孤独症诊断的金标准之一《孤独症诊断观察量表》介绍

本文介绍了"孤独症诊断观察量表"的应用及评估范围,4个模块的简要应用情况以及应用时的注意事项。     

孤独症诊断的历史发展

本综述了孤儿症诊断的历史发展，总结了诊断历史中具有时代意义的发展变化。     

ICD-11和DSM-5中孤独症谱系障碍诊断标准比较

孤独症谱系障碍(Autism Spectrum Disorders,ASD)是一种常见的神经发育障碍.目前孤独症谱系障碍诊断主要依靠国际疾病分类(ICD)和精神障碍诊断和统计手册(DSM)这两大系统.世界卫生组织发布了《国际疾病分类》第11版(ICD-11),ASD的诊断标准有了新的修改和变动.及时、准确认识并把握IC...     

中国精神障碍分类与诊断标准第3版孤独症诊断标准的临床研究

目的 比较中国精神障碍分类与诊断标准第3版（CCMD-3）与中国精神疾病分类方案与诊断标准第2版修订本（CCMD-2-R）和国际疾病分类第10版（ICD-10）儿童孤独症诊断标准的一致性及症状出现率。方法 采用临床面谈和定式工具收集病史和评估症状，先依据CCMD-2-R对117例患儿进行初次诊断，然后按照CCDM-3和ICD-10进行再诊断。结果 （1）CCMD-3与ICD-10诊断的一致率为100.0%（Kappa值=1.000),CCMD-2-R与ICD-10的一致率为95.8%（Kappa值=0.915)。（2）孤独症组在三种诊断标准中8项相同症状的出现率为79.4%-100.0%。14项不同相同症状的出现率为27.0%-98.4%;CCMD-3,CCMD-2-R和ICD-10中出现率≤50%的症状分别有2项，3项和1项，结论CCMD-3较CCMD-2-R与ICD-10诊断一致性高，但少数症状出现率仍偏低。     

孤独症伴发癫痫的相关性研究

目的探讨癫痫与孤独症间的相关性,分析两者间的关系。方法选取2011-04—2014-04在海淀区培智学校就读的146例孤独症患者为研究对象,根据是否发生癫痫,将其分为观察组和对照组,对照组21例,观察组125例,对比2组的临床表现和体征等资料,分析癫痫并孤独症患者的主要临床表现,及其与癫痫发作可能相关的独立因素。结果结果显示观察组发生孤独症的临床表现以社会交往障碍和交流障碍为主,分别占42.86%、23.81%;单因素分析结果显示在合并其他神经系统疾病、脑电图异常情况、母亲孕期异常及癫痫家族病史等方面,2组比较差异有统计学意义(P均0.05);Logistic回归分析显示合并其他神经系统疾病、脑电图异常、母亲孕期异常是孤独症患者发生癫痫的独立危险因素(P均0.05)。结论癫痫与孤独症间存在相关性,应针对其独立相关因素对患孤独症的青少年进行干预,从而预防癫痫的发生。     

孤独症谱系障碍病因、诊断、治疗的研究进展

就孤独症谱系障碍的病因研究,诊断进展以及治疗做一综述。     

孤独症的病因学研究

讨论孤独症的病因,包括遗传、神经学、影像学、免疫学及生化等方面的进展介绍。     

三种诊断标准对精神分裂症和心境障碍的诊断比较

为了解国内的精神疾病诊断标准与国际标准间的异同，使用美国精神障碍诊断与统计手册第３版修订本定式临床检查提纲（ＳＣＩＤ－Ｐ），作为国际疾病分类第１０版（ＩＣＤ－１０）、中国精神疾病分类方案与诊断标准第２版修订本（ＣＣＭＤ－２－Ｒ）和美国精神障碍诊断与统计手册第４版（ＤＳＭ－ＩＶ）的症状评定工具，对临床初步诊断为精神分裂症的１１４例患者及心境障碍的８２例患者进行上述３种诊断系统间的诊断比较。结果表明：３种标准对精神分裂症的诊断一致性差（Ｐ＜０．０５），差异原因与各标准病程规定不同有关；两两标准间的诊断一致性好。３种诊断标准对心境障碍的诊断一致性较好（Ｐ＞０．０５）；两两标准间的诊断一致性亦好。以ＩＣＤ－１０作为“金标准”，用ＣＣＭＤ－２－Ｒ及ＤＳＭ－ＩＶ诊断两种疾病均具有较好的敏感性和特异性；ＣＣＭＤ－２－Ｒ诊断精神分裂症和ＤＳＭ－ＩＶ诊断心境障碍更加准确。另外，本研究还显示ＳＣＩＤ－Ｐ及３种诊断标准具有较高的信度。提示ＣＣＭＤ－２－Ｒ，ＤＳＭ－ＩＶ均已向ＩＣＤ－１０靠拢。     

