母亲童年期不良经历与学龄前儿童自闭症行为的关联

郭锋; 汪小燕; 殷刚柱; 孙瑜

doi:10.16835/j.cnki.1000-9817.2022.08.006

母亲童年期不良经历与学龄前儿童自闭症行为的关联

doi: 10.16835/j.cnki.1000-9817.2022.08.006

安徽省合肥市妇女儿童保健中心儿童保健科，230001

基金项目:

合肥市卫生健康委2020年新冠肺炎疫情防控科研课题项目 Hwk2020zd009

中国疾病预防控制中心妇幼保健中心母婴营养与健康研究项目 2021FY007

详细信息

作者简介:
郭锋(1978-)，男，安徽濉溪人，大学本科，副主任医师，主要研究方向为儿童保健、儿童早期发展

利益冲突声明 所有作者声明无利益冲突。
中图分类号: G78 B844.1 R179
计量
- 文章访问数: 509
- HTML全文浏览量: 264
- PDF下载量: 45
- 被引次数: 0
出版历程
- 收稿日期: 2022-05-07
- 修回日期: 2022-06-22
- 网络出版日期: 2022-08-24
- 刊出日期: 2022-08-25

Relationships between maternal adverse childhood experiences and autistic behaviors in preschool children

Child Healthcare Department, Hefei Women and Children Medical Care Center, Hefei(230001), China

摘要

摘要: 目的了解母亲童年期不良经历(adverse childhood experiences, ACEs)和学龄前儿童自闭症行为发生的相关性，为有效预防学龄前儿童自闭症发生提供依据。方法采用分层整群抽样方法，选取合肥市3 655名幼儿园儿童，了解儿童一般基本情况，采用童年期不良经历问卷(ACEs-IQ)和克氏自闭症行为量表(CABS)分别评估母亲ACEs和儿童自闭症行为情况。建立多因素Logistic回归模型，控制相关混杂因素，分析母亲ACEs对学龄前儿童自闭症行为的影响。结果学龄前儿童自闭症行为检出率为6.10%，男童(7.22%)高于女童(4.86%)，差异有统计学意义(χ²=8.85，P < 0.01)。调整相关混杂因素后，母亲有ACEs组学龄前儿童自闭症行为的检出率高于母亲无ACEs组[OR值(95%CI)=2.77(1.92~3.99)，P < 0.05]。母亲ACEs与学龄前男童、女童自闭症行为的风险增加相关，男童OR值(95%CI)=2.90(1.81~4.64)，女童OR值(95%CI)=2.56(1.43~4.61)(P值均 < 0.05)。结论母亲ACEs暴露与学龄前儿童自闭症行为相关，降低学龄前儿童自闭症行为需要关注母亲ACEs的代际影响。
- 生活变动事件 /
- 母亲 /
- 孤独性障碍 /
- 回归分析 /
- 儿童，学龄前
Abstract: Objective To explore the prevalence of maternal adverse childhood experiences (ACEs) and the association with autistic behavior of preschool children, to provide a basis for the effective prevention of autism occurrence in preschool children. Methods Through stratified cluster sampling, 3 655 preschool children in Hefei City were selected and surveyed regarding general information. Maternal ACEs and childhood autistic behaviors were assessed using the Adverse Childhood Experiences International Questionnaire and the Clancy Autism Behaviour Scale, respectively. Multiple Logistic regression model was used to analyze the correlation between maternal ACEs and child autistic behaviors. Results The prevalence of autistic behavior was 6.10%, with significantly higher in boys (7.22%) than girls(4.86%)(χ²=8.85, P < 0.01). After adjustment for the confounding factors, the detection rate of autistic behaviors was higher in children of mother with ACEs than those of mother without(OR=2.77, 95%CI=1.92-3.99, P < 0.05). Maternal ACEs were associated with an increased risk of autistic behaviors both in preschool boys and girls (boys: OR=2.90, 95%CI=1.81-4.64; girls: OR=2.56, 95%CI=1.43-4.61, all P < 0.05). Conclusion Maternal ACEs are associated with increased risk of autistic behaviors among preschool children. More attention should be paid to the intergenerational effects of maternal ACEs to reduce risk of autism among preschool children.
- Life change events /
- Mothers /
- Autistic disorder /
- Regression analysis /
- Child, preschool
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

