Regression of language and non-language skills in pervasive developmental disorders
Regression of language and non-language skills in pervasive developmental disorders
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DOI：
10.1111/j.1365-2788.2008.01134.x
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发表时间：
2009-02-01
影响因子：
3.6
通讯作者：
Fombonne, E.
中科院分区：
文献类型：
--
作者：
Meilleur, A. -A. S.;Fombonne, E.
背景：作为广泛性发育障碍（PDD）的一部分，有一个亚组的个体报告有不同的症状出现，包括明显正常的早期发育，随后在2岁之前丧失语言和/或非语言技能。本研究旨在通过调查两种类型的丧失，即语言和其他技能退化，来比较表现出退化和通常相关的智力残疾的儿童的症状。方法对135例平均年龄6.3岁的PDD患儿进行回归检查。样本中有80名（59.4%）儿童被诊断为自闭症，44名（32.6%）儿童被诊断为广泛性发育障碍（PDD-NOS）， 11名（8%）儿童患有阿斯伯格综合症。自闭症诊断访谈修订版（ADI-R）用于评估损失类型并描述相关因素，包括出生等级、性别和通过接种硫柳汞暴露。结果共有30例（22%）受试者出现倒退，其中9例（30%）仅出现语言倒退，17例（57%）丧失语言以外的一项技能，4例（13%）同时丧失语言和另一项技能。与PDD-NOS（14%）和阿斯伯格综合征（0%）相比，自闭症（30%）的回归水平明显更高。语言技能退化的儿童比在这一领域没有退化的儿童（(X)除以横线= 26个月）在更早的年龄（(X)除以横线= 12个月）说话。父母和采访者在失去孩子之前一直报告发育异常。ADI-R域平均得分表明，与未退化的儿童相比，退化儿童的自闭症症状更严重，尤其是在重复行为领域。回归与硫柳汞暴露无关，通过出生年份间接估计。结论：每5个PDD患儿中就有1个出现技能丧失，通过ADI-R测量，技能丧失与稍微严重的症状相关，特别是在重复行为领域。此外，尽管看护人在衰退时经常注意到异常，但ADI-R显示，在大多数情况下，其他非典型行为实际上在衰退开始之前就存在。调查的次要因素均与回归无关。在未接触含硫柳汞疫苗的儿童中，退化率与接触硫柳汞样本的研究报告相似，这表明硫柳汞与退化性自闭症没有特定的关联。
Background As part of the pervasive developmental disorders (PDD), there is a subgroup of individuals reported to have a different onset of symptom appearance consisting of an apparently normal early development, followed by a loss of verbal and/or non-verbal skills prior to 2 years of age. This study aims at comparing the symptomatology of children who displayed a regression and often an associated intellectual disability through investigation of two types of loss, namely language and other skill regression.Methods This study examined the occurrence of regression in 135 children with PDD, mean age 6.3 years. The sample was composed of 80 (59.4%) children diagnosed with autism, 44 (32.6%) with pervasive developmental disorder-not otherwise specified (PDD-NOS) and 11 (8%) with Asperger syndrome. The Autism Diagnostic Interview Revised (ADI-R) was used to evaluate the type of loss and to characterise associated factors including birth rank, gender and thimerosal exposure through vaccination.Results A total of 30 (22%) subjects regressed: nine (30%) underwent language regression alone, 17 (57%) lost a skill other than language and four (13%) lost both language and another skill. Significantly higher levels of regression were found in autism (30%) compared with PDD-NOS (14%) and Asperger syndrome (0%). Children who regressed in language skills spoke at a significantly earlier age ((X) over bar = 12 months) than those who did not regress in this domain ((X) over bar = 26 months). Parents and interviewers consistently reported developmental abnormalities prior to the loss. ADI-R domain mean scores indicated a more severe autistic symptomatology profile in children who regressed compared with those who did not, especially in the repetitive behaviour domain. Regression was not associated to thimerosal exposure, indirectly estimated by year of birth.Conclusions A loss of skill, present in one out of five children with PDD, is associated with a slightly more severe symptomatology as measured by the ADI-R, particularly in the repetitive behaviours domain. Furthermore, although abnormalities are often noticed by the caregivers at the time of regression, the ADI-R reveals that other atypical behaviours were in fact present prior to the onset of regression in most cases. None of the secondary factors investigated were associated with regression. In children unexposed to thimerosal-containing vaccines, the rate of regression was similar to that reported in studies of samples exposed to thimerosal, suggesting that thimerosal has no specific association with regressive autism.