學齡前發展遲緩兒童之臨床評估與診斷－以新竹縣某區域醫院為基礎之病例探討

Clinical Evaluation and Diagnosis of Preschool Children with Developmental Delay-A Study of a Regional Hospital in Hsinchu County

吳雪櫻(Hsueh-Ying Wu) ； 陳怡君(I-Chun Chen) ； 湯子瑩(Tzu-Ying Tang) ； 凃富籌(Fuh-Chour Twu)

《身心障礙研究季刊》 10卷2期 (2012/06) Pp. 88-98

https://doi.org/10.30072/JDR.201206.0001

摘要

目的：“發展遲緩”為兒童復健科常見的主訴，在臨床上針對有發展遲緩主訴者，會經過一系列醫療診斷及發展評估，本研究針對新竹縣境內學齡前因疑有發展遲緩問題至隸屬於新竹縣某區域教學醫院，並為新竹縣唯一之早期療育鑑定中心求診的個案，描述分析臨床診斷及發展評估結果，並與其他相關報告做比較。方法：收集2010年間因疑似有發展遲緩問題至本院完成早期療育評估的學齡前兒童共有272位。登錄所有個案基本資料、各項功能評估結果及疾病診斷，再使用電腦軟體PC-Excel的樞紐分析進行描述性分析。結果：本研究發現臨床評估後的結果以語言發展遲緩最多，共有163例（占59.9%），其次為動作發展遲緩98位（占36%），國際疾病代碼分類之疾病診斷方面，全面發展遲緩組有34例（39.5%）診斷為有精神心智相關疾病，又以智能障礙占最多（21例）；語言發展遲緩組中則有24例（32.4%）有精神心智方面疾病之診斷；社會情緒發展遲緩組有7例診斷有相關精神心智疾病。動作發展遲緩組僅有2例有相關疾病診斷，此外，仍有107例（56.6%）無法找出相關疾病診斷。結論：本研究呈現了學齡前發展遲緩兒童臨床評估的結果，發現語言及動作發展遲緩最多，而認知及社會情緒發展遲緩相對較少，須加強臨床追蹤及評估方式的介入；區域醫院疾病診斷多以精神心智疾病為多，腦部神經肌肉病變及染色體先天症候群相對較少，且很多找不到相關疾病診斷，以上結果有助於增加臨床早期療育參與人員對學齡前發展遲緩臨床評估診斷及地域分布特性之瞭解，以做為介入治療或後續安置之參考及應用。

關鍵字

早期療育 ； 發展遲緩 ； 臨床評估

並列摘要

Objectives: Developmental delay (DD) is a common problem in child development. Children who are suspected of having DD receive a series of medical diagnosis and functional evaluation after they were referring to clinics. The study collected and analyzed the data of children who underwent clinical assessment due to developmental problems in a reginal hospital in Hsinchu County. Methods: The sample consisted of 272 preschool children who visited our department for evaluation of developmental problems. Medical charts of these cases were retrospectively reviewed and information including general data, outcome of functional assessment, and associated disorders were obtained. These data were then described and analyzed by Excel software. Results: Speech DD (163 cases, 59.9% of all) and motor DD (98 cases, 36.0%) were the main problems. Among global DD group, there were 34 cases (39.5%) diagnosed to having psychiatric disorders and mental retardation was the most common diagnosis (21 cases). 24 cases (32.4%) were diagnosed with psychiatric disorders in speech DD group. In psychosocial DD group, there were 7 cases having psychiatric disorders. Only 2 cases were identified to have associated diseases in motor DD group. Besides, a high percentage (56.6%) of children was still without related disorders even after the completion of medical assessment. Conclusions: This study revealed the results of clinical evaluations of preschool children suspected of having DD. It was found that speech and motor DD were the most common problems, but cognitive and psychosocial DD was relatively uncommon. Psychiatric disorders were common diagnosis of DD in regional hospitals, but cases of brain/neuromuscular diseases, chromosomal disorders, or congenital syndromes were rare. There were many cases that could not be identified to have related disorders. These results may enhance understandings of DD problems in preschool children, especially for all participants of early intervention program.

並列關鍵字

Clinical evaluation ； developmental delay ； early intervention

參考文獻

()。

徐澄清、蘇喜、蕭淑貞、林家青、宋維村、張珏(1978)。學齡前兒童行爲發展量表之修訂及初步常模之建立。中華民國小兒科醫學會雜誌。19(2)，142-157。

翁菁菁、鄒國蘇(2005)。三歲以下發展遲緩兒童之臨床特徵。北市醫學雜誌。2(6)，535-544。

Battaglia, A.,Carey, J.C.(2003).Diagnostic evaluation of developmental delay/mental retardation: an overview.American Journal of Medical Genetics (Semin Med Genet.).117C(1),3-14.

Chen, I.C.,Chen, C.L.,Wong, M.K.,Chung, C.Y.,Chen, C.H.,Sun, C.H.(2002).Clinical analysis of 1048 children with developmental delay.Chang Gung Medical Journal.25(11),743-50.