两种量表在诊断儿童孤独症谱系障碍中的应用价值对比

摘要

Objective To compare the diagnostic value between Autism Diagnostic Observation Schedule(ADOS) Module-1 and Children Autism Rating Scale(CARS) for children with autism spectrum disorder(ASD). Methods Fifty children with ASD(ASD group) and 43 children with cognitive and verbal disorder(non-ASD group) were enrolled,and all subjects were assessed by ADOS Module-1 and CARS.The consistency of diagnostic results between the two scales and the criteria of American Diagnostic and Statistical Manual of Mental Disorders-V(DSM-V) was evaluated.The sensitivity and specificity for the two scales in the diagnosis of ASD were analyzed, and the correlation between the scores of the two scales and the diagnostic grades based on DSM-V was analyzed among children with ASD as well.Results The results assessed by ADOS Module-1 or CARS were highly consistent with those assessed by DSM-V in the two groups(Kappa value,0.985 and 0.963 respectively;all P=0.001).The specificity and sensitivity for ADOS Module-1 in the diagnosis of ADS children aged 3 years and younger were superior to those of ADS children older than 3 years(P<0.05).No significant difference was found in the specificity or sensitivity for CARS between ADS children older than 3 years and aged 3 years and younger(P>0.05).The sensitivity and specificity for ADOS Module-1 were superior to those for CARS(P<0.05).The score for A+B dimension of ADOS Module-1 and the CARS score positively correlated with the DSM-V diagnostic grade(P<0.05).Conclusion ADOS Module-1 and CARS have favorable application value in the auxiliary diagnosis of children with ASD,and ADOS Module-1 achieves higher specificity and sensitivity in the early diagnosis of children with ASD.%目的 比较孤独症诊断观察量表(ADOS)模块1与儿童期孤独症评定量表(CARS)对儿童孤独症谱系障碍(ASD)的诊断价值.方法 选择50例ASD患儿(ASD组)和43例认知及语言障碍发育迟缓患儿(非ASD组),均采用ADOS模块1及CARS进行评估.评价两个量表与美国《精神疾病诊断与统计手册第5版》(DSM-Ⅴ)诊断结果的一致性,分析两者诊断ASD的灵敏度及特异度,以及ASD患儿两种量表评分与DSM-Ⅴ诊断分级的相关性.结果 ADOS模块1和CARS对两组患儿的评估结果与DSM-Ⅴ的一致性均高(Kappa值分别为0.985、0.963,P值均为0.001).ADOS模块1对年龄≤3岁患儿的诊断特异性及敏感性均优于>3岁患儿(P<0.05).CARS对年龄≤3岁患儿及>3岁患儿的诊断特异性、敏感性比较,差异无统计学意义(P>0.05).ADOS模块1的敏感性及特异性均优于CARS(P<0.05),其A+B领域评分、CARS评分与DSM-V诊断分级均呈正相关(P<0.05).结论 ADOS模块1与CARS在辅助诊断儿童ASD中均具有良好的应用价值,而ADOS模块1在ASD儿童的早期诊断中具有更高的特异性和敏感性.