Weisbrot Deborah M, Gadow Kenneth D, DeVincent Carla J, Pomeroy John
Divisions of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, University Hospital at Stony Brook, NY 11974, USA.
J Child Adolesc Psychopharmacol. 2005 Jun;15(3):477-96. doi: 10.1089/cap.2005.15.477.
Although the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnostic criteria generally discourage the diagnosis of other Axis I disorders in children with pervasive developmental disorder (PDD), anxiety symptoms are often observed in this clinical population. Moreover, there are some albeit limited data that suggest an association between anxiety and psychotic symptoms in children. Because co-occurring psychiatric symptoms have important clinical implications, this study examined anxiety and psychotic symptoms in children with and without PDD.
Parents and teachers completed the Early Childhood Inventory-4 (ECI-4) or the Child Symptom Inventory (CSI-4) for children evaluated in a developmental disabilities clinic (PDD) or a child psychiatry outpatient clinic (non-PDD). Children were divided into four groups: 3-5- year-olds with (n = 182) and without (n = 135) PDD, and 6-12-year-olds with (n = 301) and without (n = 191) PDD. The 6-12-year-olds were further divided into high-anxious and low-anxious subgroups based on CSI-4 ratings and compared with regard to severity of psychotic symptoms.
Teachers rated preschoolers with PDD as exhibiting more severe anxiety symptoms than the non-PDD group; however, the converse was true for parent ratings. For 6-12- year-olds, both parents and teachers rated children with PDD as significantly more anxious than non-PDD clinic referrals. In general, the severity of anxiety symptoms varied by PDD subtype (Asperger's disorder > PDDNOS > Autistic disorder) and IQ (high > low). Furthermore, highly anxious 6-12-year-olds with PDD received significantly higher parent and teacher ratings of psychotic symptom severity (strange behaviors, hearing voices, illogical thinking, inappropriate affect, and odd thoughts) than our low-anxious group, even when controlling for PDD symptom severity. Moreover, the relation between anxiety level and psychotic symptom severity was similar for both PDD and non-PDD children. Parent and teachers differed in their perceptions of the severity of specific anxiety symptoms. In addition, parent- versus teacher-defined anxiety level groups varied with regard to the differential severity of psychotic symptoms. This finding highlights the importance of continued investigation of source-specific syndromes in children with PDD. Two case vignettes are presented.
Anxiety appears to be a clinically important concern in many children with PDD. Similarities in anxiety symptom presentation and their association with psychotic symptoms in both children with and without PDD support the possibility of: (1) psychiatric comorbidity in the former; (2) at least some overlap in causal mechanisms for anxiety and psychotic symptoms in both PDD and non-PDD children; and (3) a unique diagnostic entity comprised of PDD, anxiety, and psychotic symptoms. Lastly, clinicians should seriously consider dual diagnoses in children with PDD.
尽管《精神疾病诊断与统计手册》第4版（DSM-IV）的诊断标准通常不鼓励对患有广泛性发育障碍（PDD）的儿童诊断其他轴I障碍，但在这一临床群体中经常观察到焦虑症状。此外，虽然有一些有限的数据表明儿童焦虑与精神病性症状之间存在关联。由于共病的精神症状具有重要的临床意义，本研究调查了患有和未患有PDD的儿童的焦虑和精神病性症状。
家长和教师为在发育障碍诊所（PDD）或儿童精神病门诊（非PDD）接受评估的儿童完成了幼儿量表-4（ECI-4）或儿童症状量表（CSI-4）。儿童被分为四组：3至5岁患有（n = 182）和未患有（n = 135）PDD的儿童，以及6至12岁患有（n = 301）和未患有（n = 191）PDD的儿童。6至12岁的儿童根据CSI-4评分进一步分为高焦虑和低焦虑亚组，并就精神病性症状的严重程度进行比较。
教师评定患有PDD的学龄前儿童比非PDD组表现出更严重的焦虑症状；然而，家长评定的结果则相反。对于6至12岁的儿童，家长和教师都评定患有PDD的儿童比非PDD门诊转诊儿童明显更焦虑。一般来说，焦虑症状的严重程度因PDD亚型（阿斯伯格障碍>PDDNOS>孤独症障碍）和智商（高>低）而异。此外，即使在控制PDD症状严重程度的情况下，患有PDD的高焦虑6至12岁儿童在精神病性症状严重程度（奇怪行为、幻听、不合逻辑的思维、不适当的情感和怪异想法）方面获得的家长和教师评分明显高于低焦虑组。此外，PDD儿童和非PDD儿童的焦虑水平与精神病性症状严重程度之间的关系相似。家长和教师对特定焦虑症状严重程度的认知存在差异。此外，家长和教师定义的焦虑水平组在精神病性症状的差异严重程度方面也有所不同。这一发现凸显了继续调查患有PDD儿童的特定来源综合征的重要性。文中给出了两个病例 vignettes。
焦虑似乎是许多患有PDD的儿童临床上的一个重要问题。患有和未患有PDD的儿童在焦虑症状表现及其与精神病性症状的关联方面的相似性支持了以下可能性：（1）前者存在精神疾病共病；（2）PDD儿童和非PDD儿童的焦虑和精神病性症状的因果机制至少有一些重叠；（3）一个由PDD、焦虑和精神病性症状组成的独特诊断实体。最后，临床医生应认真考虑对患有PDD的儿童进行双重诊断。
