孤独症谱系障碍儿童触觉异常特征与临床症状的关联

翟巾赫; 王晓敏; 范莉莉; 李齐; 夏薇; 孙彩虹; 王佳

doi:10.16835/j.cnki.1000-9817.2021.06.023

孤独症谱系障碍儿童触觉异常特征与临床症状的关联

doi: 10.16835/j.cnki.1000-9817.2021.06.023

哈尔滨医科大学公共卫生学院儿少卫生与妇幼保健教研室，黑龙江 150081

基金项目:

国家自然科学基金项目 81874270

详细信息

作者简介:
翟巾赫(1995-)，女，黑龙江省人，在读硕士，主要研究方向为儿童发育障碍及行为问题

通讯作者:
王佳，E-mail：wangjiahyd@163.com

中图分类号: R 748 R 179
计量
- 文章访问数: 535
- HTML全文浏览量: 269
- PDF下载量: 34
- 被引次数: 0
出版历程
- 收稿日期: 2020-09-07
- 修回日期: 2021-02-09
- 网络出版日期: 2021-06-22
- 刊出日期: 2021-06-25

Correlation analysis of tactile abnormality and clinical symptoms of children in autism spectrum disorders

Department of Children's and Adolescent Health, Public Health college, Harbin Medical University, Harbin(150081), China

摘要

摘要: 目的探索孤独症谱系障碍(ASD)儿童是否存在明显的触觉异常以及触觉异常与孤独症临床症状之间的相关性，为孤独症触觉异常的干预治疗提供科学依据。方法收集在黑龙江省孤独症定点康复机构接受康复训练的265例3.02~10.66岁ASD儿童作为病例组，并依据性别年龄匹配原则，在哈尔滨市幼儿园和小学招募223名3.15~10.99岁健康儿童作为对照组。采用简化版感觉特征问卷(SSP)评估儿童的触觉行为，同时采用社交反应量表(SRS)等评估ASD儿童的临床表现，应用Spearman相关性分析探索触觉行为与孤独症症状之间的关联。结果 ASD组儿童SSP触觉得分[33(33, 35)分]低于对照组[34(31, 35)分]，差异有统计学意义(Z=-2.73，P<0.05)；ASD组触觉异常等级(可能异常、明显异常)比例(19.6%)高于对照组(11.7%)(χ²=5.72，P<0.05)。两组男童SSP触觉得分差异有统计学意义(Z=-2.17，P<0.05)。ASD组SSP触觉得分与SRS社交认知、社交沟通和量表总分，儿童孤独症家长评定量表(ABC)、孤独症行为量表(CARS)、孤独症诊断访谈量表修订版(ADI-R)临床量表非语言沟通水平得分呈负相关(r值分别为-0.23，-0.28，-0.28，-0.35，-0.17，-0.27，P值均<0.05)。结论孤独症儿童较健康儿童存在更为明显的触觉异常表现，且在男童中更为显著。触觉异常与孤独症社交障碍等临床表现之间存在相关性。
- 孤独性障碍 /
- 触觉 /
- 体征和症状 /
- 病例对照研究 /
- 儿童
Abstract: Objective To explore whether children in autism spectrum disorders (ASD) have more obvious tactile abnormalities than healthy children, and to analyze the correlation between tactile abnormalities and clinical symptoms of autism, so as to provide a scientific basis for intervening and treating tactile abnormalities among the children with autism. Methods Totally 265 ASD children aged 3.02-10.66 years who received rehabilitation training in designated rehabilitation institutions for autism in Heilongjiang Province were collected as case group, and 223 healthy children aged 3.15-10.99 years were recruited as control group in Harbin kindergartens and primary schools according to the principle of gender and age matching. The Short Sensory Profile (SSP) was used to evaluate children's tactile behavior, and the differences between the two groups, as well as the scores of different genders and ages were analyzed. At the same time, Social Responsiveness Scale (SRS) was used to evaluate the clinical manifestations of ASD children. Spearman correlation analysis was used to explore the correlation between tactile behavior and autism symptoms. Results The tactile score of SSP in ASD group [33(33, 35)] was lower than that in control group[34(31, 35)], and the difference was statistically significant(Z=-2.73, P<0.05); And the proportion of tactile abnormality grade (possible abnormality and obvious abnormality) in ASD group (19.6%) was higher than that in control group(11.7%)(χ²=5.72, P<0.05). At the same time, the tactile sensation between the two groups of boys was significantly different(Z=-2.17, P<0.05). There was a negative correlation between SSP tactile scores in ASD group and clinical scale scores including SRS social cognition, social communication and scale scores, Autism Behavior Checklist(ABC), Childhood Autism Behavior Scale(CARS), non-verbal communication of Autism Diagnostic Interview-Revised(ADI-R)(r=-0.23, -0.28, -0.28, -0.35, -0.17, -0.27, P<0.05). Conclusion Autistic children show more obvious tactile abnormalities than healthy children, which is more significant in boys. And there is a correlation between tactile abnormalities and clinical manifestations such as autism social disorder.
- Autistic disorder /
- Touch /
- Signs and symptoms /
- Case-control studies /
- Child

