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。     

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。     

Are language and social communication intact in children with congenital visual impairment at school age?

Background: Development of children with congenital visual impairment (VI) has been associated with vulnerable socio‐communicative outcomes often bearing striking similarities to those of sighted children with autism. 1 To date, very little is known about language and social communication in children with VI of normal intelligence. Methods: We examined the presentation of language and social communication of 15 children with VI and normal‐range verbal intelligence, age 6–12 years, using a standardised language assessment and parental reports of everyday social and communicative behaviours. Their profiles were compared to those of typically developing sighted children of similar age and verbal ability. Results: Compared to their sighted peers, and relative to their own good and potentially superior structural language skills, children with VI showed significantly poorer use of language for social purposes. Pragmatic language weaknesses were a part of a broader socio‐communicative profile of difficulties, present in a substantial proportion of these children and consistent with the pattern found in sighted children with autism. Conclusions: There are ongoing socio‐communicative and pragmatic language difficulties in children with congenital VI at school age, despite their good intellectual abilities and advanced linguistic skills. Further research is required to unpack the underlying causes and factors maintaining this vulnerability in such children.     

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.     

Social communication deficits in conduct disorder: a clinical and community survey

BACKGROUND: Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour. Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered. METHODS: Using the Children's Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1. RESULTS: On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits. CONCLUSIONS: These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.     

Similar developmental trajectories in autism and Asperger syndrome: from early childhood to adolescence

Objective:  The objective of this study was to chart the developmental trajectories of high-functioning children with autism spectrum disorders (ASD) from early childhood to adolescence using the presence and absence of structural language impairment (StrLI) as a way of differentiating autism from Asperger syndrome (AS).
Method:  Sixty-four high-functioning children with ASD were ascertained at 4–6 years of age from several different regional diagnostic and treatment centers. At 6–8 years of age, the ADI-R and the Test of Oral Language Development were used to define an autism group (those with StrLI at 6–8 years of age) and an AS group (those without StrLI). Growth curve analysis was then used to chart the developmental trajectories of these children on measures of autistic symptoms, and adaptive skills in communication, daily living and socialization.
Results:  Differentiating the ASD group in terms of the presence/absence of StrLI provided a better explanation of the variation in growth curves than not differentiating high-functioning ASD children. The two groups had similar developmental trajectories but the group without StrLI (the AS group) was functioning better and had fewer autistic symptoms than the group with StrLI (the autism group) on all measures across time. The differences in outcome could not be explained by non-verbal IQ or change in early language skills.
Conclusion:  Distinguishing between autism and Asperger syndrome based on the presence or absence of StrLI appears to be a clinically useful way of classifying ASD sub-types.     

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正1发育诊断与病因诊断发育行为儿科最常见的慢性疾病是发育和行为障碍,而发育行为儿科医生是最能证实儿童发育和行为障碍,同时又能将这些儿童于最早期转诊至适当教育和治疗机构的专业人员。发育行为儿科在临床诊断上通常有2个层面:一个是描述性发育行为诊断层面,如脑瘫、智力受限、注意缺陷多动障碍(ADHD)、孤独症等;另一是寻找适当的实验室检查层面,如染色体分析、遗传代谢检查、头颅影像     

孤独症谱系障碍儿童共患睡眠障碍治疗进展

睡眠障碍是孤独症谱系障碍（ASD）患儿最常见的共患疾病之一;不仅会对患儿的日间功能产生损害;并且也会加重患儿ASD的相关症状;显著降低ASD儿童及其家庭的生活质量。因此;临床上对共患睡眠障碍的ASD患儿进行及时有效的干预和管理对提高患儿的健康水平、社会功能及生活质量具有重要意义。本文就孤独症谱系障碍儿童共患睡眠障碍的治疗进展作一综述;旨在提高临床工作者对其的认识。