目的   针对孤独症多模态证据融合与定量化辨识的关键问题，本研究提出基于图卷积神经网络（GCN）的孤独症谱系障碍（ASD）诊断模型研究思路。方法  通过对来源于ABIDE的ASD儿童脑部fMRI数据进行整理和筛选，提取脑区功能连接矩阵作为图结构的邻接矩阵，并融合临床表型数据，构建了ASD多模态关联网络。通过网络特征比较分析，识别出了ASD与典型发育组的脑功能连接网络组间差异。进一步地构建一个端到端的GCN模型，并尝试引入注意力机制，提高模型决策的可解释性。结果  该模型在诊断性能指标优于传统机器学习方法（准确率=0.710，精确率=0.709，召回率=0.780，F1=0.743，曲线下面积=0.746）。背侧注意网络与边缘系统-颞极枢纽的功能连接减弱是模型做出判断的最主要依据。结论  以异质图为多模态数据整合的基本架构，本模型为ASD的潜在病理机制探索提供了新的方法学范例。

      Objective   To develop a quantitative model for autism spectrum disorder（ASD）integration multimodal evidences．Methods The fMRI  dataset from ABIDE was  used for extracting connectivity function  network of ASD after  data preprocessing．Difference between ASD and typical development about their brain connectivity function was evaluated with t-test．Integrating phenotypic data and fMRI dataset，an graph convolutional neural network （GCN）with attention module was estimated and compared against benchmark models about their efficiency and interpretability．Results  The GCN model was evaluated outperformed other models with better accuracy indices．And regions from Dorsal Attention Network and Limbic-Temporal Pole were ranked as the highest weights for the differentiation in the model．Conclusions  This study provided a novel paradigm for quantitative diagnosis and exploring pathogenesis of ASD．

目的 探索干预因素对4~12岁孤独症谱系障碍（ASD）患儿社交反应的影响,为开展ASD患儿的早期干预提供参考。方法 选取于2020年1月—2023年3月在清远市妇幼保健院儿童神经与发育中心康复干预的ASD患儿,采用社交反应量表（SRS）对患儿进行社交行为评估,采用自编一般情况问卷对家长进行问卷调查,调查内容包括患儿的基本情况（性别、共患病情况、干预时长、上学情况等）。结果 202例ASD患儿中,男性患儿162例（80.2%）,女性40例（19.8%）,性别对社交反应的影响比较差异无统计学意义（t=2.969,P>0.05）。共患病方面,无共患病的ASD患儿与共患智力发育障碍及注意缺陷多动障碍的患儿相比,其SRS得分差异有统计学意义（F=6.920,P<0.05）。在上学情况方面,普通学校就读的患儿与特殊学校及未上学的患儿相比,其SRS得分差异有统计学意义（F=3.823,P<0.05）,但在特殊学校就读的患儿与未上学的患儿相比,差异无统计学意义（P>0.05）。在干预时长方面,干预≥1年与干预<1年及未干预的患儿比较,其SRS得分更低,差异有统计学意义（F=4.477,P<0.05）,但干预<1年与未干预患儿相比,两者差异无统计学意义（P>0.05）。结论 ASD患儿中,是否患有其他无共患病、上学情况、干预时长会影响其社交反应;存在共患疾病的ASD患儿社交反应表现更差;相较于就读特殊教育机构和未上学的患儿,就读于普通学校的ASD患儿社交障碍程度更轻;干预时间越长,其社交障碍程度也越轻。

Objective To explore the impact of intervention factors on social response in children with autism spectrum disorder（ASD）aged 4—12,and to provide reference for early intervention in children with ASD. Methods Children with ASD who underwent rehabilitation intervention at the Children's Neurology and Development Center of Qingyuan Maternal and Child Health Hospital from January 2020 to March 2023 were selected．The social behavior of the children was evaluated using the Social Response Scale（SRS）,and the parents were surveyed using a self-made general situation questionnaire．The survey content included the basic information of the children（gender,comorbidity,intervention duration,and school attendance,etc．）. Results Among the 202 cases of ASD,162 were male（80.2%）and 40 were female（19.8%）．There was no statistically significant difference in the impact of gender on social response（t=2.969,P>0.05）．In terms of comorbidities,there was a statistically significant difference in SRS scores between ASD children without comorbidities and those with comorbidities such as intellectual development disorder and attention deficit hyperactivity disorder（F=6.920,P<0.05）．In terms of school attendance,there was a statistically significant difference in SRS scores between children enrolled in regular schools and those who attended special schools and those who did not attend school（F=3.823,P<0.05）,but there was no statistically significant difference between children enrolled in special schools and those who did not attend school（P>0.05）．In terms of intervention duration,compared with children with intervention≥1 year and those with intervention<1 year and no intervention,the SRS score was lower and the difference was statistically significant（F=4.477,P<0.05）．However,compared with children with intervention<1 year and those without intervention,the difference was not statistically significant（P>0.05）. Conclusions No comorbidities,attending regular schools,and intervention duration≥1 year are positive factors that affect social response．Children with ASD who have comorbidities have poorer social response performance;compared to children who attend special education institutions and those who do not attend school,children with ASD who attend regular schools have lower levels of social impairment;the longer the intervention time,the lighter the degree of social impairment．

