孤独症患儿感觉异常行为分析

目的:了解孤独症患儿感觉异常行为的特征。方法:93例孤独症患儿,男87例,女6例,平均年龄5.3±2.9岁。参考Harison的《感觉行为列表》,适当修改后制成调查表,对患儿进行感觉异常行为调查。结果:本组患儿以视觉和听觉反应异常最为常见,见于绝大多数患儿;其次为痛觉反应迟钝和嗅觉异常行为,而触觉及味觉异常行为相对少见。重度患儿组多项感觉异常行为的发生率均明显高于轻度组。结论:孤独症患儿存在多种感觉异常行为,而且与孤独症的严重程度有关,其发生机制及对孤独症的影响值得进一步探讨。     

95例儿童孤独症临床分析

目的：探讨儿童孤独症的临床特征,展望相对应的干预措施。方法：调查孤独症患儿的父母文化的水平、城乡比例、首诊主诉、发病与就诊时间间隔。采用Gesell发育量表测定发育商。Car's量表进行症状行为评定,用社会生活能力量表进行适应性行为评定。检验分析孤独症行为与适应性行为的相关性。结果：孤独症患儿父母文化水平大多为初、高中以上文化。孤独症患儿城乡比例为：2．8：1。首诊主诉症状以语言障碍为主（占84％）。患者从发病到就诊时间平均延迟31个月。孤独症行为的严重程度与社会生活能力缺陷的程度无相关性,症状特点以语言障碍及社会交往障碍最为突出。作者对此进行了分析并提出早期干预及行为,语言训练的相应建议。     

儿童孤独症的临床及脑影像学研究

目的：对儿童孤独症的临床特征及脑影像学进行研究。方法：病例确诊依据“中国精神疾病分类方案与诊断标准（修订第二版）”中有关孤独症的诊断标准。临床资料收集来源于病史、躯体检查及精神状况检查。用单光子发射CT检查患儿的脑影像。结果：共确诊患儿86例（男75,女11）,占精神专科门诊人数的3％。他们在孕产期有明确并发症的占27％,4人有阳性家族史。言语发育和交往障碍是所有患儿的核心症状,多数有多动表现,部分患儿还伴有明显的情绪及其它行为障碍。做过头部CT或／和MRI检查的44人中,42例报告无异常。32例完成脑SPECT检查,其中24人（男23,女1）存在局部放射性分布减低,这种异常主要见于大脑皮质的额叶和颞叶,以左侧额叶最为常见。结论：SPECT在反映儿童孤独症的病理生理方面比结构性脑成像更为敏感。本病患儿大脑以质额叶和颞叶存在局部血流灌注或／和细胞功能障碍,以左侧额叶最明显。     

CCMD-3与DSM-Ⅳ儿童孤独症两种诊断标准的比较

目的：比较中国精神疾病分类方案与诊断标准第三版（CCMD-3）与美国精神障碍诊断和统计手册第四版（DSM-Ⅳ）儿童孤独症诊断的一致性，探讨CCMD-3儿童孤独症诊断中存在的问题，确定诊断标准中各症状条目的出现频率。方法：运用CCMD-3和DSM-Ⅳ儿童孤独症诊断标准对连续首次就诊的255名可疑发育障碍儿童进行诊断。结果：两种诊断系统儿童孤独症、不典型孤独症、非孤独症诊断的总体一致率为96．08％；诊断差异主要来自于儿童孤独症和不典型孤独症的诊断不一致；个别症状在孤独症儿童中出现频率较低。结论：CCMD-3和DSM-Ⅳ儿童孤独症诊断标准具有较好的诊断一致性；为进一步提高诊断一致性，对CCMD-3中个别症状条目予以调整有所必要。     

孤独症儿童的社会认知研究进展(综述)

孤独症是以社会和交流能力受损以及狭隘的兴趣和行为为特征的一种障碍性疾病.尽管患者的临床症状严重程度和智力情况千差万别,但所有患者在社会交互作用中均存在障碍.一些高功能孤独症或Asperger综合征人士在非社会领域（如物理、数学、天文学、音乐等）甚至有很强的能力，但在社会能力方面却远不如人。因此在探讨孤独症谱系障碍的共性认知机制时，研究者们提出了“社会认知缺陷”的观点，认为孤独症谱系障碍的这种缺陷存在于相对特定的脑神经网络。该领域的研究正成为当前发育行为儿科学和认知科学的重点研究内容。     