Comparing symptoms of autism spectrum disorders using the current DSM-IV-TR diagnostic criteria and the proposed DSM-V diagnostic criteria

The American Psychiatric Association has proposed major revisions for the diagnostic category encompassing Autism Spectrum Disorders (ASD), which will reportedly increase the specificity and maintain the sensitivity of diagnoses. As a result, the aim of the current study was to compare symptoms of ASD in children and adolescents (N = 208) who met criteria for ASD according to only the DSM-IV-TR to those who met criteria according to the forthcoming version of the DSM and to those that were typically developing. Participants comprising the DSM-IV-TR and DSM-V groups did not score significantly different from each other on overall autism symptoms, but both groups scored significantly different from the control group. However significant differences emerged between the DSM-IV-TR and DSM-V groups in the core domain of nonverbal communication/socialization. Implications of the results and the proposed changes to the ASD diagnostic category are discussed.     

精神分裂症患者子女行为问题的对照研究

目的探讨精神分裂症患者子女的行为问题及其相关因素。方法采用Achenback儿童行为量表（CBCL）对精神分裂症患者子女（研究组）及正常人子女（对照组）进行测试,两组各为108人,对其家庭教育状况和在学校表现进行对照研究。结果研究组行为问题的出现率为32．5％,多于对照组（11．1％）;研究组CBCL平均得分为26．32±9.35高于对照组（9．22±5．65;t=16．27,P＜0．01）。研究组的家庭教育状况及在学校表现与对照组比较,差异有显著性。结论精神分裂症患者子女发生行为问题较多,为遗传及环境因素共同作用的结果。     

社交恐怖症患者父母教养方式的对照研究

目的 探讨社交恐怖症患者父母教养方式的特异性因素。方法 采用父母教养方式评价量表(EM—BU)对符合ICD—10诊断标准的36例社交恐怖症患者进行了评定，并与31例强迫症及35例健康人作为对照者加以比较。结果 同健康对照组相比，社交恐怖症患者在父母惩罚及过分拒绝因子上的评分较高，而父母情感温暖因子上的评分较低，差别有非常显著性意义(P＜0.01)。同强迫症组相比，社交恐怖症患者在母亲惩罚因子上的评分较高，而母亲情感温暖因子上的评分较低，差别有显著性意义(P＜0．05)。结论 父母惩罚、缺少父母的情感温暖及父母的过分拒绝在社交恐怖症的发生发展中起着非常重要的作用，其中父母的惩罚可能是社交恐怖症患者的一个特异性因素。     

Diagnosing young children with autism

The starting point for any research on Autism Spectrum Disorder (ASD) involves the identification of people who evince the condition. From this point follows research on symptom presentation, genetics, epidemiology, animal models, treatment efficacy, and many other important topics. Major advances have been made in differential diagnosis, particularly with young children. This fact is particularly important since ASD is a life long condition. This review documents recent advances and the current state of research on this topic.     

A pilot study examining the use of the autism diagnostic observation schedule in community-based mental health clinics

Community-based mental health (CMH) services play an important, but relatively understudied role in the identification and treatment of youth with autism spectrum disorder (ASD) who may be receiving care for other psychiatric conditions. Little is known about the role of standardized ASD assessment measures administered by providers working in generalist community-based mental health (CMH) settings. This pilot study extracted data from three CMH clinics to examine the use of the Autism Diagnostic Observation Schedule (ADOS) by 17CMH providers who received ASD assessment training with 62 youth (Mean = 10.69 years) referred for an ASD diagnostic evaluation. Results indicated that 57% of youths assessed ultimately received an ASD diagnosis. All cases given a final ASD diagnosis were classified as “Autism” or “ASD” on the ADOS. Seventy percent of youth who did not receive a final ASD diagnosis were classified as “Non-Spectrum” on the ADOS. In these false positive cases, report narratives indicated that social communication difficulties identified on the ADOS were explained by symptoms of other mental health conditions (e.g., ADHD, anxiety). Future research is needed to examine the utility of the ADOS when used by CMH providers to facilitate CMH capacity to identify ASD.     

