,Mandarin Chinese Version(CH-ASSQ)in Beijing,China[J].Autism,2011,15(6):713-727.DOI:10.1177/1362361310396383.
[17]AMAN M G,SINGH N N,STEWART A W,et al.The aberrant behavior checklist:a behavior rating scale for the assessment of treatment effects[J].Am J Ment Defic,1985,89(5):485-491.DOI:10.1177/0013164485454034.
[18]马俊红,郭延庆,贾美香,等.异常行为量表中文版在儿童孤独症群体中的信效度[J].中国心理卫生杂志,2011,25(1):14-19.DOI:10.3969/j.issn.1000-6729.2011.01.004.
[19]MILLER H L,RAGOZZINO M E,COOK E H,et al.Cognitive set shifting deficits and their relationship to repetitive behaviors in autism spectrum disorder[J].J Autism Dev Disord,2015,45(3):805-815.DOI:10.1007/s10803-014-2244-1.
[20]D'CRUZ A M,RAGOZZINO M E,MOSCONI M W,et al.Reduced behavioral flexibility in autism spectrum disorders[J].Neuropsychology,2013,27(2):152-160.DOI:10.1037/a0031721.
[21]YERYS B E,ANTEZANA L,WEINBLATT R,et al.Neural correlates of set-shifting in children with autism[J].Autism Res,2015,8(4):386-397.DOI:10.1002/aur.1454.
[22]SHAFRITZ K M,DICHTER G S,BARANEK G T,et al.The neural circuitry mediating shifts in behavioral response and cognitive set in autism[J].Biol Psychiatry,2008,63(10):974-980.DOI:10.1016/j.biopsych.2007.06.028.
[23]MOSCONI M W,KAY M,D'CRUZ A M,et al.Impaired inhibitory control is associated with higher-order repetitive behaviors in autism spectrum disorders[J].Psychol Med,2009,39(9):1559-1566.DOI:10.1017/S0033291708004984.
[24]TAYLORSF,STERNER,GEHRINGWJ.Neural systems for error monitoring:recent findings and theoretical perspectives[J].Neuroscientist,2007,13(2):160-172.DOI:10.1177/1073858406298184.
[25]EVERLING S,DORRIS M C,KLEIN R M,et al.Role of primate superior colliculus in preparation and execution of anti-saccades and pro-saccades[J].J Neurosci,1999,19(7):2740-2754.
[26]THAKKAR K N,POLLI F E,JOSEPH R M,et al.Response monitoring,repetitive behaviour and anterior cingulate abnormalities in autism spectrum disorders(ASD)[J].Brain,2008,131(Pt9):2464-2478.DOI:10.1093/brain/awn099.
[27]ADAMS N C,JARROLD C.Inhibition and the validity of the stroop task for children with autism[J].J Autism Dev Disord,2009,39(8):1112-1121.DOI:10.1007/s10803-009-0721-8.
[28]WOLFF S.Autism:explaining the enigma[J].J Child Psychol Psychiatry,2004,45(1):172-173.DOI:10.1111/j.1469-7610.2004.t01-3-00211.x
[29]张秋月,李艳玮,王凤梅,等.孤独症谱系障碍儿童执行功能干预研究[J].广西医学,2015,37(5):623-625.DOI:10.11675/j.issn.0253-4304.2015.05.12.ZHANGQY,LIYW,WANGFM,etal.Studyof executive function intervention on children with autism spectrum disorder[J].Guangxi Medical Journal,2015,37(5):623-625.DOI:10.11675/j.issn.0253-4304.2015.05.12.
[2]NADIG A,LEE I,SINGH L,et al.How does the topic of conversation affect verbal exchange and eye gaze? A comparison between typical development and high-functioning autism[J].Neuropsychologia,2010,48(9):2730-2739.DOI:10.1016/j.neuropsychologia.2010.05.020.
[3]SOUTH M,OZONOFF S,MCMAHON W M.Repetitive behavior profiles in Asperger syndrome and high-functioning autism[J].J Autism Dev Disord,2005,35(2):145-158.
[4]LOPEZ B R,LINCOLN A J,OZONOFF S,et al.Examining the relationship between executive functions and restricted,repetitive symptoms of autistic disorder[J].J Autism Dev Disord,2005,35(4):445-460.DOI:10.1007/s10803-005-5035-x.
[5]KESTER L E.Relationship between repetitive behaviors and executive function in high functioning children with autism[D].Columbia:University of Missouri-Columbia,2011.
[6]SOUTH M,OZONOFF S,MCMAHON W M.The relationship between executive functioning,central coherence,and repetitive behaviors in the high-functioning autism spectrum[J].Autism,2007,11(5):437-451.DOI:10.1177/1362361307079606.
[7]李美华,白学军.执行功能中认知灵活性发展的研究进展[J].心理学探新,2005,25(2):35-38,43.DOI:10.3969/j.issn.1003-5184.2005.02.008.
[8]苏艳丽,柯晓燕.孤独症抑制功能的研究进展[J].国际精神病学杂志,2011,38(3):150-153.
[9]SEGAL D L.Diagnostic and statistical manual of mental disorders(DSM-Ⅳ-TR)[M].Washington DC:American Psychiatric Association,2000.
