孤独症谱系障碍儿童感觉特征及与核心表型的关联

翟巾赫; 李小雪; 徐子涵; 郝海莹; 夏薇; 范莉莉; 腾婉萌; 王佳

doi:10.16835/j.cnki.1000-9817.2023.03.005

孤独症谱系障碍儿童感觉特征及与核心表型的关联

doi: 10.16835/j.cnki.1000-9817.2023.03.005

翟巾赫¹,
李小雪¹,
徐子涵¹,
郝海莹¹,
夏薇¹,
范莉莉¹,
腾婉萌¹,
王佳^{1, 2, ,}

1.
哈尔滨医科大学公共卫生学院儿少卫生与妇幼保健学教研室，黑龙江 150081
2.
黑龙江省医学科学院

基金项目:

国家自然科学基金项目 81874270

黑龙江省自然科学基金 LH2022H051

详细信息

作者简介:
翟巾赫(1995-)，女，黑龙江省人，在读博士，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

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R748 R179
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出版历程
- 收稿日期: 2022-08-15
- 修回日期: 2023-01-29
- 刊出日期: 2023-03-25

Autism spectrum disorder's sensory characteristics and its correlation with core phenotype

1.
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(autism spectrum disorder, ASD)儿童与健康儿童感觉领域的差异，明确ASD感觉异常特征及与多种核心症状之间的关联，为开展早期识别和特异性干预提供科学依据。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ASD儿童265名作为病例组，哈尔滨市普通幼儿园和学校的223名健康儿童为对照组。采用简易感觉量表(SSP)评估两组儿童感觉水平，同时采用社交反应量表(SRS)、儿童孤独症家长评定量表(ABC)等评估孤独症患儿的社交障碍等核心症状的严重程度，分析ASD组SSP与各临床量表得分之间的相关性。结果 SSP得分比较发现，ASD组所有感觉维度得分中位数(触觉=33；味/嗅觉=18；运动敏感=13；低反应/感觉寻求=28；听觉过滤=19；力量低下=22；视/听觉=20)均低于健康对照组(Z值分别为-2.73，-4.36，-3.17，-5.09，-11.00，-10.45，-3.43，P值均 < 0.05)。ASD组儿童多感觉总分异常率为55.1%，对照组为21.2%，差异有统计学意义(χ²=57.15，P < 0.05)；相关性分析结果显示，ASD组SSP得分与SRS全部维度、孤独症诊断访谈量表修订版(ADI-R)量表的非语言交流和社会功能、孤独症继续观察量表(ADOS)交流和社会互动以及ABC和孤独症行为量表(CARS)量表总分之间均呈负相关(P值均 < 0.05)。结论 ASD儿童多感觉存在异常，其中听觉过滤维度的异常最为显著，且感觉异常水平与孤独症临床症状严重程度存在关联。在未来的临床诊疗和研究中，应增强对ASD儿童感觉症状的识别能力，以实现对ASD的早期诊断和早期干预。
- 孤独性障碍 /
- 感觉 /
- 体征和症状 /
- 儿童
Abstract: Objective To explore the differences of sensory manifestations between ASD children and typical development children, and to clarify the characteristics of sensory abnormalities in ASD and their relationship with various clinical symptoms, so as to provide scientific basis for early identification and specific intervention. Methods A total of 265 ASD children who received rehabilitation training in autism rehabilitation institutions in Heilongjiang Province were collected as the case group, and 223 typical development children in ordinary kindergartens and schools in Harbin were taken as the control group. Short Sensory Profile (SSP) was used to evaluate the difference of children's sensory perception level between the two groups, and Social Response Scale (SRS) and Autism Behavior Checklist (ABC) were used to evaluate the severity of symptoms including social disorder of autistic children. The correlation between SSP scores in ASD group and clinical scales was analyzed. Results The comparison of SSP scores between the two groups found that the median scores of all sensory dimensions in ASD group (tactile=33, taste/smell=18, motion sensitivity=13, Low response/sensation seeking=28, auditory filtering=19, low strength=22, visual/auditory=20) were lower than those of the healthy control group(Z=-2.73, -4.36, -3.17, -5.09, -11.00, -10.45, -3.43, P < 0.05). The abnormal rate of multi-sensory score in children in ASD group was 55.1%, and that in control group was 21.2%, with significant difference(χ²=57.15, P < 0.05). Correlation analysis showed that SSP score in ASD group was negatively correlated with all dimensions of SRS, nonverbal communication, and social function of ADI-R scale, ADOS communication and social interaction, and total scores of ABC and CARS(P < 0.05). Conclusion Children with ASD have atypical sensory experiences, especially in auditory filtering dimension, and the level of atypical sensation is related to the severity of clinical symptoms of autism. In the future clinical diagnosis, treatment and research, it is necessary to strengthen the ability to recognize the sensory symptoms of children with ASD, so as to realize the early diagnosis and intervention.
- Autistic disorder /
- Sensation /
- Signs and symptoms /
- Child
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 ASD组与健康对照组儿童SSP得分比较[M(P₂₅, P₇₅)]

