孤独症谱系障碍儿童语言和社交沟通障碍相关问题

社交沟通障碍及语言障碍是孤独症谱系障碍（ASD）儿童与其他儿童在互动上常见的障碍表现,而语言障碍常常也是评判ASD儿童严重程度的评判指标之一。该文从沟通障碍角度去分析、诠释ASD儿童在语言障碍及社交沟通障碍的相关表现,并介绍儿童综合行为疗法、关键反应治疗、自然情境教学法、语言表达训练、脚本法、以故事为基础的干预、社交技能训练在内的7种具有临床循证实践的语言干预方法,同时提供美国言语语言听力学会建议的干预方式。ASD儿童的语言早期干预具有重要意义,应推广以社区为基地、家庭积极参与的干预模式,积极开展家长培训,使ASD儿童能在语言关键期获得语言康复。     

叶酸和维生素B12与孤独症谱系障碍儿童症状和发育水平相关性研究

目的 探讨孤独症谱系障碍(ASD)儿童与正常儿童之间叶酸及维生素B12(VB12)水平的差异,并分析叶酸和VB12水平与ASD儿童症状及发育水平的相关性.方法 对2016-2017年海南省妇幼保健院康复中心的244例ASD儿童采用孤独症行为量表(ABC)、社交反应量表(SRS)评估ASD儿童的症状,采用Gesell发育...     

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。     

6~18岁智力障碍人群的孤独症谱系障碍样症状分析

目的 了解智力障碍（ID）人群的孤独症谱系障碍（ASD）样症状的发生情况。方法 选取2017年1~6月就读于上海市某特殊学校的6~18岁ASD人群和ID人群,以及同期在上海市某普通学校就读的同年龄段普通（TD）人群,由父母或其他监护人填写社交反应量表（SRS）,分别对其进行ASD样症状评估。结果 共纳入69例ASD、74例ID和177例TD研究对象。ID组SRS量表检查阳性率（47.3%）显著高于TD组（1.7%）（P < 0.001）,低于ASD组（87.0%）（P < 0.001）。ASD组、ID组和TD组SRS量表总分分别为114±26、80±24、38±19分,其中ID组SRS量表总分显著高于TD组得分（P < 0.05）,以社交认知维度差异最为显著（Cohen's d值为2.00）。轻-中度ID亚组和重-极重度ID亚组的SRS总分及各维度得分差异无统计学意义（P > 0.05）,且SRS得分与IQ之间无明显相关性（P > 0.05）。结论 6~18岁ID人群较普通人群存在更显著的ASD样症状,应对ID人群尽早进行ASD筛查并给予干预。     

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睡眠障碍影响因素研究进展

孤独症谱系障碍（ASD）是一组较为严重的神经发育障碍性疾病,睡眠障碍是其常见的共患病之一。近年来,国内外也越来越关注ASD儿童的睡眠障碍,缓解ASD患儿睡眠障碍不仅有助于改善临床症状,增加康复疗效,促进预后,同时也会减轻抚养者的压力,但其发病机制较为复杂且缺乏特异性生物指标,造成了诊断和治疗的不确定性。该综述通过对国内外有关ASD儿童睡眠障碍影响因素的研究成果进行系统整理并作一总结,为未来更好地预防和治疗ASD儿童睡眠障碍提供有益的参考。     

孤独症谱系障碍共患注意力缺陷多动障碍的研究进展

研究发现,很多孤独症谱系障碍(autism spectrum disorders,ASD)儿童伴有不同程度的注意力缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的症状.与单纯ASD儿童相比,共患病儿童的ASD症状更明显,认知功能也受损更严重,其生活也会受到影响.该文对目前共患ADHD的ASD儿童临床表现以及执行功能的相关研究做出综述.     

