Table of Content

01 March 2023, Volume 31 Issue 3

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Professional Forum

Status and challenges of early recognition and early diagnosis of autism spectrum disorder

KE Xiaoyan

2023, 31(3):  238-240.  DOI: 10.11852/zgetbjzz2023-0013

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Autism spectrum disorder(ASD) is a neurodevelopmental disorder that seriously impacts the development of children. It has become a clinical consensus that early identification and early intervention are effective means. For professional reference, this paper mainly reviews and discusses the progress in early detection, early screening and early diagnosis of autism spectrum disorder in the domestic and overseas researches, as well as the problems in clinical practice.

Original Articles

Construction and evaluation of a Gradient Boosting Machines prediction model for children withautism spectrum disorder complicated with intellectual impairment

SONG Chao, HU Lifei, WU Lingling, JIANG Zhongquan

2023, 31(3):  241-245.  DOI: 10.11852/zgetbjzz2022-1433

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Objective To construct and evaluate a Gradient Boosting Machines(GBM) prediction model for children with autism spectrum disorder (ASD) and comorbid intellectual impairment, so as to provide a new perspective for early screening of this population. Method From January 2017 to December 2021, 241 children with a clear diagnosis of ASD in the Children's Hospital, Zhejiang University School of Medicine were included in the analysis. The prediction model of GBM was trained using sociodemographic and behavioral observation data and compared with traditional Logistic regression (LR) in this study. Hyperparameter adjustment was performed using grid search with ten-fold cross-validation, feature selection methods were performed using cross-validation LASSO, and the performance of the model was evaluated using discrimination and calibration. Explainability analysis was evaluated using SHapley Additive exPlanation (SHAP). Results The sample totaled 241 children with ASD, of whom 98 (40.66%) had intellectual impairments. Eight predictor variables were screened by the LASSO method, including language ability, mother's education attainment, age at the time of behavioral observation, stereotyped speech, pointing/gestures, social quality, unusual sensory interest and repetitive stereotyped behaviors. Both LR and GBM models before and after feature selection were better at distinguishing whether children with ASD had combined intellectual impairment. The area under curve (AUC) of the GBM model after feature selection (0.870, 95%CI: 0.749 - 0.989) was close to that of the conventional LR (0.851, 95%CI: 0.704 - 0.921). Regarding calibration, good calibration was observed for all models, except for the poor calibration of the full variable LR. In terms of feature importance, language ability contributed the most to the prediction of combined intellectual functioning deficits in children with ASD. Conclusion The prediction model for children with ASD complicated with intellectual impairment constructed by the feature selection method of LASSO and the GBM model has good performance and some clinical value.

Correlation of serum folate acid and vitamin B12 levels with gut microbiota in children with autism spectrum disorder

LI Zheng, XIAO Guiyuan, LUO Yating, HE Chunyan, WANG Nianrong, ZHAO Yan

2023, 31(3):  246-251.  DOI: 10.11852/zgetbjzz2022-0550

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Objective To analyze the correlation of serum folate acid and vitamin B12 levels with gut microbiota in children with autism spectrum disorder (ASD). Method From January 2020 to February 2021, totally 79 ASD children aged 2 to 7 years and 79 sex- and age-matched neurotypical children in the outpatient department of Chongqing Maternal and Child Health Hospital were enrolled in this study. Serum folate acid and vitamin B12 levels were detected by Chemiluminescence method. The V3-V4 hypervariable regions of bacterial 16SrRNA gene in fecal samples were sequenced. Results Serum folate acid level of children in the ASD group was significantly lower than that of the healthy control group [33.55 (20.47, 39.73) nmol/L vs. 35.50 (27.80, 41.90) nmol/L] (Z=-2.114, P=0.035). Serum vitamin B12 level of children in the ASD group was significantly lower than that of the healthy control group [539.0 (422.50, 702.75) pmol/L vs. 632.0 (519.0, 859.0) pmol/L] (Z=-3.114, P=0.002). There was no difference in the Alpha diversity and Beta diversity of the gut microbiota between the ASD group and control group (P>0.05). In the genus level, ASD children had significantly increasing abundance of Sutterella and Desulfovibrio and decreasing abundance of Bifidobacterium and Rheinheimera compared with the control group (P<0.05). Spearman correlation analysis indicated that serum folate acid level was positively correlated with the abundance of Bifidobacterium (r=0.203) and Prevotella (r=0.179), and negatively correlated with Escherichia abundance (r=-0.223, P＜0.05). Serum vitamin B12 level was positively correlated with the abundance of Bifidobacterium (r=0.172, P=0.048). Conclusion Serum folate acid and vitamin B12 levels are lower in ASD children, which are correlated with the abundance of some gut microbiota.

