孤独症谱系障碍儿童便秘及睡眠问题与情绪行为问题的关系

Relationship of constipation and sleep disorders with emotional and behavioral problems in children with autism spectrum disorder

摘要:

目的：探讨孤独症谱系障碍（autism spectrum disorder，ASD）儿童便秘及睡眠问题与情绪行为问题的关系。方法：本研究纳入2017年7月至2018年2月在重庆医科大学附属儿童医院发育与行为中心及某特殊训练机构就诊的172例ASD儿童，同时纳入性别匹配的重庆市某幼儿园129名正常儿童为对照。采用问卷调查ASD儿童和发育正常儿童的便秘及睡眠问题发生情况及常见问题行为，采用孤独症儿童行为检查（the autism behavior checklist，ABC）量表对ASD儿童进行核心症状评估，分析ASD儿童便秘及睡眠问题对情绪行为问题的影响。结果：ASD儿童的便秘发生率为32.6%（95%CI=25.5%~39.6%），高于正常儿童的15.5%（95%CI=9.2%~21.8%），差异有统计学意义（P=0.001）；ASD儿童睡眠问题发生率高达71.5%（95%CI=64.7%~78.3%），较正常儿童高（45.7%，95%CI=37%~54.4%），差异有统计学意义（P=0.000）。有睡眠问题的ASD儿童在ABC量表的交往维度得分更高（P=0.044）。ASD儿童的便秘与睡眠问题存在正相关关系（rs=0.219，P=0.004）。在ASD儿童中，有便秘或睡眠问题的ASD儿童更易出现情绪变化大、喜怒无常等情绪问题（P<0.05）；也更易出现自言自语或不断重复一些话、不断变换动作和姿势等多种重复刻板行为表现（P<0.05）；有睡眠问题的ASD儿童更易用物品攻击人（P<0.05）。ASD儿童共患便秘及睡眠问题的发生率为27.3%（47例），高于正常儿童的12.4%（16例），差异有统计学意义（P<0.05）。共患便秘及睡眠问题的ASD儿童更易出现情绪变化大、喜怒无常、无明显原因突然发怒等情绪问题（P<0.05）；共患便秘及睡眠问题的ASD儿童更易出现自言自语或不断重复一些话、不断变换动作和姿势等重复刻板行为表现（P<0.05）。未发现共患便秘及睡眠问题更易发生攻击及自伤行为（P>0.05）。结论：鉴于ASD儿童便秘和睡眠问题的高发生率及其对情绪问题和重复刻板行为问题的影响，需要将识别便秘、睡眠问题等共患问题纳入儿童保健的诊疗常规中，同时将共患便秘和睡眠问题作为ASD儿童慢病管理的一部分，以实现ASD患儿个体化综合治疗的需要，可有效控制ASD儿童常见问题行为和提高ASD儿童的社会功能。

Abstract:

Objective：To explore the relationship of constipation and sleep disorders with emotional and behavioral problems in children with autism spectrum disorder（ASD）. Methods：This study included 172 children with ASD who visited the Development and Behavior Center of Children’s Hospital of Chongqing Medical University and a special training institution in Chongqing from July 2017 to February 2018，as well as 129 sex-matched normal children from a kindergarten in Chongqing（as controls）. A questionnaire was used to investigate the incidence of constipation and sleep disorders as well as common problematic behaviors in the normal children and those with ASD. The autism behavior checklist（ABC） was used to evaluate the core symptoms of children with ASD，and the influence of constipation and sleep disorders on emotional and behavioral problems was analyzed in children with ASD. Results：The incidence rates of constipation and sleep disorders were significantly higher in the children with ASD than in the nor－mal children[constipation：32.6%（95%CI=25.5%-39.6%） vs. 15.5%（95%CI=9.2%-21.8%），P=0.001；sleep disorders：71.5%（95%CI=64.7%-78.3%） vs. 45.7%（95%CI=37%-54.4%），P=0.000]. ASD children with sleep disorders had higher scores on the interaction dimensions of ABC（P=0.044）. A positive correlation between constipation and sleep disorders was observed in the children with ASD（rs=0.219，P=0.004）. ASD children with constipation or sleep disorders were more prone to emotional problems including drastic emotional changes and irregular moodiness（P<0.05），as well as soliloquy，palinphrasia，constant changes in movements and postures，and other stereotyped behaviors（P<0.05）. ASD children with sleep disorders were more likely to attack people with objects（P<0.05）. The children with ASD had a significantly higher comorbidity rate of constipation and sleep disorders than the normal children[27.3%（47 cases） vs. 12.4%（16 cases），P<0.05]. ASD children with comorbidity of constipation and sleep disorders were more prone to emotional problems including drastic emotional changes，irregular moodiness，and unexplained anger（P<0.05），as well as soliloquy，palinphrasia，constant changes in movements and postures，and other stereotyped behaviors（P<0.05）. The tendency towards attack and self-harm was not observed in the children with comor－bidity of constipation and sleep disorders（P>0.05）. Conclusion：Considering the high incidence rate of constipation and sleep disorders and their impact on mood and repetitive and stereotyped behaviors，it is necessary to include the identification of comorbid diseases like constipation and sleep disorders in the diagnosis and treatment in routine child care，and to integrate the comorbidity of constipa－tion and sleep disorders as part of the chronic disease management of children with ASD，so as to meet the needs of individualized comprehensive treatment for children with ASD. All these measures will effectively control the common problematic behaviors in chil－dren with ASD and improve their social function.