孤独症谱系障碍的免疫相关机制与治疗研究进展

孤独症谱系障碍(ASD)是以社交障碍和行为异常为特征的神经发育障碍性疾病。目前的诊疗手段主要基于行为学特征, 客观的诊断指标和疾病机制性治疗仍在研究中。越来越多的证据表明, 免疫、肠道菌群和神经系统异常相互联系, 共同参与ASD的发病过程。综述ASD的免疫相关机制、基因和表观遗传学改变以及免疫治疗进展, 可为ASD的早期诊断和治疗提供新思路。     

孤独症谱系障碍儿童血清微量元素水平与核心症状间关系的全国多中心调查

目的 探讨孤独症谱系障碍（autism spectrum disorder,ASD）儿童的血清微量元素水平与ASD核心症状之间的关系。方法 2018年9月至2019年9月在中国13个城市三级甲等医院门诊和特殊教育机构调查了1 020例ASD儿童和1 038例年龄、性别相匹配的健康儿童,采用孤独症行为量表、社交反应量表和孤独症评定量表评估ASD儿童的核心症状,采用电感耦合等离子体质谱法测定血清微量元素镁、铁、铜、锌的水平。结果 ASD儿童的血清镁、铜和锌水平显著低于健康儿童（均P < 0.05）。重度ASD儿童的血清镁和锌水平显著低于轻-中度ASD儿童（均P < 0.05）。偏相关分析结果显示,血清镁水平与孤独症行为量表总分、交往能力得分呈负相关（分别r=-0.318、0.282,均P < 0.001）;血清锌水平与孤独症行为量表总分、交往能力得分及躯体运动得分呈负相关（分别r=-0.221、-0.270、-0.207,均P < 0.001）。结论 血清镁和锌水平与ASD儿童核心症状具有一定关联,但这种关联的意义需要进一步研究;临床上应注意监测ASD儿童的微量元素营养状况。     

孤独症谱系障碍遗传检测意义及方法选择专家建议

孤独症谱系障碍（autism spectrum disorder,ASD）是一组高异质性的神经发育障碍性疾病,目前有关ASD的发病机制尚未阐明,但研究证实遗传物质即基因突变是ASD和ASD样症状的重要病因。遗传检测技术的不断发展,为认识ASD和ASD样症状的遗传背景奠定了良好的基础,该文就相关问题及建议进行叙述。     

A population‐based investigation of behavioural and emotional problems and maternal mental health: associations with autism spectrum disorder and intellectual disability

Background: While research indicates elevated behavioural and emotional problems in children with autism spectrum disorders (ASD) and decreased well‐being in their parents, studies do not typically separate out the contribution of ASD from that of associated intellectual disabilities (ID). We investigated child behavioural and emotional problems, and maternal mental health, among cases with and without ASD and ID in a large population‐representative sample. Methods: Cross‐sectional comparison of child behavioural and emotional problems and maternal mental health measures among 18,415 children (5 to 16 years old), of whom 47 had an ASD, 51 combined ASD with ID, 590 had only ID, and the remainder were the comparison group with no ASD or ID. Results: The prevalence of likely clinical levels of behavioural and emotional problems was highest among children with ASD (with and without ID). After controlling for age, gender, adversity, and maternal mental health, the presence of ASD and ID significantly and independently increased the odds for hyperactivity symptoms, conduct, and emotional problems. Emotional disorder was more prevalent in mothers of children with ASD (with or without ID). The presence of ASD, but not ID, significantly increased the odds for maternal emotional disorder. As has been found in previous research, positive maternal mental health was not affected by the presence of ASD or ID. Conclusions: ASD and ID are independent risk factors for behavioural and emotional problems. ASD (but not ID) is positively associated with maternal emotional disorder. Approaches to diagnosing hyperactivity and conduct problems in children with ASD may need to be reconsidered.     

Amélioration de la santé orale des enfants avec autisme : les outils à notre disposition

Autism spectrum disorder (ASD) is a life-long heterogeneous psychiatric disorder, characterized by impaired social interaction and communication, and the presence of repetitive and stereotyped behaviors as well as restricted interests. These features have an impact on the oral health of these individuals: high risk of dental caries, poorer periodontal status, and bruxism are often described. Children with ASD often provide limited collaboration with medical procedures, particularly those considered invasive such as dental care. Children with ASD are prone to agitation, self-injury, and emotional dysregulation; they can also present hypersensitivity to sensory input. These features make it difficult for professionals to examine and treat children with ASD; they interfere with dental care and constitute a barrier to it. Most of them are treated under general anesthesia or sedation. Therefore, children with ASD present a challenge for the dental community. Adapted and specific strategies are required to allow individuals with ASD to go beyond the barriers of dental care. Different tools and techniques of evidence-based practice can be considered: visual pedagogy, behavioral approaches, and numeric devices can be used. Pediatricians have a key role in the oral care of children with autism. The aim of this article is to present the oral health associated with ASD, to set out the possible ways to improve oral health, to enable the practitioner to detect problems, to raise awareness, and to help patients and their families in their care pathway.     