Factors influencing the rehabilitation effect of children with autism spectrum disorder receiving program for the education & enrichment of relational skills training and construction of a Nomogram prediction model

DONG Haipeng, YANG Siyuan, LI Weidong, YU Jing

2023, 31(3):  252-258.  DOI: 10.11852/zgetbjzz2022-0821

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Objective To explore the influencing factors of program for the education & enrichment of relational skills(PEERS) training on the rehabilitation effect of children with autism spectrum disorder (ASD), to construct a Nomogram for predicting rehabilitation effect, and to test the predictive efficiency of the model. Method A total of 146 ASD children who received PEERS training in Guangzhou Women and Children Medical Center from February 2019 to September 2021 were included in the study. The participants were divided randomly into training set (102 cases) and validation set (44 cases) in a ratio of 7∶3, by using the R software. All children were evaluated by the Autism Treatment Evaluation Checklist(ATEC) before and after training, and were divided into good rehabilitation group (ATEC score decline rate ≥30%) and poor rehabilitation group (ATEC score decline rate < 30%) according to the rehabilitation effect. The t-test and χ²test were used to compare the baseline characteristics of the training set and validation set. Univariate Logistic analysis and multivariate Logistic analysis were used to determine the factors influencing the rehabilitation effect of children with ASD in training set. Nomogram was constructed by the RMS packages in R software based on the multivariate Logistic model, and the differentiation and prediction efficiency was evaluated. Results Among 102 ASD children receiving PEERS training, of whom 75 cases (73.53%) recovered well and 27 cases (26.47%) recovered poorly. Multivariate Logistic regression analysis of the training set showed that the initial age of training (OR=1.708, P=0.013), severity of disease (OR=3.040, P=0.034), and no confidence in healing of caregivers (OR=4.265, P=0.013) were risk factors for the rehabilitation effect of ASD children after PEERS training. The receiver operating characteristic (ROC) curve showed that the Nomogram model has good discrimination (AUC=0.791, 95%CI:0.685 - 0.896), and the calibration curve showed that the model has good prediction efficiency. Conclusion The Nomogram prediction model, based on four factors:the severity of the child's condition, the child's age at training onset, the caregiver's education and the caregiver's confidence in healing, has good discriminatory and predictive power for the rehabilitation outcomes of ASD children after group social training.

Changes and clinical significance of serum 25-(OH)D₃ and vitamin D-binding protein levels in adolescent patients with first-episode depressive disorder

YANG Liu, LIU Yushan, WU Ningbo, SUN Jing

2023, 31(3):  259-262.  DOI: 10.11852/zgetbjzz2022-0902

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Objective To test the levels of serum 25-hydroxyvitamin D₃[25-(OH)D₃] and vitamin D-binding protein (VDBP) in adolescent patients with first-episode depressive disorder, and to analyze their clinical significance. Method A total of 100 adolescent patients with first-episode depressive disorder admitted to Qinhuangdao First Hospital from April 2021 to March 2022 were selected as the depression group, and 100 healthy adolescents who took physical examinations during the same period were selected as the control group. The levels of serum 25-(OH)D₃ and VDBP were detected by enzyme-linked immunosorbent assay. Hamilton Depression Scale (HAMD) was used to assess the degree of depression in patients with depression, and then the adolescents were divided into mild group (n=41), moderate group (n=32) and severe group (n=27). The levels of serum 25-(OH)D₃ and VDBP among depression group, control group and adolescent patients with first-episode depressive disorder with different degrees of depression were compared. The correlation of serum 25-(OH)D₃ and VDBP levels with HAMD score in adolescent patients with first-episode depressive disorder and the influencing factors of the occurrence of first-episode depressive disorder were analyzed. Results Compared with the control group, the level of serum 25-(OH)D₃ in the depression group decreased (t=10.625, P<0.05), while the level of VDBP increased (t=13.158, P<0.05). The level of serum 25-(OH)D₃ of children in mild, moderate and severe depression group decreased in turn (t=58.319, P<0.05), while the level of VDBP increased in turn (F=18.805, P<0.05). Serum 25-(OH)D₃ level was negatively correlated with HAMD score and VDBP in adolescent patients with first-episode depressive disorder (r=-0.517, -0.511, P<0.05), while serum VDBP level was positively correlated with HAMD score (r=0.498, P<0.05). Serum 25-(OH)D₃ deficiency(OR=1.775) and high level of VDBP (OR=1.519) were risk factors for the occurrence of first-episode depressive disorder (P<0.05). Conclusions The serum 25-(OH)D₃ level is lower in the adolescent patients with first-episode depressive disorder, and the VDBP level is higher.Serum 25-(OH)D₃level is negatively correlated with VDBP, both of which were significantly correlated with HAMD scores. Both VDBP and 25-(OH)D₃ can be used as auxiliary indicators to determine the severity of adolescent depression.

