Bishop Somer L, Thurm Audrey, Farmer Cristan, Lord Catherine
Department of Psychiatry, University of California, San Francisco, San Francisco, California;
Pediatrics and Developmental Neuroscience Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland; and.
Pediatrics. 2016 Mar;137(3):e20152959. doi: 10.1542/peds.2015-2959. Epub 2016 Feb 3.
Delayed onset of independent walking is common in intellectual disability (ID). However, in children with autism spectrum disorders (ASD), delayed walking has not been reported as frequently, despite the high rate of concurrent ID in ASD. This study directly examined the relationship between delayed walking and severity of ID in children with ASD versus other non-ASD diagnoses.
Participants were 1185 individuals (ASD, n = 903; non-ASD, n = 282) who received an assessment at age 4 to 12 years (6.89 ± 2.25) that yielded an estimate of nonverbal IQ (NVIQ) and retrospectively reported age of walking from the Autism Diagnostic Interview-Revised. The relationship between diagnostic group and delayed walking (defined as occurring at ≥16 months) as a function of NVIQ was explored using the Cox proportional hazards model.
Children with ASD were less likely to exhibit delayed walking than those with non-ASD diagnoses, and this difference was larger at lower levels of NVIQ (P = .002). For example, rates of delayed walking for ASD and non-ASD were 13% and 19%, respectively, in those with NVIQ >85 but 31% and 60% in children with NVIQ <70.
Although lower IQ scores were associated with increased rates of late walking in both ASD and non-ASD groups, children with low IQ were more likely to show delayed walking in the absence of ASD. This raises the possibility of separate etiological pathways to ID in children with and without ASD.
独立行走延迟在智力障碍（ID）中很常见。然而，在自闭症谱系障碍（ASD）儿童中，尽管ASD并发ID的比例很高，但行走延迟的报道却没有那么频繁。本研究直接考察了ASD儿童与其他非ASD诊断儿童的行走延迟与ID严重程度之间的关系。
研究对象为1185名个体（ASD组903人，非ASD组282人），他们在4至12岁（平均6.89±2.25岁）接受了评估，得出了非言语智商（NVIQ）的估计值，并通过修订版自闭症诊断访谈回顾性报告了开始行走的年龄。使用Cox比例风险模型探讨诊断组与作为NVIQ函数的行走延迟（定义为在≥16个月时出现）之间的关系。
与非ASD诊断的儿童相比，ASD儿童出现行走延迟的可能性较小，且这种差异在较低NVIQ水平时更大（P = 0.002）。例如，NVIQ>85的ASD和非ASD儿童行走延迟率分别为13%和19%；而NVIQ<70的儿童中，这一比例分别为31%和60%。
尽管在ASD组和非ASD组中，较低的智商分数都与后期行走发生率增加有关，但在没有ASD的情况下，低智商儿童更有可能出现行走延迟。这增加了ASD患儿和非ASD患儿ID病因途径不同的可能性。