Empathy in children with autism and conduct disorder: group-specific profiles and developmental aspects

Background: A deficit in empathy is discussed to underlie difficulties in social interaction of children with autism spectrum disorder (ASD) and conduct disorder (CD). To date, no study has compared children with ASD and different subtypes of CD to describe disorder‐specific empathy profiles in clinical samples. Furthermore, little is known about age influences on the development of empathic skills. The aim of the current study was to compare cognitive and emotional empathy in different age groups of children with ASD, CD with elevated or low callous‐unemotional‐traits (CU+ vs. CU?) and a matched control group (CG). Methods: Fifty‐five boys with ASD, 36 boys with CD‐CU+, 34 boys with CD‐CU? and 67 controls were included. The study implemented three tasks on emotion recognition, perspective taking and emotional affection induced by another person’s situation. Multivariate Analysis of variance with the factors group and age (median split) including their interaction term was performed to describe disorder‐specific profiles. Results: Empathy profiles showed differential impairment in children with ASD and CD‐CU+. Boys with ASD were impaired in cognitive empathy while participants with CD‐CU+ were impaired in emotional empathy. Children with CD‐CU? did not differ from the CG. However, boys with CD‐CU? were less emotionally reactive in response to film stimuli than children with ASD. Furthermore, we found strong age effects indicating an increase in cognitive and affective empathic skills beyond early infancy in all groups. Conclusions: In this study, distinct empathic profiles in children with ASD and CD‐CU+ were found. Furthermore, the work demonstrates improvement of empathic skills throughout childhood and adolescence, which is comparable for individuals with psychiatric disorders and control children. These results yield implications for further research as well as for therapeutic interventions.     

Déficits précoces de l’empathie et psychopathologie

Empathy is a complex social-cognitive ability that is best understood by distinguishing its emotional, cognitive and motivational dimensions, which from early childhood interact between the child and her/his social environment. To date, among the many factors that are acknowledged to influence the development of empathy, children's temperament and parenting behaviors have been identified as interacting in predicting the extent to which children demonstrate empathic responses. Recent studies in developmental social neuroscience cast light on the neural networks engaged in the development of each of the dimensions that constitute empathy, which are needed to navigate social interaction and establishing positive social relationships. Indeed, early deficits in empathic processes can lead to difficulties in socialization, particularly associated with reduced attention to others’ emotions, especially when they are suffering, a lesser degree of remorse and guilt, and a greater tendency to ignore social norms or break the rules. Difficulties in socialization are particularly visible in two well-known developmental disorders: children with autism spectrum disorders (ASD) and children with conduct disorder and callous unemotional traits (CU). This paper provides a critical and selective review of recent empirical studies in psychopathology and developmental neuroscience by addressing the dimensions underlying empathy, specifically emotional sharing and caring for others. For children with ASD, some studies report that they pay less attention to another person in distress. However, functional neuroimaging studies conducted with ASD adolescents indicate that the emotional dimension appears to be preserved, but a lack of emotional self-regulation may impair them from experiencing empathic concern. Children with conduct disorder and CU traits clearly manifest a reduced autonomic nervous system response to others’ distress or suffering. This may account for their disregard or contempt for others’ well-being and social norms. Functional neuroimaging studies show that atypical patterns of brain activity at 15 months of age can predict later severe conduct disorder. Neural regions engaged in emotional processing such as the anterior cingulate cortex, insula and amygdala shown reduced activation to empathy-eliciting stimuli in children with CU. Finally, the genetic nature of CU traits is highlighted in several studies. We conclude by proposing several avenues for developmental research to identify biomarkers from an early age and by inviting to focus on psychological interventions with those populations accordingly.     

