近20年有关孤独症谱系障碍早期筛查工具研究的可视化分析

doi:10.3969/j.issn.1006-9771.2023.11.008

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (11): 1304-1315.doi: 10.3969/j.issn.1006-9771.2023.11.008

近20年有关孤独症谱系障碍早期筛查工具研究的可视化分析

胡嘉铨¹, 祝丽玲², 姜志梅¹^,³()

1.佳木斯大学附属第三医院，黑龙江佳木斯市 154007
2.佳木斯大学公共卫生学院，黑龙江佳木斯市 154007
3.佳木斯大学康复医学院，黑龙江佳木斯市 154007

收稿日期:2022-08-15 修回日期:2023-09-05 出版日期:2023-11-25 发布日期:2023-11-30
通讯作者: 姜志梅，女，主任医师，教授，博士生导师。E-mail： mynard93@163.com
作者简介:胡嘉铨(1998-)，男，汉族，安徽阜阳市人，硕士研究生，主要研究方向：儿童脑发育与行为障碍研究。
基金资助:
1.佳木斯大学优秀学科团队项目(JDXKTD-2019006);2.佳木斯大学博士专项科研基金启动项目(JMSUZB2018-03)

Early screening tools for autism spectrum disorder in the past two decades: a visualized analysis

HU Jiaquan¹, ZHU Liling², JIANG Zhimei¹^,³()

1. The Third Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154007, China
2. School of Public Health, Jiamusi University, Jiamusi, Heilongjiang 154007, China
3. School of Rebalititation Medicine, Jiamusi University, Jiamusi, Heilongjiang 154007, China

Received:2022-08-15 Revised:2023-09-05 Published:2023-11-25 Online:2023-11-30
Contact: JIANG Zhimei, E-mail： mynard93@163.com
Supported by:
Jiamusi University Excellent Discipline Team Project(JDXKTD-2019006);Jiamusi University Doctoral Special Research Fund Initiation Project(JMSUZB2018-03)

摘要/Abstract

摘要：

目的分析近20年孤独症谱系障碍(ASD)领域研究热点和前沿趋势。

方法检索Web of Science核心合集数据库2002年至2022年ASD早期筛查工具相关文献，采用CiteSpace对关键词进行聚类分析，绘制知识图谱，根据检索结果分析研究学科，并进行综合解读。

结果共纳入研究文献115篇，近20年ASD早期筛查工具研究热度持续升高。发文量较高的研究学科主要有儿科学、神经病学和神经科学、心理学。共获得191个关键词，关键词LLR聚类分析得到11个聚类集群。

结论附后续访谈的改良版婴幼儿孤独症筛查量表(M-CHAT-R/F)、简明版婴幼儿社交和情感评估量表(BITSEA)已进行大规模样本筛查并追踪观察效度，具有良好的心理测量特性和高临床诊断价值。开发新的ASD早期筛查工具和验证M-CHAT-R/F不同语言版本信效度及其数字化和网络化研究是当前的研究热点；ASD早期筛查工具的文化调适以及发育监测框架下的应用可能是前沿研究趋势。

关键词: 孤独症谱系障碍, 早期筛查工具, 文献计量学, 可视化分析

Abstract:

Objective To analyze the research hotspots and frontier trends in the field of early screening tools of autism spectrum disorder (ASD) over the past two decades.

Methods The literature on early screening tools for ASD was searched in Web of Science core collection database from 2002 to 2022. CiteSpace was used for cluster analysis of keywords, to draw knowledge mapping. Research disciplines were analyzed and comprehensively interpreted.

Results A total of 115 articles were included. The number of researches on early screening tools for ASD had been increasing over the past two decades. The research disciplines with higher publication volume included pediatrics, neurology and neuroscience, and psychology. A total of 191 keywords were identified, and the LLR keyword clustering analysis yielded eleven clusters.

