儿童保健门诊语音障碍儿童初诊现状分析

Current status of initial diagnosis of speech sound disorder in a child healthcare clinic

摘要:

目的 了解儿童保健科医生对语音障碍（SSD）的认识。方法 收集并分析2017年1月至2019年5月期间初次就诊并诊断为SSD的506例儿童的临床资料。结果 506例SSD儿童中，90.5% SSD儿童病史中描述发育行为相关表现；97.6%完善发育行为评估，以筛查性智能及发育测试为主（485/506，95.8%）。116例（22.9%）共患神经发育障碍性疾病，最常见的为语言障碍、全面发育迟缓和智力障碍，45.7%（53/116）发育行为相关病史中未记录异常表现。家属自觉听力异常儿童的神经发育障碍性疾病发生率高于家属自觉听力正常儿童，体查时对声源反应异常儿童的神经发育障碍性疾病发生率高于对声源反应正常儿童（P < 0.05）。506例SSD儿童中，病史中及体查时未关注听力的比例分别达33.2%、31.2%。92例（18.2%）完善诊断性听力测试，听力损失检出率为12%（11/92）。11例听力损失儿童病史中，3例既往听力筛查通过，3例家属自觉听力正常，7例体查时对声源反应正常。结论 SSD儿童易共患神经发育障碍性疾病，关注交流表现有助于其诊断，但病史询问易遗漏，应结合发育行为评估。SSD儿童的神经心理发育状况得到了儿童保健医师的关注，发育行为评估完成率高，但目前以筛查性智能发育测试为主。SSD儿童听力损失检出率高，儿童保健医生对其听力损失问题认识不足，诊断性听力测试未得到重视，临床不应以既往听力筛查结果或生活场景中儿童对声源的反应评估听力水平。

Abstract:

Objective To investigate the understanding of speech sound disorder (SSD) among child health practitioners. Methods The clinical data of 506 children with an initial diagnosis of SSD from January 2017 to May 2019 were retrospectively analyzed. Results Of the 506 SSD children, 90.5% had a description of developmental behavior in their medical records; 97.6% received a developmental-behavioral evaluation, mostly intellectual and developmental screening tests, which were given to 95.8% (485/506) of the total children. A total of 116 (22.9%) children also had neurodevelopmental disorders, commonly presenting with language disorder, global developmental delay, and intellectual disability; however, 53 (45.7%) of the 116 children had no history records of such abnormal developmental behavior. The incidence of neurodevelopmental disorders was significantly higher in the children with abnormal hearing reported by their families than in the children with normal hearing reported by their families (P < 0.001). The children with abnormal response to sound stimulation on physical examination had significantly more frequent neurodevelopmental disorders than those with normal response to sound stimulation (P < 0.05). Among the 506 children with SSD, hearing condition was ignored in 33.2% in history records, and in 31.2% on physical examination. Ninety-two children (18.2%) completed the diagnostic hearing test, 12% (11/92) of whom were diagnosed with hearing loss. Of the 11 children with hearing loss, three had passed a hearing screening, three had family-reported normal hearing, and seven had normal response to sound stimulation on physical examination. Conclusions SSD is frequently comorbid with neurodevelopmental disorders in children. Children's communication performance is a key to the diagnosis of neurodevelop-mental disorders. It's necessary to the diagnosis of SSD to perform a medical history collection about neuropsychological development and a developmental-behavior evaluation. There is a high proportion of children with SSD receiving the developmental-behavioral evaluation, suggesting that child health practitioners pay close attention to the neuropsychological development of SSD children, but mostly, the evaluation merely involves intellectual developmental screening tests. The detection rate of hearing loss in children with SSD is high. However, child health practitioners underestimate this problem, and have an insufficient understanding of the importance of the diagnostic hearing test. The diagnostic hearing test should be the preferred recommendation for assessing hearing ability rather than past hearing screening results or children's response to sound stimulation in life scenes.