Le syndrome d’évitement pathologique des demandes : psychopathie autistique ? Syndrome d’Asperger ? Autisme atypique ? Ou trouble envahissant du développement (TED) spécifique ?

The aim of this paper is to inform French clinicians about “pathological demand avoidance” syndrome, also referred to as PDA, described by Elizabeth Newson (1929–2014), professor of developmental psychology at the University of Nottingham in the 1980s. E. Newson discerned a particular behavioral pattern in a subgroup of children who were referred to her for suspicion of autism or Asperger's syndrome without confirmed diagnostic assessment. These children have an inability to tolerate demands imposed upon them and try to resist with strategies of avoidance; being essentially socially manipulative is not compatible with the shared representation of autism. They give an impression of sociability, but they often lack a sense of social identity (e.g. believing themselves to be on a par with or superior to adults), pride or shame. They have mood swings led by need to control their relationship. They appear comfortable in role playing and pretending – often adopting borrowed roles when interacting with others (e.g. relating to peers in the manner of a teacher). In recent years, PDA has attracted increasing clinical attention mainly in the United Kingdom and Northern Europe, but little is known in France. Its validity as well as its place in the nosography are still being debated. E. Newson considered PDA to be a specific pervasive developmental disorder while other clinicians classified it in autism spectrum disorders (ASD). It remains true that PDA is a real clinical problem that imposes a therapeutic challenge: the need for these subjects to control the relationship makes it very difficult to treat. In this article, we illustrate the cardinal signs of this syndrome with a clinical case to facilitate its recognition. We discuss two differential diagnoses: oppositional defiant disorder and ASD. We found that the autistic psychopathy described by Hans Asperger resembles PDA. The interest of E. Newson's work is to highlight the affective and emotional presentation of the symptoms not described in DSM-5 which only emphasizes the deficits of social cognition (deficits in socio-emotional reciprocity, non-verbal communication, restricted interests etc.). Educational approaches effective for PDA differ from “typical” ASD and include novelty, humor and flexibility.     

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??Autism spectrum disorder??ASD?? is an innate neurobehavioral development disorder??which leads to the occurrence of major symptoms. Neuropsychological study of nearly half a century is part of the basis of abnormal development of ASD brain??which constructs some influencing theories??and also becomes a part of the basis of defining ASD and cognitive rehabilitation treatment at present. The research results are represented by abnormal the expression and emotion recognition??psychological theory defect??common attention or gaze abnormalities??inhibitory control defect??the social motivation defect??imaging findings??and mirror neuron abnormalities. The related research is still fragmented with some limitations??even contradictory??so it still needs time to reveal the cause of ASD.     

Factors influencing scores on the social responsiveness scale

Background: The Social Responsiveness Scale (SRS) is a parent‐completed screening questionnaire often used to measure autism spectrum disorders (ASD) severity. Although child characteristics are known to influence scores from other ASD‐symptom measures, as well as parent‐questionnaires more broadly, there has been limited consideration of how non‐ASD‐specific factors may affect interpretation of SRS scores. Previous studies have explored effects of behavior problems on SRS specificity, but have not addressed influences on the use of the SRS as a quantitative measure of ASD‐symptoms. Method: Raw scores (SRS‐Raw) from parent‐completed SRS were analyzed for 2,368 probands with ASD and 1,913 unaffected siblings. Regression analyses were used to assess associations between SRS scores and demographic, language, cognitive, and behavior measures. Results: For probands, higher SRS‐Raw were associated with greater non‐ASD behavior problems, higher age, and more impaired language and cognitive skills, as well as scores from other parent report measures of social development and ASD‐symptoms. For unaffected siblings, having more behavior problems predicted higher SRS‐Raw; male gender, younger age, and poorer adaptive social and expressive communication skills also showed small, but significant effects. Conclusions: When using the SRS as a quantitative phenotype measure, the influence of behavior problems, age, and expressive language or cognitive level on scores must be considered. If effects of non‐ASD‐specific factors are not addressed, SRS scores are more appropriately interpreted as indicating general levels of impairment, than as severity of ASD‐specific symptoms or social impairment. Additional research is needed to consider how these factors influence the SRS’ sensitivity and specificity in large, clinical samples including individuals with disorders other than ASD.