Mediating role of parenting style in the association between maternal adverse childhood experiences and parenting stress

ZHA Jinhong, LI Ruoyu, JIA Liyuan, HUANG Yongling, WAN Yuhui

2023, 31(3):  263-267.  DOI: 10.11852/zgetbjzz2022-1201

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Objective To explore the mediating effect of parenting style between maternal adverse childhood experiences (ACEs) and parenting stress, in order to provide reference for improving maternal parenting stress. Method In June 2021 and December 2021, baseline and follow-up surveys were conducted in mothers of preschool children from Wuhu, Lu'an and Fuyang city in Auhui province, respectively, and 6 111 valid questionnaires were included. ACEs (baseline), parenting style (baseline) and parenting stress (follow-up) were measured by Adverse Childhood Experiences Questionnaire, Parenting Style Questionnaire and Parenting Stress Questionnaire for the mothers of preschool children, respectively. The association between variables was analyzed by Spearman correlation, and the mediating effect was tested by the Bootstrap program and PROCESS software. Results Maternal ACEs was positively correlated with negative parenting styles (doting, permissive, authoritarian, inconsistent) and parenting stress(r=0.217 - 0.329, P＜0.01). Parenting stress score was positively correlated with negative parenting styles(doting, permissive, authoritarian, inconsistent) (r=0.226 - 0.278, P＜0.01) and negatively correlated with positive parenting styles (r=- 0.340, P＜0.01). After controlling the confounding factors such as children's gender, age, parents' age and parents' education level, the mediating effects of maternal parenting style (doting, democratic, permissive, authoritarian and inconsistent) in the association between maternal ACEs and parenting stress were 14.74%, 7.86%, 18.64%, 11.89% and 22.51% (P＜0.01), respectively, and the common mediation effect of the five intermediary factors accounted for 36.84% of the total effect. Conclusions Parenting style plays a partial mediating role in the association between maternal ACEs and parenting stress. Improving maternal parenting style can help mothers with ACEs to alleviate parenting stress.

Original Articles

Bioinformatics analysis of the regulation of miR-429 towards target genes in tic disorders

JIANG Jilong, CHEN Yanhui, HUANG Huifang, HUANG Yuxian

2023, 31(3):  268-273.  DOI: 10.11852/zgetbjzz2022-0746

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Objective To predict tic disorders (TD) related target genes of microRNA (miRNA, miR)-429 by using bioinformatics analysis, and to take intersection between the target genes of miR-429 and TD related genes (TRGs), so as to further understand the impaction of miR-429 in TD. Method MiRbase was used to obtain the sequences of mature miR-429 in multiple species for conserved analysis.GeneCards database and DisGeNET database were used to acquire TRGs.MiRDB database and DIANA-microT were used to gain the target genes of miR-429.TD related target genes were obtained by intersection of the target genes gained by MiRDB database and DIANA-microT with TRGs.RNAhybird database was used to predict the sequences and minimum free energy (MFE) of hybridization.Functional enrichment analysis of TD related target genes was performed by DAVID database. Results Only 1 nucleotides among the 22 nucleotides of miR-429 was different among specie.A total of 9 genes were identified as TD related target genes.The sequences of hybridization of ASH1L and SLITRK1 with miR-429 did not include the nucleotide that differed among species, indicating that the two hybird pairs were more conserved.The first gene with the smallest MFE of hybridization were CHD2 (-25.0 kcal/mol).The first terms in each category of functional enrichment analysis were adult behavior of biological process, glutamatergic synapse of cell components and chromatin binding of molecular functions.No statistically significant pathway enrichment was obtained. Conclusion MiR-429 might impact behaviors in TD by regulating glutamatergic synapses via related genes, especially SLITRK1.