HTML全文

表 1 不同组别学龄前儿童自闭症行为检出率比较

Table 1. Comparison of autism behavior detection rates among preschool children of different groups

组别	选项	人数	检出人数	χ²值	P值
性别	男	1 926	139(7.22)	8.85	< 0.01
	女	1 729	84(4.86)
胎次	一胎	2 070	145(7.00)	6.80	0.01
	其他	1 585	78(4.92)
早产	是	254	25(9.84)	6.67	0.01
	否	3 401	198(5.82)
出生体重	低出生体重	127	6(4.72)	0.48	0.79
	正常	2 993	183(6.11)
	巨大儿	535	34(6.36)
出生时父亲年龄/岁	≤42	3 506	208(5.93)	4.26	0.04
	>42	149	15(10.07)
出生时母亲年龄/岁	≤42	3 631	218(6.00)	9.15	< 0.01
	>42	24	5(20.83)
视屏时间/(h·d^-1)	< 1	1 551	70(4.51)	11.86	< 0.01
	≥1	2 104	153(7.27)
睡眠时间	早于21:00	356	14(3.93)	8.94	0.01
	21:00—22:00	2 873	171(5.95)
	晚于22:00	426	38(8.92)
家庭结构	核心家庭	2 650	154(5.81)	5.66	0.06
	大家庭	877	55(6.27)
	其他	128	14(10.94)
注： ()内数字为检出率/%。

下载: 导出CSV

表 2 不同形式母亲童年期不良经历影响学龄前儿童自闭症行为的Logistic回归分析

Table 2. Logistic regression analysis on the influence of different forms of maternal ACEs on preschool children's autistic behavior

自变量	选项	人数	检出人数	检出率/%	模型1		模型2
自变量	选项	人数	检出人数	检出率/%	OR值(OR值95%CI)	P值	OR值(OR值95%CI)	P值
情感忽视	无	1 743	55	3.16	1.00		1.00
	有	1 912	168	8.79	2.96(2.17~4.04)	< 0.01	2.93(2.14~4.01)	< 0.01
躯体忽视	无	2 968	151	5.09	1.00		1.00
	有	687	72	10.48	2.18(1.63~2.93)	< 0.01	2.21(1.64~2.98)	< 0.01
情感虐待	无	3 352	180	5.37	1.00		1.00
	有	303	43	14.19	2.91(2.04~4.16)	< 0.01	2.98(2.08~4.28)	< 0.01
躯体虐待	无	3 404	180	5.29	1.00		1.00
	有	251	43	17.13	3.70(2.58~5.31)	< 0.01	3.72(2.58~5.38)	< 0.01
社区暴力	无	3 525	188	5.33	1.00		1.00
	有	130	35	26.92	6.54(4.32~9.90)	< 0.01	6.61(4.32~10.11)	< 0.01
同伴欺凌	无	3 540	194	5.48	1.00		1.00
	有	115	29	25.22	5.82(3.73~9.08)	< 0.01	5.24(3.33~8.27)	< 0.01
性虐待	无	3 613	206	5.70	1.00		1.00
	有	42	17	40.48	11.25(5.98~21.16)	< 0.01	10.80(5.64~20.68)	< 0.01
家庭功能不全	无	2 478	136	5.49	1.00		1.00
	有	1 177	87	7.39	1.37(1.04~1.82)	0.03	1.31(0.99~1.74)	0.06
ACEs	无	1 261	36	2.85	1.00		1.00
	有	2 394	187	7.81	2.88(2.01~4.15)	< 0.01	2.77(1.92~3.99)	< 0.01
注：模型1为单因素分析; 模型2控制性别、胎次、是否早产、出生时父母年龄、视屏时间、睡眠时间。

下载: 导出CSV

表 3 不同形式母亲童年期不良经历对男、女童自闭症行为的多因素Logistic回归分析

Table 3. Multivariate Logistic regression analysis on the influence of different forms of maternal ACEs on autistic behavior in boys and girls

