中国科学院行为科学重点实验室知识库

目的分析康复训练机构孤独症谱系障碍(ASD)、智力发育障碍(IDD)或全面发育迟缓(GDD)儿童早期语言及词汇发展特点, 为ASD儿童干预训练的教学词汇提供依据。方法横断面研究。2019年3月至2020年2月, 采用自制涵盖名词、动词、副词、形容词及代词共464个词汇的问卷对北京首儿李桥儿童医院康复医学科及北京市顺义区首儿雅稚儿童康复中心75例1～6岁神经发育障碍的ASD患儿(ASD组)、IDD和GDD患儿[发育障碍(DD)组]进行调查, 以获取有效沟通词汇;采用《儿童神经心理行为检查量表:2016版》进行发育评估;同期在首都儿科研究所附属儿童医院儿童保健门诊招募发育正常、智龄相当的37例儿童[典型发展(TD)组]作对照研究。采用秩和检验或χ2检验进行数据分析。结果 ASD组儿童31例, 月龄36.0(27.0～59.0)个月, 智龄20.6(12.0～35.0)个月;DD组儿童44例, 月龄37.0(12.0～77.0)个月, 智龄24.3(6.0～56.0)个月;TD组37例, 月龄20.0(10.0～61.0)个月, 智龄21.9(12.0～55.0)个月。3组智龄比较, 差异无统计学意义(χ2=0.718, P=0.698)。ASD组和DD组总发育商[56(36～83)、68(17～92)]均显著低于TD组[99(79～128)], 差异有统计学意义(χ2=45.234、48.583, 均P<0.001)。ASD组发育评估分量表中的大运动、精细动作、适应能力、语言、社会行为发育商及交流警示行为指数分别为77、52、60、39、52、40;DD组分别为75、64、73、60、60、8。除大运动外, ASD组儿童发育水平均低于DD组儿童, 差异均有统计学意义(χ2=5.763、5.172、11.174、6.108、41.917, 均P<0.05)。ASD组、DD组及TD组有效沟通词汇分别为10个、174个、146个, 差异有统计学意义(χ2=12.785, P=0.002)。ASD组、DD组及TD组儿童能说短语者比例分别为9.7%、29.5%、51.4%, 差异有统计学意义(χ2=13.733, P=0.001)。ASD组、DD组及TD组有效沟通词汇数量分析:以75%及以上儿童能完成为统计界点, 3组有效沟通词汇数量分别为0个、1个、49个;以50%～<75%儿童能完成为统计界点, 3组有效沟通词汇数量分别为6个(依次为妈妈、拜拜、爸爸、抱抱、门、不)、187个、71个;以25%～<50%儿童能完成为统计界点, 3组有效沟通词汇数量分别为112个、183个、103个, 3组有效沟通词汇数量比较, 差异有统计学意义(χ2=456.694, P<0.001)。将ASD组25%以上和TD组50%以上的有效沟通词汇进行匹配, 重叠93个, 占ASD组78.8%(93/118个), 占TD组77.5%(93/120个)。重叠的有效沟通词汇中, 名词占67.7%(63/93个), 动词占26.9%(25/93个)。结论 ASD及DD患儿汉语普通话习得词汇与相同智龄TD儿童相似, 但ASD儿童的词汇表达和理解能力明显低下;ASD患儿与TD儿童有效沟通词汇在不同百分比上有重叠, 这些词汇为优化、筛选训练用词提供了借鉴, 选择以名词和动词为主可能有助于ASD患儿提升训练效果。

Abstract：Objective:To analyze the characteristics of vocabulary and phrase acquisition in Mandarin-exposed children with autism spectrum disorder (ASD), intellectual developmental disability (IDD) or general developmental delay (GDD) in rehabilitation training institutions, and to provide a basis for selecting training vocabulary for ASD children.Methods:A cross-sectional study was carried out on 75 cases of 1-6-year-old children with neurodevelopmental disorders of ASD (the ASD group), IDD and GDD [the developmental disability(DD) group] by using a self-designed questionnaire containing nouns, verbs, adverbs, adjectives and pronouns, 464 words in total.The participants were recruited from Department of Rehabilitation Medicine, Beijing Shouer Liqiao Children′s Hospital and Beijing Shunyi District Shouer Yazhi Children′s Rehabilitation Center from March 2019 to February 2020.Effective co-mmunication vocabulary was obtained." Children Neuropsychological and Behavioral Scale, Revision 2016" was used for developmental evaluation.At the same time, 37 children with normal development and equivalent intellectual age [the typical development(TD) group] were recruited from the outpatient department of children′s Health Department of Children′s Hospital, Capital Institute of Pediatrics as a control group.The rank sum test or chi- square test was used for data analysis. Results:There were 31 children in the ASD group, with a median chronological age of 36.0 (27.0-59.0) months and median mental age of 20.6 (12.0-35.0) months.There were 44 children in the DD group, with a median chronological age of 37.0 (12.0-77.0) months and median mental age of 24.3 (6.0-56.0) months.There