三歲以下發展遲緩兒童之臨床特徵

Clinical Characteristics of Young Children with Developmental Delay

10.6200/TCMJ.2005.2.6.05

翁菁菁(Ching-Ching Wong)；鄒國蘇(Kuo-Su Tsou)

發展遲緩 ； 早期療育 ； 相關疾病診斷 ； developmental delay ； early intervention ； related disease

北市醫學雜誌

2卷6期（2005 / 06 / 01）

535 - 544

繁體中文

目的：了解門診個案中0-3歲兒童確定有發展遲緩者之求診原因、發展遲緩類型、相關疾病診斷與可能病因及後續處置建議。方法：採取病歷回溯法，將2002年1月1至 2004年1月31日的245位0-3歲門診初診個案中，確定有發展遲緩者之病歷摘取相關資料，進行描述性分析。結果：研究期間292位0-3歲早療評估中心門診初診個案中，確定有發展遲緩者共246位。確定為發展遲緩兒童當中男性有180位，女性有66位。0-1歲有4.1%，1-2歲有29.2%，2-3歲有66.7%。求診原因以語言發展問題為最多占85.8%。發展遲緩類型以語言發展遲緩最多占95.5%，全面發展遲緩者占54.5%。其中有精神疾病診斷者占74.0%。以DSM-IV為診斷依據以廣泛性發展障礙最多31.7%。生理疾病診斷方面有視力問題的占6.5%，有聽力問題的占2.8%，有腦部／神經肌肉系統疾病的占11.4%，有先天遺傳代謝疾病的占5.7%。造成發展遲緩的可能病因方面因中樞神經受損造成發展遲緩者約占8.9%，因先天性／基因異常造成約占6.5%，因早產造成的約占3.7%，因環境刺激不足造成之發展遲緩者約占46.3%，不明原因的約占34.6%。後續療育與處置建議方面，親職諮詢的占77.6%，轉介學校教育資源的占76.0%。結論：0-3歲發展遲緩兒童大多合併有相關疾病診斷，此結果可作為臨床醫師於發展遲緩兒童的診斷與處置建議之參考。

Background and Purpose: This study identifies the common clinical characteristics, related diagnoses, probable etiologies and recommendations after early intervention of children younger than 3 years old with developmental delay, who visited the Taipei Development Assessment Center. Method: The sample consisted of 246 children younger than 3 years old with developmental delay diagnosed at Taipei Development Assessment Center between January 1, 2002 and January 31, 2004. We reviewed medical charts retrospectively to obtain information for the study. Psychiatric diagnoses were made according to the DSM-IV criteria by child psychiatrists. Results: The male- female ratio of all patients was about 2.7:1 (180/66). The majority were 2-3 years old (66.7%). The main problems were speech delay (85.8%) and motor coordination difficulties (28.0%). After formal development assessment, the common types of development delay were noted as language delay (95.5%), cognitive delay (54.9%) and fine motor delay (52.8%). There were 182 children (74.0%) diagnosed with at least one psychiatric disorder. The common psychiatric diagnoses were noted as pervasive developmental disorders (31.7%), language development disorders (28.5%) and mental retardation (11.8%). Among these were 28 (11.4%) who were diagnosed with brain/neuromuscular diseases and 14 (5.7%) who were diagnosed with genetic diseases. Early psychosocial deprivation was the most probable etiology for developmental delay (46.3%). 19.1% may have been caused by biological factors (6.5% genetic defects or congenital anomalies, 8.9% CNS lesions, 3.7% premature birth). Parenting skills consultations were provided (77.6%) and referral to pre-school systems was recommended to the majority of parents (76.0%). Conclusion: The study revealed there were psychiatric disorders and related physical diseases existing in children younger than 3 years old with developmental delay, therefore it is necessary for them to undergo comprehensive evaluation.

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