自变量	选项	男童				女童
自变量	选项	人数	检出人数	检出率/%	OR值(OR值95%CI)	人数	检出人数	检出率/%	OR值(OR值95%CI)
情感忽视	无	936	34	3.63	1.00	807	21	2.60	1.00
	有	990	105	10.61	3.16(2.11~4.73)^*	922	63	6.83	2.67(1.61~4.42)^*
躯体忽视	无	1 561	91	5.83	1.00	1 407	60	4.26	1.00
	有	365	48	13.15	2.51(1.72~3.66)^*	322	24	7.45	1.80(1.10~2.94)^*
情感虐待	无	1 768	115	6.50	1.00	1 584	65	4.10	1.00
	有	158	24	15.19	2.74(1.69~4.44)^*	145	19	13.10	3.53(2.04~6.13)^*
躯体虐待	无	1 788	112	6.26	1.00	1 616	68	4.21	1.00
	有	138	27	19.57	3.77(2.35~6.06)^*	113	16	14.16	3.56(1.97~6.42)^*
社区暴力	无	1 858	119	6.40	1.00	1 667	69	4.14	1.00
	有	68	20	29.41	6.12(3.46~10.81)^*	62	15	24.19	7.19(3.78~13.68)^*
同伴欺凌	无	1 867	123	6.59	1.00	1 673	71	4.24	1.00
	有	59	16	27.12	4.74(2.56~8.80)^*	56	13	23.21	5.70(2.89~11.24)^*
性虐待	无	1 904	131	6.88	1.00	1 709	75	4.39	1.00
	有	22	8	36.36	7.35(2.97~18.21)^*	20	9	45.00	17.14(6.74~43.55)^*
家庭功能不全	无	1 302	82	6.30	1.00	1 176	54	4.59	1.00
	有	624	57	9.13	1.39(0.97~2.00)	553	30	5.42	1.17(0.74~1.86)
ACEs	无	671	22	3.28	1.00	590	14	2.37	1.00
	有	1 255	117	9.32	2.90(1.81~4.64)^*	1 139	70	6.15	2.56(1.43~4.61)^*
注： *P < 0.05。

下载: 导出CSV

参考文献(31)

