Bishop Somer L, Havdahl Karoline Alexandra, Huerta Marisela, Lord Catherine
Department of Psychiatry, University of California, San Francisco, CA, USA.
Lovisenberg Diaconal Hospital, Oslo, Norway.
J Child Psychol Psychiatry. 2016 Aug;57(8):909-16. doi: 10.1111/jcpp.12510. Epub 2016 Jan 8.
More refined dimensions of social-communication impairment are needed to elucidate the clinical and biological boundaries of autism spectrum disorders (ASD) and other childhood onset psychiatric disorders associated with social difficulties, as well as to facilitate investigations in treatment and long-term outcomes of these disorders.
This study was intended to identify separable dimensions of clinician-observed social-communication impairments by examining scores on a widely used autism diagnostic instrument. Participants included verbally fluent children ages 3-13 years, who were given a clinical diagnosis of ASD (n = 120) or non-ASD (i.e. ADHD, language disorder, intellectual disability, mood or anxiety disorder; n = 118) following a comprehensive diagnostic assessment. Exploratory and confirmatory factor analysis examined the factor structure of algorithm items from the Autism Diagnostic Observation Schedule (ADOS), Module 3.
Results indicated that a three-factor model consisting of repetitive behaviors and two separate social-communication behavior factors had superior fit compared to a two-factor model that included repetitive behaviors and one social-communication behavior factor. In the three-factor model, impairments in 'Basic Social-Communication' behaviors (e.g. eye contact, facial expressions, gestures) were separated from impairments in 'Interaction quality.' Confirmatory factor analysis in an independent sample of children in the Simons Simplex Collection (SSC) further supported the division of social-communication impairments into these two factors. Scores in Interaction Quality were significantly associated with nonverbal IQ and male sex in the ASD group, and with age in the non-ASD group, while scores in basic social communication were not significantly associated with any of these child characteristics in either diagnostic group.
Efforts to conceptualize level, or severity, of social-communication impairment in children with neurodevelopmental disorders might be facilitated by separating the most basic (or proximal) social-communication impairments from those that could arise from a range of other phenotypic variables. Identification of social-communication subdimensions also highlights potential avenues for measuring different types of social-communication impairments for different purposes (e.g. for differential diagnosis vs. response to treatment).
需要更精细的社会沟通障碍维度，以阐明自闭症谱系障碍（ASD）及其他与社交困难相关的儿童期起病的精神障碍的临床和生物学界限，并促进对这些障碍的治疗及长期预后的研究。
本研究旨在通过检查一种广泛使用的自闭症诊断工具的得分，来确定临床医生观察到的社会沟通障碍的可分离维度。参与者包括3至13岁语言流畅的儿童，他们在经过全面诊断评估后被临床诊断为ASD（n = 120）或非ASD（即注意力缺陷多动障碍、语言障碍、智力残疾、情绪或焦虑障碍；n = 118）。探索性和验证性因素分析检查了来自自闭症诊断观察量表（ADOS）模块3的算法项目的因素结构。
结果表明，与包含重复行为和一个社会沟通行为因素的双因素模型相比，由重复行为和两个独立的社会沟通行为因素组成的三因素模型具有更好的拟合度。在三因素模型中，“基本社会沟通”行为（如眼神接触、面部表情、手势）的障碍与“互动质量”的障碍区分开来。对西蒙斯单纯形队列（SSC）中儿童的独立样本进行的验证性因素分析进一步支持将社会沟通障碍分为这两个因素。在ASD组中，互动质量得分与非言语智商和男性性别显著相关，在非ASD组中与年龄显著相关，而基本社会沟通得分在两个诊断组中均与这些儿童特征中的任何一项无显著关联。
将最基本（或最接近）的社会沟通障碍与可能由一系列其他表型变量引起的障碍区分开来，可能有助于对神经发育障碍儿童的社会沟通障碍水平或严重程度进行概念化。社会沟通子维度的识别还突出了为不同目的（如鉴别诊断与治疗反应）测量不同类型社会沟通障碍的潜在途径。