Conclusion Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) and Brief Infant-Toddler Social and Emotional Assessment (BITSEA) have been subjected to large-scale sample screening and follow-up observation for validity, demonstrating good psychometric properties and high clinical diagnostic value. The development of new early screening tools for ASD, validation of the reliability and validity of different language versions of the M-CHAT-R/F, and research on digital and networked M-CHAT-R/F are current research hotspots. Cultural adaptation of early screening tools for ASD and their application within the developmental monitoring framework may represent frontier research trends.

Key words: autism spectrum disorder, early screening tools, bibliometrics, visualized analysis

中图分类号:

R794.94

胡嘉铨, 祝丽玲, 姜志梅. 近20年有关孤独症谱系障碍早期筛查工具研究的可视化分析[J]. 《中国康复理论与实践》, 2023, 29(11): 1304-1315.

HU Jiaquan, ZHU Liling, JIANG Zhimei. Early screening tools for autism spectrum disorder in the past two decades: a visualized analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(11): 1304-1315.

图/表 5

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图2

表1

表2

表3

ASD早期筛查工具各语言版本心理测量特性"

筛查工具	语言版本	常模信息	临界值	信度	敏感性	特异性	阳性预测值	阴性预测值
M-CHAT	*英文^[12]	18~25月龄的1 122例低风险儿童，18~30月龄的171例高风险儿童	2个及以上关键项目或3个及以上任意项目答案为否，疑为ASD	0.85	0.87~0.97	0.95~0.99	0.36~0.79	0.99
	阿拉伯文^[26]	18~36月龄的228例儿童	同原版	-	0.87~0.95	0.76~0.89	0.82~0.90	0.86~0.93
	西班牙文^[27]	样本1：18~36月龄的2 417例低风险儿童，63例高风险儿童；样本2：18~36月龄的2 055例高风险儿童	同原版	-	样本1：1.00 样本2：1.00	样本1：0.98 样本2：0.98	样本1：0.35 样本2：0.19	样本1：1.00 样本2：1.00
	日文^[28-29]	信度检测样本：4~17月龄的24例低风险儿童；效度检测样本：18月龄的1 187例儿童	2个及以上任意项目或简明版中的1个及以上任意项目答案为否，疑为ASD	0.56	0.72~0.77	0.84	0.09~0.12	-
	韩文^[30]	16~36月龄的2 300例低风险儿童	同原版	仅进行项目因子分析	-	-	-	-
	法文^[31]	24月龄的1 250例低风险儿童	同原版	-	0.67	0.94	0.14	0.99
	瑞典文^[32]	29月龄的3 999例低风险儿童	同原版	-	0.77	-	0.92	-
	挪威文^[33]	18月龄的52 026例低风险儿童	同原版	-	0.34	0.93	0.02	-
	泰文^[34]	18~48月龄的732例低风险儿童，8~48月龄的109例高风险儿童	同原版	-	0.91	1.00	0.96	0.99
M-CHAT-R/F	*英文^[35]	16~30月龄的3 309例低风险儿童，484例高风险儿童	0~2分：低风险，无需进一步评估，除非存在其他风险因素 3~7分：中等风险，需要进行随访以确定是否需要转诊 8~20分：高风险，立即转诊进行评估和干预	0.85	0.91	0.99	0.11(无随访) 0.65(有随访)	0.99
	中文^[36]	16~30月龄的7 928例低风险儿童	同原版	0.57	0.96	0.86	0.07	1.00
	西班牙文^[37]	14~36月龄的6 625例低风险儿童	同原版	0.59(无随访) 0.62(有随访)	0.79	0.99	0.39	0.99
	冰岛文^[38]	30月龄的1 585例低风险儿童	同原版	-	0.62	0.99	0.72	0.99
	塞尔维亚文^[39]	16~30月龄的128例低风险儿童，20例高风险儿童	同原版	0.91	-	-	-	-
