孤独症谱系障碍患儿睡眠问题影响因素分析

目的 分析孤独症谱系障碍(ASD)患儿睡眠问题的影响因素。方法 调查181例ASD患儿相关资料,包括一般情况、喂养史及生活状况、母亲孕产期情况、分娩及新生儿情况,采用儿童睡眠习惯问卷(CSHQ)评价患儿的睡眠质量,分析ASD患儿发生睡眠问题的影响因素。结果181例ASD患儿中,有睡眠问题145例(有睡眠问题组),无睡眠问题36例(无睡眠问题组)。两组在父母文化程度、家庭关系、家庭年收入、营养物质补充、户外活动时间、电子频幕使用时间和主要抚养者方面差异均有统计学意义(P<0.05)。电子屏幕使用时间>1 h是ASD患儿发生睡眠问题的独立危险因素(P<0.05),父母文化程度本科及以上、补充维生素D和维生素AD以及户外活动时间>2 h是保护性因素(P<0.05)。结论 父母文化程度、营养物质补充、户外活动时间和电子屏幕使用时间是ASD患儿发生睡眠问题的影响因素。     

利培酮联合泼尼松龙治疗退化型孤独症谱系障碍患儿的临床研究

目的:探讨利培酮联合泼尼松龙对退化型孤独症谱系障碍(autism spectrum disorder,ASD)患儿核心症状和炎症因子的影响.方法:选取2018年11月至2020年4月于西安交通大学医学院第一附属医院治疗的退化型ASD患儿218例,根据随机数字表法分为泼尼松龙组和对照组,每组109例.所有患儿均口服利培酮...     

不明原因智力低下和孤独症谱系障碍儿童脆性X综合征的筛查结果分析

目的 不明原因智力低下和孤独症谱系障碍儿童脆性X综合征FMR1基因筛查结果分析.方法 选择不明原因智力低下和孤独症谱系障碍患儿35例,采用常规G显带染色体核型分析患儿染色体畸变情况,CNV-seq技术分析染色体拷贝数变异,PCR结合毛细管电泳法分析FMR1基因5'非编码区的CGG重复序列数目.结果 35例患儿中核型异常...     

孤独症谱系障碍患儿的执行功能特征和影响因素

孤独症谱系障碍（ASD）是一种常见的神经发育障碍性疾病。ASD患儿的执行功能缺陷表现在工作记忆、抑制性控制和认知灵活性、语言及社交功能损害等方面;如果伴有注意缺陷多动障碍（ADHD）、睡眠障碍及智力障碍等共患病时,其执行功能缺陷常常更严重。本文主要总结ASD儿童执行功能特征和影响因素方面的研究进展。     

维生素D治疗孤独症谱系障碍患儿疗效及安全性的Meta分析

摘要：目的:系统评价维生素D治疗儿童孤独症谱系障碍（ASD）的效果,以期为临床ASD的治疗提供参考。方法:计算机检索PubMed、the Cochrane Library、Web of Science、Embase、CNKI、VIP、SinoMed及WanFang Data数据库,搜索维生素D治疗ASD的随机及非随机对照试验,检索时限为建库至2021年11月5日,由2位研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果:共纳入10项研究,共997例患儿。Meta分析结果显示,与干预前相比,使用维生素D可明显降低儿童孤独症评定量表（CARS）总分[MD=-5.19,95%CI（-7.14,-3.23）,P<0.01],降低ABC量表各能区得分:感觉能区[MD=-3.85,95%CI（-6.18,-1.52）,P<0.01]、交往能区[MD=-3.12,95%CI（-4.11,-2.12）,P<0.01]、躯体运动能区[MD=-5.59,95%CI（-7.21,-3.97）,P<0.01]、语言能区[MD=-2.15,95%CI（-3.90,-0.39）,P<0.05]、生活自理能区[MD=-3.46,95%CI（-4.27,-2.64）,P<0.01],降低SRS总分[MD=-3.75,95%CI（-5.22,-2.28）,P<0.01],降低ATEC总分[MD=-17.19,95%CI（-31.71,-2.68）,P=0.02]。结论:维生素D治疗可改善ASD患儿的核心症状,但受纳入研究数量和质量的限制,上述结论仍需开展更多高质量的研究予以验证。     

