Subdimensions of social-communication impairment in autism spectrum disorder.
Subdimensions of social-communication impairment in autism spectrum disorder.
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DOI：
10.1111/jcpp.12510
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发表时间：
2016-08
期刊：
影响因子：
--
通讯作者：
Lord C
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文献类型：
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作者：
Bishop SL;Havdahl KA;Huerta M;Lord C
需要更精细的社交沟通障碍维度来阐明自闭症谱系障碍（ASD）以及其他与社交困难相关的儿童期发病的精神障碍的临床和生物学界限，并促进对这些障碍的治疗和长期结果的研究。
当前的研究旨在通过检查一种广泛使用的自闭症诊断工具的得分，来确定临床医生所观察到的社交沟通障碍的可分离维度。参与者包括3至13岁语言表达流利的儿童，他们在经过全面诊断评估后被临床诊断为自闭症谱系障碍（n = 120）或非自闭症谱系障碍（即注意缺陷多动障碍、语言障碍、智力残疾、情绪或焦虑障碍；n = 118）。探索性和验证性因素分析检验了《自闭症诊断观察量表》（ADOS）第3模块算法项目的因素结构。
结果表明，由重复行为以及两个独立的社交沟通行为因素组成的三因素模型，与包含重复行为和一个社交沟通行为因素的两因素模型相比，拟合度更佳。在三因素模型中，“基本社交沟通”行为（例如眼神接触、面部表情、手势）的障碍与“互动质量”的障碍是分开的。在西蒙斯单纯型集合（SSC）中一个独立儿童样本的验证性因素分析进一步支持将社交沟通障碍分为这两个因素。在自闭症谱系障碍组中，互动质量得分与非言语智商和男性性别显著相关，在非自闭症谱系障碍组中与年龄显著相关，而在两个诊断组中，基本社交沟通得分与这些儿童特征中的任何一个均无显著相关性。
将神经发育障碍儿童的社交沟通障碍的水平或严重程度概念化的努力，可能会因将最基本（或近端）的社交沟通障碍与可能由一系列其他表型变量引起的障碍区分开来而得到促进。社交沟通子维度的确定也凸显了为不同目的（例如用于鉴别诊断与对治疗的反应）测量不同类型社交沟通障碍的潜在途径。
More refined dimensions of social-communication impairment are needed to elucidate the clinical and biological boundaries of autism spectrum disorders (ASD) and other childhood onset psychiatric disorders associated with social difficulties, as well as to facilitate investigations in treatment and long-term outcomes of these disorders. The current study was intended to identify separable dimensions of clinician-observed, social-communication impairments by examining scores on a widely used autism diagnostic instrument. Participants included verbally fluent children ages 3 to 13 years, who were given a clinical diagnosis of ASD (n=120) or non-ASD (i.e., ADHD, language disorder, intellectual disability, mood or anxiety disorder; n=118) following a comprehensive diagnostic assessment. Exploratory and confirmatory factor analysis examined the factor structure of algorithm items from the Autism Diagnostic Observation Schedule (ADOS), Module 3. Results indicated that a three-factor model consisting of repetitive behaviors and two separate social-communication behavior factors had superior fit compared to a two-factor model that included repetitive behaviors and one social-communication behavior factor. In the three-factor model, impairments in ‘Basic Social-Communication’ behaviors (e.g., eye contact, facial expressions, gestures) were separated from impairments in ‘Interaction quality.’ Confirmatory factor analysis in an independent sample of children in the Simons Simplex Collection (SSC) further supported the division of social-communication impairments into these two factors. Scores in Interaction Quality were significantly associated with nonverbal IQ and male sex in the ASD group, and with age in the non-ASD group, while scores in basic social communication were not significantly associated with any of these child characteristics in either diagnostic group. Efforts to conceptualize level, or severity, of social-communication impairment in children with neurodevelopmental disorders might be facilitated by separating the most basic (or proximal) social-communication impairments, from those that could arise from a range of other phenotypic variables. Identification of social-communication subdimensions also highlights potential avenues for measuring different types of social-communication impairments for different purposes (e.g., for differential diagnosis vs. response to treatment).