孤独症儿童社会交往能力发展与执行功能和心理推理能力的关系

摘要

目的:探讨孤独症儿童社会交往能力发展与执行功能和心理推理能力的关系.方法:采用横断面研究方法,选取符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)诊断标准,同时经学龄儿童情感障碍和精神分裂症问卷-终身版(K-SADS)评定无严重精神共患病的6～17岁孤独症儿童共46例.以社交反应量表(SRS)评估其社会交往能力,以复杂图形记忆、连线试验、言语流畅性、Stroop色词命名和一、二级错误信念任务评定其执行功能和心理推理能力水平.将SRS总分及各因子分(社交知觉、社交认知、社交沟通、社交动机、孤独症行为)与执行功能各项测评结果进行相关分析,对一级和二级错误信念任务通过组和非通过组的SRS总分及各因子分进行均数t检验.结果:执行功能方面,Rey复杂图形记忆任务的各项得分均与SRS孤独症行为因子分呈正相关(r=0.31、0.33、0.41、0.38,Ps＜0.05),即时记忆结构分与SRS社交动机因子分呈正相关(r=0.30,P＜0.05),延时记忆结构分与SRS总分呈正相关(r=0.34,P＜0.05);Stroop色词命名任务中第1试错误数与SRS社交认知因子分呈正相关(r=0.32,P＜0.05),Stroop色词命名中其他任务、言语流畅性任务及连线任务结果与SRS结果相关均无统计学意义(r=-0.21 ～0.24,Ps≥0.05).心理推理能力方面,错误信念通过组与未通过组的SRS得分差异无统计学意义(t=-0.68～1.73,Ps≥0.05).结论:孤独症儿童社会交往能力的发展与其执行功能有关系,社会交往能力发展与其心理推理能力无明显关系.%Objective:To explore the relationship between development of social skills and executive function and theory of mind in children and adolescents with autism.Methods:Forty-six children and adolescents with autism aged 6 to 17 years were recruited.The diagnosis was made according to the Diagnostic and Statistical Manual of Mental Disorder,Fourth Edition(DSM-Ⅳ),and severe mental disorders were excluded by the screening of the Schedule for Affective Disorders and Schizophrenia for School-Age children (K-SADS).The Rey Complex Figure Test (RCFT),Trail-Making Test,Verbal Fluency Test,Stroop Color-word Task,the First-Order Belief Test and the Second-Order Belief Test were used to assess executive function and theory of mind,and Social Response Scale (SRS) was used to assess social skills.The correlation between results of Executive Function and SRS was analyzed.The SRS scores between groups passing and without passing of First-Order Belief Test and Second-Order Belief were compared.Results:In the aspect of Executive Function,RCFT scores were positively correlated with autistic behavior factor score of SRS (r =0.31-0.41,Ps ＜ 0.05),meanwhile,immediate recall structure scores of RCFT were positively correlated with social motivation factor scores of SRS (r =0.30,P ＜ 0.05),delayed recall structure scores of RCFT were positively correlated with SRS total scores(r =0.34,P ＜ 0.05).In Stroop Colorword Task,errors of the first task were positively correlated with social cognitive factor scores of SRS (r =0.32,P ＜ 0.05).There were no correlation between other Executive Function results and SRS scores (r =-0.21-0.24,Ps ≥0.05).In the aspect of Theory of Mind,there was no significant difference in SRS scores between groups passing or without passing (t =-0.68-1.73,Ps ≥ 0.05).Conclusion:The development of social skill in children and adolescents with autism may have relationship withexecutive function,but have no relationship with the theory of mind.