Review

Atypical interpersonal synchronization and its neural mechanism in children with autism spectrum disorder

ZHAO Lihua, LI Jing

2023, 31(3):  274-278.  DOI: 10.11852/zgetbjzz2021-1836

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Interpersonal synchrony has been treated as a critical element to build up social communication system. Systematic study of neuroscience literature showed interpersonal synchrony decreased or disrupted at different levels for children who have been identified with autism spectrum disorder (ASD), including behavior level, intelligence level and emotional level. Furthermore, magnetoencephalography neuroimaging evidence has shown that there is reduction or interruption of brain synchronous coordination response between ASD children and peers. It is difficult to realize the sharing of implicit mental state and the synchronization of explicit interactive behavior. Future studies may propose modelling of interpersonal synchrony for ASD individual from three aspects, including cognitive solidification, behavioral disharmony and emotional expression imbalance, and explore whether the atypical interpersonal synchronization of ASD children is the product of impaired social function or the potential mechanism of impaired social function.

Application of gut microbiom intervention in autism spectrum disorder

ZHAO Yingxin, HE Fan, ZHENG Yi

2023, 31(3):  279-283.  DOI: 10.11852/zgetbjzz2021-1702

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The prevalence of autism spectrum disorder(ASD) is rising, which has become one of the main challenges of modern medicine. In addition to the core symptoms such as continuous damage to social interaction and limited and repeated interests, activities or behavior patterns, it will also be accompanied by gastrointestinal symptoms, irritability and aggressive behavior, emotional problems, hyperactivity symptoms, sleep problems, etc., which will bring heavy mental and economic burden to caregivers. At present, the etiology of ASD is not clear.The main treatment of ASD is behavioral therapy, and there is no effective drug to treat its core symptoms. In recent years, more and more attention has been paid to the potential mediating role of gut microbiom as risk factors in patients with ASD. Several clinical studies have shown that changes of gut microbiom can not only improve the gastrointestinal symptoms of ASD, but also improve its maladaptive behavior. Further studies are warranted to explore the effect of gut microbiom on ASD symptoms so as to provide more powerful evidence for clinical practice.

Research progress in the effects of alternative seating on children with autism spectrum disorder

WANG Jing, HUANG Shan, GAO Xueting

2023, 31(3):  284-288.  DOI: 10.11852/zgetbjzz2021-1855

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This paper reviews the current empirical researches regarding the effect of dynamic seating intervention on autism spectrum disorder(ASD). It is concluded that compared with traditional seating, alternative seating has a positive effect on improving related behavior in ASD children. Compared with alternative seating such as cushions and T-stools, therapy balls have a larger positive effect on improving related behavior in ASD children. There are individual differences among intervention effects. Further studies are warranted to analyze the relationship between intervention results and characteristics of participants such as sensory processing mode, function level, speech problems and other features in order to identify which group in ASD is suitable for dynamic seating intervention and to explore the underlying mechanism of the positive effect.

Research advance in assessment tools for paternal involvement

YIN Xiaohui, XU Yahong

2023, 31(3):  289-293.  DOI: 10.11852/zgetbjzz2022-0407

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This paper reviews the assessment tools for paternal involvement, and summarizes the major contents, population and limitations of the assessment tools, hoping to provide reference for the development of tools for father involvement, the selection of effective assessment tools and related research.

Research progress in self-harm in adolescents

LIU Dan, XIAO Zeping

2023, 31(3):  294-298.  DOI: 10.11852/zgetbjzz2021-1398

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Self-harm refers to an intentional act of self-poisoning or self-injury, irrespective of motivation. It becomes more common after age 12, usually reaches its peak in late adolescence and young adulthood, and resolves spontaneously afterwards. The rate of self-harm in adolescents varies between countries, approximately around 10% in self-report school-based surveys. Diathesis-stress model is used to explain the theoretical foundation of the risk factors to self-harm. Important risk factors include socio-demographic factors, environmental factors and psychological factors. With non-suicidal self-injury disorder (NSSID) being a condition for further study in DSM-5, further studies pertaining to its clinical practice are needed.