高压氧治疗10例儿童孤独症谱系障碍的临床观察

目的探讨高压氧治疗孤独症谱系障碍的临床疗效。方法我院2013年7月至2014年7月10例孤独症谱系障碍(ASD)患者在常规训练的基础上,配合高压氧治疗,10 d为1个疗程,每天1次,2个疗程之间间隔10 d。每个患儿3~5个疗程,高压氧治疗前及治疗后均做孤独症行为评定量表(ABC)及儿童孤独症评定量表(CARS),降低10分以上者为显效,降低5~10分为有效,降低5分以下者为无效。结果 1例显效,4例有效,5例无效。结论 ASD症状越轻,干预的年龄越小,治疗时间越长,效果越好。高压氧治疗孤独症谱系障碍(ASD)确实有一定的临床疗效。     

多媒体感觉统合训练配合言语训练对伴智力低下孤独症谱系障碍儿童智力发育和事件相关电位的影响

目的 探讨多媒体感觉统合训练配合言语训练对伴智力低下孤独症谱系障碍(ASD)儿童智力发育和事件相关电位(ERP)的影响。方法 将三门峡市中心医院接诊的82例伴智力低下ASD病儿采用随机数字表法等分为联合组和常规组,常规组接受常规康复治疗,联合组在常规组基础上给予多媒体感觉统合训练+言语训练,均治疗6个月,比较两组治疗前后孤独症行为评定量表(ABC)、视听整合连续执行测试(ⅣA-CPT)、中国韦氏儿童智力量表(WISC-R)评分及ERP P3潜伏期、波幅的变化。结果 治疗后,两组ABC各维度评分、ERP P3潜伏期均明显降低(P<0.05),ⅣA-CPT评分、WISC-R评分和ERP P3波幅均明显升高(P<0.05);联合组ABC[(45.51±7.58)比(52.83±8.54)分]、ⅣA-CPT、WISC-R评分及ERP P3潜伏期[(426.88±23.71)比(439.72±24.49)ms]、波幅变化幅度[(7.23±1.67)比(6.35±1.40)μV]均大于常规组。结论 多媒体感觉统合训练配合言语训练可有效改善伴智力低下ASD病儿的认知功能、执行功能,促进病儿智力发育和语言发育。     

近10年中医药治疗儿童孤独症谱系障碍综述

通过对近10年来中医药治疗儿童孤独症谱系障碍(ASD)的相关文献进行检索和分析,从病因病机、辨证论治2个方面阐述中医药治疗儿童ASD的研究现状.现有研究证实中医药治疗ASD具有显著疗效,但存在中药的基础实验研究较少、临床循证医学研究缺乏、患儿配合度较低等不足,今后需进一步改进和加强研究,为中医药治疗本病提供科学的理论基...     

利培酮联合常规教育及康复训练治疗自闭症谱系障碍的临床观察

目的 探究利培酮联合常规教育及康复训练治疗自闭症谱系障碍的临床效果.方法 选择本院于2015年4月至2016年5月期间收治的自闭症谱系障碍患儿78例为研究对象,将所有患儿随机分为两组,每组39例;对照组患儿实施康复训练和常规教育治疗,观察组患儿在对照组的基础上实施利培酮治疗;比较两组患儿临床疗效和不良反应发生情况.结果 治疗前,观察组ATEC评分与对照组相比,差异无统计学意义(P＞0.05);治疗后,观察组ATEC评分为(73.42±8.98)分,低于对照组的(86.42±9.12)分,差异有统计学意义(P＜0.05);治疗后观察组患儿不良反应发生率为15.38％,对照组未出现明显的不良反应,两组比较差异有统计学意义(P＜0.05).结论 对自闭症谱系障碍患儿实施利培酮联合常规教育及康复训练治疗效果显著,能有效提高患儿的临床疗效,利于患者预后,在临床应用中具有较高的推广价值.     

