A prospective study of toddlers with ASD: short-term diagnostic and cognitive outcomes
A prospective study of toddlers with ASD: short-term diagnostic and cognitive outcomes
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DOI：
10.1111/j.1469-7610.2009.02101.x
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发表时间：
2009-10-01
影响因子：
7.6
通讯作者：
Volkmar, Fred
中科院分区：
文献类型：
--
作者：
Chawarska, Katarzyna;Klin, Ami;Volkmar, Fred
背景：尽管近期因自闭症谱系障碍（ASD）鉴别诊断而被转诊的幼儿数量有所增加，但对于该群体早期诊断的短期稳定性以及认知结果的了解仍然有限。
方法：对89名诊所转诊的幼儿在平均21.5（标准差 = 4.9）个月时的认知、社交和沟通技能进行评估，并在46.9（标准差 = 7.7）个月时再次评估。确定诊断表现稳定和不稳定的组，并就其在初次诊断时获得的认知和社交沟通技能特征进行比较。
结果：ASD诊断的稳定性为100%；自闭症诊断在74%的病例中稳定，而在广泛性发育障碍未特定型（PDD - NOS）组和非ASD组中分别为83%和81%。在最初被诊断为PDD - NOS的幼儿中有17%以及最初被诊断为非ASD障碍的幼儿中有19%出现社交障碍症状恶化导致被诊断为自闭症。然而，在最初表现为自闭症的儿童中约有1/4有显著改善，在随访时需要重新诊断为PDD - NOS。对发育技能特征的分析表明，在生命的第二年，言语和非言语沟通技能的评估对ASD内亚型的诊断区分具有特别的相关性。
结论：幼儿ASD诊断的稳定性较高，尽管在少数病例中症状严重程度预计会有显著变化。同时考虑认知、社交和沟通技能特征可提高诊断分类的准确性和对结果的预测。
Background:Despite recent increases in the number of toddlers referred for a differential diagnosis of autism spectrum disorders (ASD), knowledge of short-term stability of the early diagnosis as well as cognitive outcomes in this cohort is still limited.Method:Cognitive, social, and communication skills of 89 clinic-referred toddlers were assessed at the average age of 21.5 (SD = 4.9) months, and reassessed at 46.9 (SD = 7.7) months. Groups with stable and unstable diagnostic presentation were identified and compared on their profile of cognitive and social-communicative skills obtained at the time of initial diagnosis.Results:Stability of the ASD diagnosis was 100%; diagnosis of autism was stable in 74% of cases as compared to 83% and 81% in PDD-NOS and Non-ASD groups, respectively. Worsening of social disability symptoms resulting in autism diagnosis was noted in 17% of toddlers initially diagnosed with PDD-NOS and in 19% of toddlers with initial diagnosis of non-ASD disorder. However, marked improvement was noted in approximately 1/4 of children initially presenting with autism, warranting diagnostic reassignment to PDD-NOS at follow-up. An analysis of developmental skills profiles suggests particular relevance of the assessment of verbal and nonverbal communication skills to diagnostic differentiation between subtypes within ASD in the second year of life.Conclusions:Stability of ASD diagnosis in toddlers is high, though marked changes in severity of symptoms is to be expected in a minority of cases. Simultaneous consideration of cognitive, social, and communication skills profiles enhances accuracy of diagnostic classification and prediction of outcome.