中国实用儿科杂志

中国实用儿科杂志 ›› 2024, Vol. 39 ›› Issue (4): 294-298.DOI: 10.19538/j.ek2024040612

• 论著 • 上一篇    下一篇

语言流畅孤独症谱系障碍儿童核心症状与智商关系研究

  

  1. 中山大学附属第三医院儿童发育行为中心，广东  广州  510630
  • 出版日期:2024-04-06 发布日期:2024-05-09
  • 通讯作者: 朱风雷，电子信箱：zhuflei3@mail.sysu.edu.cn
  • 基金资助:
    国家自然科学基金面上项目（81873801）

Relationship between core symptoms and IQ in verbally fluent children with autism spectrum disorders

  1. Child Developmental and Behavioral Center，the Third Affiliated Hospital of Sun Yat-sen University，Guangzhou  510630，China
  • Online:2024-04-06 Published:2024-05-09

摘要： 目的    探究6～18岁语言流畅的孤独症谱系障碍（autism spectrum disorders，ASD）儿童核心症状与智商（intelligence quotient，IQ）之间的关系，为ASD儿童的个性化干预目标制定提供参考。方法    选取2019年4月至2022年5月中山大学附属第三医院儿童发育行为中心语言流畅且符合《美国精神障碍诊断与统计手册》第5版（DSM-Ⅴ）诊断标准的6～18岁ASD患儿（183例）为观察组，另选取同期体检正常儿童（91名）为对照组。使用孤独症诊断观察量表（ADOS，单元三）对ASD核心症状进行量化评分，并用韦氏儿童智力量表第4版（中文版）（WISC-Ⅳ）测定所有被试儿童的IQ。采用Pearson相关分析对孤独症核心症状与IQ关系进行探索。结果    6～18岁语言流畅ASD儿童总IQ、言语理解、知觉推理、工作记忆及加工速度指数均低于正常儿童，差异均有统计学意义（均P<0.05）。61.7%的ASD IQ处于平均智力水平，27.9%低于平均水平。在总IQ、言语理解、工作记忆、加工速度方面，ASD及正常儿童性别差异均无统计学意义（均P>0.05）。在知觉推理方面，ASD男性儿童分数高于女性，差异有统计学意义（P<0.05），而正常儿童差异无统计学意义。ASD不同年龄及不同性别间，ADOS沟通分数、社会互动分数、沟通+社会互动分数、刻板分数间差异无统计学意义（均P>0.05）。ADOS沟通分数、社会互动分数及沟通+社会互动总分数与总IQ均呈负相关关系（r=-0.43，P<0.01；r=-0.31，P<0.01；r=-0.40，P<0.01），而ADOS刻板分数与总IQ相关关系无统计学意义（r=-0.10，P=0.20）。结论    ASD儿童平均总IQ及各功能区分数均落后于正常儿童，个体间总IQ差异较大，知觉推理能力存在性别差异。不同年龄、不同性别ASD儿童ADOS各领域分数差异无统计学意义，需要针对社交沟通、社会互动等方面缺陷进行持续支持。ASD儿童核心症状与其IQ负相关，提示在临床实践中，应针对ASD核心缺陷进行干预。

关键词: 孤独症谱系障碍, 智商, 核心症状, 孤独症诊断观察量表, 儿童

Abstract: Objective    To explore the relationship between core symptoms and Intelligence Quotient（IQ）of 6～18 year old children with autism spectrum disorders（ASD）who are fluent in speech，and provide reference for the formulation of individualized intervention goals for them. Methods    The 6～18-year old verbally fluent children with ASD who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition（DSM-V）were selected as the observation group（n=183）. At the same time，normal children（n=91）who underwent physical examination were selected as the control group.The core symptoms of ASD children were quantitatively scored using the Autism Diagnostic Observation Schedule（ADOS，module 3）. Wechsler Intelligence Scale for Children-Fourth Edition（Chinese version）（WISC-Ⅳ）was used to measure the children's IQ. Pearson correlation analysis was used to explore the relationship between core symptoms and IQ. Results    The average total IQ，verbal comprehension，perceptual reasoning，working memory and processing speed index of 6～18-year old verbally fluent children with ASD were lower than those of normal children，and the differences were statistically significant（all P<0.05）. About 61.7% of the children with ASD had an average IQ，while 27.9% were below the average. There was no gender difference between ASD and normal children in total IQ，language comprehension，working memory or processing speed（all P>0.05）. In terms of perceptual reasoning，ASD boys had higher scores than girls，and the difference was statistically significant（P<0.05），but there was no difference in normal children. In terms of ADOS communication scores，social interaction scores，communication + social interaction scores，and stereotyped scores，there was no significant difference either between ASD boys and girls，or among different age groups of ASD children（all P>0.05）.ADOS communication score，social interaction score and total communication + social interaction score were all negatively correlated with total IQ（r=-0.43，P<0.01；r=-0.31，P<0.01；r=-0.40，P<0.01），while the ADOS stereotype score was not significantly related to total IQ（r=-0.10，P=0.20）. Conclusion    Both the average total IQ and the scores of each functional area of the ASD children are lower than those of the normal children. There are large differences in total IQ among ASD individuals，and gender differences in perceptual reasoning ability. There is no significant difference in ADOS scores among different age groups or gender of children with ASD，thus ongoing support is needed for deficits in social communication and social interaction. There is a negative correlation between core symptoms and IQ in children with ASD.Consequently，interventions should focus on the core deficits of ASD in clinical practice.

Key words: autism spectrum disorders（ASD）, intelligence quotient（IQ）, core symptoms, autism diagnostic observation schedule（ADOS）, child