学龄前期及学龄期孤独症谱系障碍儿童脑结构异常的研究

目的 研究学龄前期及学龄期孤独症谱系障碍（ASD）儿童脑结构异常的发生率及类型。方法 选取上海市74 252名3~12岁学龄前期及学龄期儿童为研究对象。通过问卷调查方式收集每位儿童的基本信息,家长及教师根据儿童实际情况填写儿童社会交往量表（SCQ）。针对所有高度可疑ASD儿童由专科医师根据DSM-5诊断标准进行确诊,同时根据家长意愿完善颅脑MRI检查。结果 学龄前期及学龄期儿童ASD总体发病率为2.59‰（192/74 252）。共收集到73名ASD儿童和185名正常儿童的颅脑MRI资料,ASD儿童中脑结构异常率为55%（40/73）,主要异常类型为一侧或双侧脑室扩大（80%,32/40）及一侧或双侧额颞部脑沟加深（30%,12/40）。ASD儿童双侧侧脑室白质信号降低、一侧或双侧额颞脑沟加深比例高于正常儿童（P < 0.05）。结论 学龄前期及学龄期ASD儿童中脑结构异常发生率高,主要结构异常为一侧或双侧脑室扩大及一侧或双侧额颞脑沟加深,推测其脑结构的异常可能与ASD的发病相关,关于发生异常的脑区结构与ASD儿童的症状之间的关系有待进一步研究确证。     

孤独症谱系障碍儿童智力发育与表情识别能力的关系

目的探讨孤独症谱系障碍(ASD)儿童的智力发育特点、表情识别能力及两者之间的关系。方法招募6~16岁的ASD儿童(ASD组,总智商均大于70)和年龄、性别匹配的正常发育儿童(对照组)各27例,使用韦氏儿童智力量表(第四版)和中国人物静态面部表情图片对两组儿童进行智力评估和表情识别测试。结果 ASD组总智商、言语理解、知觉推理、加工速度以及工作记忆指数得分均低于对照组(P0.05)。ASD组儿童的表情识别总正确率及高兴、生气、伤心、害怕表情识别的正确率均低于对照组儿童(P0.05)。ASD组表情识别总正确率、高兴及害怕表情识别的正确率与知觉推理呈正相关(r分别为0.415、0.455、0.393,P0.05),生气表情识别的正确率与工作记忆指数呈正相关(r=0.397,P0.05)。结论 ASD儿童在智力发育的多个领域落后于正常儿童,其表情识别能力受损。患儿智力中的知觉推理能力和工作记忆能力与表情识别能力存在正相关关系,推测知觉推理和工作记忆能力不足可能是影响ASD儿童表情认知的重要因素。     

孤独症谱系障碍的研究进展

孤独症谱系障碍是一组并不少见的以社会交往障碍、交流障碍和狭隘重复性行为为特征的疾病,在过去的十年,孤独症的流行病学、病因、早期诊断、早期干预和预后等领域取得了诸多重要进展,文章对此作一阐述.     

学龄前期孤独症谱系障碍儿童交叉式团体与个体沙盘干预的疗效比较

目的 探讨学龄前期孤独症谱系障碍（ASD）儿童交叉式团体与个体沙盘干预的疗效。方法 将80例4~6岁ASD儿童随机分成试验组和对照组,每组40例。试验组患儿与正常儿童以1：3配比交叉式加入团体沙盘,对照组患儿采用一对一个体沙盘干预。以异常行为评定量表（ABC）和孤独症治疗评估量表（ATEC）评估治疗3个月后的整体疗效。结果 实际入选试验组33例,对照组28例。试验组干预3个月后ABC量表情绪不稳、社交退缩、刻板行为因子得分及总分较干预前下降;对照组干预后刻板行为、言语失当得分及总分较干预前下降（P < 0.05）。试验组社交退缩和总分的干预前后差值大于对照组（P < 0.05）。试验组干预3个月后ATEC量表社交、感知觉、行为及总分较干预前下降,对照组语言、社交、行为及总分较干预前下降（P < 0.05）。试验组语言、社交、感知觉和总分的干预前后差值大于对照组（P < 0.01）。干预后试验组目光交流和沙具刻板排列的改善优于对照组（P < 0.05）。结论 个体沙盘和交叉式团体沙盘干预均可改善学龄前ASD患儿的症状。交叉式团体沙盘对ASD患儿的干预效能优于个体沙盘,以社交、情绪及刻板行为改善为著。     