幼儿言语发育迟缓分析

目的:了解幼儿言语发育迟缓与听力情况.方法:对30例言语发育迟缓患儿,进行了解咨询其家属有关与患儿生活环境客观因素及既往病史,并行听觉脑干诱发电位(ABR)听阈测试.结果:30例ABR波V反应阈为25dBnHL,2例I～V波间期稍延长.通过进一步检查经儿科专科医生会诊,发现有孤独症行为和大脑发育不全18例,诊断不明确者12例.在孤独症和不明确诊断的患儿中存有一些自身与成长环境的客观因素.结论:如果听力正常,言语发育迟缓主要是患儿孤独症与智力低下所致.     

催产素在孤独症患者社交障碍中的作用及治疗潜能(综述)

孤独症是一种原因不明的广泛性神经发育障碍性疾病,至今尚无有效的治疗方法。作为孤独症的特征性症状之一,社交障碍严重影响患者的身心健康与生活质量。研究显示,催产素在社会交往中发挥重要作用,而催产素缺乏或利用不足可能与孤独症患者的社交障碍有关。本文总结了近年来关于催产素与孤独症社交障碍的研究进展,并提出催产素用于孤独症临床治疗的可能性,希望能够对孤独症的研究和治疗提供帮助。     

儿童支气管哮喘患者行为问题调查

小儿支气管哮喘的发病率在 0 .11%～ 2 .0 3%之间[1] ,其发生与发展与多种因素有关 ,按传统医学模式该病与遗传、感染、过敏体质和过敏原有关。在治疗过程中往往仅考虑到以上的生物学因素 ,而忽视其他相关因素 ,特别是与支气管哮喘的发生有密切关系的行为因素还没有引起人们足够的重视。为了了解支气管哮喘患儿的行为特征 ,对支气管哮喘患儿的行为特征进行了研究 ,希望找出行为与支气管哮喘相互关系中的规律 ,为临床工作提供一些参考。1　临床资料与研究方法研究对象是 1998年 2月至 2 0 0 1年 2月间在滨州医学院附属医院小儿内科住院或门诊…     

孤独症儿童社会交往障碍的个案研究

儿童孤独症是一组广泛性发育障碍,症状一般在1或2周岁时显现.其症状主要表现在语言发展障碍、社会交往障碍、认知障碍、感知觉障碍方面[1].虽然孤独症患儿在认知、社会情感和人际交往方面的发展有很大障碍,但他们在某些方一面,如记忆力、运动能力、音乐能力或空间概念上都显示出非凡的能力[2].大量的研究已经表明,孤独症儿童对音乐有不同寻常的兴趣,并显示出不同寻常的感受力和注意力,其中有些甚至是音乐天才,而音乐用于孤独症的治疗已经取得了显著的效果.舍温(Sherwin)在1953年就已经发现了孤独症儿童对音乐有明显的反应.比如在音调的记忆,古典音乐片断的认知,演奏乐器、歌唱、聆听音乐上都显示出强烈的兴趣与能力[3].     

儿童自闭症的分析和心理治疗

儿童自闭症又称儿童孤独症 ( Infantile autism) ,起病年龄在 30个月之前 ,以精神和心理发育的广泛性障碍为特征的一种疾病。美国儿童及成人孤独症学会顾问委员会认为孤独症儿童行为有以下 4个特征 :发育速度和顺序异常 ;对任何一种感觉刺激的反应异常 ;言语、语言认知及非言语性认知异常。与人、物和事的联系异常。自婴儿期起病 ,极度孤独 ,不能交往 ,对某些物体特殊依恋 ,预后欠佳[1 ] 。1　主要表现社会交往障碍。不能与他人 (包括父母 )建立正常的社会交往 ,社交缺陷是其核心症状。有的患儿早期就表现避免与他人目光接触 ,缺少面部表情…     

Comparing phenotypes in patients with idiopathic autism to patients with velocardiofacial syndrome (22q11 DS) with and without autism

