Clinical Profile Associated with Adverse Childhood Experiences: The Advent of Nervous System Dysregulation.
Clinical Profile Associated with Adverse Childhood Experiences: The Advent of Nervous System Dysregulation.
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DOI：
10.3390/children4110098
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发表时间：
2017-11-15
期刊：
影响因子：
--
通讯作者：
Anand KJS
中科院分区：
文献类型：
--
作者：
Elbers J;Rovnaghi CR;Golianu B;Anand KJS
背景：我们报告了儿童神经病学诊所中患有多种医学症状的儿童的患病率，描述了他们的症状概况，并探讨了他们与不良童年经历（ace）的关系。方法：我们回顾性分析了100例连续的儿童神经病学门诊患者。如果患者年龄≥5岁，且报告≥4种无法解释的症状≥3个月，则纳入患者。记录了六个功能域的症状概况：(1)执行功能障碍，(2)睡眠障碍，(3)自主神经失调，(4)躯体化，(5)消化症状，(6)情绪失调。对所有患者进行a评分。结果：17例患者报告了≥4种医学症状。100%的患者出现躯体化、睡眠障碍和情绪失调，大多数患者出现执行功能障碍（94%）、自主神经失调（76%）和消化问题（71%）。42名儿童报告≥1次ACE，但与其他儿童相比，≥4次症状的儿童更有可能报告ACE(88%对33%；p < 0.0001)，并且ACE总中位数得分更高（3对1；p < 0.001）。结论：有多种医学症状的儿童应筛查潜在的ace暴露。跨多个功能域的症状的临床特征表明，涉及压力和神经系统失调的假定神经生物学机制需要进一步研究。
Background: We report the prevalence of children with multiple medical symptoms in a pediatric neurology clinic, describe their symptom profiles, and explore their association with adverse childhood experiences (ACEs). Methods: We retrospectively reviewed 100 consecutive patients from an outpatient pediatric neurology clinic. Patients were included if they were ≥5 years old and reported ≥4 symptoms that were unexplained for ≥3-months. Symptom profiles across six functional domains were recorded: (1) executive dysfunction, (2) sleep disturbances, (3) autonomic dysregulation, (4) somatization, (5) digestive symptoms, and (6) emotional dysregulation. ACEs were scored for all patients. Results: Seventeen patients reported ≥4 medical symptoms. Somatization, sleep disturbances, and emotional dysregulation occurred in 100% patients, with executive dysfunction (94%), autonomic dysregulation (76%), and digestive problems (71%) in the majority. Forty-two children reported ≥1 ACE, but children with ≥4 symptoms were more likely to report ACEs compared to other children (88% vs. 33%; p < 0.0001) and had a higher median total ACE score (3 vs. 1; p < 0.001). Conclusions: Children with multiple medical symptoms should be screened for potential exposure to ACEs. A clinical profile of symptoms across multiple functional domains suggests putative neurobiological mechanisms involving stress and nervous system dysregulation that require further study.
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