[10]KAUFMAN J,BIRMAHER B,BRENT D,et al.Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version(K-SADS-PL):initial reliability and validity data[J].J Am Acad Child Adolesc Psychiatry,1997,36(7):980-988.DOI:10.1097/00004583-199707000-00021.
[11]龚耀先,蔡太生,周世杰,等.韦氏儿童智力量表在中国的修订及应用[J].医学研究通讯,1999,28(2):14-15.
[12]杜芸芸.双任务情境下孤独症儿童执行功能研究[D].银川:宁夏医科大学,2017.
[13]齐军慧,刘靖,李雪,等.孤独症儿童社会交往能力发展与执行功能和心理推理能力的关系[J].中国心理卫生杂志,2017,31(3):219-224.DOI:10.3969/j.issn.1000-6729.2017.03.008.QI J H,LIU J,LI X,et al.Relationship between development of social skill and executive function and theory of mind in children and adolescents with autism[J].Chinese Mental Health Journal,2017,31(3):219-224.DOI:10.3969/j.issn.1000-6729.2017.03.008.
[14]闫俊,王玉凤,崔玉华.强迫性障碍患者的执行功能研究[J].中国心理卫生杂志,2007,21(7):492-495.DOI:10.3321/j.issn:1000-6729.2007.07.020.YAN J,WANG Y F,CUI Y H.Executive function in obsessivecompulsive disorder[J].Chinese Mental Health Journal,2007,21(7):492-495.DOI:10.3321/j.issn:1000-6729.2007.07.020.
[15]EHLERS S,GILLBERG C,WING L.A screening questionnaire for Asperger syndrome and other high-functioning autism spectrum disorders in school age children[J].J Autism Dev Disord,1999,29(2):129-141.
[16]GUO Y Q,TANG Y,RICE C,et al.Validation of the Autism Spectrum Screening Questionnaire,Mandarin Chinese Version(CH-ASSQ)in Beijing,China[J].Autism,2011,15(6):713-727.DOI:10.1177/1362361310396383.
[17]AMAN M G,SINGH N N,STEWART A W,et al.The aberrant behavior checklist:a behavior rating scale for the assessment of treatment effects[J].Am J Ment Defic,1985,89(5):485-491.DOI:10.1177/0013164485454034.
[18]马俊红,郭延庆,贾美香,等.异常行为量表中文版在儿童孤独症群体中的信效度[J].中国心理卫生杂志,2011,25(1):14-19.DOI:10.3969/j.issn.1000-6729.2011.01.004.
[19]MILLER H L,RAGOZZINO M E,COOK E H,et al.Cognitive set shifting deficits and their relationship to repetitive behaviors in autism spectrum disorder[J].J Autism Dev Disord,2015,45(3):805-815.DOI:10.1007/s10803-014-2244-1.
[20]D'CRUZ A M,RAGOZZINO M E,MOSCONI M W,et al.Reduced behavioral flexibility in autism spectrum disorders[J].Neuropsychology,2013,27(2):152-160.DOI:10.1037/a0031721.
[21]YERYS B E,ANTEZANA L,WEINBLATT R,et al.Neural correlates of set-shifting in children with autism[J].Autism Res,2015,8(4):386-397.DOI:10.1002/aur.1454.
[22]SHAFRITZ K M,DICHTER G S,BARANEK G T,et al.The neural circuitry mediating shifts in behavioral response and cognitive set in autism[J].Biol Psychiatry,2008,63(10):974-980.DOI:10.1016/j.biopsych.2007.06.028.
[23]MOSCONI M W,KAY M,D'CRUZ A M,et al.Impaired inhibitory control is associated with higher-order repetitive behaviors in autism spectrum disorders[J].Psychol Med,2009,39(9):1559-1566.DOI:10.1017/S0033291708004984.
[24]TAYLORSF,STERNER,GEHRINGWJ.Neural systems for error monitoring:recent findings and theoretical perspectives[J].Neuroscientist,2007,13(2):160-172.DOI:10.1177/1073858406298184.
[25]EVERLING S,DORRIS M C,KLEIN R M,et al.Role of primate superior colliculus in preparation and execution of anti-saccades and pro-saccades[J].J Neurosci,1999,19(7):2740-2754.
[26]THAKKAR K N,POLLI F E,JOSEPH R M,et al.Response monitoring,repetitive behaviour and anterior cingulate abnormalities in autism spectrum disorders(ASD)[J].Brain,2008,131(Pt9):2464-2478.DOI:10.1093/brain/awn099.
[27]ADAMS N C,JARROLD C.Inhibition and the validity of the stroop task for children with autism[J].J Autism Dev Disord,2009,39(8):1112-1121.DOI:10.1007/s10803-009-0721-8.
[28]WOLFF S.Autism:explaining the enigma[J].J Child Psychol Psychiatry,2004,45(1):172-173.DOI:10.1111/j.1469-7610.2004.t01-3-00211.x
[29]张秋月,李艳玮,王凤梅,等.孤独症谱系障碍儿童执行功能干预研究[J].广西医学,2015,37(5):623-625.DOI:10.11675/j.issn.0253-4304.2015.05.12.ZHANGQY,LIYW,WANGFM,etal.Studyof executive function intervention on children with autism spectrum disorder[J].Guangxi Medical Journal,2015,37(5):623-625.DOI:10.11675/j.issn.0253-4304.2015.05.12.