1 东莞市妇幼保健院康复医学科，广东 东莞 523000
目的：探究ASD三级筛查在东莞市6~36个月婴幼儿中的应用价值，了解孤独症谱系障碍(autism spectrum disorder，ASD)患病情况，以便对其采取早期康复措施。方法：选取6~36个月常住人口活产出生儿童2 000例为研究对象，应用ASD警示指标作检查进行初级保健筛查，初筛阳性儿童运用中文简化版改良婴幼儿孤独症筛查量表(Modified Checklist for Autism in Toddlers，M-CHAT)作检查进行一级筛查，一筛阳性儿童运用孤独症行为量表(Autism Behavior Checklist，ABC)、儿童孤独症评定量表(Childhood Autism Rating Scale，CARS)进行二级筛查协助诊断ASD，二筛阳性儿童为高度疑似ASD，由儿童康复专家医生运用诊断工具美国精神疾病诊断分类手册第5版(Diagnostic and Statistical Manual of Mental Disorders V，DSM-V)标准进行诊断分级。结果：共筛查东莞市2 000例适龄儿童，依据筛查标准，初筛阳性率为3.8%(76/2 000)，一筛阳性率51.32%(39/76)，二筛阳性率69.23%(27/39)，最终经DSM-V标准确诊27例ASD患儿，患病率为13.50‰，其中男21例，女6例，男性患病率为1.88%，显著高于女性的0.68%(P<0.05)，不同确诊年龄、出生地的ASD患病率比较，差异无统计学意义(P>0.05)。经神经心理发育测评发现，27例ASD患儿中7例量表均分≥85分的智力发育正常患儿，10例84~70分的智力偏低患儿，8例69~35分为智力轻中度低下的患儿，2例≤34分的智力重度低下患儿，确诊年龄<18个月的患儿大运动评分显著低于确诊年龄≥18个月的患儿(P<0.05)。结论：依据ASD三级筛查新模式，东莞市2 000名适龄儿童ASD患病率为13.5‰，略高于多数报道中的10‰，该筛查模式有助于ASD患儿的早发现、早干预、早治疗。
Application of early screening and recognition for children with autism spectrum disorder in Dongguan
CorrespondingAuthor: HUANG Xiaoling
This work was supported by the Social Science and Technology Development (Key) Project of Dongguan City, China (2018507150071631).
Objective: To explore the application value of autism spectrum disorder (ASD) three-level screening in infants aged 6–36 months in Dongguan and to understand the prevalence of ASD, so as to take early rehabilitation measures. Methods: A total of 2 000 alive infants aged 6–36 months were enrolled as the research subjects. The examinations were conducted by ASD warning indexes for primary care screening. The first-level screening was performed on positive children in initial screening by Chinese simplified version of Modified Checklist for Autism in Toddlers (M-CHAT). The second-level screening was performed on them by Autism Behavior Checklist (ABC) and Childhood Autism Rating Scale (CARS) for auxiliary diagnosis of ASD. The positive children in second-level screening were highly suspected with ASD. And they were diagnosed and graded by children’s rehabilitation specialists by means of Diagnostic and Statistical Manual of Mental Disorders V (DSM-V). Results: A total of 2 000 children of school age in Dongguan were screened. According to the screening criteria, the positive rate of primary screening was 3.8% (76/2 000), the positive rate of first screening was 51.32% (39/76), and the positive rate of second screening was 69.23% (27/39). Finally, 27 cases (13.50‰) of ASD were diagnosed by DSM-V standard, including 21 male cases and 6 female cases. The prevalence rate of male was significantly higher than that of female (1.88% vs 0.68%) (P<0.05). There was no significant difference in the prevalence of ASD among children with different confirmed age and places of birth (P>0.05). According to neuropsychological development evaluation, it was found that among the 27 ASD children, there were 7 cases with normal intelligence development (average score of scale not lower than 85 points), 10 cases with relatively low intelligence (84–70 points), 8 cases with mild to moderate mental retardation (69–35 points), and 2 cases with severe mental retardation (score not higher than 34 points). The gross motor scores in children with confirmed age younger than 18 months was significantly lower than those not younger than 18 months (P<0.05). Conclusion: According to the new mode of ASD three-level screening, the prevalence of ASD among 2 000 school-age children in Dongguan is 13.5‰, slightly higher than the 10‰ in most reports. The screening mode is conductive to the early detection, early intervention, and early treatment of ASD children.
autism spectrum disorder; child; screening; Diagnostic and Statistical Manual of Mental Disorders V