孤独症谱系障碍临床特征分析

目的:探讨孤独症谱系障碍的临床特点,为诊断提供参考性建议。方法:分别对75例孤独症谱系障碍患儿及77例精神发育迟滞患儿进行Gesell发育诊断量表(GDDS)和儿童孤独症评定量表(CARS)的评估并进行比较;并将孤独症谱系障碍组按月龄分为0-36月组和37-72月组;对75例孤独症谱系障碍进行婴儿-初中学生社会生活能力量表(S-M量表)评定并与GDDS中的适应性得分进行比较。结果:①孤独症谱系障碍组和精神发育迟滞组患儿在GDDS中的得分没有明显差异,两组患儿语言均中度落后,其他条目均轻度落后;②在CARS的得分中孤独症谱系障碍组明显高于精神发育迟滞组;③孤独症谱系障碍0-36月组在视觉反应得分中高于37-72月组;而37-72月组在语言沟通、智力反应水平及一致性中得分高于0-36月组;④通过秩和检验,S-M量表得分与GDDS中适应性得分比较有显著差异。结论:孤独症谱系障碍患儿发育水平明显落后于同龄儿童,其中语言落后明显;孤独症谱系障碍患儿在言语沟通、社会互动等方面存在明显异常;孤独症谱系障碍患儿在智力反应水平及一致性方面存在不均衡性。     

儿童孤独症的临床与神经电生理检测的研究

目的:探讨BAEP、EEG检测在孤独症患儿中的作用。方法:对2001～2007年经临床确诊为儿童孤独症并作BAEP及EEG检查的30例资料进行分析。结果:本组30例孤独症患儿中,BAEP正常11例(37%),异常19例(63%),其异常表现为Ⅲ波的PL、Ⅰ-Ⅲ波和Ⅲ-Ⅴ波的IPL延长。EEG正常23例(77%),异常7例(23%)。BAEP与EEG两者的异常率比较,经χ2检验,P<0.05。结论:研究发现虽然BAEP异常率和EEG的异常率有差异(前者明显高于后者),但可以说有部分孤独症患儿存在BAEP、EEG异常是无可置疑的,孤独症患儿BAEP的异常可能与孤独症本身的特性有关。     

异常行为量表中文版在儿童孤独症群体中的信效度

目的:引进并探讨异常行为量表(Aberrant Behavior Checklist,ABC)在我国儿童孤独症群体的适用性。方法:对206例孤独症儿童(1.5~14.0岁)进行ABC评定,其中49例患儿由父母分别填写ABC,30例患儿于2~4周后由同一位家长再次评定,以检验评定者信度和重测信度;根据适用年龄范围对部分患儿评定儿童孤独症评定量表、孤独症行为评定量表、Conner父母评定量表及Achenbach儿童行为量表,经比较检验ABC的校标效度;对ABC结构模型进行验证性因素分析以检验结构效度。结果:ABC中文版各因子的评定者信度(ICC)在0.820~0.898之间(P<0.001),重测信度(ICC)0.873~0.944(P<0.001),各因子及总量表的内部一致性系数为0.748~0.951;ABC中文版各因子与儿童孤独症评定量表、孤独症行为评定量表、Conner父母评定量表及Achenbach儿童行为量表的相应因子间呈正相关(r=0.27~0.67,均P<0.01);验证性因素分析检验了结构的有效性(χ2/df=1.91,RMSEA=0.060,GFI=0.704,NFI=0.62,CFI=0.77)。结论:异常行为量表中文版的信、效度较好,适用于儿童孤独症的量化评估,但仍需进一步修订完善。     

