Excoffier E, Vila G, Taupiac E, Mouren-Simeoni M-C, Bouvard M-P
Service de Psychiatrie de l'Enfant et de l'Adolescent, APHP-Hôpital Robert-Debré, Paris.
Encephale. 2007 Sep;33(4 Pt 1):585-91. doi: 10.1016/s0013-7006(07)92057-6.
Social deficit is the core symptom of pervasive developmental disorder. In other child psychiatric disorders, social problems are also described but mainly as a result of the disease symptomatology. However, some recent studies suspect that in several disorders such as attention deficit hyperactive disorder, patients have an endogenous social disturbance. The aim of our research was to study abnormal child social behaviour in several disorders, using a dimensional approach. It is a preliminary validation study of the French version of the Children's Social Behaviour Questionnaire, a dimensional instrument constructed by Luteijn, Minderaa et al.
Five clinical groups, according to the DSM IV criteria, formed a population of 103 children aged 6 to 16 years old: autistic disorder, attention deficit hyperactive disorder (ADHD), emotional disorder (anxious, depressed), mental retardation and normal children. Parents completed the Child Behaviour Checklist (CBCL) and the Children's Social Behaviour Questionnaire (CSBQ). The research worker and the child's physician completed a data form. The data form included information about medical history, development and socio-demographic criteria. The CBCL explored children's behaviours and general psychopathology, and included social dimensions (withdrawn, social problems, aggressive/delinquent behaviours, thought problems). The CSBQ, a dimensional questionnaire, explored children's social behaviours and included five dimensions: <
Correlations between CSBQ and CBCL dimensions are consistent. Positive correlations exist for: <
Social behaviour profiles are different and characteristic for each disorder. However, social symptoms are not specific for one disorder and common social signs do exist between different disorders. Our results are concordant with the Luteijn study and literature data. The results support the hypothesis of a dimensional pathogenesis in social behaviour disturbance. We discuss the benefit of a dimensional approach to complete the categorical one. The Children's Social Behaviour Questionnaire seems to be an interesting instrument to explore social behaviour disturbances in several child disorders.
社交缺陷是广泛性发育障碍的核心症状。在其他儿童精神疾病中,也有社交问题的描述,但主要是疾病症状的结果。然而,最近的一些研究怀疑,在注意力缺陷多动障碍等几种疾病中,患者存在内源性社交障碍。我们研究的目的是采用维度方法研究几种疾病中儿童的异常社交行为。这是对儿童社交行为问卷法语版的初步验证研究,该问卷是由卢泰恩、明德拉阿等人构建的维度工具。
根据《精神疾病诊断与统计手册》第四版标准,五个临床组构成了一个由103名6至16岁儿童组成的群体:自闭症谱系障碍、注意力缺陷多动障碍(ADHD)、情绪障碍(焦虑、抑郁)、智力障碍和正常儿童。家长完成儿童行为清单(CBCL)和儿童社交行为问卷(CSBQ)。研究人员和儿童的医生完成一份数据表格。数据表格包括病史、发育和社会人口学标准等信息。CBCL探究儿童的行为和一般精神病理学,包括社交维度(退缩、社交问题、攻击/违纪行为、思维问题)。CSBQ是一个维度问卷,探究儿童的社交行为,包括五个维度:“外化行为表现”、“社交接触”、“社交洞察力”、“社交焦虑”、“社交刻板印象”。CSBQ的英文版在荷兰人群中经过验证,被翻译成法语并进行了验证(双向回译)。由于CBCL和CSBQ问卷都是维度工具,因此对维度进行了比较。所有工具结果分别进行分析;在组间进行了相关性分析和比较。
CSBQ和CBCL维度之间的相关性是一致的。存在正相关的维度有:“外化行为表现”与“外部行为”、“攻击行为”和“违纪行为”;“社交接触”与“内部行为”和“退缩”;“社交洞察力”与“社交问题”和“注意力问题”;“社交焦虑场”与“焦虑/抑郁”、“思维问题”和“内部行为”;“社交刻板印象”与“思维问题”。CSBQ的平均结果如下:1. 自闭症组在“社交接触”维度得分最高,ADHD组在“外化行为表现”维度得分最高,智力障碍组在“社交洞察力”维度得分最高。2. 组间比较显示:自闭症组和ADHD组在“社交接触”和“社交焦虑”方面存在显著差异,但在“社交洞察力”和“外化行为表现”方面没有显著差异;自闭症组和智力障碍组在“社交接触”方面存在显著差异,但在其他维度没有显著差异;ADHD组和智力障碍组仅在“外化行为表现”方面存在显著差异;ADHD组和情绪障碍组之间没有显著差异;对照组得分非常低。CBCL结果为:除正常对照组外,所有组在“社交问题”和“注意力问题”方面得分异常;自闭症组和情绪障碍组在“焦虑/抑郁”、“退缩”和“内部行为”方面得分异常;ADHD组在“攻击行为”、“违纪行为”和“外部行为”方面得分异常;“内部行为”得分处于临界值。
每种疾病的社交行为特征各不相同且具有特异性。然而,社交症状并非某一种疾病所特有,不同疾病之间确实存在共同的社交迹象。我们的结果与卢泰恩研究及文献数据一致。这些结果支持社交行为障碍维度发病机制的假设。我们讨论了采用维度方法来完善分类方法的益处。儿童社交行为问卷似乎是探索几种儿童疾病中社交行为障碍的一种有趣工具。