Research progress in executive function of adolescents with adverse childhood experiences and the influencing factors

PENG Lianhua, LIU Dongdong, LONG Nannan, XU Ping, CHEN Yang, MAO Ping

2023, 31(3):  299-303.  DOI: 10.11852/zgetbjzz2022-0317

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As a global public health problem, adverse childhood experiences (ACEs) can seriously damage the executive function of adolescents, resulting in inhibition and control disorders, working memory impairment and cognitive flexibility impairment. Executive dysfunction can significantly increase the risk of adolescent psychopathology and health risk behavior, resulting in a huge economic burden to themselves and society. This review summarizes the executive function status of adolescents with ACEs and the influencing factors, in order to provide reference for the improvement of executive function of adolescents with ACEs and promote the development of adolescents' physical and mental health.

Meta Analysis

Meta-analysis of the efficacy of parent-mediated intervention in the treatment of autism spectrum disorder

LIN Huanxi, LIU Panting, TONG Meiling, CHI Xia, QIAN Jun, HONG Qin

2023, 31(3):  304-310.  DOI: 10.11852/zgetbjzz2022-0266

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Objective To evaluate the efficay of parent-mediated intervention on the improvement of symptoms of children with autism spectrum disorder (ASD), in order to provide theoretical basis for the treatment and intervention of ASD children. Method Randomized controlled trials regarding the effects of parent-mediated intervention on ASD children were searched in eight databases, including PubMed, Embase, Web of Science, CINAHL, cnki, Wanfang, VIP and Sinomed. RevMan 5.3 software was used for statistical analysis and the Cochrane collaboration tool was used to evaluate the quality of the literature. Results A total of 1 299 ASD children from 17 randomized controlled trials (RCTs) were included in this study. Meta-analysis results showed that significant improvement was observed in core symptoms of ASD children with parent-mediated intervention, including social interaction (SMD=0.34, 95%CI: 0.16 - 0.52, P＜0.05), adaptive behavior (MD=5.48, 95%CI:2.44 - 8.52, P<0.001), shared or joint attention(SMD=0.31, 95%CI:0.05 - 0.56, P＜0.05) and the severity of autism (SMD=-0.93, 95%CI:-1.10 - -0.77, P＜0.001), but expressive language, receptive language and stereotyped behaviors had no significant improvement. After intervention, parents' stress was significantly reduced (SMD=-0.30, 95%CI:-0.54 - -0.07,P=0.01). Conclusion Parent-mediated interventions have a beneficial effect on symptoms improvement and parental stress reduction in ASD children, but high quality research is warranted to confirm the conclusion further.

Clinical Research

Application of electroencephalogram spectrum analysis in early diagnosis and rehabilitation intervention evaluation of children with autism spectrum disorder

YI Aiwen, XIN Jing, BAI Yan, XU Jiaxin, LIANG Fujian, FENG Xiaojian

2023, 31(3):  311-315.  DOI: 10.11852/zgetbjzz2022-0504

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Objective To analyze the application value of electroencephalogram (EEG) characteristics in different frequency bands in early diagnosis and rehabilitation intervention evaluation of children with autism spectrum disorder (ASD) by using EEG spectrum analysis technology. Method From January to December 2021, 35 ASD children aged 2 to 4 years who met the inclusion criteria were recruited into the ASD group, and received comprehensive rehabilitation intervention for 3 months.The resting state EEG signals of ASD children were collected before and after treatment, and the symptom of ASD children were evaluated by Chinese version of Autism Treatment Evaluation Checklist (ATEC).Meanwhile, 30 normal children with similar age (normal children group) were selected to collect resting state EEG signals.The relative power changes of four frequency bands[delta (δ,1 - 4Hz), theta (θ,4 - 8Hz), alpha (α,8 - 13Hz) and beta (β,13 - 35Hz)]in each brain region were analyzed by EEG power spectrum analysis. Results ASD children had greater relative power in all five brain regions in the δ band than normal children before treatment (t=3.909, 2.941, 0.098, 0.097, 0.108), while the α band was significantly smaller than normal children (t=-3.919,-4.076,-4.924,-4.351,-4.453), and the differences were significant (P<0.05).For ASD children, the differences in both δ and α bands were statistically significant before and after intervention (P<0.05).For the θ and β bands, there was no statistically significant difference in the relative power in the five brain regions between ASD children before and after treatment compared to the normal group (P>0.05).The differences in the subscale scores and total scores on the ATEC scale for ASD children before and after treatment were statistically different (P<0.05). Conclusion The relative power changes of δ and α bands in five brain regions of ASD children are specific, which can provide a certain reference for the early diagnosis of ASD, and can be used as an objective evaluation indicator for the efficacy evaluation of rehabilitation intervention.

