Autism from 2 to 9 years of age
Autism from 2 to 9 years of age
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DOI：
10.1001/archpsyc.63.6.694
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发表时间：
2006-06-01
影响因子：
--
通讯作者：
Pickles, A
中科院分区：
文献类型：
--
作者：
Lord, C;Risi, S;Pickles, A
背景：自闭症是从婴幼儿时期开始的一种不寻常的发展模式。目的：检查2-9岁自闭症谱系诊断的稳定性，并确定预测以后诊断的特征。设计：从标准化工具中对诊断分类进行前瞻性研究，包括父母访谈(自闭症诊断访谈-修订[ADI-R])，观察量表(语言前自闭症诊断观察量表/自闭症诊断观察量表[ADOS])，以及在2岁和9岁时进行的独立临床诊断，与临床研究团队的标准诊断进行比较。设置：3个初始队列：连续转诊到(1)国家资助的社区自闭症中心，(2)私立大学自闭症诊所，以及(3)社区诊所发育迟缓的病例对照。参与者：2岁时，192例自闭症转介和22例发育迟缓病例对照；172名儿童在9岁时被观察。主要结果：9岁时的共识最佳估计诊断。结果：2岁和9岁时最佳估计诊断之间的符合率为67，加权kappa为0.72。诊断的变化主要是由于从普适性发育障碍到自闭症的变化。两岁时的每一项测量都对9岁时的自闭症有很强的预测作用，父母面谈的优势比为6.6，观察的优势比为6.8，临床判断的优势比为12.8。在2岁时考虑言语智商(P=.001)后，ADI-R重复领域(P=0.02)、ADOS社交领域(P=0.05)和重复领域(P=0.005)对9岁儿童自闭症有显著的预测作用。结论：9岁时孤独症的诊断稳定性在2岁时非常高，而对于普及性发育障碍则较弱。经验丰富的临床医生的判断，经过标准仪器的培训，一直添加到父母访谈和标准化观察中可获得的信息中。
Context: Autism represents an unusual pattern of development beginning in the infant and toddler years.Objectives: To examine the stability of autism spectrum diagnoses made at ages 2 through 9 years and identify features that predicted later diagnosis.Design: Prospective study of diagnostic classifications from standardized instruments including a parent interview (Autism Diagnostic Interview-Revised [ADI-R]), an observational scale (Pre-Linguistic Autism Diagnostic Observation Schedule/Autism Diagnostic Observation Schedule [ADOS]), and independent clinical diagnoses made at ages 2 and 9 years compared with a clinical research team's criterion standard diagnoses.Setting: Three inception cohorts: consecutive referrals for autism assessment to (1) state-funded community autism centers, (2) a private university autism clinic, and (3) case controls with developmental delay from community clinics.Participants: At 2 years of age, 192 autism referrals and 22 developmentally delayed case controls; 172 children seen at 9 years of age.Main Outcome Measures: Consensus best-estimate diagnoses at 9 years of age.Results: Percentage agreement between best-estimate diagnoses at 2 and 9 years of age was 67, with a weighted kappa of 0.72. Diagnostic change was primarily accounted for by movement from pervasive developmental disorder not otherwise specified to autism. Each measure at age 2 years was strongly prognostic for autism at age 9 years, with odds ratios of 6.6 for parent interview, 6.8 for observation, and 12.8 for clinical judgment. Once verbal IQ (P = .001) was taken into account at age 2 years, the ADI-R repetitive domain (P = .02) and the ADOS social (P = .05) and repetitive domains (P = .005) significantly predicted autism at age 9 years.Conclusions: Diagnostic stability at age 9 years was very high for autism at age 2 years and less strong for pervasive developmental disorder not otherwise specified. Judgment of experienced clinicians, trained on standard instruments, consistently added to information available from parent interview and standardized observation.