作者： Michael E. Msall，MD 芝加哥大学Comer儿童医院发育行为儿科主任 肯尼迪研究中心发育行为儿科教授 翻译： 王师尧医师 中儿儿科培训策划, 中儿责任编辑, 新加坡儿科急诊科 石应珊医师 中儿创始人及培训总策划, 芝加哥大学Comer儿童医院普儿科 谬见 自闭症是一种精神疾病。 事实 自闭症是一种神经发育障碍，会影响对语言的理解和使用、复杂的行为调节和社交技能。 谬见 自闭症是由分娩和分娩过程中的问题引起的。 事实 分娩期间的并发症在科学上与自闭症不相关。人们越来越认识到早产和小于胎龄儿的患自闭症的风险会增加。与自闭症相关的主要已知病因包括 苯丙酮尿症、结节性硬化症、先天性风疹、脆性 X 综合症和严重早产儿视网膜病变。 谬见 自闭症儿童无法学习。 事实 所有自闭症儿童都能学习。他们在运动技能、精细运动操作技能、非语言智力和基本适应技能方面具有能力。自闭症儿童具有一定的交流、认知和复杂适应能力。 谬见 社交媒体上应该已流传开, 自闭症是由不良的养育方式, 任何健康问题, 产前暴露或母亲无法控制的状况引起。 事实 自闭症是一种神经生物学疾病，其中整合语言、复杂学习和社会交流的大脑系统受损。了解大脑的联系是一个正在积极探索的科学领域。 谬见 实验性替代医学治疗包括避免使用疫苗、特殊饮食、大量的维生素和自然疗法，可以治愈自闭症。 事实 自闭症不是由疫苗、食物过敏或乳糜泻引起的。自闭症的最佳治疗方法是建立在儿童优势上的特别教育计划, 提供家庭支持，并全面解决交流、社交和行为方面的挑战。所有孩子都受益于个体关注、户外活动、音乐和露营。所有成年人都受益于私人培训、度假和有人倾听。 谬见 儿科药物对自闭症儿童没有任何作用。 事实 所有儿童都需要一个评估健康和发育的医疗之家，该医疗之家会与亚专科的专家合作，监测可能干扰发育的感官、神经和医学状况。最佳实践是设定全面且可实现的目标，并倡导增进功能和参与度的优质的综合支持。 Myth Autism is a mental illness. Reality Autism is a neurodevelopmental disorder that affects understanding and use of language, complex behavioral regulation, and social skills. Myth Autism is caused by problems during labor and delivery. Reality Complications during labor and delivery have not been scientifically linked to autism. There is increased recognition that preterm birth and small for gestational age status increase the risks for autism. Major known etiologies associated with autism include PKU, tuberous sclerosis, congenital rubella, fragile X, and severe ROP. Myth Children with autism can not learn. Reality All children with autism learn. They have strengths in motor skills, fine motor manipulative skills, non-verbal intelligence, and basic adaptive skills. There is a range of communicative, cognitive, and complex adaptive abilities in children with autism. Myth Autism is caused by poor parenting and any health event, prenatal exposure or things beyond maternal control should be widely disseminated in social media . Reality Autism is a neurobiological disorder whereby brain systems integrating language, complex learning, and social communication are impaired. Understanding brain connectivity is an area of vigorous scientific exploration. Myth Experimental alternative medical treatments involving avoidance of vaccines, specialized diets, megavitamins, and natural therapies can cure autism. Reality Autism is not caused by vaccines, food allergies or celiac disease. The best treatments for autism are special educational programs that build on a child’s strengths, provide family supports, and comprehensively address communicative, social, and behavior challenges. All children benefit from individual attention, playing outdoors, music, and going to camp. All adults benefit from personal trainers, going on vacation, and having someone who listens. Myth There is no role for pediatric medicine for children with autism. Reality All children require a medical home that assesses health and development that collaborates with medical subspecialists to monitor sensory, neurological, and medical conditions that can interfere with development. Best practices are to set goals that are holistic and attainable, and advocate for quality comprehensive supports that promote functioning and participation 【参考文献及资料】 Autism Speaks www.autismspeaks.org; AssocScienceinAutismTreatment:www.asatonline.org. Levy SE, Hyman SL. Novel Treatments for Autistic Spectrum Disorders. MRDD Research Rev 2005; 11:131-142. Levy SE, Mandell DS, Schultz RT. Autism, Lancet.2009;374(9701):1627-38. Gray L, Msall E, Msall M. Communicating about autism: Decreasing fears and stresses thru parent-professional partnerships. Infants & Young Children. 21(4):256-271, 2008. Msall ME. Establishing a Translational Science for Autistic Spectrum Disorders for Children and Their Families: Optimizing Function, Participation, and Well-Being. J Pediatrics 2009;(154)3:319-321. Siegel B. Helping Children with Autism Learn: Treatment approaches for parents and professionals. NY: Oxford2003. Rosenblatt AI, Carbone PS. Autism Spectrum Disorders.IL: American Academy of Pediatrics, 2013. Szatmari PA. Mind Apart: Understanding Children with Autism & Asperger Syndrome. NY: Guilford, 2004. Lord C McGee JP. Educating Children with Autism. Washington DC Nat. Academy Press 2001 www.nap.edu. 10. Vismara LA, Rogers SJ. Behavioral treatments in ASD: what do we know?Annu Rev Clin Psychol. 2010Apr 27; 6:447-68. 11.Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, Donaldson A, Varley J. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics. 2010 Jan; 125(1):e17-23. 12.Ozonoff S, Young GS, Carter A, et al. Recurrence risk for autismspectrum disorders: a Baby Siblings Research Consortium study. Pediatrics. 