学习障碍儿童智力水平、智商结构的特点分析

学习障碍（learning disability，LD）指不存在智力低下和视、听觉障碍，没有教育剥夺及原发性情绪障碍而出现计算、语言表达等特殊学习技能障碍综合征，学龄儿童患病率3％～8％，其突出的临床表现是学习成绩差。我们研究LD儿童智商、智商结构特点，为临床早期诊断、干预提供参考。     

孤独症谱系障碍患儿的睡眠障碍

<正>孤独症谱系障碍(autism spectrum disorder,ASD)是一类以社交障碍、交流障碍和重复刻板行为为特征的神经发育障碍,包括孤独症(autism)、阿斯伯格综合征(Asperger syndrome,AS)和广泛性发育障碍未分类型(pervasive     

孤独症谱系障碍发病影响因素研究

目的通过对比分析孤独症谱系障碍(ASD)儿童和正常儿童的健康影响因素差异,进一步探索儿童ASD的发病因素,为ASD防治提供参考依据。方法采用1∶1病例对照研究回顾性调查2014年5月至2015年5月辽宁省锦州市妇婴医院诊治的196例ASD儿童和体检正常的非ASD儿童,填写自拟健康影响因素调查问卷,对比分析两组儿童发育指标及影响因素差异。结果两组间平均身高、体重差异无统计学意义(P0.05),ASD组儿童头围大于对照组,差异有统计学意义(t=2.41,P=0.02)。条件Logistic回归分析显示儿童一眼识别理解能力(β=-3.077)、头围(β=0.341)差异均有统计学意义(P均0.05)。母亲生育年龄35岁、家庭关系、有家族神经障碍类疾病史、父亲从事劳动类型等变量回归系数检验均有统计学意义(P均0.05),与疾病发生有关联;孕期情绪急躁易怒(β=1.966,OR=7.144)、精神刺激(β=2.067,OR=7.902)和妊娠呕吐(β=2.576,OR=13.138)等因素与疾病发生呈正向相关(P均0.05);而补充营养品(β=-2.435,OR=0.088)、胎动正常(β=-2.008,OR=0.134)与ASD呈负向关联(P均0.05)。结论母亲年龄超过35岁、父亲从事体力劳动、家庭关系紧张、有家族神经障碍疾病史、精神刺激、孕期情绪暴躁、妊娠呕吐等因素可能是ASD发病的危险因素;而母亲在35岁前生育、孕期及时补充营养品、保持心情愉悦,同时在儿童生长发育过程中注意与其语言交流、监测头围正常,保持家庭和谐,增加对儿童的陪伴在一定程度上能降低ASD的发生。     

孤独症谱系障碍动物模型的研究进展

孤独症谱系障碍是一种神经发育障碍性疾病。其病因多样,多数认为是环境与遗传的共同结果。动物模型,作为孤独症谱系障碍疾病的研究工具,通过生化作用诱导与基因分子缺陷,从而获得不同的孤独症动物亚型,以研究孤独症的病因,行为学表型,探索药物及干预疗法的安全性和有效性,以期提高孤独症个体的生活质量。     

孤独症谱系障碍儿童的运动技能障碍

孤独症谱系障碍(autism spectrum disorders, ASD儿童的运动技能障碍常表现为早期运动落后、协调障碍、体能下降及视动整合障碍等,在不同程度上影响了他们的生活、学习及社会交往。由于ASD儿童的核心症状相对明显,故其运动技能障碍常常会被忽视。ASD儿童应早期进行运动功能的监测,选择合适方法进行运动评估,针对其运动技能障碍特点进行相应训练,以促进其运动技能的发育,从而辅助改善其核心功能障碍。运动干预在改善ASD儿童功能的证据日益增加,临床上不应该忽视ASD儿童的运动技能障碍及其康复干预,而应得到更多关注。     

孤独症谱系障碍儿童功能性近红外光谱成像拓扑结构44例病例系列报告

背景 青春期是大脑成熟和发育的重要时期.孤独症谱系障碍(ASD)青少年存在异常的前额叶和颞叶皮层激活和功能连通性,并可能与症状严重程度相关.目的 图论研究ASD个体的脑网络拓扑属性的发育轨迹与年龄、认知和症状严重程度的相关性.设计病例系列报告.方法 纳入符合DSM?Ⅳ?TR/DSM?Ⅴ/ICD?10/ICD?11诊断标...     

孤独症谱系障碍儿童反向眼动功能研究进展

新近研究发现孤独症谱系障碍(ASD)的大脑执行功能存在反应抑制缺陷,反向眼动实验是直接评定抑制功能的一种新手段,为探究认知障碍儿童的反应抑制认知功能提供了新途径,并逐渐向ASD的神经心理功能的研究拓展.研究者指出ASD儿童眼动抑制能力存在缺陷.     