	土耳其文^[40]	16~36月龄的6 712例低风险儿童	同原版	0.67	1.00	0.91	0.09	1.00
Q-CHAT	*英文^[14,41]	研究1：18~24月龄的754例低风险儿童，100例ASD儿童研究2：18~30月龄的3 770例低风险儿童	27分	0.67~0.83	0.44	0.98	0.28	-
	韩文^[42]	2~5岁的80例低风险儿童，24例高风险儿童	33.5分	0.66	-	-	-	-
	意大利文^[43]	16~24月龄的2 400例低风险儿童	27分	0.68	-	-	-	-
	波斯文^[44]	平均27.14月龄的50例正常儿童，平均29.62月龄的50例ASD儿童	27分	0.89	0.96	0.90	-	-
CHAT-23	*中文^[15]	智力年龄为18~24月龄的53例ASD儿童，35例PDD-NOS儿童以及125例正常儿童	≥ 6个任意项目阳性或≥ 2个核心项目或≥ 2个观察项目为否，疑为ASD	part B部分kappa值为0.95	0.74~0.89	0.76~0.91	0.85	-
SACS-R	*英文^[45-46]	研究1：12、18、24月龄的20 770例低风险儿童研究2：研究1中识别出的99例疑患ASD儿童	8月龄儿童：2个关键项目为否，疑为ASD； 12和18月龄儿童：4个关键项目中3个为否，疑为ASD； 24月龄的儿童：5个关键项目中3个为否，疑为ASD	0.88	0.91	0.99	-	-
	中文^[47]	12、18、24月龄的10 514例低风险儿童	同原版	-	0.53	1.00	0.42	1.00
FYI	*英文^[48-49]	研究1：12月龄的1496例低风险儿童研究2：12月龄的699例低风险儿童	总风险得分：19.2分(≥ 96百分位) 社会沟通领域：22.5分(第94百分位) 感觉-调节领域：14.75分(第88百分位)	0.81	0.44	0.99	0.31	0.99
	中文^[50]	12月龄的518例低风险儿童	总风险得分范围：5~42分，未确定临界值	-	-	-	-	-
	希伯来文^[51]	12月龄的471例低风险儿童	总风险得分范围：0~33.88分，未确定临界值	0.69	-	-	-	-
	意大利文^[52]	12月龄的657例低风险儿童	总风险得分范围：0~18.39分，未确定临界值	-	-	-	-	-
BeDevel	*韩文^[53]	18~42月龄的55例正常儿童、75例ASD儿童和25例发育迟缓儿童	18~23月龄的儿童：BeDevel-I中13个项目有2个为否；BeDevel-P中15个项目有9个为否； 24~35月龄的儿童：BeDevel-I中13个项目有3个为否；BeDevel-P中18个项目有11个为否； 36~42月龄的儿童：BeDevel-I中16个项目有6个为否；BeDevel-P中19个项目有9个为否	0.87~0.96	0.83	0.81	0.80	0.83
ESAT	*荷兰文^[54]	14~15月龄的31 724例低风险儿童	14个项目有3个及以上为否，疑为ASD	-	0.68	0.96	0.10	0.99
	挪威文^[55]	18月龄的12 666例低风险儿童	同原版	-	-	-	0.07~0.30	-
BITSEA	*英文^[56]	12~36月龄的1 788例低风险儿童	BITSEA问题量表： ≤ 15分：低风险 16~21分：中风险 ≥ 22分：高风险 BITSEA能力量表： ≥ 10分：低风险 6~9分：中风险 ≤ 5分：高风险	0.79	0.67~0.95	0.68~0.95	0.74~0.93	0.75~0.93
	芬兰文^[57-58]	8~36月龄的50例低风险儿童	同原版	0.75	-	-	-	-
	法文^[59]	12~36月龄的589例低风险儿童	同原版	0.65~0.79	-	-	-	-
	荷兰文^[60]	24月龄的3 170例低风险儿童	同原版	0.61~0.76	-	-	-	-
	土耳其文^[61]	12~42月龄的462例低风险儿童	同原版	0.72~0.82	0.83~0.90	0.88~0.91	-	-
ITC	*英文^[21]	9~36月龄的2 443例低风险儿童	共分为9~12月龄、12~15月龄、15~18月龄、18~24月龄、24~30月龄和30~36月龄6组年龄段，根据得分将儿童分为通过、监测和进一步评估三类	-	0.85	0.89	-	-
CNBS-R2016	*中文^[22]	18~30月龄的371例单纯全面发育迟缓儿童，260例ASD儿童	10.5分	-	0.75	0.80	0.72	0.82
BISCUIT	*英文^[62]	17~37月龄的499例ASD儿童，383例待分类PDD-NOS儿童和2 180例非ASD发育迟缓儿童	17分以下：ASD/发育迟缓 17~39分：ASD/待分类PDD-NOS 39分或以上：ASD	-	0.67~0.94	0.74~0.89	-	-
RITA-T	*英文^[24,63]	18~24月龄的23例ASD儿童，19例非ASD发育迟缓儿童和19例正常儿童	15分	-	1.00	1.00	1.00	0.96
	阿拉伯文^[64]	18~36月龄的19例ASD高风险儿童，19例正常儿童	15分	0.91	0.96	0.84	0.88	-
SORF	*英文^[65]	16~27月龄的130例ASD儿童，61例发育迟缓儿童和56例正常儿童	20分	-	0.80	0.78	0.81	0.78