2011Sep;128(3):e488-95. Epub 2011 Aug 15. 13. Whitehouse AJO, Varcin KJ,Pillar S et al.. Effect of Preemptive Intervention on Developmental OutcomesAmong Infants Showing Early Signs of Autism: A Randomized Clinical Trial ofOutcomes to Diagnosis. JAMA Pediatr. 2021 Nov 1;175(11):e213298. PMID:34542577; PMCID: PMC8453361. 14. Laverty C, Surtees A,O’Sullivan R, Sutherland D, Jones C, Richards C. The prevalence and profile ofautism in individuals born preterm: a systematic review andmeta-analysis. J Neurodev Disord. 2021;13:41.Published 2021 Sep 21. doi:10.1186/s11689-021-09382-1. 15.Hyman SL, Levy SE, Myers SM; Council on ChildrenWith Disabilities, Section on Developmental and Behavioral Pediatrics .Identification, evaluation, and management of children with autism spectrumdisorder. Pediatrics. 2020;145(1):e20193447. doi:10.1542/peds.2019-3447. 16.Sandbank M, Bottema-Beutel K, Woynaroski T.Intervention recommendations for children with autism in light of a changingevidence base. JAMA Pediatr. 2021;175(4):341-342. 17.Whitehouse AJO. Elizabeth Usher Memorial Lecture:rethinking the clinical pathway for autism spectrum disorder and challengingthe status quo. Int J Speech Lang Pathol. 2017;19(3):208-217. 18. Suarez VD, Moon EI, Najdowski AC.Systematic Review of Acceptance and Commitment Training Components in theBehavioral Intervention of Individuals with Autism and Developmental Disorders.Behav Anal Pract. 2021 Jun 2;15(1):126-140. doi: 10.1007/s40617-021-00567-7.PMID: 35340380; PMC. 19. Attar N, Al-Hroub A, El Zein F. Effects ofThree Music Therapy Interventions on the Verbal Expressions of Children WithAutism Spectrum Disorder: A Combined Single-Subject Design. Front Psychol. 2022Mar 4;13:819473. doi: 10.3389/fpsyg.2022.819473. PMID: 35310290. 20. Green J, Leadbitter K, Ellis C, et alCombined social communication therapy at home and in education for youngautistic children in England (PACT-G) Lancet Psychiatry. 2022 Apr;9(4):307-320. 21. Chen T, WenR, Liu H, Zhong X, Jiang C. Dance intervention for negative symptoms inindividuals with autism spectrum disorder: A systematic review andmeta-analysis. Complement Ther Clin Pract. 2022 Feb 23;47:101565. doi:10.1016/j.ctcp.2022.101565. Epub ahead of print. PMID: 35259569. 22. Lilja MM,Sandblom E, Lichtenstein P, et al.. The effect of autistic traits on responseto and side-effects of pharmacological ADHD treatment in children with ADHD JNeurodev Disord. 2022 Mar 6;14(1):17. doi: 10.1186/s11689-022-09424-2. PMID:35249540; PMCID: PMC8903657. 23. Davenport MA, Berry JR, Mazurek MO, McCraeCS. Using Telehealth to Deliver Family-Based Cognitive Behavioral Treatment ofInsomnia in a School-Aged Child With Autism Spectrum Disorder. J CognPsychother. 2021 Nov 1;35(4):235-254. doi: 10.1891/JCPSY-D-20-00062. PMID: 35236746. 24. MatsumuraN, Fujino H, Yamamoto T, Effectiveness of a Parent Training Programme forParents of Adolescents with Autism Spectrum Disorders: Aiming to Improve DailyLiving Skills. Int J Environ Res Public Health. 2022 Feb 18;19(4):2363. doi:10.3390/ijerph19042363. PMID: 35206550 Matsumura N, Fujino H, Yamamoto T, Tanida Y,Ishii A, Tatsumi A, Nakanishi M, Tachibana M, Mohri I. 25. Schilbach L.Autism and other disorders of social interaction: where we are and where to gofrom here. Eur Arch Psychiatry Clin Neurosci. 2022 Mar;272(2):173-175. doi:10.1007/s00406-022-01391-y. 26.Mandy W. Six ideas about how to address theautism mental health crisis. Autism. 2022 Feb;26(2):289-292. doi:10.1177/13623613211067928. PMID: 35109701. 27. Ghanouni P,Quirke S. Resilience and Coping Strategies in Adults with Autism SpectrumDisorder. J Autism Dev Disord. 2022 Jan 25:1–12. doi:10.1007/s10803-022-05436-y. PMID: 35079928. 28. Smith E,Constantin A, Johnson H, Brosnan M. Digitally-Mediated Social Stories SupportChildren on the Autism Spectrum Adapting to a Change in a 'Real-World' Context.J Autism Dev Disord. 2021 Feb;51(2):514-526. doi: 10.1007/s10803-020-04558-5.PMID: 32519189; PMCID: PMC7835189. 29. Lord C,Brugha TS, Charman T, Cusack J, Dumas G, Frazier T, Jones EJH, Jones RM,Pickles A, State MW, Taylor JL, Veenstra-VanderWeele J. Autism spectrumdisorder. Nat Rev Dis Primers. 2020 Jan 16;6(1):5. doi:10.1038/s41572-019-0138-4. PMID: 31949163; PMCID: PMC8900942. 30. Lord C,Elsabbagh M, Baird G, Veenstra-Vanderweele J. Autism spectrum disorder. Lancet.2018 Aug 11;392(10146):508-520. doi: 10.1016/S0140-6736(18)31129-2. Epub 2018Aug 2. PMID: 30078460.
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#自闭症谱系障碍#
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