目的 检验家庭睡眠习惯调查(FISH)在评估孤独症谱系障碍(ASD)患儿睡眠评估中的信度和效度。方法 随机抽取在清远市妇幼保健院儿童语言行为科干预的199例2~6岁ASD共患睡眠障碍患儿,其照顾者同时完成FISH和儿童睡眠习惯问卷(CSHQ),2周后再次同时完成上述两个问卷,以检验FISH的信度和效度。结果 验证性因素分析的结果表明,五因素模型拟合良好(χ²=79.05,df=44,χ²/df=1.80, P<0.001,SRMR=0.06,GFI=0.94,IFI=0.89,RMSEA=0.06),总量表及各分量表有较高的内部一致性信度(0.71~0.77)和重测信度(0.79~0.88)。FISH的白天习惯分别与CSHQ的入睡延迟、夜醒呈负相关,入睡前习惯分别与CSHQ的睡眠抵触、睡眠焦虑、白天睡眠呈负相关,睡眠常规分别与CSHQ的睡眠抵触、入睡延迟、睡眠焦虑呈负相关,睡前父母行为分别与CSHQ的睡眠抵触、睡眠焦虑呈负相关,总分与CSHQ总分呈负相关,差异均有统计学意义(P＜0.05)。结论 FISH具有较好的信度和效度,可作为ASD患儿睡眠习惯的评估工具。

Objective To test the reliability and validity of the famity inveritory of sleep habits(FISH) in the sleep assessment among children with autism spectrum disorder (ASD). Methods A random sample of 199 children with ASD and sleep disorders intervened in the Children's Language and Behavior Department of Maternal and Child Health Hospital of Qingyuan City were selected, their caregivers completed the FISH and the children's sleep habit questionnaire(CSHQ) at the same time, and completed the above two questionnaires again 2 weeks later to test the reliability and validity of the FISH. Results The results of confirmatory factor analysis showed that the five-factor model fits well (χ²=79.05, df=44, χ²/df=1.80, P<0.001, SRMR=0.06, GFI=0.94, IFI =0.89, RMSEA=0.06), the total scale and each subscale had high internal consistent reliability (0.71~0.77) and test-retest reliability (0.79~0.88). The daytime habits of FISH were negatively correlated with sleep delay and waking up at night of CSHQ respectively, the habits before sleep of FISH were negatively correlated with sleep conflict, sleep anxiety and daytime sleep of CSHQ respectively, the sleep routine of FISH was negatively correlated with sleep conflict, sleep delay and sleep anxiety of CSHQ respectively, the parents' behavior before sleep of FISH was negatively correlated with sleep conflict and sleep anxiety of CSHQ respectively, and the total score of FISH was negatively correlated with CSHQ, with statistically significant differences (P<0.05). Conclusions The FISH had good reliability and validity, and can be used as an assessment tool for children with ASD.

       目的   探讨运动干预联合治疗性聆听对孤独症谱系障碍儿童社会交往功能的影响。方法   选取黄河三门峡医院2020年1月—2023年10月收治的100例孤独症患儿，应用随机数字表法分为两组，各50例。对照组患儿实施常规护理，观察组在对照组基础上增加运动干预联合治疗性聆听。分别在干预前及干预6个月后采用孤独症治疗评价量表（ATEC）、儿童感觉统合发展评定量表、格塞尔发育量表（GDS）及中国韦氏儿童智力量表（WISC-R）评价两组患儿社会交往能力、感觉统合发展水平、神经发育水平及智力水平变化。结果   干预后两组患儿的ATEC各部分评分，包括健康/生理/行为、感知/认知能力、社交能力、语言表达/沟通能力及ATEC总分均降低，观察组低于对照组（P＜0.05）；干预后两组患儿学习能力发展、本体感觉、触觉防御、前庭功能及儿童感觉统合发展评定量表总分均升高，观察组高于对照组（P＜0.05）；干预后两组患儿动作能、应物能、言语能、应人能相关神经发育情况评分均升高，观察组高于对照组（P＜0.05）；干预后两组患儿言语智商、操作智商、总智商相关WISC-R评分均升高，观察组高于对照组（P＜0.05）。结论  运动干预联合治疗性聆听对孤独症谱系障碍儿童应用效果显著，可提升其社会交往能力，促进感觉统合发展，进而促进其神经发育及智力水平提升。

       Objective  To  explore the  effect  of  exercise intervention  combined with therapeutic listening  on  social communication function in children with autism spectrum disorder．Methods  A total of 100 autistic children who were admitted to our hospital from January 2020 to October 2023 were selected and divided into two groups by random number table method，with 50 children each．The control group received routine care，while the observation group  received exercise intervention combined with therapeutic listening in addition to routine care．The Autism Treatment Evaluation Scale （ATEC），Children’s Sensory Integration Development Scale，Gesell Development Scale，and Wechsler Intelligence Scale for Children-Revised by China （WISC-R）were used before and 6 months after the intervention to evaluate the social communication ability，sensory integration development level，neural development level，and intellectual level changes of the two groups of children．Results  After intervention，the score of every dimension in ATEC including the health/physiology/behavior，perception/cognitive ability，social ability，language expression/communication ability，and total ATEC score of the two groups of children decreased，and the observation group was lower than the control group （P＜0.05）．After intervention，the total scores of the learning ability development insufficient，proprioceptive dysfunction，excessive tactile defense，vestibular dysfunction，and children’s sensory integration development assessment scale in both groups of children increased，with the observation group being higher than the control group （P＜0.05）．After intervention，the neurological development scores related to motor，adapt，language，and social ability in both groups of children increased，and the observation group was higher than the control group （P＜0.05）．After intervention，the WISC-R scores related to verbal intelligence，operational intelligence，and total intelligence in both groups of children increased，and the observation group was higher than the control group （P＜0.05）．Conclusions  The combination of exercise intervention and therapeutic listening has asignificant effect on children with autism spectrum disorder，which can enhance their social communication ability，promote sensory integration development，and ultimately promote their neural development and intellectual level improvement．