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学龄前高功能孤独症儿童与全面发育迟缓儿童执行功能特征研究

Executive function characteristics of preschool children with high functioning autism and children with global developmental delay

摘要目的:探讨学龄前高功能孤独症谱系障碍(high functioning autism,HFA)儿童和全面发育迟缓(global developmental delay,GDD)儿童执行功能的特点,以及与典型发育(typically developmental,TD)儿童执行功能的差异。方法:选取2020年1月至2021年1月在贵阳市妇幼保健院儿童保健科心理行为门诊和重庆市第九人民医院儿童保健科发育行为门诊就诊的4~6岁男性HFA、GDD和TD儿童各20例进行对比研究,采用学龄前儿童执行功能行为评定量表(behavior rating scale of executive function-preschool version,BRIEF-P)父母版和执行功能系列任务程序对HFA、GDD、TD儿童的执行功能进行评估。采用SPSS 26.0软件进行统计分析,统计分析方法包括方差检验、独立样本 t检验、 χ2检验、Kruskal Wallis检验和Mann-Whitney U检验。 结果:3组儿童在动物任务(Pig)、动物叫声反串任务(silly sounds game,SSG)、工作记忆任务(pick the picture,PTP)和认知灵活性任务(something’s the same,STS)的正确率均差异有统计学意义[Pig:HFA组:0.87(0.76,0.99),GDD组:0.97(0.85,0.99),TD组:1.00(0.98,1.00), χ2=15.646, P<0.001;SSG:HFA组:0.76(0.53,0.91),GDD组:0.76(0.65,0.99),TD组:0.94(0.76,1.00), χ2=6.448, P=0.040;PTP:HFA组:(0.66±0.18),GDD组:(0.66±0.19),TD组:(0.78±0.11), F=3.221, P=0.048;STS:HFA组:0.67(0.63,0.70),GDD组:0.72(0.46,0.78),TD组:0.87(0.83,0.90), χ2=26.898, P<0.001]。组间比较显示,HFA组在Pig、SSG、PTP和STS的正确率显著低于TD组(均 P<0.05);GDD组在Pig和STS正确率显著低于TD组(均 P<0.05)。抑制控制中,在Pig、SSG反应时间方面,3组儿童差异具有统计学意义[Pig:HFA组:(1 694.36±222.83)ms,GDD组:(1 513.46±244.91)ms,TD组:(1 444.84±197.95)ms, F=5.810, P=0.005;SSG:HFA组:(2 202.42±195.58)ms,GDD组:(2 116.52±323.27)ms,TD组:(1 937.17±252.74)ms, F=4.610, P=0.014],在箭头任务(Arrows)的反应时间方面差异无统计学意义( P>0.05)。3组在BRIEF-P抑制控制、组织计划、抑制自我调控、认知灵活性及总得分上差异有统计学意义( P<0.05),其余各因子和维度得分上均差异无统计学意义(均 P>0.05)。 结论:学龄前HFA儿童和GDD儿童执行功能存在受损。学龄前HFA儿童和GDD儿童执行功能均与同年龄TD儿童差异显著,并且HFA儿童在执行功能各成分的受损程度严重于GDD儿童。

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abstractsObjective:To investigate the characteristics of executive function of preschool children with high functioning autism spectrum disorder (HFA) and with global developmental delay (GDD), and the differences among HFA, GDD and typically developmental (TD) children.Methods:From January 2020 to January 2021, 20 male HFA, 20 male GDD and 20 male TD children aged 4-6 years who visited the Psychological Behavior Clinic of the Child Health Department of Guiyang Maternal and Child Health Hospital and the Developmental Behavior Clinic of the Children Health Department of the Ninth People's Hospital in Chongqing were selected for comparative study.The executive function of HFA, GDD and TD children was assessed with the behavior rating scale of executive function-preschool version(BRIEF-P) and the executive function task program (EF-TOUCH). SPSS 26.0 software was used for statistical analysis, including variance test, independent sample t-test, χ2 test, Kruskal Wallis test and Mann-Whitney U test. Results:In the EF-TOUCH program task, the accuracy of the three groups of children's performance in the pig task (Pig), the silly sounds game (SSG), the working memory task (pick the picture, PTP) and the task of cognitive flexibility (something's the same, STS) were statistically different(Pig: HFA group: 0.87(0.76, 0.99), GDD group: 0.97(0.85, 0.99), TD group: 1.00(0.98, 1.00), χ2=15.646, P<0.001; SSG: HFA group: 0.76(0.53, 0.91), GDD group: 0.76(0.65, 0.99), TD group: 0.94(0.76, 1.00), χ2=6.448, P=0.040; PTP: HFA group: 0.66±0.18, GDD group: 0.66±0.19, TD group: 0.78±0.11; F=3.221, P=0.048; STS: HFA group: 0.67(0.63, 0.70), GDD group: 0.72(0.46, 0.78), TD group: 0.87(0.83, 0.90), χ2=26.898, P<0.001). The accuracies of Pig, SSG, PTP and STS in HFA group were significantly lower than those in TD group(all P<0.05), and the accuracies of Pig and STS in GDD group were significantly lower than those in TD group(both P<0.05). In inhibition control, there were statistically differences in response time of Pig and SSG among the three groups (Pig: HFA group: (1 694.36±222.83)ms, GDD group: (1 513.46±244.91)ms, TD group: (1 444.84±197.95)ms, F=5.810, P=0.005; SSG: HFA group: (2 202.42±195.58)ms, GDD group: (2 116.52±323.27)ms, TD group: (1 937.17±252.74)ms, Z=4.610, P=0.014). There were no significant differences in the reaction time of Arrows task ( P>0.05). There were significant differences in BRIEF-P inhibition control, organizational planning, inhibition self-regulation, cognitive flexibility and total scores among the three groups ( P<0.05), while there were no significant differences in the scores of other factors and dimensions ( P>0.05). Conclusion:The executive function of pre-school children with high functioning autism spectrum disorder and children with global developmental delay is impaired.The executive function of children with high functioning autism spectrum disorder and children with global developmental delay is significantly different from that of typically developmental children of the same age.Moreover, the executive function of children with HFA is more severely damaged from all components than that of children with GDD.

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