School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland.
School of Medicine, University of Glasgow, Glasgow, Scotland.
PLoS One. 2024 Jan 10;19(1):e0296077. doi: 10.1371/journal.pone.0296077. eCollection 2024.
Children's health services in many countries are moving from single condition diagnostic silo assessments to considering neurodevelopment in a more holistic sense. There has been increasing recognition of the importance of clinical overlap and co-occurrence of different neurotypes when assessing neurodivergent children. Using a cross-sectional service evaluation design, we investigated the overlap of neurodivergences in a cohort of children referred for autism assessment, focusing on motor, learning, and attention/activity level domains. We aimed to determine what proportion of children in a cohort referred for an autism assessment showed traits of additional neurodivergences, and what proportion were further investigated.
We evaluated anonymised medical records of children aged between two and 17 years referred for autism assessment. We used validated questionnaires to assess for neurodivergent traits. A weighted scoring system was developed to determine traits in each neurodevelopmental domain and a score above the median was considered to indicate a neurodivergent trait. Evidence of further investigations were recorded. We then examined the relationships between autism traits and traits of additional neurodivergence.
114 participants were included for evaluation. 62.3% (n = 71) had completed questionnaires for analysis. Of these, 71.8% (n = 51) scored greater than the median for at least one additional neurotype, indicating the presence of other neurodivergent traits, and 88.7% (n = 64) attracted a diagnosis of autism. Only 26.3% of children with evidence of additional neurotypes were further investigated beyond their autism assessment.
Our results demonstrate the extensive overlap between additional neurodivergent traits in a population of children referred with suspected autism and show that only a small proportion were further investigated. The use of standardised questionnaires to uncover additional neurodivergences may have utility in improving the holistic nature of neurodevelopmental assessments.
许多国家的儿童健康服务正从单一疾病诊断的评估模式转变为更加全面地考虑神经发育问题。越来越多的人认识到，在评估神经发育障碍儿童时，不同神经类型的临床重叠和共同出现是很重要的。我们采用横断面服务评估设计，调查了一个自闭症评估队列中神经发育障碍的重叠情况，重点关注运动、学习和注意力/活动水平领域。我们旨在确定在一个因自闭症而接受评估的队列中，有多少比例的儿童表现出其他神经发育障碍的特征，以及有多少比例的儿童接受了进一步的调查。
我们评估了年龄在 2 至 17 岁之间因自闭症评估而转介的儿童的匿名医疗记录。我们使用经过验证的问卷评估神经发育障碍的特征。开发了加权评分系统来确定每个神经发育领域的特征，评分高于中位数被认为存在神经发育障碍特征。记录了进一步调查的证据。然后，我们检查了自闭症特征与其他神经发育障碍特征之间的关系。
共有 114 名参与者接受了评估。其中 62.3%（n=71）完成了问卷分析。在这些参与者中，71.8%（n=51）至少在一种额外的神经类型上的评分高于中位数，表明存在其他神经发育障碍特征，88.7%（n=64）被诊断为自闭症。仅有 26.3%有额外神经类型证据的儿童在自闭症评估之外接受了进一步的调查。
我们的研究结果表明，在一个疑似自闭症的儿童群体中，额外的神经发育障碍特征之间存在广泛的重叠，并且只有一小部分儿童接受了进一步的调查。使用标准化问卷来发现其他神经发育障碍可能有助于提高神经发育评估的整体性。
