Paul F. Lazarsfeld Center for the Social Sciences, Columbia University, New York, New York 10027, USA.
Pediatrics. 2012 May;129(5):e1112-20. doi: 10.1542/peds.2011-1601. Epub 2012 Apr 2.
The goal of this study was to describe the typical longitudinal developmental trajectories of social and communication functioning in children with autism and to determine the correlates of these trajectories.
Children with autism who were born in California from 1992 through 2001 and enrolled with the California Department of Developmental Services were identified. Subjects with <4 evaluations present in the database were excluded, resulting in a sample of 6975 children aged 2 to 14 years. Score sequences were constructed based on 9 evaluative items for social, communication, and repetitive behavior functioning. Typical trajectories were identified by using group-based latent trajectory modeling, and multinomial logistic regression models were used to determine the odds of classification within each trajectory varied by individual and family-level factors.
Six typical patterns of social, communication, and repetitive behavior functioning were identified. These trajectories displayed significant heterogeneity in developmental pathways, and children whose symptoms were least severe at first diagnosis tended to improve more rapidly than those severely affected. One group of ∼10% of children experienced rapid gains, moving from severely affected to high functioning. Socioeconomic factors were correlated with trajectory outcomes; children with non-Hispanic, white, well-educated mothers were more likely to be high functioning, and minority children with less-educated mothers or intellectual disabilities were very unlikely to experience rapid gains.
Children with autism have heterogeneous developmental pathways. One group of children evidenced remarkable developmental change over time. Understanding what drives these outcomes is thus critical.
本研究旨在描述自闭症儿童社交和沟通功能的典型纵向发展轨迹，并确定这些轨迹的相关因素。
本研究确定了 1992 年至 2001 年期间在加利福尼亚州出生并在加利福尼亚州发育服务部注册的自闭症儿童。数据库中存在<4 次评估的受试者被排除在外，最终纳入了 6975 名年龄在 2 至 14 岁的儿童。基于社交、沟通和重复行为功能的 9 项评估项目构建了得分序列。采用基于群组的潜在轨迹建模确定了典型轨迹，采用多项逻辑回归模型确定了个体和家庭层面因素对每种轨迹分类的可能性的影响。
确定了 6 种典型的社交、沟通和重复行为功能发展模式。这些轨迹在发展途径上存在显著的异质性，最初诊断时症状最轻的儿童往往比受影响严重的儿童更快地改善。约 10%的儿童表现出快速的改善，从严重影响到高功能。社会经济因素与轨迹结果相关；非西班牙裔、白人、母亲受教育程度高的儿童更有可能具有高功能，而母亲受教育程度较低或患有智力障碍的少数族裔儿童则不太可能出现快速改善。
自闭症儿童的发育途径具有异质性。一组儿童的发育变化显著。因此，了解是什么推动了这些结果是至关重要的。
