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。     

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.     

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。     

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。     

Repetitive and stereotyped movements in children with autism spectrum disorders late in the second year of life

Objectives:  The purpose of this study was to examine group differences and relationships with later developmental level and autism symptoms using a new clinical tool developed to measure repetitive and stereotyped movements (RSM) in young children.
Method:  Videotaped behavior samples using the Communication and Symbolic Behavior Scales Developmental Profile (CSBS; Wetherby & Prizant, 2002 ) were coded for children with autism spectrum disorders (ASD; n  =   50), developmental delays without ASD (DD; n  =   25), and typical development (TD; n  =   50) between 18 and 24 months of age.
Results:  Children with ASD demonstrated significantly higher rate and larger inventory of RSM with objects and body during a systematic behavior sample than both the DD and TD groups. Measures of RSM were related to concurrent measures of social communication and predicted developmental outcomes and autism symptoms in the fourth year for the ASD group. None of the correlations between RSM and autism symptoms remained significant when controlling for CSBS Symbolic level. RSM with objects predicted unique variance in the severity of autism symptoms in the fourth year beyond that predicted by social communication measures alone.
Conclusions:  This study provides support for the diagnostic significance of RSM in children under 24 months of age and documents the utility of this RSM measurement tool as a companion to the CSBS.     

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.     

Association of ADHD,tics, and anxiety with dopamine transporter (DAT1) genotype in autism spectrum disorder

Background: Autism spectrum disorder (ASD) is associated with high rates of psychiatric disturbance to include attention‐deficit/hyperactivity disorder (ADHD), tic disorder, and anxiety disorders. The aim of the present study was to examine the association between a variable number tandem repeat (VNTR) functional polymorphism located in the 3’‐untranslated region of the dopamine transporter gene (DAT1) and the severity of these symptoms as well as the association between the DAT1 DdeI polymorphism and severity of tics. Methods: Parents (n = 62) and teachers (n = 57) completed a DSM‐IV‐referenced rating scale for 67 children with ASD. Results: According to parent ratings, children with the 10‐10 repeat allele (versus a combined group of all other genotypes) exhibited less severe symptoms of hyperactivity and impulsivity as well as less severe language deficits. Teacher ratings indicated that social anxiety and tic symptoms were more severe for children with the 10‐10 genotype versus all others. Exploratory analyses provided preliminary support for the notion that heterozygosity (9–10 repeat genotype) may be a risk/protective factor. There were no associations of tic severity with the DAT1 DdeI polymorphism. Conclusion: Collectively, these results suggest that the extraordinary variability in ASD clinical phenotypes may be explained in part by the same genes that are implicated in a host of other psychiatric disorders in non‐ASD populations. Nevertheless, replication with independent samples is necessary to confirm this preliminary finding.