Sleep problems of children with autism spectrum disorder and its influencing factors

LI Zhenghua, LIANG Cailing, HE Yi, LIU Qi, WANG Ji, ZHANG Lijun

2023, 31(3):  316-321.  DOI: 10.11852/zgetbjzz2022-0769

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Objective To analyze the sleep status and its influencing factors of children with autism spectrum disorder (ASD), in order to provide evidence for improving the sleep quality of ASD children. Method The general characteristics, sleep status and parents' mental health of 207 ASD children and 204 control children were assessed with the Sleep Habit Questionnaire (CSHQ) and Symptom Checklist 90 (SCL-90) from October 2019 to October 2020. The severity of autism symptoms was assessed with the Childhood Autism Rating Scale (CARS).The differences in the distribution of children's sleep problems and their parents' mental health status between the two groups were compared. Logistic regression was used to analyze the risk factors of sleep problems in ASD children. Results The detection rates of sleep disorders in children in ASD group and control group were 86.47% and 72.55%, respectively, with statistically significant difference (χ² =12.251, P<0.05). Multivariate analysis showed that children with ASD (OR=2.41), parents' total SCL-90 score (OR=1.15) and screen time＞2h/d (OR=3.07) were more likely to have sleep problems. When study population was further limited to ASD children, the results showed that ASD children whose CARS rating was severe (OR=6.81), screen time＞2h/d (OR=9.02) and whose parents were exposed to electronic screens before children went to sleep (OR=9.10) were more likely to have sleep problems. Conclusions ASD children may be more likely to experience sleep problems. The severity of autism symptoms, parents' mental health problems, daily screen time and parents' exposure to electronic screens before falling asleep are potential influencing factors for ASD children to develop sleep problems.

Characteristics of fine motor development in primary school students with attention deficit hyperactivity disorder

ZHU Xiaotong, REN Yuanchun, LIU Jing, LI Xue, WANG Fang, YIN Tingni, XIE Yongtao, SONG Yiqi, FAN Biyao, JI Ning

2023, 31(3):  322-326.  DOI: 10.11852/zgetbjzz2022-0421

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Objective To explore the fine motor development characteristics of primary students with attention deficit hyperactivity disorder (ADHD), in order to provide an objective basis for developing non-drug treatment for ADHD. Method From September 2019 to April 2021, children who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) were screened from the first and second grade students of a general public elementary school in Beijing and the psychiatric outpatient clinic of a tertiary care hospital. Finally 32 predominantly inattentive type ADHD were enrolled, of whom 26 were boys and 6 were girls, with the average age of (8.47±1.23) years old. Sex- and age-matched typically developed (TD) children from nearby elementary schools were recruited as controls. All subjects were divided into the lower grade group of 6 to 8 years old and the senior grade group of 9 to 10 years old, using Movement Assessment Battery for Children (MABC-2), Grooved Pegboard Test (GPT) and Developmental Test of Visual Perception-3 (DTVP-3) to evaluate the level of fine motor development and visual perception ability of all children. Results 1) The score of the MABC-2(t=2.22), manual dexterity(t=3.44) and DTVP-3 (except figure-ground) of ADHD students(t=4.45,6.55,2.13,2.13) were lower than those of TD children (P＜0.05). ADHD children took more time using their dominant and non-dominant hand to complete GPT than TD students, and the differences were statistically significant (t=2.72, 3.31, P＜0.05). 2) The score of MABC-2(t=3.11), pins(t=3.61,2.50), traces and DTVP-3 (except figure-ground ) of ADHD children(t=4.70,6.24,2.28,2.07) in lower grades were significantly lower than those of normal group (P＜0.05). The time of ADHD using dominant and non-dominant hands to finish GPT were more than that of TD group (t=3.48, 3.47, P＜0.05). 3) The score of MABC-2 dominant nail insertion of ADHD children in senior grade was lower than that of TD group, and the difference was statistically significant (t=2.91, P＜0.05). Conclusions ADHD primary students have poor development of fine motor skills, including poor hand fine operation skills, low visual perception processing and visual-motor integration abilities. The fine motor development of ADHD primary students in the lower grades lags behind more significantly, which is improved in ADHD children in senior grades, but still can not reach the level of TD students with the same age.