At least three research groups have reported that autism is diagnosed in up to 20% of children with velocardiofacial syndrome (VCFS). However the degree of phenotypic overlap between VCFS-affected children with autism and those with idiopathic autism has not been established. The purpose of this study was to define and differentiate the behavioral phenotype of autism in samples of children with either (VCFS) or idiopathic autism. Five groups of children ages 5-15 were included in the between-group design. Parent report of autism behaviors (based on the Autism Diagnostic Interview-Revised, ADI-R) were compared between children with VCFS, children with VCFS and autism (VCFS + autism), siblings of the children with VCFS, a community control group, and a group of children with idiopathic autism. Autism diagnoses were based according to the ADI-R. Parental responses to the ADI-R indicated that relative to children with VCFS-only, children with idiopathic autism and children with VCFS + autism exhibited less make believe play and more rituals, motor stereotypies and repetitive use of objects. However several other core autism behaviors, including difficulties sharing attention, deficits in gestural communication and initiating conversation, and presence of circumscribed interests, appear to be phenotypic VCFS behaviors, characterizing children with VCFS regardless of an autism diagnosis. Accordingly, the autism phenotype in VCFS differs to some extent from that of idiopathic autism. Several features of idiopathic autism are spared in VCFS, and other features appear to be a function of the VCFS phenotype independent of autism. These findings carry implications for clinicians who diagnose and treat VCFS or autism, and for researchers who study genotype-phenotype associations in autism.     

The expression and understanding of jealousy in children with autism

We investigated the expression and understanding of jealousy in 16 high-functioning children with autism and 17 typically developing children matched for IQ, chronological age, gender, and maternal education. We examined the expression of jealousy via children's behaviors, verbalizations, and affects demonstrated during two jealousy-provoking triadic scenarios (drawing and playing) enacted among the child in the experimental group (autism or typical), that child's main caregiver (mostly mothers), and a familiar peer or sibling. The two scenarios corresponded with the two types of jealousy described in past studies: social-comparison jealousy (drawing scenario) and social-relational jealousy (playing scenario). To tap children's understanding, we asked them to identify jealousy from a picture, to provide examples of times they felt jealous, and to offer suggestions for coping with jealousy. The main results revealed that children with autism expressed jealousy in situations similar to their typical age mates but manifested it in different behaviors. Moreover, children with autism revealed a less coherent understanding of the feeling. We discuss the meaning of the gap between demonstrating and understanding jealousy in light of the two central theoretical views conceptualizing the core emotional deficit in children with autism.     

The use of actigraphy to study sleep disorders in preschoolers: some concerns about detection of nighttime awakenings

STUDY OBJECTIVES: This study compared actigraphy with videosomnography in preschool-aged children, with special emphasis on the accuracy of detection of nighttime awakenings. DESIGN: Fifty-eight participants wore an actigraph for 1 week and were videotaped for 2 nights while wearing the actigraph. SETTING: Participants were solitary sleepers, studied in their homes. PARTICIPANTS: One group (n = 22) was diagnosed with autism, another group (n = 11) had developmental delays without autism, and a third group (n = 25) were typically developing children; age ranged from 28 to 73 months (mean age 47 months); 29 boys and 29 girls. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Nocturnal sleep and wakefulness were scored from simultaneously recorded videosomnography and actigraphy. The accuracy of actigraphy was examined in an epoch-by-epoch comparison with videosomnography. Findings were 94% overall agreement, 97% sensitivity, and 24% specificity. Statistical corrections for overall agreement and specificity resulted in an 89% weighted-agreement and 27% adjusted specificity. CONCLUSIONS: Actigraphy has poor agreement for detecting nocturnal awakenings, compared with video observations, in preschool-aged children.     

Effects of selective neonatal temporal lobe lesions on socioemotional behavior in infant rhesus monkeys (Macaca mulatta).

Normal infant monkeys and infant monkeys with neonatal damage to either the medial temporal lobe or the inferior temporal visual area were assessed in dyadic social interactions at 2 and 6 months of age. Unlike the normal infant monkeys, which developed strong affiliative bonds and little or no behavioral disturbances, the lesioned monkeys (each of which was observed with an unoperated control) exhibited socioemotional abnormalities and aberrant behaviors. The socioemotional changes predominated at 6 months of age and were particularly severe in monkeys with medial temporal lesions. In both the pattern and time course, the socioemotional deficits produced by the neonatal medial temporal lesions bear a striking resemblance to the behavioral syndrome in children with autism. Further analysis of these lesion-induced abnormalities in nonhuman primates may therefore provide insight into this debilitating human developmental disorder.     

