| Objective:Evaluating the application value of the Children Neuropsychological and Behavioral Scale-Revision 2016(CNBS-R2016)in children with Autism Spectrum Disorder(ASD)in order to provide scientific evidence for early detection and intervention of ASD.Methods:285 children aged 0-6 years old who were diagnosed as Autism Spectrum Disorder(ASD)、Developmental Language Disorder(DLD)or Global Developmental Delay(GDD)in Wuhan Tongji Hospital from March to November 2019 were recruited.We collected their neuropsychological behavior assessment data of CNBS-R2016,Checklist for Autism in Toddlers(CHAT-23)、Autism Behavior Checklist(ABC)、Childhood Autism Rating Scale(CARS)and Autism Diagnostic Observation Scale,Second Edition(ADOS-2).Moreover,70 Typically Developing Children(TD)who had normal health examination in our department in the same time period were recruited as the normal control group.We summarized the developmental characteristics of the ASD by analyzing the test results of CNBS-R2016,Spearman analysis was used to analyze the correlation between the Warning Behavior scores of CNBS-R2016 and the severity of symptoms in children with ASD.Furthermore,we analyzed the Warning Behavior scores of four groups in children;the ROC curve was used to explore the cut off value of Warning Behavior in screening for ASD and to evaluate its value in clinical screening of ASD.Results:1.127 children with ASD were enrolled,including 97 boys(76.38%)and 30 girls(23.62%).Their mean chronological age is 3.17±1.15 years old and mean developmental age is 19.84±8.16 months.92 children were diagnosed with DLD,including 70 boys(69.57%)and 22 girls(30.43%)with a mean chronological age of 2.82±0.60 years old and a mean developmental age of 25.46±5.60 months.66 children were diagnosed with GDD,including 48 boys(81.82%)and 18 girls(18.18%)with a mean chronological age of 2.96±0.85 years old and a mean developmental age of 21.33±5.12 months.70 typically developing children that including 53 boys(75.71%)and 17 girls(24.29%),with a mean chronological age of 2.92±0.96 years old and a mean developmental age of37.84±12.98 months.There were no statistical difference in the gender distribution and chronological age in these four groups of children(P>0.05),and the developmental age in ASD 、 DLD and GDD groups were lower compared with TD group(P < 0.001).Children with ASD had poorer developmental age compared with DLD and GDD groups,the latter of which was less severe comparing to the former pair of comparison(P<0.001).2.Developmental delay is commonly seen in children with ASD、DLD and GDD groups presenting with different developmental characteristics.Children with ASD showed global but uneven deficiencies in all developmental areas,Generally,their language abilities,social behavior and adaptive abilities were the most severely delayed.3.The correlation coefficients between the scores of warning behavior and ABC,CARS,ADOS-2 of children with ASD were 0.519,0.545 and 0.464,respectively,and the correlation intensity were all statistically significant(P < 0.001).4.The warning behavior scores in ASD group ranged from 1 to 72,and 92.91%(118 cases)scored 12 or above,with an average score of 25.69 and median score of 24.The warning behavior scores in DLD group ranged from 0 to 16,and 95.65%(88 cases)of them scored below 12,with an average score of 2.32 and median score of 0.The warning behavior scores in GDD group ranged from 0 to 43,and 72.73%(48 cases)scored below 12,with an average score of 9.62 and median score of 0.The warning behavior scores in TD group ranged from 0 to 8,and 98.57%(69 cases)scored less than 7,with an average score of 0.46 and median score of 0.There were statistically significant difference in the warning behavior scores(H=270.268,P<0.001)and the proportion of population in each score segment(X2=319.764,P<0.001)among the four groups of children.5.ROC curve analysis showed that a warning behavior score of 12 was the best cut off value for screening ASD children,and the corresponding area under the ROC curve(AUC)was 0.960(95%CI 0.941-0.979,P < 0.001).Comparing to the gold standard,the sensitivity was 0.93,the specificity was 0.90,the false positive rate was 0.10,the false negative rate was 0.07,the positive likelihood ratio was 9.30,the negative likelihood ratio was 0.08,the agreement rate was 91.28%,and the Cohen’s Kappa coeffecient was0.815(P < 0.001);The positive predictive value was 84.29%,and the negative predictive value was 95.81%.The agreement rate with the results of ADOS-2,CARS,ABC and CHAT-23 were 89.86%,83.81%,84.21%,88.42%,and Kappa values were0.607,0.668,0.682 and 0.768,respectively.6.With a cut off value of 12 points,the sensitivity of 0.93 was statistically higher than CARS(0.71)or ABC(0.73)alone(P < 0.001),but was the same as that of CHAT-23(0.93).The specificity of 0.90 was statistically lower than that of CARS(0.98)and ABC(0.97)and higher than CHAT-23(0.88)alone(P < 0.001).Conclusion:1.There were various levels of delay in developmental areas in Children with ASD,especially the developmental characteristics of their Language,social behavior and adaptability were different from those of DLD,GDD and TD groups.The developmental assessment of CNBS-R2016 has certain value and helpful for the preliminary screening and differential diagnosis of ASD.2.The warning behavior scores of children with ASD have a positively related with the severity of their symptoms.3.ROC curve analysis indicated that the warning behavior scores of 12 points was the best cut off value for screening ASD.We recommended that ASD child should undergo further diagnostic evaluation if the warning behavior scores are 12 or above in CNBS-R2016 assessment,and also recommend that further diagnostic evaluation should be performed for the child who is highly suspected in clinical symptoms even if the warning behavior scores are less than 12.4.CNBS-R2016 is a developmental assessment scale with a reasonable value of ASD screening.It can be used to assist screening out ASD children.Therefore,the application of CNBS-R2016 in children aged 0-6 years old in China is worth popularizing. |
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