Acupuncture for children with autism spectrum disorder

Wong VCN, Chen W‐X, Liu W‐L. Randomized controlled trial of electro‐acupuncture for autism spectrum disorder. Altern Med Rev 2010; 15: 136–46.     

孤独症谱系障碍儿童血清激素水平对照研究

目的　探讨孤独症谱系障碍（autism spectrum disorder,ASD）儿童与正常儿童血清激素水平的差异。方法　采用病例对照的研究方法,按照美国《精神障碍诊断和统计手册》第五版（DSM-Ⅴ）诊断标准收集2018年6月至2020年12月湖南省妇幼保健院120例ASD儿童（男68例/女52例,月龄24～108个月）和120例正常对照儿童（男68例/女52例,月龄24～109个月）。采用电化学发光法测定血清孕酮（P）、睾酮（T）、卵泡刺激素（FSH）、促黄体生成素（LH）、生长激素（GH）、皮质醇激素（CORT）、促肾上腺皮质激素（ACTH）水平。计量资料采用Wilcoxon秩和检验,计数资料采用χ²检验。结果　ASD儿童血清P、LH、CORT、ACTH水平分别为0.61（0.36,0.95）nmol/L、0.38（0.26,0.45）IU/L、345.28（223.98,465.50）nmol/L、10.41（6.43,16.65）pg/ml,高于对照组的0.16（0.16,0.16）nmol/L、0.25（0.21,0.32）IU/L、167.80（125.15,203.45）nmol/L、8.49（5.50,14.74）pg/ml（均P<0.05）;两组血清T、FSH、GH水平比较差异均无统计学意义（均P>0.05）。ASD儿童中,女性血清FSH、GH水平分别为2.66（1.32,3.80）IU/L、3.68（0.90,6.37）μg/L,高于男性0.93（0.65,1.31）IU/L、1.56（0.53,3.95）μg/L（均P<0.05）;血清P、T、LH、CORT、ACTH水平男女比较差异均无统计学意义（均P>0.05）。结论　ASD儿童血清P、LH、CORT、ACTH水平升高,无明显性别差异,提示其水平变化与ASD的发生密切相关。     

Copy-number variations associated with autism spectrum disorder

Autism spectrum disorder (ASD) is a clinically heterogeneous developmental disorder with a strong genetic component. Rare genetic disorders and various chromosomal abnormalities are thought to account for approximately 10% of people with ASD. The etiology of the remaining cases remains unknown. Recent advances in array-based technology have increased the resolution in detecting submicroscopic deletions and duplications, referred to as copy-number variations. ASD-associated copy-number variations, which are considered to be present in individuals with ASD but not in unaffected individuals, have been extensively investigated. These data will provide us with an opportunity not only to search for genes causing or contributing to ASDs but also to understand the genetics of ASD.     

Psychopharmacological interventions in autism spectrum disorder

Introduction: Individuals with autism spectrum disorder (ASD) commonly present for treatment of emotional and behavioral disturbances associated with ASD’s “core” symptoms. Psychotropic medications are widely utilized in alleviating associated emotional and behavioral symptoms.

Areas covered: Emotional and behavioral disturbances associated with ASD include irritability/severely disruptive behavior, which comprises the heaviest symptom burden; hyperactivity and other Attention-Deficit-Hyperactivity-Disorder (ADHD)-type symptoms; repetitive/stereotyped behaviors; and social withdrawal. Existing evidence for medications for each of these symptom clusters will be examined in this review.

Expert opinion: Psychopharmacological treatment of core and associated symptoms in ASD is challenging, in large part because of the heterogeneity in the presentation of ASD. Furthermore, children and adolescents with ASD are more vulnerable to the side effects of psychopharmacological intervention than their age-matched, typically developing counterparts. Currently, risperidone and aripiprazole are the only medications that have been (relatively) reliably shown to help treat certain symptom clusters associated with ASD, namely severely disruptive behavior and hyperactivity. Recent studies have begun to look at medications with mechanisms that are novel in the treatment of ASD and that may address underlying pathophysiology and/or core symptoms such as glutamate-modulating agents. Overall, randomized, placebo-controlled studies of medications for the treatment of ASD are scarce.     