孤独症患儿脑干听觉诱发电位研究

目的 :探讨孤独症患儿脑干听觉诱发电位 (BAEP)的表现。方法 :将研究对象分 3组 :(I)孤独症组 (AD ;2 2例 ) ;(II)单纯智力低下组 (MR ,2 0例 ) ;(III)正常对照组 (NG ,30例 )。智商测验采用 0 - 4岁小儿神经心理发育量表及韦氏智力量表 ;研究对象给予脑干听觉诱发电位测试。结果 :(1 )ADBAEP之III、V波潜伏期及I-III,I-V波峰间期 (IPL)较NG延长 (P <0 0 0 1 )。(2 )ADBAEP之III波潜伏期及I-III波IPL较MR组延长 (P <0 0 0 5)。 (3) :MRV波潜伏期及III-V、I-V波IPL较NG延长 (P <0 0 0 1 )。结论 :(1 )孤独症患儿的脑干听觉诱发电位异常 ,尤其是脑干传导时间 (BTT)的延长 ,提示脑干机能障碍导致信息向大脑传递通路的损害可能是造成孤独症患儿在认知、社会及语言能力等方面异常发育的原因之一。 (2 )孤独症患儿BAEP异常原因可能与孤独症本病特性有关而非伴随智力低下所致。     

体感游戏康复治疗对孤独症儿童社交障碍、日常生活能力及情绪行为的影响

目的:分析体感游戏康复治疗对孤独症儿童社交障碍、日常生活能力及情绪行为的影响。方法:选取2014年9月至2017年1月期间在我院儿科接受规律性康复治疗与训练的孤独症儿童70例,按随机数表法分为实验组(n=35)和对照组(n=35),对照组患儿接受传统综合治疗,包括药物治疗及常规康复训练;实验组患儿在对照组基础上进行体感游戏康复治疗。治疗前后采用能力低下儿童评定量表(PEDI)、儿童孤独症症状评定量表(CARS)及儿童孤独症行为量表(ABC)评估日常生活能力、社交障碍及情绪行为等改善效果。结果:两组治疗前PEDI评分、CARS评分、ABC评分比较均无统计学意义,治疗后3项评分均显著改善,且实验组治疗后PEDI评分显著高于对照组,CARS评分、ABC评分显著低于对照组(t=2.40,-3.72,-3.90;P0.05)。结论:体感游戏康复治疗对孤独症儿童社交障碍、日常生活能力及异常情绪行为改善效果显著。     

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…     

儿童孤独症患儿脑电图特征分析

目的：通过观察和分析儿童孤独症患儿脑电图（EEG）改变,探讨脑电图检查对儿童孤独症的诊断意义。方法：对115例儿童孤独症患儿的脑电图检查结果进行分析。结果：115例患儿,异常脑电图52例,异常率45．2％。轻度异常23例,表现为基本节律减慢,慢波多于同龄;中度和重度异常29例,其中局限行异常14例,出现痫样放电10例,局限性异常＋痫样放电5例。结论：EEG客观反映了儿童孤独症患儿的脑功能情况,对儿童孤独症有诊断价值     

听觉统合训练对孤独症谱系障碍患者的临床疗效

目的:研究听觉统合训练(auditory integration training,AIT)对孤独症谱系障碍(autism spectrum disorder,ASD)的临床疗效。方法:选择44例2.5～6.0岁的ASD患儿做为研究对象,分为听统组21例和对照组23例,听统组应用AIT加综合干预方法,对照组仅用综合干预方法。采用孤独症行为量表(Autism behavior checklist,ABC)、儿童孤独症评定量表(Childhood Autism Rating Scale,CARS)及相关发育障碍心理教育评定量表中文修订版(China Psycho Educational Profile,C-PEP)评定临床疗效。结果:治疗4周时两组患儿的ABC量表和CARS量表得分均下降,但差异无统计学意义(P0.05)。治疗12周时,与对照组相比,听统组的ABC量表总得分显著下降(t=-2.044,P0.05),尤其是感觉因子和生活自理能力因子得分显著下降,差异有统计学意义(t=-2.056,-2.075,P0.05);听统组的CARS量表总得分也下降显著,差异有统计学意义(t=-2.066,P0.05)。研究结束时,AIT组的C-PEP测评升高,月当量较对照组的显著升高,差异有统计学意义(t=2.300,P0.05)。结论:AIT对ASD患儿治疗有效,可以改善患儿的感觉异常,提高患儿的生活自理能力。因此,AIT是一项干预ASD患儿的有效措施。     