Diagnostic utility of the autism diagnostic observation schedule in a clinical sample of adolescents and adults

BackgroundThe Autism Diagnostic Observation Schedule (ADOS) Module 4 was investigated in an independent clinical sample of highfunctioning adolescent and adult males and females with suspected autism spectrum disorder. Special attention was paid to the performance of the ADOS in the subgroups autism spectrum disorders (ASD), personality disorders and disorders with onset usually occurring in childhood and adolescence.MethodThe recently revised algorithm and severity scores for Module 4 were used to analyze predictive values compared to the original algorithm in a sample of N = 356, 21% females, age range 12–68 yrs.ResultsBoth algorithms have good sensitivity and specificity, with slightly better results for the revised algorithm. Diagnostic accuracy is lower for females, older individuals, and individuals with personality disorders or higher intellectual abilities.ConclusionThe revised algorithm has good utility when used as part of a comprehensive assessment procedure conducted by an experienced examiner and including information on developmental history.     

Inositol treatment of autism

Summary Recent studies suggest that serotonin reuptake inhibitors are helpful in at least some symptoms of autism. Inositol is a precursor of the second messenger for some serotonin receptors, and has been reported effective in depression, panic disorder and obsessive-compulsive disorder. However a controlled double-blind crossover trial of inositol 200 mg/kg per day showed no benefit in 9 children with autism. Since biochemical studies suggest that inositol may augment serotonin effects, future studies could evaluate inositol in children already receiving serotonin reuptake inhibitors.     

Reading enhancements for students with autism spectrum disorder: A matched randomized pilot experimental study

BackgroundFor students with autism spectrum disorder (ASD), improving reading comprehension is critical for increasing both their opportunities for successful postsecondary experiences including attending college and obtaining meaningful employment. The purpose of this pilot study was to investigate the effects of a multicomponent reading intervention on the vocabulary and reading outcomes of middle grade students with ASD.MethodWe conducted a matched randomized pilot experimental study for students with ASD in grades 3–8 (N = 28) identified by their district personnel as having reading difficulties (i.e., not passing state reading test). An independent researcher matched participants according to symptom severity and reading fluency and then randomly assigned a member of each pair to treatment or comparison condition. Participants in treatment condition were provided 1:1 instruction for 23–30 sessions (M = 27) of 30 min each four to five days per week. Instructional components included (a) vocabulary instruction; (b) fluency with text, and (c) reading comprehension. In this pilot study, data were analyzed using repeated measures multilevel models in HLM 7. Due to the associated low statistical power to detect effects, the small sample size, and the exploratory nature of the study, we selected an alpha level of 0.10. Data were modeled as student-level variables classifying students based on their ASD symptomology from mild (level 1) to severe (level 3).ResultsThe multicomponent intervention was associated with significant gains in WJ-PC scores of 22.62 (se = 8.19, df = 3, p = .070) for students at GARS severity level 1. Significant gains favoring the intervention were also detected on vocabulary score of 10.19 (se = 2.78, df = 3, p = .035) and for students rated at GARS severity level 1 and for students rated at GARS severity level 2 [vocabulary score 5.46 (se = 1.60, df = 3, p = .042)]. Significant effects were not detected for scores on a standardized measure of reading and fluency (TOSREC), and a researcher-developed measure of reading comprehension.ConclusionsThis pilot study shows enough promise to warrant future studies employing larger sample sizes and fully powered randomized control trial (RCT) studies. Although growth is modest and appears to be limited to participants who are in the mid to higher range of the autism spectrum, considering the large percentage of students with ASD in the mid to higher range, this study contributes to the development of evidence-based practices. We interpret the findings as having implications for future research with larger sample sizes and in providing initial guidance on instruction for consideration by practitioners.