Psychopharmacology of autistic spectrum disorders in children and adolescents

This article provides an overview of the psychopharmacologic management of irritability, hyperactivity, and repetitive behaviors in children and adolescents with autism spectrum disorder. A review of the current literature on medications used to treat these conditions with emphasis on randomized controlled trials is presented.     

Use of complementary and alternative treatments for children with autistic spectrum disorders is increasing

Interventions considered to be CAM are in constant flux. New treatments emerge, older treatments become less popular, and the cycle recurs. Data supporting new treatments should be scrutinized for scientific study design, clinical safety, and scientific validity. Many families approach the clinician armed with brochures, handouts, and printouts from Web sites that are dedicated to the care and support of parents and children with ASD. A recent web search using "autism and detoxification" resulted in almost 8,000 sites. The Defeat Autism Now! (DAN!) Project arose in 1995 from collaboration of members of the Autism Research Institute. The DAN! Project advocates a specific and extensive protocol for diagnosis and treatment and can be viewed at http://www.autism.com/ari/#dan. The scientific validation and support for many interventions is incomplete and disparate from the recommendation in the American Academy of Pediatrics Policy Statement. Families should be encouraged to discuss all proposed investigations or treatments they wish to try with their primary care provider so the practitioner can serve as the medical home (Sidebar, page 688). The clinician should communicate and collaborate with the family and educational professionals to encourage objective identification of what works. With increasing access to health information and societal pressure for families to actively participate in their health management, continued growth of interest in CAM can be anticipated. Clinicians must remember that parents may have different beliefs regarding the effectiveness of treatment and different tolerance for treatment risks. Practitioners must keep avenues of communication open, remain open-minded, and not assume a "don't ask, don't tell" posture in the context of providing a medical home to the increasing number of children diagnosed with autism.     

Breastfeeding and intelligence of preschool children

AIM: To investigate whether breastfeeding during infancy is a determinant of intelligence at 3.5 y. METHODS: Five hundred and fifty European children enrolled at birth in the Auckland Birthweight Collaborative Study were assessed at 3.5 y of age. Approximately half were small for gestational age (SGA < or =10th percentile) at birth and half were appropriate for gestational age (AGA >10th percentile). Duration of breastfeeding was recorded at maternal interview, and the intelligence of children was assessed using the Stanford Binet Intelligence Scale. Regression analysis was used to calculate estimates of difference in intelligence scores between breastfeeding groups for the total sample and the group of SGA children. Analyses of the total sample were weighted to account for the disproportionate sampling of SGA children. RESULTS: Breastfeeding was not significantly related to intelligence scores in the total sample despite a trend for longer periods of breastfeeding to be associated with higher intelligence scores. However, in the SGA group, breastfeeding was significantly related to IQ at 3.5 y. Small for gestational age children who were breastfed for longer than 12 mo had adjusted scores 6.0 points higher than those who were not breastfed (p=0.06). CONCLUSION: Breastfeeding may be particularly important for the cognitive development of preschool children born small for gestational age.     

Risperidone use in children with Down syndrome, severe intellectual disability, and comorbid autistic spectrum disorders: a naturalistic study

OBJECTIVE: We report on an open-label, naturalistic study using risperidone to treat disruptive behaviors and self-injury in children with Down syndrome, severe intellectual disability, and comorbid autism spectrum disorders (DS+ASDs). We hypothesized that hyperactivity and disruptive behaviors would improve in response to risperidone treatment consistent with previous studies of children with ASD. METHODS: Subjects were children (mean age, 7.8 +/- 2.6 years), consisting of 20 males and three females identified through our outpatient Down Syndrome Clinic between 2000 and 2004. RESULTS: Using the Aberrant Behavior Checklist as the primary outcome measure, all five subscales showed significant improvement following risperidone treatment. The mean duration of treatment was 95.8 +/- 16.8 days, and mean total daily dose was 0.66 +/- 0.28 mg/day. The Hyperactivity, Stereotypy, and Lethargy subscale scores showed the most significant reduction (p < .001), followed by Irritability (p < .02), and Inappropriate Speech (p < .04). Children with disruptive behavior and self-injury showed the greatest improvement. Sleep quality improved for 88% of subjects with preexisting sleep disturbance. Subjects for whom a follow-up weight was available showed a mean weight increase of 2.8 +/- 1.5 kg during the treatment period. CONCLUSIONS: These findings support our clinical impression of improvement on important target behaviors such as aggression, disruptiveness, self-injury, stereotypy, and social withdrawal. Low-dose risperidone appears to be well tolerated in children with DS+ASD, although concerns about weight gain and metabolic alterations may limit its usefulness over the long term in some children.