Effects of home isolation during COVID-19 pandemic on the mental health of preschool children in Shanghai

MA Chenhuan, JIANG Lian, CHU Liting, PAN Lizhu, ZHU Peiying, WANG Yu

2023, 31(3):  327-331.  DOI: 10.11852/zgetbjzz2022-0559

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Objective To analyze the characteristics and changes of emotional and behavioral problems of preschool children in Shanghai during the home isolation of the coronavirus disease 2019(COVID-19) pandemic, so as to provide basis for psychological education and psychological and behavioral interventions for preschool children. Method From April 24th to 28th, 2022, a total of 2 124 children aged 3 to 6 years were selected from 17 kindergartens in Jing'an and Yangpu districts of Shanghai. The parents of children completed the Chinese version of the parent-reported Strengths and Difficulties Questionnaire (SDQ). Results The detection rates of emotional and behavioral problems in children aged 3 to 6 years in Shanghai ranged from 3.34% to 24.81%, and the detection rate of conduct problem(12.81%) and peer problem(24.81%) increased obviously. The detection rate of peer problems and prosocial behavior of boys were higher than girls (χ²=12.577, 9.793, P<0.01). The detection rate of prosocial behavior in 3-year-old children group was higher than other age groups (χ²=11.473, P<0.05). Compared with the Shanghai norm, boys aged 4 years and girls aged 4 to 6 years had lower emotional symptoms score; boys aged 5 to 6 years and girls aged 4 to 6 years had higher conduct problems score; children aged 6 years had lower hyperactivity score; boys aged 4 to 5 years had higher peer problems score; girls aged 4 years had higher total difficulties score, and the differences were significant (P<0.05). Compared with SH2019, boys aged 4 to 5 years and girls aged 4 to 6 years had lower emotional symptoms score; children aged 4 and 6 years had higher conduct problems score; girls aged 4 years had higher hyperactivity score and children aged 5 years had lower score; children aged 4 to 6 years had higher peer problems score; children aged 5 years had higher prosocial behavior score; children aged 4 years had higher total difficulties score, and the differences were significant (P<0.05). Conclusions During the home isolation in the COVID-19 pandemic in 2022, the detection rates of emotional and behavioral problems are increasing for preschool children in Shanghai, especially for conduct problems and peer problems. Boys and younger children have higher detection rates of emotional and behavioral problems, who should be differentiated and focused when providing relevant psycho-health education and implementing psycho-behavioral interventions in the future.

Experience Exchange

Characteristics of sensory abnormalities in children with autism spectrum disorder

NI Yufei, XU Xiaojing, WANG Feiying, GU Qiuyan, JIANG Zhengzheng, XU Zhanbin

2023, 31(3):  332-335.  DOI: 10.11852/zgetbjzz2022-0381

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Objective To analyze the characteristics of sensory abnormalities in children with autism spectrum disorder (ASD), so as to provide reference for early diagnosis and scientific intervention of ASD children. Method A cross-sectional survey was conducted, and 234 ASD children who took rehabilitation training in Nantong rehabilitation institutions were enrolled in this study from August 2021 to February 2022. Simplified Sensory Profile (SSP) was used to investigate children's sensory characteristics. Results Among 234 ASD children, 128(54.7%) had abnormal total scores of sensory characteristics, including 58 (24.8%) with possible abnormalities and 70 (29.9%) with obvious abnormalities. Among the seven dimensions, the abnormal rate of auditory filtering was the highest (82.1%), followed by low strength/weakness, movement sensitivity, taste/smell sensitivity, low response/sensation seeking, vision/hearing sensitivity and touch sensitivity. The total prevalence rate of paresthesia was 91.0%. There was no significant difference in the score of SSP scale among ASD children at different gender and age groups (t=1.200, 1.124, P>0.05). The detection rate of sensory abnormalities in boys was 56.8%, which was significantly higher than that in girls (47.1%) (χ²=6.882, P<0.05). But there was no significant difference in the distribution of sensory abnormalities among children at different age groups (χ²=0.454, P>0.05). Conclusion Sensory processing abnormalities are common in ASD children, and more obvious in male children.

