Relationships between maternal adverse childhood experiences and autistic behaviors in preschool children
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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。 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. -
Key words:
- Life change events /
- Mothers /
- Autistic disorder /
- Regression analysis /
- Child, preschool
1) 利益冲突声明 所有作者声明无利益冲突。 -
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/%。 
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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 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。
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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 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。
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