[1]	HUA R, WEI M, ZHANG C. The complex genetics in autism spectrum disorders[J]. Sci China Life Sci, 2015, 58(10): 933-945. doi: 10.1007/s11427-015-4893-5
[2]	刘贤, 林穗方, 陈文雄, 等. 中国儿童孤独症谱系障碍患病率Meta分析[J]. 中国儿童保健杂志, 2018, 26(4): 402-406, 429. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201804017.htm LIU X, LIN S F, CHEN W X, et al. Prevalence of autism spectrum disorders among children in China: a systematic review and Meta-analysis[J]. Chin J Child Health Care, 2018, 26(4): 402-406, 429. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201804017.htm
[3]	郝金奇, 付慧渊, 杨文瀚, 等. 内蒙古中东部蒙古族儿童孤独症流行现状及影响因素分析[J]. 中国学校卫生, 2021, 42(7): 1024-1028. doi: 10.16835/j.cnki.1000-9817.2021.07.015 HAO J Q, FU H Y, YANG W H, et al. Analysis of epidemic status and influencing factors of Mongolian children with autism in central and eastern Inner Mongolia[J]. Chin J Sch Health, 2021, 42(7): 1024-1028. doi: 10.16835/j.cnki.1000-9817.2021.07.015
[4]	KATIE A P, DAWN M H, ANGIE S G, et al. Adverse childhood experiences and the presence of cancer risk factors in adulthood: a scoping review of the literature from 2005 to 2015[J]. J Pediatr Nurs, 2019, 44: 81-96. doi: 10.1016/j.pedn.2018.10.009
[5]	FRANZ D J, GRIFFIN A M, SALDANA L, et al. A longitudinal examination of service utilization and trauma symptoms among young women with prior foster care and juvenile justice system involvement[J]. Child Welfare, 2019, 97(5/6): 199-215.
[6]	BELLIS M A, HARDCASTLE K, FORD K, et al. Does continuous trusted adult support in childhood impart life-course resilience against adverse childhood experiences-a retrospective study on adult health-harming behaviours and mental well-being[J]. BMC Psychiatry, 2017, 17(1): 110. doi: 10.1186/s12888-017-1260-z
[7]	CONDON E M, HOLLAND M L, SLADE A, et al. Maternal adverse childhood experiences, family strengths, and chronic stress in children[J]. Nurs Res, 2019, 68(3): 189-199. doi: 10.1097/NNR.0000000000000349
[8]	LETOURNEAU N, DEWEY D, KAPLAN B J, et al. Intergenerational transmission of adverse childhood experiences via maternal depression and anxiety and moderation by child sex[J]. J Dev Orig Health Dis, 2019, 10(1): 88-99. doi: 10.1017/S2040174418000648
[9]	WHO. Adverse Childhood Experiences International Questionnaire(ACE-IQ)[EB/OL]. (2019-06-13)[2022-05-05]. http://www.who.int/violence_injury_prevention/violence/activities/adverse_childhood_experiences/en/.
[10]	SUN X, ALLISON C, AUYEUNG B, et al. Comparison between a mandarin Chinese version of the childhood autism spectrum test and the Clancy Autism Behaviour Scale in mainland China[J]. Res Dev Disabil, 2014, 35(7): 1599-1608. doi: 10.1016/j.ridd.2014.02.005
[11]	庄晓伟, 陈玉明. 儿童孤独症早期筛查工具概述[J]. 中国全科医学, 2016, 19(S1): 350-353. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX2016S1138.htm ZHUANG X W, CHEN Y M. Screening tool for children with autism[J]. Chin Gen Pract, 2016, 19(S1): 350-353. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX2016S1138.htm
[12]	吴剑波, 尹晓娜, 吴传安, 等. 儿童婴幼儿期视屏接触时间与孤独症样行为的关联[J]. 中国学校卫生, 2020, 41(1): 21-24. doi: 10.16835/j.cnki.1000-9817.2020.01.006 WU J B, YIN X N, WU C A, et al. Association between screen time and autistic behavior in infants and toddlers[J]. Chin J Sch Health, 2020, 41(1): 21-24. doi: 10.16835/j.cnki.1000-9817.2020.01.006
[13]	陈欣, 刘海霞, 玄坤, 等. 农村学龄前儿童留守状况、视屏时间与自闭症行为的关系[J]. 中华行为医学与脑科学杂志, 2021, 30(6): 546-553. doi: 10.3760/cma.j.cn371468-20201209-00055 CHEN X, LIU H X, XUAN K, et al. The relationship between left-behind status, screen time and behavior of autism in preschool children of rural area[J]. Chin J Behav Med Brain Sci, 2021, 30(6): 546-553. doi: 10.3760/cma.j.cn371468-20201209-00055
[14]	刘宏彦, 梁颖, 冷俊宏, 等. 婴幼儿孤独症筛查量表(CHAT-23)探索性因子分析及应用[J]. 中国公共卫生, 2020, 36(3): 419-423. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW202003038.htm LIU H Y, LIANG Y, LENG J H, et al. Analysis on the Checklist for Autism in Toddler: common factor and application in autism screening among small children[J]. Chin J Public Health, 2020, 36(3): 419-423. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW202003038.htm