HTML全文

表 1 ASD组与对照组儿童SSP触觉领域得分比较[M(P₂₅, P₇₅)]

Table 1. Comparison of SSP tactile characteristics between ASD group and control group[M(P₂₅, P₇₅)]

组别	人数	做个人卫生时，有反抗、哭闹的表现	天气暖和时喜欢穿长袖衣服，或天冷时喜欢穿短袖衣服	不喜欢光着脚，尤其是光脚踩沙子或草地	对身体的触碰，反应很强烈甚至有攻击性	害怕溅起的水	很不愿意排队，或与他人靠近	不停擦或抓身体曾被触碰到的部位	触觉总分
ASD组	265	5(4, 5)	5(5, 5)	5(5, 5)	5(4, 5)	5(4, 5)	5(4, 5)	5(5, 5)	33(33, 35)
对照组	223	5(4, 5)	5(5, 5)	5(5, 5)	5(4, 5)	5(4, 5)	5(5, 5)	5(5, 5)	34(31, 35)
Z值		-1.15	-2.96	-3.96	-3.00	-2.03	-6.82	-1.80	-2.73
P值		0.25	< 0.01	< 0.01	0.76	0.04	< 0.01	0.07	0.01

下载: 导出CSV

参考文献(32)

[1]	American Psyciatric Association. Diagnostic and statistical manual of mental disorders, fifth edition[M]. Washington DC: American Psychiatric Association, 2013: 50-51.
[2]	MAENNER M J, SHAW K A, BAIO J. Prevalence of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 sites, United States, 2016[J]. MMWR Surveill Summ, 2020, 69(4): 1-12. doi: 10.15585/mmwr.ss6904a1
[3]	美国精神医学学会. 精神障碍诊断与统计手册[M]. 北京: 北京大学出版社, 2016: 22-23. American Psychiatric Association. Handbook of diagnosis and statistics of mental disorders[M]. Beijing: Peking University Press, 2016: 22-23.
[4]	MCINTOSH D N, MILLER L, SHYU V, et al. Development and validation of the short sensory profile[M]. San Antonio: Sensory Profile User's Manual, 1999: 59-73.
[5]	周秉睿. 孤独症谱系障碍核心症状的评估量表应用研究[D]. 上海: 复旦大学, 2014. ZHOU B R. Study on the application of autism spectrum disorder core symptom assessment scale[D]. Shanghai: Fudan University, 2014.
[6]	CONSTANTINO J N, GRUBER C P. Social Responsiveness Scale (SRS) manual[M]. USA: Western Psychological Services, 2005.
[7]	龚俊, 邹时朴, 刘冬梅, 等. 社交反应量表的信效度分析[J]. 中国医学创新, 2019, 16(1): 19-23. doi: 10.3969/j.issn.1674-4985.2019.01.005 GONG J, ZOU S P, LIU D M, et al. Reliability and validity of social responsiveness scale[J]. Chin Med Innovat, 2019, 16(1): 19-23. doi: 10.3969/j.issn.1674-4985.2019.01.005
[8]	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 MA J H, GUO Y Q, JIA M X, et al. Reliability and validity of the Chinese version of the Aberrant Behavior Checklist (ABC) in children with autism[J]. Chin Ment Health J, 2011, 25(1): 14-19. doi: 10.3969/j.issn.1000-6729.2011.01.004
[9]	卢建平, 杨志伟, 舒明耀, 等. 儿童孤独症量表评定的信度、效度分析[J]. 中国现代医学杂志, 2004(13): 119-121, 123. doi: 10.3969/j.issn.1005-8982.2004.13.037 LU J P, YANG Z W, SHU M Y, et al. Raliability, validity analysis of the childhood autism rating scale[J]. Chin J Modern Med, 2004(13): 119-121, 123. doi: 10.3969/j.issn.1005-8982.2004.13.037
