Analysis of epidemic status and influencing factors of Mongolian children with autism in central and eastern Inner Mongolia
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摘要:
目的 了解内蒙古中东部蒙古族儿童孤独症(ASD)流行病现状及其影响因素，为促进内蒙古ASD儿童的康复和救治提供依据。 方法 采用随机整群抽样的方法，在内蒙古赤峰市、乌兰察布市、通辽市、呼伦贝尔市、锡林郭勒盟5个盟市内抽取16所幼儿园及小学，对7 108名3~14岁蒙古族儿童进行问卷调查；首先用克氏孤独症行为量表(CABS)进行儿童ASD的初筛，对初筛阳性者、教师提名者进行孤独症行为检测量表调查，总得分≥62分为明确存在孤独症样症状，再由1名儿童精神医学专业的主任医生和1名副主任医师，参照美国精神障碍诊断与统计手册第5版的诊断标准，对筛查阳性儿童逐个进行儿童孤独症评定量表的评定, 并根据家长和知情者提供的病史和精神检查结果，结合DSM-IV诊断标准明确诊断。 结果 蒙古族儿童ASD患病率为0.37%。蒙古族ASD组与正常组儿童在多动、家庭有无极度内向者、母亲生育年龄、父亲文化程度、母亲文化程度、父亲性格温和、母亲性格暴躁、新生儿疾病、胎儿孕周分布均有统计学意义(χ2/Z值分别为16.68，14.93，64.43，-3.76，-2.86，4.57，11.12，12.33，16.66，P值均 < 0.05)。 结论 应采取塑造健康生长环境、调整父母教育方式、关注儿童早期语言发育水平、避免新生儿期疾病等措施可能会预防儿童ASD的发生。 Abstract:Objective To understand the epidemic status and influencing factors of Mongolian children with ASD in central and eastern Inner Mongolia, so as to provide data support for formulating prevention and intervention strategies and improving the overall epidemiological investigation of ASD in Inner Mongolia. Methods Sixteen kindergartens and primary schools were selected from Chifeng City, Ulanqab City, Tongliao City, Hulunbuir City and Xilingol League cities in Inner Mongolia by means of random cluster sampling. Firstly, 7 108 children aged 3-14 were initially screened with the Kirschner Autism Behavior Scale(CABS), and then the children with ASD positive were given the autism behavior test scale (ABC). According to the diagnostic criteria, the professionals, including chief physicians and associate chief physicians from the major of child psychiatry, diagnosed ASD with the total score of ABC scale ≥62. Univariate and Logistic regression multivariate analysis were carried out among Mongolian children to find out the influencing factors related to the occurrence of Mongolian ASD in Inner Mongolia. Results The prevalence of Mongolian children was 0.37%. Mongolian ASD group and Mongolian normal children series in the household register, habitual twitch, hyperactivity, bite lips, families have extreme introverts, mothers age, father's cultural level, cultural degree of mother, father mother mild character, irritable, neonatal diseases, fetal gestational age distribution had statistical significance(χ2/Z=12.58, 16.68, 14.93, 64.43, -3.76, -2.86, 4.57, 11.12, 12.33, 16.66, P < 0.05). Conclusion Measures such as shaping a healthy growth environment, adjusting parental style, paying attention to the level of early childhood language development, and preventing neonatal diseases might lower the risk of ASD in children. -
Key words:
- Autistic disorder /
