孤独症谱系障碍儿童的行为管理

孤独症谱系障碍（ASD）是一类发生于儿童期的神经发育障碍性疾病,以社会交往和社会交流缺陷以及限制性重复性行为、兴趣和活动两大核心表现为特征。因此,ASD干预的一个重点即是通过进行有效的行为管理来改善行为紊乱问题。应用行为分析是一门科学,其在ASD儿童康复教育中的运用效果具有循证依据,在ASD儿童行为管理中,康复医师应牢牢掌握行为的基本原理理论,在理论指导下运用具有循证实践基础的策略和方法科学地开展工作。     

孤独症谱系障碍儿童的康复干预模式

该文介绍了孤独症谱系障碍的康复干预模式的分类,并依据循证依据(evidence-base practice,EBP)以及混合性研究方式(mixing methodologies)判断有效的基础上举例介绍我国目前使用的一些方法及其进展。     

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。     

Feeding difficulties in children with autism spectrum disorder: Aetiology,health impacts and psychotherapeutic interventions

Feeding difficulties are common and significant issues for children with autism spectrum disorder and their families. Key features of autism are intrinsically linked with factors contributing to these children's feeding difficulties. Following a multidisciplinary assessment to exclude non‐behavioural reasons for the feeding difficulty, there are two mainstay modalities of treatment: operant conditioning and systematic desensitisation. Currently, evidence points towards operant conditioning as the most efficacious psychotherapy. However, recent research into cognitive behavioural therapy for older children with feeding difficulties has shown promising results and will be an area to monitor in the coming years. This review outlines the causes and health impacts and evaluates current evidence supporting the available psychotherapeutic interventions for children with autism spectrum disorder experiencing feeding difficulties.     

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。     

Childhood autism spectrum disorder in the Barwon region: a community based study

OBJECTIVE: To establish a community database for children with autism spectrum disorder (ASD) to determine prevalence and identify subgroups based on key intellectual, clinical and family parameters. METHODS: Data were collected for children previously diagnosed with an ASD in the Barwon region using parental interview and review of the child's paediatric and psychological records. Preschool diagnoses were typically made by specialist psychologists and school-age diagnoses made by a multidisciplinary team. RESULTS: One hundred and seventy-seven children in the Barwon region were identified as having ASD (82% response rate). The prevalence of ASD was one per 255 children aged two to 17 years. The prevalence increased 10 fold over a 16-year period and this increase was relatively even across all levels of child intellectual functioning. Forty-two percent of children were intellectually disabled (IQ < 70) and performance IQ was significantly higher than verbal IQ but typical block design-comprehension subtest patterns were not common. Nine sibling pair families were identified, 24% were labelled as having attention deficit hyperactivity disorder (ADHD), 6% had epilepsy, and 18.3% were macrocephalic where data were available. Family difficulty was associated with the degree of obsessions/rituals, frequency and intensity of anger/aggression, and ADHD but overall was not associated with the child's intellectual status. CONCLUSIONS: The relatively rapid increase in prevalence is consistent with overseas studies and suggests significant changes in diagnostic criteria, increasing community awareness and the need for support at all levels of intellectual functioning. Increased occurrence in siblings and relatives gives further evidence for a genetic cause.     

孤独症谱系障碍儿童的情绪意识及欺凌预防

情绪障碍是孤独症谱系障碍（autism spectrum disorder,ASD）患者的主要临床症状之一,与缺乏情绪意识、社交认知和叙情障碍有关。表现为难以识别、辨别和处理自己和他人的情感信息、做出不恰当的情绪反应行为。ASD儿童和青少年常以施害者、受害者或施害-受害者的身份参与校园欺凌,并由此带来一系列身心不利后果。欺凌预防不仅应包括针对ASD核心症状、共患病的干预,更涉及建立伙伴的同理心和社交技巧、教师责任和支持性服务、父母参与、社交融合等多个方面。     