[10]	郭延庆, 杨晓玲, 刘靖, 等. 孤独症诊断访谈量表(修订本)的诊断效度及信度研究[J]. 中华精神科杂志, 2002, 35(1): 45-48. doi: 10.3760/j:issn:1006-7884.2002.01.015 GUO Y Q, YANG X L, LIU J, et al. Reliability and diagnostic validity study on autism diagnostic interview-revised. [J]. Chin J Psychiatry, 2002, 35(1): 45-48. doi: 10.3760/j:issn:1006-7884.2002.01.015
[11]	汤宜朗, 郭延庆, CATHERINE E R, 等. 孤独症诊断的金标准之一《孤独症诊断观察量表》介绍[J]. 国际精神病学杂志, 2010, 37(1): 38-40. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ201001011.htm TANG Y L, GUO Y Q, CATHERINE E R, et al. Introduction of autism diagnostic observation scale[J]. Int J Psychiatry, 2010, 37(1): 38-40. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYJ201001011.htm
[12]	JANET K K, MADHUKAR H T, CAROLYN R G. et al. The pattern of sensory processing abnormalities in autism[J]. Autism, 2006, 10(5): 480-494. doi: 10.1177/1362361306066564
[13]	ASMIKA, OKTAFIANI L, KUSWORINI K, et al. Autistic children are more responsive to tactile sensory stimulus[J]. Iran J Child Neurol Autumn, 2018, 12(4): 37-44. http://www.ncbi.nlm.nih.gov/pubmed/30279707
[14]	TERESA T L, KATHERINE B, MARK T, et al. Altered tactile processing in children with autism spectrum disorder[J]. Autism Res, 2016, 9(6): 616-620. doi: 10.1002/aur.1563
[15]	DUNN W. The sensations of everyday life: empirical theoretical, and pragmatic considerations[J]. Am J Occup Ther, 2001, 55(6): 608-620. doi: 10.5014/ajot.55.6.608
[16]	KIENTZ M A, DUNN W. A comparison of the performance of children with and without autism on the Sensory Profile[J]. Am J Occup Ther, 1997, 51(7): 530-537. doi: 10.5014/ajot.51.7.530
[17]	TOMCHEK S D, DUNN W. Sensory processing in children with and without autism: a comparative study using the short sensory profile[J]. Am J Occupat Ther, 2007, 61(2): 190-200. doi: 10.5014/ajot.61.2.190
[18]	JENNIFER H, JESSICA L, CARISSA J. Tactile responsiveness patterns and their association with core features in autism spectrum disorders[J]. Res Autism Spectr Dis, 2012, 6(1): 337-344. doi: 10.1016/j.rasd.2011.06.007
[19]	BALASCO L, PROVENZANO G, BOZZI Y. Sensory abnomalities in autism spectrum disorders: a focus on the tactile domain, from genetic mouse models to the clinic[J]. Front Fsychiatry, 2019, 10: 1016. doi: 10.3389/fphys.2019.01016
[20]	MARK M, ERICKA L, STEWART H, et al. Autism spectrum disorder in the scope of tactile processing[J]. Dev Cogn Neurosci, 2018, 29: 140-150. doi: 10.1016/j.dcn.2016.12.005
[21]	LAUREN L O, JACQUELINE R M, DANIELLE T M, et al. Targeting peripheral somatosensory neurons to improve tactile-related phenotypes in ASD models[J]. Cell, 2019, 178(4): 867-886. doi: 10.1016/j.cell.2019.07.024
