Mitchell Shelley, Brian Jessica, Zwaigenbaum Lonnie, Roberts Wendy, Szatmari Peter, Smith Isabel, Bryson Susan
Autism Research Unit, The Hospital for Sick Children, Toronto, Ontario, Canada.
J Dev Behav Pediatr. 2006 Apr;27(2 Suppl):S69-78. doi: 10.1097/00004703-200604002-00004.
It is well recognized that delayed "first words" is among the most common presenting symptoms of autistic spectrum disorders (ASD). However, data on earlier language and communication development in children with ASD are limited to retrospective reports from parents and from home videos. In this study, we prospectively collected parent report data on early communication and language development in 97 infant siblings of children with ASD and 49 low-risk controls. Parents completed the MacArthur Communicative Development Inventory--Infant Form at 12 and 18 months. Analysis compared 3 groups defined on the basis of diagnostic assessment at 24 months: (1) siblings with ASD (n = 15), (2) siblings not meeting diagnostic criteria for ASD (n = 82), and (3) low-risk controls, none of whom had ASD (n = 49). Children with ASD showed delays in early language and communication compared with non-ASD siblings and controls. At 12 months, the ASD group was reported to understand significantly fewer phrases and to produce fewer gestures. At 18 months, they showed delays in their understanding of phrases, comprehension and production of single words, and use of gestures. Siblings not diagnosed with ASD also used fewer play-related gestures at 18 months than low-risk controls, even when children with identified language delays were excluded. Overall, this prospective study confirms that delays in communication and language development are apparent early in life in children with ASD, and emphasizes that developmental surveillance should include monitoring for delays in gesture, which may be among the earliest signs of ASD.
众所周知，“开口说话延迟”是自闭症谱系障碍（ASD）最常见的症状之一。然而，关于ASD儿童早期语言和沟通发展的数据仅限于家长的回顾性报告以及家庭录像。在本研究中，我们前瞻性地收集了97名ASD儿童的婴儿手足和49名低风险对照儿童早期沟通和语言发展的家长报告数据。家长在孩子12个月和18个月时完成了《麦克阿瑟沟通发展量表——婴儿版》。分析比较了根据24个月时的诊断评估定义的三组儿童：（1）患有ASD的手足（n = 15），（2）未达到ASD诊断标准的手足（n = 82），以及（3）低风险对照儿童，他们均无ASD（n = 49）。与非ASD手足和对照儿童相比，患有ASD的儿童在早期语言和沟通方面存在延迟。在12个月时，据报告ASD组理解的短语显著更少，做出的手势也更少。在18个月时，他们在短语理解、单词理解和产出以及手势使用方面都表现出延迟。即使排除了已确定有语言延迟的儿童，未被诊断为ASD的手足在18个月时使用的与玩耍相关的手势也比低风险对照儿童少。总体而言，这项前瞻性研究证实，ASD儿童在生命早期就明显存在沟通和语言发展延迟，并强调发育监测应包括对手势延迟的监测，这可能是ASD最早的迹象之一。
