Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments
Exploring the borderlands of autistic disorder and specific language impairment: a study using standardised diagnostic instruments
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DOI：
10.1111/1469-7610.00114
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发表时间：
2002-10-01
期刊：
影响因子：
--
通讯作者：
Norbury, CF
中科院分区：
文献类型：
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作者：
Bishop, DVM;Norbury, CF
背景：进行了两项研究以检验关于语用语言障碍（PLI——先前被称为语义 - 语用障碍）仅仅是自闭症障碍或未另行分类的广泛性发育障碍（PDDNOS）的另一种说法。
方法：在研究1中，根据儿童沟通检查表将21名6至9岁有语言障碍的儿童细分为13例语用语言障碍（PLI）和8例典型的特定语言障碍（SLI - T）。家长完成修订版自闭症诊断访谈（ADI - R）和社会沟通问卷（SCQ），并对儿童进行通用自闭症诊断观察量表（ADOS - G）测试。在研究2中，另外11名患有SLI - T的儿童和18名患有PLI的儿童使用SCQ和ADOS - G进行评估。此外，对6名被诊断为高功能自闭症的儿童和18名正常发育的儿童进行了评估。
结果：ADI - R和SCQ诊断之间有较好的一致性，但基于这些家长报告测量的诊断与基于ADOS - G的诊断之间一致性较差。在许多儿童中，症状表现随年龄而变化。研究1中的4名PLI儿童和研究2中的1名儿童在家长报告（ADI - R或SCQ）和ADOS - G上都符合自闭症障碍的标准。其他许多儿童表现出一些自闭症特征，但有一部分有语用困难的儿童通过两种工具都未被诊断为患有自闭症或PDDNOS。这些儿童往往使用语调/韵律异常的刻板语言，但他们看起来善于交际且有沟通能力，有正常的非语言沟通，并且在语言/社会沟通领域之外几乎没有异常。
结论：有沟通问题的儿童存在语用困难应促使临床医生评估自闭症症状，但认为所有有语用困难的儿童都患有自闭症或PDDNOS是危险的。
Background: Two studies were conducted to test claims that pragmatic language impairment (PLI-previously referred to as semantic-pragmatic disorder) is simply another term for autistic disorder or pervasive developmental disorder not other-wise specified (PDDNOS). Method: In Study 1, 21 children aged from 6 to 9 years with language impairments were subdivided on the basis of the Children's Communication Checklist into 13 cases of pragmatic language impairment (PLI) and eight cases of typical specific language impairment (SLI-T). Parents completed the Autism Diagnostic Interview Revised (ADI-R) and the Social Communication Questionnaire (SCQ), and the children were given the Autism Diagnostic Observation Schedule - Generic (ADOS-G). In Study 2, a further 11 children with SLI-T and 18 with PLI were assessed using the SCQ and ADOS-G. In addition, six children diagnosed with high-functioning autism and 18 normally developing children were assessed. Results: There was good agreement between ADI-R and SCQ diagnoses, but poor agreement between diagnoses based on these parental report measures and those based on ADOS-G. In many children, symptom profiles changed with age. Four PLI children from Study I and one from Study 2 met criteria for autistic disorder on both parental report (ADI-R or SCQ) and ADOS-G. Many of the others showed some autistic features, but there was a subset of children with pragmatic difficulties who were not diagnosed as having autism or PDDNOS by either instrument. These children tended to use stereotyped language with abnormal intonation/ prosody, but they appeared sociable and communicative, had normal nonverbal communication, and showed few abnormalities outside the language/social communication domains. Conclusions: Presence of pragmatic difficulties in a child with communication problems should prompt the clinician to evaluate autistic symptomatology, but it is dangerous to assume that all children with pragmatic difficulties have autism or PDDNOS.