Language outcome in autism: randomized comparison of joint attention and play interventions

This study reports results of a randomized controlled trial aimed at joint attention (JA) and symbolic play (SP) in preschool children with autism, with prediction to language outcome 12 months later. Participants were 58 children (46 boys) with autism between 3 and 4 years of age. Children were randomized to a JA intervention, an SP intervention, or control group. Interventions were conducted 30 min daily for 5-6 weeks. Assessments of JA skills, SP skills, mother-child interactions, and language development were collected at 4 time points: pre- and postintervention and 6 and 12 months postintervention by independent testers. Results indicate that expressive language gains were greater for both treatment groups compared with the control group, and results could not be explained by differences in other interventions in which children participated. For children beginning treatment with the lowest language levels, the JA intervention improved language outcome significantly more than did the SP or control interventions. These findings suggest clinically significant benefits of actively treating JA and SP skills in young children with autism.     

Autism: A review for family physicians

Autism is a complex neurodevelopmental disorder characterized by qualitative impairments in social interaction and communication, with restricted, repetitive, stereotyped patterns of behavior, interests and activities. These behaviors manifest along a wide spectrum and commence before 36 months of age. Diagnosis of autism is made by ascertaining whether the child's specific behaviors meet the Diagnostic and Statistical Manual of Mental Disorders-IV-Revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Recent neuroimaging research studies indicate that autism may be caused by atypical functioning in the central nervous system, particularly in the limbic system: amygdala and hippocampus. In a third of autistic children, loss of language and/or social skills occurs during the second year of life, usually between 15 and 21 months of age. Comorbidity with mental retardation, epilepsy, disruptive behaviors and learning difficulty is not uncommon. Although there is currently no known cure for autism there is evidence to suggest that early intervention therapy can improve functioning of autistic children. Judicious use of psychotropic drugs is necessary to manage associated aggression, hyperactivity, self-mutilation, temper tantrums; but drugs are not a substitute for behavioral and educational interventions. The family physician can play an important role in detecting autism early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child's progress on a long term basis.     

儿童孤独症高危因素和早期特征的回顾性分析

目的 :探讨儿童孤独症在母孕期、围产期、婴幼儿期的高危因素及该症的早期表现。方法 :对符合DSM -IV孤独症诊断标准的儿童孤独症 4 9人和年龄、性别匹配的正常儿童 32人进行回顾性研究 ,以了解孤独症的高危因素及其早期表现。结果 :孤独症儿童较正常儿童的高危因素增多 ,孤独症早期表现明显 ,大多数孤独症儿童父母在两岁之前就觉得自己的孩子存在异常之处。结论 :对高危因素在孤独症的致病作用方面进行了讨论。提倡重视儿童孤独症的早期诊断     

小学儿童父母体罚的基本特点

目的:考察我国小学儿童遭受父母体罚的基本特点。方法:采用Straus编制的亲子冲突解决策略量表测查938名小学儿童的父母。结果:63.2%的小学儿童父母在近半年内对孩子实施过体罚,实施体罚的平均次数约为8次;我国父母使用最普遍的体罚方式依次是用手打孩子的屁股,打孩子的手、胳膊或腿,打孩子的脸、头或揪孩子的耳朵,体罚孩子最多的身体部位依次为屁股,手和胳膊;父母对男孩实施轻度体罚和严厉体罚的普遍性及实施严厉体罚的频繁性均显著均高于女孩;父母对一、二、三年级儿童实施轻度体罚和严厉体罚的普遍性显著高于对四、五、六年级儿童的体罚;低中社经地位家庭中的父母对儿童实施轻度体罚和严厉体罚的普遍性及实施严厉体罚的频繁性均显著高于高社经地位家庭的父母。结论:在我国,父母体罚的普遍性和频繁性均较高,且其发生情况与儿童的性别,年龄和家庭的社经地位有关。