Trajectories of Autism Severity in Children Using Standardized ADOS Scores
Trajectories of Autism Severity in Children Using Standardized ADOS Scores
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DOI：
10.1542/peds.2011-3668
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发表时间：
2012-11-01
期刊：
影响因子：
8
通讯作者：
Lord, Catherine
中科院分区：
文献类型：
--
作者：
Gotham, Katherine;Pickles, Andrew;Lord, Catherine
目的：绘制自闭症谱系障碍(ASD)从儿童早期到青春期早期严重程度的纵向轨迹。根据已报道的儿童自闭症的发展轨迹，我们假设，随着时间的推移，相当少数的儿童将显示出自闭症严重程度的显著变化，其中“改善者”表现出最高的平均基线和言语智商(VIQ)增长率。方法：患者包括345名临床转诊和研究参与者，他们在1个或更多的时间点对自闭症的临床诊断做出了最好的估计，并重复了自闭症诊断观察表(ADOS)、VIQ和非言语智商得分。标准化的ADOS严重程度评分被应用于在2至15岁之间纵向收集的1026项评估(最近一次评估时的VIQ：平均值=58，SD=35)。对有和没有协变量的潜在严重程度轨迹等级进行了分数拟合。自适应行为和VIQ随时间变化的轨迹在每个最适合的潜在类别内建模。结果：4类模型最能代表观察数据。超过80%的参与者被分配到持续(稳定)高或中等严重的班级；随着时间的推移，两个小班的严重程度分别增加或降低。年龄、性别、种族和非语言智商不能预测班级成员；VIQ是一个重要的预测因素。基线VIQ在进步和恶化的班级中最高；在进步的班级中以最大的速度增加。结论：如果复制ADOS严重程度的轨迹分类，可能有助于临床预后，并为神经生物学和遗传学研究提供样本亚型。儿科2012；130：e1278-e1284
OBJECTIVES: To plot longitudinal trajectories of autism spectrum disorder (ASD) severity from early childhood to early adolescence. In line with reported trajectories in toddlers, we hypothesize that a substantial minority of children will show marked changes in ASD severity over time, with "Improvers" demonstrating the highest mean baseline and rate of growth in verbal IQ (VIQ).METHODS: Patients included 345 clinic referrals and research participants with best-estimate clinical diagnoses of ASD at 1 or more time points, and repeated Autism Diagnostic Observation Schedule (ADOS), VIQ, and nonverbal IQ scores. Standardized ADOS severity scores were applied to 1026 assessments collected longitudinally between the ages of 2 and 15 (VIQ at most recent assessment: mean = 58, SD = 35). Scores were fitted for latent severity trajectory classes with and without covariates. Adaptive behavior and VIQ trajectories over time were modeled within each of the best-fit latent classes.RESULTS: A 4-class model best represented the observed data. Over 80% of participants were assigned to persistent (stable) high or moderately severe classes; 2 small classes respectively increased or decreased in severity over time. Age, gender, race, and nonverbal IQ did not predict class membership; VIQ was a significant predictor. Baseline VIQ was highest in the improving and worsening classes; it increased at the greatest rate in the improving class. Adaptive behavior declined in all but the improving class, with consistent impairment in all classes.CONCLUSIONS: If replicated, identified trajectory classes of ADOS severity may contribute to clinical prognosis and to subtyping samples for neurobiological and genetic research. Pediatrics 2012;130:e1278-e1284