Possible effect of acupuncture in autism spectrum disorder

Wong VC, Sun JG. Randomized controlled trial of acupuncture versus sham acupuncture in autism spectrum disorder. J Altern Complement Med 2010; 16: 545–53.     

Maternal folic acid and micronutrient supplementation is associated with vitamin levels and symptoms in children with autism spectrum disorders

To explore possible associations between maternal use of micronutrient supplements and the subsequent vitamin levels and symptoms in offspring with autism spectrum disorder (ASD), a total of 416 children with ASD and 201 typically developing (TD) children were enrolled. The children born to mothers without folic acid (FA) and micronutrient supplementation during pregnancy had more severe social cognition impairments, social communication impairments, autism behaviour mannerisms, developmental delays in adaptive and gross motor behaviour and gastrointestinal problems than children born to mothers who used FA and micronutrient supplements (P＜0.05). Interestingly, there was an association between maternal micronutrient supplementation and vitamin A (VA), vitamin D (VD) and folate levels in the ASD children (P<0.05), and levels of these vitamins also were associated with symptoms of ASD. Maternal FA and/or micronutrient supplementation may potentially moderate the symptoms of ASD. Interrupting the chain of micronutrient deficiencies between pregnant mothers and children may be beneficial in improving symptoms of ASD.     

Pharmacotherapy to control behavioral symptoms in children with autism

Introduction: Autistic disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) are pervasive developmental disorders (PDDs) frequently associated with behavioral symptoms that may require pharmacotherapy to manage.

Areas covered: Behavioral symptoms in children with autism include interfering repetitive behaviors, irritability, and hyperactivity and inattention, among others. The psychotropic medications examined in this review include: serotonin reuptake inhibitors, typical and atypical antipsychotics, medications used to treat attention-deficit/hyperactivity disorder, naltrexone, buspirone, divalproex sodium, lamotrigine, levetiracetam, memantine, mirtazapine, riluzole, pioglitazone, and topiramate.

Expert opinion: For the treatment of interfering repetitive behaviors, serotonin reuptake inhibitors demonstrate less efficacy and are more poorly tolerated in children with autism compared to adults. Antipsychotics are the most efficacious drugs for the treatment of irritability in children with autism and other PDDs. For the treatment of hyperactivity and inattention, psychostimulants demonstrate some benefit. However, they are overall less efficacious and cause more side effects in children with PDDs compared to typically developing children with attention-deficit/hyperactivity disorder. Results from double-blind, placebo-controlled trials of these agents and others for the treatment of the behavioral symptom domains described above will be discussed in this review.     

Pharmacotherapy to control behavioral symptoms in children with autism

INTRODUCTION: Autistic disorder, Asperger's disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS) are pervasive developmental disorders (PDDs) frequently associated with behavioral symptoms that may require pharmacotherapy to manage. AREAS COVERED: Behavioral symptoms in children with autism include interfering repetitive behaviors, irritability, and hyperactivity and inattention, among others. The psychotropic medications examined in this review include: serotonin reuptake inhibitors, typical and atypical antipsychotics, medications used to treat attention-deficit/hyperactivity disorder, naltrexone, buspirone, divalproex sodium, lamotrigine, levetiracetam, memantine, mirtazapine, riluzole, pioglitazone, and topiramate. EXPERT OPINION: For the treatment of interfering repetitive behaviors, serotonin reuptake inhibitors demonstrate less efficacy and are more poorly tolerated in children with autism compared to adults. Antipsychotics are the most efficacious drugs for the treatment of irritability in children with autism and other PDDs. For the treatment of hyperactivity and inattention, psychostimulants demonstrate some benefit. However, they are overall less efficacious and cause more side effects in children with PDDs compared to typically developing children with attention-deficit/hyperactivity disorder. Results from double-blind, placebo-controlled trials of these agents and others for the treatment of the behavioral symptom domains described above will be discussed in this review.