[15]	LOOMES R, HULL L, MANDY W P L. What is the male-to-female ratio in autism spectrum disorder?A systematic review and Meta-analysis[J]. J Am Acad Child Adolesc Psychiatry, 2017, 56(6): 466-474. doi: 10.1016/j.jaac.2017.03.013
[16]	MONTES G. Having older siblings is associated with lower rates of depression, ADD/ADHD, anxiety and behavior problems among children with ASD[J]. Matern Child Health J, 2018, 22(5): 642-647. doi: 10.1007/s10995-018-2459-4
[17]	ANGELIDOU A, ASADI S, ALYSANDRATOS K D, et al. Perinatal stress, brain inflammation and risk of autism-review and proposal[J]. BMC Pediatr, 2012, 12: 89. doi: 10.1186/1471-2431-12-89
[18]	IDRING S, MAGNUSSON C, LUNDBERG M, et al. Parental age and the risk of autism spectrum disorders: findings from a Swedish population-based cohort[J]. Int J Epidemiol, 2014, 43(1): 107-115. doi: 10.1093/ije/dyt262
[19]	AL-MAMARI W, IDRIS A B, AL-ZADJALI A A, et al. Parental age and the risk of autism spectrum disorder in Oman: a case-control study[J]. Sultan Qaboos Univ Med J, 2021, 21(3): 465-471. doi: 10.18295/squmj.4.2021.024
[20]	CHEN J Y, STRODL E, HUANG L H, et al. Early Electronic screen exposure and autistic-like behaviors among preschoolers: the mediating role of caregiver-child interaction, sleep duration and outdoor activities[J]. Children(Basel), 2020, 7(11): 200.
[21]	VEATCH O J, SUTCLIFFE J S, WARREN Z E, et al. Shorter sleep duration is associated with social impairment and comorbidities in ASD[J]. Autism Res, 2017, 10(7): 1221-1238. doi: 10.1002/aur.1765
[22]	ZAREI K, XU G, ZIMMERMAN B, et al. Adverse childhood experiences predict common neurodevelopmental and behavioral health conditions among U.S. children[J]. Children(Basel), 2021, 8(9): 761.
[23]	ROTH M, NEUNER F, ELBERT T. Transgenerational consequences of PTSD: risk factors for the mental health of children whose mothers have been exposed to the Rwandan genocide[J]. Int J Ment Health Syst, 2014, 8(1): 12. doi: 10.1186/1752-4458-8-12
[24]	PARRA A. Negative experiences in childhood, parental style, and resilience among people reporting paranormal experiences[J]. J Nerv Ment Dis, 2019, 207(4): 264-270. doi: 10.1097/NMD.0000000000000955
[25]	LANGE B C L, CALLINAN L S, SMITH M V. Adverse childhood experiences and their relation to parenting stress and parenting practices[J]. Commun Ment Health J, 2019, 55(4): 651-662. doi: 10.1007/s10597-018-0331-z
[26]	HAMPTON S, ALLISON C, AYDIN E, et al. Autistic mothers' perinatal well-being and parenting styles[J]. Autism, 2022. DOI: 10.1177/13623613211065544.
[27]	GREENLEE J L, PIRO-GAMBETTI B, PUTNEY J, et al. Marital satisfaction, parenting styles, and child outcomes in families of autistic children[J]. Fam Process, 2022, 61(2): 941-961. doi: 10.1111/famp.12708
[28]	WANG X, YIN G, GUO F, et al. Associations of maternal adverse childhood experiences with behavioral problems in preschool children[J]. J Interpers Viol, 2021. DOI: 10.1177/08862605211050093.
[29]	汪小燕, 殷刚柱, 邵子瑜, 等. 母亲童年期不良经历与学龄前儿童睡眠质量的关联[J]. 中华疾病控制杂志, 2021, 25(5): 594-599. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202105018.htm WANG X Y, YIN G Z, SHAO Z Y, et al. The role of maternal adverse childhood experiences on the sleep quality of preschool children[J]. Chin J Dis Control Prev, 2021, 25(5): 594-599. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ202105018.htm
[30]	马居飞, 匡桂芳, 曲烨, 等. 孤独症谱系障碍儿童父母性格特征和家庭环境的病例对照研究[J]. 中国学校卫生, 2015, 36(6): 861-863. http://www.cjsh.org.cn/article/id/zgxxws201506018 MA J F, KUANG G F, QU Y, et al. Case-control study of parents' personality in children with autism spectrum disorder and family environment characteristics[J]. Chin J Sch Health, 2015, 36(6): 861-863. http://www.cjsh.org.cn/article/id/zgxxws201506018
[31]	XIAO J, GAO Y, YU Y, et al. Associations of parental birth characteristics with autism spectrum disorder (ASD) risk in their offspring: a population-based multigenerational cohort study in Denmark[J]. Int J Epidemiol, 2021, 50(2): 485-495. doi: 10.1093/ije/dyaa246