学龄期孤独症儿童社交技能训练的疗效

目的:探讨社交技能训练对学龄期孤独症儿童社会交往障碍的改善作用,为建立我国学龄期孤独症儿童的社交技能训练模式奠定基础。方法:共入组49例6~16岁符合美国精神障碍诊断与统计手册第4版(DSM-IV)孤独症诊断标准的儿童,其中训练组30例,对照组19例,两组年龄、性别、智商相匹配。对训练组患儿进行为期14周的社交技能训练,每周训练1次,每次90 min,家长接受同期团体训练以了解患儿训练的内容。在训练开始前和训练14周结束时,分别对训练组和对照组患儿用异常行为量表评估患儿孤独症症状的变化程度。结果:训练组训练14周后,异常行为量表总分[(53.1±27.6)vs.(37.0±23.4)]和社会退缩[(14.6±8.7)vs.(10.0±6.6)]、不恰当言语[(3.8±2.7)vs.(2.8±2.7)]、情绪不稳[(12.3±8.9)vs.(7.5±6.3)]、刻板行为[(4.9±3.7)vs.(3.8±3.0)]、多动[(17.4±9.4)vs.(12.8±8.2)]等5个因子分均较训练前下降(Ps0.05)。训练前两组间异常行为量表总分及各因子分差异无统计学意义(Ps0.05),训练14周后训练组异常行为量表总分[(16.1±14.3)vs.(1.1±15.5)]和社会退缩[(4.6±6.2)vs.(-0.9±5.1)]、情绪不稳[(4.8±5.3)vs.(-0.7±4.3)]、多动[(4.6±5.5)vs.(0.8±6.0)]等3个因子的基线-终点减分均明显多于对照组(Ps0.05)。结论:社交技能训练能够有效改善孤独症儿童的社会交往障碍,并能够有效改善孤独症儿童的情绪不稳和多动症状。对不恰当语言和刻板行为的疗效有待于进一步研究探讨。     

听觉统合训练改善孤独症儿童情绪行为的疗效

目的 探讨听觉统合训练改善孤独症儿童情绪行为的临床效果,为进一步探讨孤独症儿童的治疗途径提供临床依据。方法 选取我院2016年5月~2018年10月有情绪行为的120例孤独症儿童为研究对象,随机分为对照组和治疗组,各60例。对照组进行常规的康复训练,治疗组在常规康复训练的基础上配合听觉统合训练。采用孤独症谱系及相关发育障碍儿童评估用心理教育量表（C-PEP3）和中残联编制的《孤独症儿童发展评估量表》评估两组患儿情绪行为改善情况。结果 治疗前两组评分比较,差异无统计学意义（P＞0.05）;治疗后,两组C-PEP3评分均降低,且治疗组C-PEP3评分低于对照组,差异有统计学意义（P＜0.05）;治疗组患儿总有效率高于对照组,差异有统计学意义（P＜0.05）。结论 常规康复训练配合听觉统合训练可有效改善孤独症儿童情绪行为,提高临床疗效,矫正患儿听觉系统,从而有效改善患儿的情绪失调以及行为紊乱问题。     

轻型孤独症患儿行为特征的探讨

儿童孤独症是以社交障碍、语言障碍和重复刻板行为为特征的广泛性发育障碍 ,近年来发病率呈上升的趋势 ,其中轻型患儿占有相当的比例[1] 。因病因尚不清楚 ,因此尚无特异性的诊断手段 ,主要依靠临床症状和表现。而轻型孤独症患儿由于症状较轻或不典型 ,因此增加了临床诊断的困难 ,易被漏诊或误诊而使患儿失去获得早期干预的机会。目前国内有关孤独症的研究主要限于典型孤独症患儿 ,而有关轻型患儿的研究尚未见报道。我们对轻型孤独症患儿的临床表现及行为特征进行了探讨 ,旨在为轻型孤独症患儿的正确诊断提供依据。1　对象和方法1.1　研究对…     

Sensory gating in young children with autism: relation to age, IQ, and EEG gamma oscillations