- Mental health /
- Regression analysis /
- Child /
- Minority groups
1) 郝金奇和付慧渊为共同第一作者 -
表 1 内蒙古中东部不同组别蒙古族儿童各不良习惯报告率比较
Table 1. Comparison of reporting rates of bad habits among different groups of mongolian children in central and eastern Inner Mongolia
组别 人数 多动 咬指甲 遗尿 口吃 入睡困难 吃饭习惯不好 注意力不集中 吮指 患病儿童 26 13(50.00) 5(19.23) 1(3.85) 0 3(11.54) 8(30.77) 8(30.77) 3(11.54) 正常儿童 7 082 1 303(18.40) 1 061(14.98) 75(1.06) 77(1.09) 694(9.80) 5 167(72.96) 185(2.61) 513(7.24) χ2值 16.68 0.33 1.85 0.29 0.07 0.30 0.23 0.67 P值 0.00 0.57 0.17 0.59 0.79 0.58 0.63 0.41 注： ()内数字为报告率/%。 
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表 2 蒙古族ASD组与健康儿童基本特征分布比较
Table 2. Comparison of basic conditions of Mongolian children in different groups
组别 选项 患病儿童(n=26) 健康儿童(n=7 082) χ2/Z值 P值 性别 男 17(65.38) 3 842(54.25) 16.68 0.00 女 9(34.62) 3 240(45.75) 年龄/岁 3~5 6(23.08) 1 841(26.00) 1.85 0.17 6~12 20(76.92) 5 241(74.00) 户籍 城镇 7(26.92) 4 114(58.09) 0.07 0.79 农村 19(73.08) 2 968(41.91) 不良习惯 无 2(0.08) 1 841(26.00) 0.23 0.63 有 24(0.92) 5 241(74.00) 运动水平 与同龄相当 16(51.54) 5 524(78.00) -1.06 0.29 好于同龄人 5(19.23) 1 204(17.00) 比同龄人差 5(19.23) 354(5.00) 语言发展水平 与同龄相当 14(53.84) 5 382(0.76) -4.43 0.00 好于同龄人 2(7.70) 1 416(0.20) 比同龄人差 10(38.46) 284(0.04) 注： ()内数字为构成比/%。
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表 3 蒙古族儿童新生儿时期及围产期情况组间比较
Table 3. Comparison of Mongolian children's neonatal and perinatal conditions in different groups
组别 选项 患病儿童(n=26) 健康儿童(n=7 082) χ2/Z值 P值 新生儿疾病 否 19(73.08) 6 515(91.99) 12.33 0.00 是 7(26.92) 567(8.11) 胎儿孕周 足月儿 20(76.92) 6 515(91.99) 16.66 0.00 早产 2(7.70) 425(6.00) 过期产 4(15.38) 142(2.01) 分娩方式 顺产 13(50.00) 3 045(43.00) 0.44 0.51 剖宫产 13(50.00) 4 037(57.00) 新生儿疾病 纯母乳 20(76.92) 4 603(65.00) 1.61 0.45 混合 4(15.38) 1 629(23.00) 人工喂养 2(7.70) 850(12.00) 注： ()内数字为构成比/%。
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表 4 不同组别蒙古族儿童家庭基本情况构成比较
Table 4. Comparison of basic family situation of Mongolian children in different groups
组别 选项 患病儿童(n=26) 健康儿童(n=7 082) χ2/Z值 P值 父亲文化程度 小学 5(19.23) 683(9.64) -3.76 0.00 中学 16(61.53) 2 408(34.00) 大学及以上 5(19.23) 3 901(55.08) 母亲文化程度 小学 4(15.38) 576(8.13) -2.86 0.00 中学 16(61.53) 2 435(0.35) 大学及以上 6(23.07) 3 991(56.35) 父亲性格温和 否 23(88.46) 4 857(68.58) 是 3(11.54) 2 176(30.73) 母亲性格暴躁 否 22(84.62) 6 792(95.91) 11.12 0.00 是 4(15.38) 240(3.39) 家庭内有无极度内向者 无 22(84.61) 6 856(976.81) 14.93 0.00 有 3(11.54) 122(1.72) 儿童主要养育者 父母 19(73.08) 6 345(89.59) 4.82 0.31 (外)祖父母 4(15.37) 451(6.37) 保姆 2(7.70) 9(0.13) 其他 1(3.85) 34(0.48) 母亲生育年龄/岁 20~34 24(92.30) 6 173(87.16) 64.43 0.00 35~45 2(7.70) 909(12.84) 注： ()内数字为构成比/%。
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