Effect of group attention quality training on attention quality in preschool children with attention deficit hyperactivity disorder

ZHOU Meijun, WEI Rongmei, YUAN Xiaoling, ZHAO Ting, ZHAO Shuo

2023, 31(3):  336-340.  DOI: 10.11852/zgetbjzz2022-0728

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Objective To analyze the effect of four-dimensional training of attentional quality in group form on preschool children with attention deficit hyperactivity disorder (ADHD), in order to provide experimental basis and reference for improving attentional function of ADHD with group attentional quality training. Method A total of 64 preschool ADHD children aged 4 to 6 who were admitted to the outpatient department of Children's Rehabilitation Department in Yangzhou Maternal and Child Health Hospital from January 2020 to December 2021 were selected as the study subjects, and were randomly divided into the experimental group and the control group. The control group received conventional cognitive behavior, sensory integration and social training, while the experimental group was given group attention training additionally. Before and after the experiment, the NJ22B Children's Attention Tester was used to evaluate the children's attention quality, and the SNAP-Ⅳ was used to evaluate the children's attention deficit and hyperactivity. Results Before intervention, there was no statistical significance between the two groups in the total score of SNAP-Ⅳ in attention, hyperactivity and attention stability, breadth, transfer and distribution of attention quality between the experimental group and the control group (P>0.05). In the experimental group, the scores of SNAP-Ⅳ inattention(t=8.487), hyperactivity(t=8.558) and attention stability (Z=4.784), breadth(Z=4.560), transfer(Z=3.087), distribution(Z=3.536) and the total score of attention quality(Z=4.918) were significantly different before and after intervention (P<0.001). After intervention, there were statistically significant differences between the control group and the experimental group in the SNAP-Ⅳ hyperactivity/impulsivity(t=2.961), total score(t=3.461), as well as attentional stability(Z=2.347) and total attentional quality score(Z=2.507) in the SNAP-Ⅳ test (P<0.05). Conclusion Group attention quality training can improve attention quality ability of preschool ADHD children, reduce hyperactivity impulse and improve attention.

Influencing factors of overweight and obesity among children and adolescents in Zhejiang province

BAO Hongsheng, SUN Yuanfang, TANG Liyan, GUO Yingjie

2023, 31(3):  341-345.  DOI: 10.11852/zgetbjzz2022-0470

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Objective To investigate the current quo and influencing factors of overweight and obesity among children and adolescents in Zhejiang province, so as to provide basis for making strategies for comprehensive prevention and treatment of overweight and obesity. Method Using stratified random cluster sampling method, a total of 4 577 primary and junior high school students of 6 cities in Zhejiang province were enrolled in this study to take physical examination and fill out the questionnaire in October 2021. Results The detection rates of overweight and obesity of children and adolescents in Zhejiang province were 14.2% and 8.3%, respectively.The detection rates of overweight and obesity in boys were higher than those in girls (χ²=58.31,20.09, P＜0.01).The detection rates of overweight and obesity in urban students were slightly higher than those in rural students, but the difference was not significant (χ²=0.135, 0.713, P>0.05). The detection rates of overweight and obesity in junior middle school students were slightly lower than those in primary school students, and there were statistically significant differences in overweight rate in different stages (χ²= 6.21,1.99, P<0.05), but there was no significant difference in obesity rate (P>0.05). Multivariate Logistic regression analysis showed that in terms of demography, the risk factors of overweight and obesity of children andadolescents in Zhejiang province were boys(OR=2.001, 95%CI:1.728 - 2.317), primary school students (OR=1.741, 95%CI:1.314 - 2.308), family monthly income ≥15 000 yuan (OR=3.617, 95%CI:2.498 - 5.237), taking physical activity ≤ 4 days/weeks (OR=5.462, 95%CI:4.193 - 7.115),taking fried food more than once a day (OR=23.453, 95%CI:16.790 - 32.761) (P<0.01). Conclusions The situation of overweight and obesity among children and adolescents in Zhejiang Province is serious. It is suggested that a cooperative governance mechanism should be carried out with the joint efforts of society, school and family for comprehensive prevention and control.