Unusual reactions to auditory stimuli are often observed in autism and may relate to ineffective inhibitory modulation of sensory input (sensory gating). A previous study of P50 sensory gating did not reveal abnormalities in high-functioning school age children [C. Kemner, B. Oranje, M.N. Verbaten, H. van Engeland, Normal P50 gating in children with autism, J. Clin. Psychiatry 63 (2002) 214-217]. Sensory gating deficit may, however, characterize younger children with autism or be a feature of retarded children with autism, reflecting imbalance of neuronal excitation/inhibition in these cohorts. We applied a paired clicks paradigm to study P50 sensory gating, and its relation to IQ and EEG gamma spectral power (as a putative marker of cortical excitability), in young (3-8 years) children with autism (N=21) and age-matched typically developing children (N=21). P50 suppression in response to the second click was normal in high-functioning children with autism, but significantly (p<0.03) reduced in those with mental retardation. P50 gating improved with age in both typically developing children and those with autism. Higher ongoing EEG gamma power corresponded to lower P50 suppression in autism (p<0.02), but not in control group. The data suggest that ineffective inhibitory control of sensory processing is characteristic for retarded children with autism and may reflect excitation/inhibition imbalance in this clinical group.     

整合视听连续执行测试与儿童感觉统合能力的相关性分析

目的：通过整合视听连续执行测试和儿童感觉统合能力评定，探讨二者之间的相关性及各亚型ADHD儿童的感觉统合能力的差异。方法：根据整合视听连续执行测试结果将170名儿童分成4组，对各组儿童进行感觉统合能力评定。结果：注意缺陷为主型儿童的视觉反应控制商数与本体感及身体协调因子分呈负相关；多动-冲动为主型儿童的综合尺度反应控制商数、视觉反应控制商数、综合尺度注意力商数、听觉注意力商数与学习能力发展因子分呈正相关；混合型儿童的综合尺度注意力商数、视觉注意力商数与学习能力发展因子分呈正相关；注意缺陷为主型和混合型儿童的大肌肉及平衡感、学习能力发展因子分低于临界值；多动-冲动为主型儿童的学习能力发展因子分低于临界值．触觉防御及情绪因子分高于临界值；其他各项因子分接近临界值。结论：根据整合视听连续执行测试结果诊断的ADHD各亚型的综合商数与感觉统合能力发展评定量表因子分的相关性是不同的；各亚型ADHD儿童的感觉统合能力均较低，且都存在着学习能力发展不足问题；注意缺陷为主型和混合型儿童的大肌肉及平衡感失调比多动-冲动为主型儿童更明显。     

Auditory and Visual Processing in Children With Dyslexia

This study investigated the temporal stability and longitudinal replicability of visual and auditory sensory processes found to be poor in children with dyslexia. Seventy children with dyslexia and 52 normal readers were tested twice, 9 months apart, on measures of visual and auditory sensory processing and on phonological and orthographic skills. About 30% of children with dyslexia were found to have sensory deficits. Associations were found between sensory and cognitive skills. Based on analyses of agreement, the temporal stability of the sensory tasks was poor. Future research should develop sensory measures with high temporal stability that can control for maturation.     

Electrophysiological response during auditory gap detection: Biomarker for sensory and communication alterations in autism spectrum disorder?

ABSTRACT

Sensory symptoms, including auditory processing deficits, are common in autism spectrum disorder (ASD). Processing of temporal aspects of auditory input is understudied; yet, deficits in this domain could contribute to language-related impairments. In children with ASD and well-matched controls, this study examined electrophysiological response to silent gaps in auditory stimuli. Results revealed attenuated amplitude of the P2 event-related potential (ERP) component in ASD. The P2 amplitude reduction was also associated with sensory, language, and diagnostic features. These results suggest that neural response during auditory gap detection is a promising ASD biomarker that could be useful for stratifying subgroups and evaluating treatment response.     