表3

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聚类编号	大小	silhouette	平均年份	聚类名称
#0	25	0.867	2010	筛查工具
#1	24	0.914	2010	敏感性特异性
#2	24	0.944	2008	早期检测
#3	19	0.856	2012	ASD家族风险
#4	19	0.973	2014	验证
#5	19	0.916	2015	早期识别
#6	16	0.847	2014	早产儿
#7	14	0.922	2012	心理测量特性
#8	14	0.976	2019	跨文化普适性
#9	11	0.974	2011	护士识别
#10	3	0.990	2019	儿童健康监测
#11	3	0.983	2014	ESAT

近20年有关孤独症谱系障碍早期筛查工具研究的可视化分析

Early screening tools for autism spectrum disorder in the past two decades: a visualized analysis

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可视化

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参考文献 70

相关文章 15

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筛查工具	项目数/n	适用年龄/月	计分方式	耗时/min	评估方式	免费获取	是否网络化
M-CHAT	23	16~30	是/否	5~10	照料者填写问卷报告	是	是
M-CHAT-R/F	20	16~30	是/否	5~10	照料者填写问卷报告，若筛查结果 > 3分，专业人员开展结构化问题	是	是
Q-CHAT	25	18~24	Likert 5级计分	10	照料者填写问卷报告	是	是
CHAT-23	27	16~30	是/否	10~20	照料者填写问卷报告，并结合专业人员观察评定	是	是
SACS-R	5	12~30	-	30	专业人员观察评定	否	-
FYI	63	12	Likert 4级计分；多项选择；两个开放式问题	15~20	照料者填写问卷报告	是	是
BeDevel	32	24~60	是/否	18~42	照料者填写问卷报告	-	-
ESAT	14	14~15	是/否	15	照料者填写问卷报告	-
BITSEA	42	12~36	Likert 3级计分	10~15	照料者填写问卷报告	否	-
ITC	24	9~36	Likert 3级计分； Likert 4级计分	10	照料者填写问卷报告	否	是
CNBS-R2016	261	0~72	是/否	-	专业人员观察评定	否	-
BISCUIT	Part1: 62 Part2: 65 Part3: 17	17-37	Likert 3级计分	20~30	照料者填写问卷报告	否
RITA-T	7	14~24	Likert 3级计分； Likert 4级计分； Likert 5级计分	5~10	专业人员观察评定	否	-
SORF	22	18~72	Likert 4级计分	20	专业人员观察评定	否	-

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