[22]	杨灿. 中职生感觉寻求、应对方式与攻击性行为的关系研究[D]. 石家庄: 河北大学, 2016. YANG C. Study on the relationship among sense seeking, coping style and aggressive behavior of secondary vocational school students[D]. Shijiazhuang: Hebei University, 2016.
[23]	宋建太, 陶玲, 钱志余, 等. 基于静息态fMRI和DTI的大脑性别差异性研究[J]. 生物医学工程研究, 2014, 33(4): 211-215. https://www.cnki.com.cn/Article/CJFDTOTAL-SDSG201404004.htm SONG J T, TAO L, QIAN Z Y, et al. Research on the differences of brain between the sexes based on the fMRI and DTI of resting state[J]. J Bio Engin Res, 2014, 33(4): 211-215. https://www.cnki.com.cn/Article/CJFDTOTAL-SDSG201404004.htm
[24]	UENO Y, TAKAHASHI A, OSHIO A. Relationship between sensory-processing sensitivity and age in a large cross-sectional Japanese sample[J]. Heliyon, 2019, 5(10): e02508. http://www.sciencedirect.com/science/article/pii/S2405844019361687
[25]	MARC W H, MICHAEL E R. Age differences in suprathreshold sensory function[J]. Age, 2014, 36(1): 1-8. doi: 10.1007/s11357-013-9536-9
[26]	GRACE T B, MIKE C, JOHN S. Longitudinal assessment of stability of sensory features in children with autism spectrum disorder or other developmental disabilities[J]. Autism Res, 2019, 12(1): 100-111. doi: 10.1002/aur.2008
[27]	RIQUELME I, HATEM S M, MONTOYA P. Abnormal pressure pain, touch sensitivity, proprioception, and manual dexterity in children with autism spectrum disorders[J]. Neural Plastic, 2016, 2016: 1723401. DOI: 10.1155/2016/1723401.
[28]	MAMMEN M A, MOORE G A, SCARAMELLA L V, et al. Infant avoidance during a tactile task predicts autism spectrum behaviors in toddlerhood[J]. Infant Ment Health J, 2015, 36(6): 575-587. doi: 10.1002/imhj.21539
[29]	HERTENSTEIN, MATTHE J. Touch: its communicative functions in infancy[J]. Human Devel, 2002, 45(2): 70-94. doi: 10.1159/000048154
[30]	WALLACE G L, BUDGETT J, CHARLTON R A. Aging and autism spectrum disorder: evidence from the broad autism phenotype[J]. Autism Res, 2016, 9(12): 1294-1303. doi: 10.1002/aur.1620
[31]	CASCIO C J, FOSS-FEIG J H, BURNETTE C P, et al. The rubber hand illusion in children with autism spectrum disorders: delayed influence of combined tactile and visual input on proprioception[J]. Autism, 2012, 16(4): 406-419. doi: 10.1177/1362361311430404
[32]	SILVA L M, SCHALOCK M, GABRIELSEN K R. About face: evaluating and managing tactile impairment at the time of autism diagnosis[J]. Autism Res Treat, 2015, 2015: 612507. DOI: 10.1155/2015/612507.