Muratori Filippo, Turi Marco, Prosperi Margherita, Narzisi Antonio, Valeri Giovanni, Guerrera Silvia, Santocchi Elisa, Apicella Fabio, Lattarulo Caterina, Calderoni Sara, Vicari Stefano
Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Front Psychiatry. 2019 Mar 12;10:107. doi: 10.3389/fpsyt.2019.00107. eCollection 2019.
An increased prevalence of psychiatric comorbidity (PC) in individuals with Autism Spectrum Disorders (ASD) is consistently reported. While several studies have examined PC in school-aged children, adolescents and adults with ASD, investigations on PC in preschoolers are less common. In this study, we explore the prevalence and the type of PC in a sample of 989 preschoolers with ASD through the DSM-Oriented Scales (DOS) of the Child Behavior Checklist (CBCL 1½-5) and their possible links with the core features of ASD and cognitive functioning. Results indicated that 37.8% of the sample had at least one PC in addition to ASD; these subjects displayed significantly higher Total score ( = 0.02) and Social Affect score ( = 0.003) on the ADOS-based calibrated severity scores (CSS), as well as lower ( ≤ 0.0001) performance IQ (pIQ) compared to ASD individuals without PC. As far as the specific DOS, Affective Problems (AP) were detected in 23.4% of the whole sample, ADHD Problems (ADHD) in 17.3%, Anxiety Problems (AXP) in 16.7%, and Oppositional Problems (OP) in 7.9%. These different comorbidities were isolated in 195 subjects (Mono-comorbid group: 19.7% of the whole sample), while 179 subjects (18.1% of the whole sample) had two or more types of PC (Multi-comorbid group). One-way ANOVA revealed that subjects with multi-comorbidity have statistically significant lower pIQ and higher Total score and Social Affect score on CSS-ADOS. Specific differences for each type of comorbidity and gender differences were also discussed. Taken together, results indicate a considerable presence of PC in preschoolers with ASD that should be accurately considered during the assessment and diagnosis process in order to plan a tailored intervention based not only on core symptoms of ASD, but also on comorbid psychiatric condition since preschool age.
一直有报告称，自闭症谱系障碍（ASD）患者中精神疾病共病（PC）的患病率有所上升。虽然有几项研究调查了学龄儿童、青少年和成年ASD患者的PC情况，但对学龄前儿童PC的研究较少。在本研究中，我们通过儿童行为检查表（CBCL 1½ - 5）的DSM导向量表（DOS），对989名患有ASD的学龄前儿童样本中的PC患病率和类型进行了探索，以及它们与ASD核心特征和认知功能之间的可能联系。结果表明，37.8%的样本除患有ASD外，还至少有一种PC；与没有PC的ASD个体相比，这些受试者在基于ADOS的校准严重程度评分（CSS）上的总分（ = 0.02）和社会情感评分（ = 0.003）显著更高，而表现智商（pIQ）更低（ ≤ 0.0001）。就具体的DOS而言，在整个样本中，23.4%的儿童被检测出有情感问题（AP），17.3%有注意缺陷多动障碍问题（ADHD），16.7%有焦虑问题（AXP），7.9%有对立问题（OP）。这些不同的共病情况在195名受试者中被分离出来（单一共病组：占整个样本的19.7%），而179名受试者（占整个样本的18.1%）有两种或更多类型的PC（多重共病组）。单因素方差分析显示，多重共病的受试者在CSS - ADOS上的pIQ显著更低，总分和社会情感评分更高。还讨论了每种共病类型的具体差异以及性别差异。综上所述，结果表明患有ASD的学龄前儿童中存在相当数量的PC，在评估和诊断过程中应准确考虑这一点，以便不仅基于ASD的核心症状，还基于学龄前就存在的共病精神状况来制定量身定制的干预措施。