儿童孤独症谱系障碍与癫癎共患病的研究

目的探讨儿童孤独症谱系障碍(ASD)与癫癎的相关性。方法选取ASD患儿190例,采用自编问卷、儿童孤独症评定量表和孤独症行为量表对儿童ASD与癫癎相关问题进行调查。结果 190例ASD患儿中,20例(10.5%)曾有癫癎发作,12例(6.3%)被诊断为癫癎。有癫癎发作的ASD儿童1岁前出现体格发育问题及听力问题的比例较无癫癎发作的ASD儿童显著增高(P0.05);被诊断为癫癎的患儿及正接受癫癎治疗的患儿1岁前出现体格发育问题的比例显著增高(P0.05)。有癫癎发作的ASD儿童其感觉反应能力和行为能力较无癫癎发作的ASD儿童差(P0.05)。癫癎治疗对ASD儿童行为有正向影响(P0.05)。结论儿童ASD与癫癎患病有显著关联,可根据儿童1岁前生长发育状况、感觉反应能力和行为能力及有无癫癎发作评估二者共患的可能性。     

孤独症谱系障碍的多学科合作研究与干预

孤独症谱系障碍（autism spectrum disorder,ASD）是一组临床异质性高的神经发育障碍性疾病,常伴有共患病,其病因尚不明确,终身致残率高,可致儿童、青少年和成人在社交、认知和语言发展以及适应性功能等多个方面的障碍;在研究和干预中多学科（multidisciplinary）合作是新趋势,以从不同层面探究病因机制和临床转化;并提倡集合不同专业背景的人员对ASD患者及其家庭进行帮助,对临床诊断、教育、健康和社会关怀等方面的决策制定提供支持。     

Toxicity biomarkers in autism spectrum disorder: A blinded study of urinary porphyrins

Background: Recent studies suggest that children diagnosed with an autism spectrum disorder (ASD) have significantly increased levels of urinary porphyrins associated with mercury (Hg) toxicity, including pentacarboxyporphyrin (5cxP), precoproporphyrin (prcP), and coproporphyrin (cP), compared to typically developing controls. However, these initial studies were criticized because the controls were not age‐ and gender‐matched to the children diagnosed with an ASD. Methods: Urinary porphyrin biomarkers in a group of children (2–13 years of age) diagnosed with an ASD (n= 20) were compared to matched (age, gender, race, location, and year tested) group of typically developing controls (n= 20). Results: Participants diagnosed with an ASD had significantly increased levels of 5cxP, prcP, and cP in comparison to controls. No significant differences were found in non‐Hg associated urinary porphyrins (uroporphyrins, hexacarboxyporphyrin, and heptacarboxyporphyrin). There was a significantly increased odds ratio for an ASD diagnosis relative to controls among study participants with precoproporphyrin (odds ratio = 15.5, P < 0.01) and coproporphyrin (odds ratio = 15.5, P < 0.01) levels in the second through fourth quartiles in comparison to the first quartile. Conclusion: These results suggest that the levels of Hg‐toxicity‐associated porphyrins are higher in children with an ASD diagnosis than controls. Although the pattern seen (increased 5cxP, prcP, and cP) is characteristic of Hg toxicity, the influence of other factors, such as genetics and other metals cannot be completely ruled out.     

孤独症谱系障碍的共患病与药物治疗

孤独症谱系障碍(autism spectrum disorder, ASD是一组多因素导致的大脑发育障碍性疾病,目前尚无特效药物,以行为干预为主。ASD的共患病在ASD儿童中极为常见,共患病的存在对ASD的治疗和预后有着重要影响。近年来,ASD的病因研究及行为干预已成为国内外研究热点,但其共患病及药物干预的研究较少,为此,笔者就国内外相关文献加以概述,希望对临床ASD共患病及药物治疗研究有所帮助。     

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.     

孤独症谱系障碍相关风险基因与神经发育

<正>孤独症谱系障碍(autism spectrum disorder,ASD)是一种严重的神经系统发育性疾病,多发于儿童发育早期,大约影响全球1%的人群,男女患病率约4∶1,重度患者中男女比例约为1∶1。ASD伴复杂的临床症状,其核心症状有社会交往以及多元化社会互动的持续受损和狭窄、重复刻板的行为、兴趣或者活动等~([1])。除上述症状外,患者可能同时伴随有癫痫、睡眠障碍、抑郁、焦虑以及胃     

The co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder symptoms in parents of children with ASD or ASD with ADHD