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

组别	人数	触觉	味/嗅觉	运动敏感	低反应/感觉寻求	听觉过滤	力量低下	视/听觉	多感觉总分
ASD组	265	33(30, 35)	18(15, 20)	13(11, 15)	28(26, 31)	19(16, 22)	22(18, 27)	20(17, 22)	152(138, 164)
健康对照组	223	34(31, 35)	19(17, 20)	14(12, 15)	31(27, 33)	24(21, 28)	29(25, 30)	21(19, 23)	167(155, 178)
Z值		-2.73	-4.36	-3.17	-5.09	-11.00	-10.45	-3.43	-9.53
P值		0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

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表 2 ASD组与健康对照组儿童SSP各维度异常检出率比较

Table 2. Comparison of abnormal detection rates of SSP in ASD group and control group

组别	人数	触觉	味/嗅觉	运动敏感	低反应/感觉寻求	听觉过滤	力量低下	视/听觉	多感觉总分
ASD组	265	52(19.6)	67(25.2)	108(40.8)	84(31.7)	207(77.8)	176(66.2)	86(32.3)	145(55.1)
健康对照组	223	26(11.7)	21(9.4)	70(31.5)	45(20.4)	77(34.8)	57(25.7)	51(23.1)	46(21.2)
χ²值		5.72	20.45	4.43	7.94	91.72	79.52	5.11	57.15
P值		0.02	< 0.01	0.04	0.01	< 0.01	< 0.01	0.02	< 0.01
注： ()内数字为检出率/%。

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表 3 ASD组儿童SSP与SRS/ADI-R/ADOS得分Spearman相关性分析(r值)

Table 3. Spearman correlation analysis between SSP scores and SRS/ADI-R/ADOS scores in ASD group(r)

简易感觉量表	SRS(n=113)						ADI-R(n=90)		ADOS(n=94)
简易感觉量表	社交知觉	社交认知	社会交流	社交动机	孤独症行为方式	总分	非语言交流	社会互动	交流	社交互动
触觉	-0.19	-0.23^*	-0.28^**	-0.22^*	-0.11	-0.28^**	-0.27^*	-0.16	0.13	-0.18
味/嗅觉	-0.23^*	-0.18	-0.19^*	-0.18	-0.26^**	-0.23^*	-0.15	-0.21^*	0.23^*	0.04
运动敏感	-0.12	-0.11	-0.11	-0.18	-0.03	-0.14	-0.13	-0.21^*	0.10	-0.07
低反应/感觉寻求	-0.35^**	-0.41^**	-0.44^**	-0.39^**	-0.47^**	-0.53^**	-0.15	-0.15	0.05	-0.18
听觉过滤	-0.31	-0.26^**	-0.44^*	-0.42^**	-0.27^**	-0.46^**	-0.14	-0.17	-0.09	-0.25^*
力量低下	-0.17	-0.17	-0.22^*	-0.08	-0.00	-0.19^*	0.16	0.07	-0.02	-0.06
视/听觉	-0.19^*	-0.14	-0.19^*	-0.24^*	-0.26^**	-0.26^**	-0.07	-0.19	0.08	-0.03
多感觉总分	-0.38^**	-0.35^**	-0.45^**	-0.36^**	-0.35^**	-0.49^**	-0.11	-0.17	0.06	-0.15
注： P < 0.05，*P < 0.01。

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