were 37 children in the TD group, with a median chronological age of 20.0 (10.0-61.0) months and median mental age of 21.9 (12.0-55.0) months.No significant difference was found in the mental age among the 3 groups ( χ2=0.718, P=0.698). The total development quotients of the ASD group and the DD group were 56 (36-83) and 68 (17-92), respectively, which were significantly lower than that of the TD group [99 (79-128)] ( χ2=45.234, 48.583; all P<0.001). Developmental assessment subscales: the developmental quotients of gross motor, fine motor, adaptive ability, language and social behavior as well as communication warning behavior indices in the ASD group were 77, 52, 60, 39, 52 and 40, respectively; the above scores in the DD group were 75, 64, 73, 60, 60 and 8, respectively.The developmental levels of the ASD group in all the above 6 aspects, except for the gross motor, were significantly lower than those of the DD group ( χ2=5.763, 5.172, 11.174, 6.108, 41.917; all P<0.05). The effective communication vocabulary was 10 in the ASD group, 174 in the DD group and 146 in the TD group, and the difference was significant ( χ2=12.785, P=0.002). The ratio of children that could speak phrases was 9.7%in the ASD group, 29.5%in the DD group, and 51.4% in the TD group.The difference was significant ( χ2=13.733, P=0.001). Based on the analysis of the effective communication vocabulary, the number of effective communication words was none in the ASD group, only 1 in the DD group and 49 in the TD group if taking that more than 75% of the children could speak the word as the statistical cut-off point.If taking that 50%-<75% of the children could speak the word as the cut-off point, the number of effective communication words was only 6 (Mama, Baibai, Baba, Baobao, Men, and Bu successively) in the ASD group, 187 in the DD group, and 71 in the TD group.If taking that 25%-<50% of the children could speak the word as the cut-off point, the number of effective communication words was 112, 183 and 103 in ASD, DD and TD groups, respectively.There was a statistically significant difference in the number of effective communication words among the three groups ( χ2=456.694, P<0.001). Matching the effective communication vocabulary that more than 25% of the children in the ASD group could speak with that that more than 50% of the children in the TD group could speak, there were 93 overlapping words, accounting for 78.8%(93/118) of the ASD group and 77.5%(93/120) of the TD group.In the overlapping words, nouns accounted for 67.7%(63/93) and verbs accounted for 26.9%(25/93). Conclusions:The vocabulary acquired by children with ASD and DD is similar to that by TD children of the same mental age.However, ASD children have extremely low vocabulary expression and comprehension ability.The effective communication words of ASD and TD children overlap at different percentages.These overlapping words provide a basis for optimizing the selection of training vocabulary.Training vocabulary dominated by nouns and verbs may help to improve the effect of intervention training in ASD children.