Honda Hideo, Shimizu Yasuo, Nitto Yukari, Imai Miho, Ozawa Takeshi, Iwasa Mitsuaki, Shiga Keiko, Hira Tomoko
Yokohama Rehabilitation Center, Kohoku-ku, Yokohama, Japan.
J Child Psychol Psychiatry. 2009 Aug;50(8):972-81. doi: 10.1111/j.1469-7610.2009.02055.x. Epub 2009 Feb 27.
For early detection of autism, it is difficult to maintain an efficient level of sensitivity and specificity based on observational data from a single screening. The Extraction and Refinement (E&R) Strategy utilizes a public children's health surveillance program to produce maximum efficacy in early detection of autism. In the extraction stage, all cases at risk of childhood problems, including developmental abnormality, are identified; in the refinement stage, cases without problems are excluded, leaving only cases with conclusive diagnoses.
The city of Yokohama, Japan, conducts a routine child health surveillance program for children at 18 months in which specialized public health nurses administer YACHT-18 (Young Autism and other developmental disorders CHeckup Tool), a screening instrument to identify children at risk for developmental disorders. Children who screen positive undergo further observation, and those without disorders are subsequently excluded. To study the efficacy of early detection procedures for developmental disorders, including autism, 2,814 children born in 1988, examined at 18 months of age, and not already receiving treatment for diseases or disorders were selected.
In the extraction stage, 402 (14.3%) children were identified for follow-up. In the refinement stage, 19 (.7%) of these were referred to the Yokohama Rehabilitation Center and diagnosed with developmental disorders. The extraction stage produced four false negatives, bringing total diagnoses of developmental disorders to 23 (.8%) - including 5 with autistic disorder and 9 with pervasive developmental disorder - not otherwise specified (PDDNOS). Sensitivity was 60% for autistic disorder and 82.6% for developmental disorders. Specificity for developmental disorders rose to 100% with the E&R Strategy. Picture cards used in YACHT-18 provided a finer screen that excluded some false positive cases.
An extraction and refinement methodology utilizing child health surveillance programs achieve high efficacy for early detection of autism.
对于自闭症的早期检测，基于单次筛查的观察数据难以维持高效的敏感性和特异性水平。提取与细化（E&R）策略利用一项公共儿童健康监测计划，以在自闭症早期检测中产生最大效果。在提取阶段，识别出所有有儿童期问题风险的病例，包括发育异常；在细化阶段，排除无问题的病例，仅留下确诊病例。
日本横滨市针对18个月大的儿童开展常规儿童健康监测计划，由专业公共卫生护士使用YACHT - 18（幼儿自闭症及其他发育障碍检查工具），这是一种用于识别发育障碍风险儿童的筛查工具。筛查呈阳性的儿童接受进一步观察，随后排除无疾病的儿童。为研究包括自闭症在内的发育障碍早期检测程序的效果，选取了1988年出生、在18个月大时接受检查且未接受疾病或障碍治疗的2814名儿童。
在提取阶段，402名（14.3%）儿童被确定进行随访。在细化阶段，其中19名（0.7%）被转介至横滨康复中心并被诊断为发育障碍。提取阶段产生了4例假阴性，使发育障碍的总诊断数达到23名（0.8%）——包括5名自闭症障碍患者和9名未另行说明的广泛性发育障碍（PDDNOS）患者。自闭症障碍的敏感性为60%，发育障碍的敏感性为82.6%。采用E&R策略后，发育障碍的特异性升至100%。YACHT - 18中使用的图片卡片提供了更精细的筛查，排除了一些假阳性病例。
利用儿童健康监测计划的提取与细化方法在自闭症早期检测中具有高效性。