Background: Autism spectrum disorder (ASD) and attention‐deficit/hyperactivity disorder (ADHD) share about 50–72% of their genetic factors, which is the most likely explanation for their frequent co‐occurrence within the same patient or family. An additional or alternative explanation for the co‐occurrence may be (cross‐)assortative mating, e.g., the tendency to choose a partner that is similar or dissimilar to oneself. Another issue is that of parent‐of‐origin effect which refers to the possibility of parents differing in the relative quantity of risk factors they transmit to the offspring. The current study sets out to examine (cross‐)assortative mating and (cross‐)parent‐of‐origin effects of ASD and ADHD in parents of children with either ASD or ASD with ADHD diagnosis. Methods: In total, 121 families were recruited in an ongoing autism‐ADHD family genetics project. Participating families consisted of parents and at least one child aged between 2 and 20 years, with either autistic disorder, Asperger disorder or PDD‐NOS, and one or more biological siblings. All children and parents were carefully screened for the presence of ASD and ADHD. Results: No correlations were found between maternal and paternal ASD and ADHD symptoms. Parental ASD and ADHD symptoms were predictive for similar symptoms in the offspring, but with maternal hyperactive‐impulsive symptoms, but not paternal symptoms, predicting similar symptoms in daughters. ASD pathology in the parents was not predictive for ADHD pathology in the offspring, but mother’s ADHD pathology was predictive for offspring ASD pathology even when corrected for maternal ASD pathology. Conclusions: Cross‐assortative mating for ASD and ADHD does not form an explanation for the frequent co‐occurrence of these disorders within families. Given that parental ADHD is predictive of offspring’ ASD but not vice versa, risk factors underlying ASD may overlap to a larger degree with risk factors underlying ADHD than vice versa. However, future research is needed to clarify this issue.     

�¶�֢��ϵ�ϰ���ͯ��̬�۶�ϵͳԤ��ģ�ͽ����о�

??Objective??To understand the characteristics of eye tracking in children with autism spectrum disorder??ASD???? to provide objective indicators for early diagnosis of ASD??and to establish a diagnostic predictive model which is suitable for clinical diagnosis. Methods??The subjects of the study were 38 children with ASD??22.03±4.97 months old?? and 35 children ??21.38±4.36 months old?? with developmental normal children??TD group??. Visual stimulation is a dynamic video of geometries and social figures??for 2 minutes with Eyelink1000 plus eye tack instrument. The ASD group and the TD group indexes were analyzed by ndependent-samples T-test and Chi-square Test??showed that the factors affecting the difference was statistically significant the regression analysis of the two Logistic classification??based on the children with ASD eye tacking prediction model and dynamic scene video scoring system. The receiver operating haracteristic curve??ROC curve?? and the area under the curve??AUC?? model is used to predict the accuracy of self display of children with ASD. Results??73 children were analyzed with single factor and Logistic regression analysis??we selected 4 significant predictive indexes of children with ASD????DGI??fixation time??and??DGI?? numbers of fixations??the percentage of fixation time on DGI times??and the numbers of fixations on DSI. Regression equation In??P/1-P????β0+β1X1+β3X3+β5X5+β6X6??13.03+1.01X1+0.25X3-98.72X5-0.55X6?? which β0??13.03 is a constant term??βi is regression coefficient. The self built model predicts AUC for children with ASD was 0.713. Conclusion??Self built model is of great value in predicting children with ASD.     

Service utilization in a sample of preschool children with autism spectrum disorder: A Canadian snapshot

OBJECTIVE:

To describe services received by preschool children diagnosed with autism spectrum disorder (ASD) during the five-year period following their diagnosis.

METHOD:

An inception cohort of preschoolers diagnosed with ASD from Halifax (Nova Scotia), Montreal (Quebec), Hamilton (Ontario), Edmonton (Alberta) and Vancouver (British Columbia) were invited to participate. Parents/caregivers (n=414) described the services provided to their children at four time points: baseline (T1; within four months of diagnosis; mean age three years); six months later (T2); 12 months later (T3); and at school entry (T4). Data were first coded into 11 service types and subsequently combined into four broader categories (no services, behavioural, developmental and general) for analysis.

RESULTS:

More than 80% of children at T1, and almost 95% at T4 received some type of service, with a significant number receiving >1 type of service at each assessment point. At T1, the most common service was developmental (eg, speech-language therapy). Subsequently, the most common services were a combination of behavioural and developmental (eg, intensive therapy based on applied behaviour analysis and speech-language therapy). Service provision varied across provinces and over time.

DISCUSSION:

Although most preschool children with ASD residing in urban centres were able to access specialized services shortly after diagnosis, marked variation in services across provinces remains a concern.