Links between multisensory processing and autism

Autism spectrum disorder is typically associated with social deficits and is often specifically linked to difficulty with processing faces and other socially relevant stimuli. Emerging research has suggested that children with autism might also have deficits in basic perceptual abilities including multisensory processing (e.g., simultaneously processing visual and auditory inputs). The current study examined the relationship between multisensory temporal processing (assessed via a simultaneity judgment task wherein participants were to report whether a visual stimulus and an auditory stimulus occurred at the same time or at different times) and self-reported symptoms of autism (assessed via the Autism Spectrum Quotient questionnaire). Data from over 100 healthy adults revealed a relationship between these two factors as multisensory timing perception correlated with symptoms of autism. Specifically, a stronger bias to perceive auditory stimuli occurring before visual stimuli as simultaneous was associated with greater levels of autistic symptoms. Additional data and analyses confirm that this relationship is specific to multisensory processing and symptoms of autism. These results provide insight into the nature of multisensory processing while also revealing a continuum over which perceptual abilities correlate with symptoms of autism and that this continuum is not just specific to clinical populations but is present within the general population.     

自闭症儿童的家庭治疗

目的采用家庭治疗促进自闭症儿童心理康复。方法遵循随机抽样的原则,在正在接受结构化教育、感觉综合训练、听觉统合训练的自闭症儿童中,随机选择1/2比例（5名）儿童同时进行家庭治疗。结果与对照组相比,实验组的感觉能力（t=3.769,P=0.003）、交往能力（t=2.567,P=0.039）、躯体运动能力（t=2.687,P=0.035）、总分（t=2.719,P=0.033）的得分显著改善,其他项目也存在着下降的趋势。结论家庭治疗可以促进自闭症儿童心理康复,提升患儿的感觉能力、人际交往能力、躯体运动能力。     

Sensorimotor integration in the primate superior colliculus. I. Motor convergence

Orienting movements of the eyes and head are made to both auditory and visual stimuli even though in the primary sensory pathways the locations of auditory and visual stimuli are encoded in different coordinates. This study was designed to differentiate between two possible mechanisms for sensory-to-motor transformation. Auditory and visual signals could be translated into common coordinates in order to share a single motor pathway or they could maintain anatomically separate sensory and motor routes for the initiation and guidance of orienting eye movements. The primary purpose of the study was to determine whether neurons in the superior colliculus (SC) that discharge before saccades to visual targets also discharge before saccades directed toward auditory targets. If they do, this would indicate that auditory and visual signals, originally encoded in different coordinates, have been converted into a single coordinate system and are sharing a motor circuit. Trained monkeys made saccadic eye movements to auditory or visual targets while the activity of visual-motor (V-M) cells and saccade-related burst (SRB) cells was monitored. The pattern of spike activity observed during trials in which saccades were made to visual targets was compared with that observed when comparable saccades were made to auditory targets. For most (57 of 59) V-M cells, sensory responses were observed only on visual trials. Auditory stimuli originating from the same region of space did not activate these cells. Yet, of the 72 V-M and SRB cells studied, 79% showed motor bursts prior to saccades to either auditory or visual targets. This finding indicates that visual and auditory signals, originally encoded in retinal and head-centered coordinates, respectively, have undergone a transformation that allows them to share a common efferent pathway for the generation of saccadic eye movements. Saccades to auditory targets usually have lower velocities than saccades of the same amplitude and direction made to acquire visual targets. Since fewer collicular cells are active prior to saccades to auditory targets, one determinant of saccadic velocity may be the number of collicular neurons discharging before a particular saccade.     

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.     

Consensus recommendations on altered sensory functioning in Phelan-McDermid syndrome

Altered sensory functioning is often observed in individuals with SHANK3 related Phelan-McDermid syndrome (PMS). Compared to typically developing individuals and individuals with an autism spectrum disorder, it has been suggested that there are distinctive features of sensory functioning in PMS. More hyporeactivity symptoms and less hyperreactivity and sensory seeking behaviour are seen, particularly in the auditory domain. Hypersensitivity to touch, possible overheating or turning red easily and reduced pain response are often seen.In this paper the current literature on sensory functioning in PMS is reviewed and recommendations for caregivers, based on consensus within the European PMS consortium, are given.