Identification and diagnosis of autism spectrum disorder among Chinese children in early stage
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摘要:
目的 探索中国在孤独症(ASD)儿童诊断方面的变化。 方法 2020年9月通过“中国特殊儿童评估干预平台(ALSOLIFE)”收集6 498名1~6和6~16岁孤独症儿童家庭为研究对象，使用互联网问卷调查其发现症状和诊断情况，利用ANOVA进行均值比较，运用χ2检验比较组间对于发现症状时间、首诊时间、确诊时间和相关诊断延迟的差异。 结果 孤独症儿童初始识别症状的月龄：学前组(1~6岁，4 049例)为26.05月龄(2.17岁)，学龄组(6~16岁，2 449例)为30.76月龄(2.56岁)。孤独症儿童首诊月龄：低年龄组为28.21月龄(2.35岁)，高年龄组为34.29月龄(2.86岁)，就诊延迟平均为3.43个月，其中高年龄组平均4.52个月，低年龄组平均2.78个月。孤独症儿童确诊月龄：高年龄组38.01月龄(3.17岁)，低年龄组31.07月龄(2.59岁)，从首诊到确诊的延迟为3.16个月，其中高年龄组3.71个月，低年龄组2.83个月，以上各项差异均有统计学意义(F值分别为328.30，535.64，507.71，103.03，17.79，P值均 < 0.01)。确诊医院中，大部分儿童仍旧在三甲医院就诊。 结论 ASD儿童的诊断效率发生了较大的提升，发现症状和确诊时间提前，就诊和确诊的延迟在缩短。 Abstract:Objective To investigate and explore the changes of the diagnosis of Chinese children with autism spectrum disorder (ASD). Methods The families of two groups of children aged 1-6 and 6-16 years who were diagnosed with ASD were selected from ALSOLIFE platform, and the online questionnaire was used to investigate the symptoms and its diagnosis-related information. ANOVA was applied to compare the mean values, and χ2 analysis was taken to compare the differences of two groups in the time of finding symptoms, the time of the first diagnosis, the time of treatment, and the diagnosis delayment. Results The initial recognition age of symptoms was 26.05 months age (2.17 years) in the young group (1-6 years), and 30.76 months age (2.56 years) in the old group (6-16 years). The age of first visit doctor was 28.21 months age (2.35 years) in the young group and 34.29 months (2.86 years) in the old group, while the average delay was only 3.43 months, of which the average delay was 4.52 months in the old group and 2.78 months in the young group. The age of diagnosed as ASD was 38.01 months age (3.17 years) in the young group and 31.07 months age (2.59 years) in the old group, while the average delay from first diagnosis to last diagnosis was 3.16 months. The delay from first diagnosis to last one was 3.71 months age in old age group, and 2.83 for the younger age group, The above differences were statistically significant (F=328.30, 535.64, 507.71, 103.03, 17.79, P < 0.01). Most of the children were still in the top hospitals to get diagnosed, but the role of child care was becoming more and more important. Conclusion The diagnosis efficiency of ASD children has been greatly improved, the time of symptom identification and diagnosis is advanced, and the delay of seeing a doctor and diagnosis is shortened. -
Key words:
- Autistic disorder /
- Diagnosis /
- Mental health /
- Child
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表 1 学龄前与学龄期孤独症儿童发现和确诊时间比较[M(P25, P75), 月]
Table 1. The average months and intervals from first symptoms discovery to Diagnosed by category[M(P25, P75), month]
年龄岁 人数 发现 首诊 确诊 发现至首诊 首诊至确诊 1~6 4 049 26.05(25.80, 26.30) 28.21(27.96, 28.47) 31.07(30.76, 31.37) 2.78(2.62, 2.93) 2.83(2.60, 3.05) 6~16 2 449 30.76(30.25, 31.26) 34.29(33.77, 34.81) 38.01(37.42, 38.61) 4.52(3.17, 4.86) 3.71(3.33, 4.08) 合计 6 498 27.83(27.58, 28.08) 30.50(30.24, 30.76) 33.68(33.38, 33.99) 3.43(3.27, 3.60) 3.16(2.96, 3.16) Z值 328.30 535.64 507.71 103.03 17.79 P值 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 
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表 2 不同年龄组ASD儿童首次发现症状方式和提醒者身份分布较好
Table 2. Comparison of the ways of first symptoms discovery and the reminder identities by category
年龄/岁 察觉方式 提醒者身份 人数 自我察觉 他人提醒 人数 专业人士 准专业人士 亲戚、朋友、邻居等 其他人 1~6 4 049 2 571(63.50) 1 478(36.50) 1 478 320(21.65) 311(21.04) 781(52.84) 66(4.47) 6~16 2 449 1 492(60.92) 957(39.08) 957 131(13.69) 326(34.06) 443(46.29) 57(5.96) 合计 6 498 4 063(62.53) 2 435(37.38) 2 435 451(18.52) 637(26.16) 1 224(50.27) 123(5.05) 注： ()内数字为构成比/%。
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表 3 不同年龄组ASD儿童确诊医院及科室分布
Table 3. Comparison of the diagnosed hospitals and diagnosed hospital departments by category
年龄/岁 人数 医院级别 确诊科室 三甲 三级 二级 其他 神经内科 儿科 儿童保健/儿童发展中心 精神科 其他 1~6 4 049 3 437(84.89) 206(5.09) 275(6.79) 131(3.24) 373(9.21) 311(7.68) 2 671(65.97) 347(8.57) 347(8.57) 6~16 2 449 2 122(86.65) 92(3.76) 104(4.25) 131(5.35) 248(10.13) 261(10.66) 1 471(60.07) 286(11.68) 183(7.47) 合计 6 498 5 559(85.55) 298(4.59) 379(5.83) 262(4.03) 621(9.56) 572(8.80) 4 142(63.79) 633(9.74) 530(8.16) 注： ()内数字为构成比/%。
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