我们可以多早诊断出自闭症?
作者: mints 编译 / 196次阅读 时间: 2020年10月12日
来源: 《自闭症》 标签: 自闭症
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As long as the diagnosis of autism is based on behaviour, a definitive pronouncement can only be made with hindsight. Perhaps, once a biological test is available, the diagnosis can be made before birth, but such a test still seems far in the future. Having to rely on behavioural criteria means having to live with ambiguity. And because the range of differences between all children is so large, even experienced clinicians can make misjudgements when pressed for a categorical pronouncement too early.

只要自闭症的诊断是基于行为的,就只能事后做出明确的申明。也许一旦有了生物检测,就可以在出生前做出诊断,但这样的检测似乎还遥遥无期。必须依赖行为准则意味着不得不接受模棱两可的生活。而且,由于所有儿童之间的差异如此之大,即使是经验丰富的临床医生也会在过早地要求作出明确声明的压力下做出错误判断。
 
What happens when parents seek professional help, when the social and emotional development of their child seems to deteriorate or simply not move on? In the past there has often been a long and sometimes harrowing road, but now health professionals are more knowledgeable about autistic disorders and highly aware of the need for early intervention. Ideally, an experienced clinician will interview the parents about their child’s development in detail, and will also test and observe the child. Then provision can be made for a programme of special education to start right away. For this reason it is important that this diagnosis is done as early as possible.

当父母发现他们的孩子的社会和情感发展似乎恶化或根本没有继续前进,而寻求专业建议时会发生什么?在过去,常常有一个漫长的,有时是悲惨的道路,但现在的卫生专业人员更了解自闭症障碍,也高度意识到需要早期干预。理想情况下,有经验的临床医生会非常详细的向父母询问孩子的发育细节,也会对孩子进行测试和观察。然后,就可以为立即开始提供特殊教育计划预案。因此,尽早进行诊断是很重要的。

However, there is a dilemma. Researchers asked the question: if a child is diagnosed at the age of 24 months, how certain is the diagnosis? Researchers investigated how likely it is that the diagnosis is confirmed two years later. They showed that in the majority of cases the diagnosis was indeed confirmed, but still one-third of the cases were eventually not considered autistic. The study also showed that there is almost complete certainty about the diagnosis when the child is older than 30 months.

然而,这是一个两难的选择。研究人员提出了一个问题:如果一个孩子在24个月大时被诊断出自闭症,那么这个诊断确定程度有多大?结果显示,大多数病例的诊断确实得到了证实,但仍有三分之一的病例最终没有被认为是自闭症。研究还表明,当孩子超过30个月大时,诊断几乎完全确定。


Many people feel that despite the risk of false alarms, early diagnosis is a desirable aim. One interesting solution to the problem is to proceed in two stages. At the first stage, around the age of 18 months, there could be screening for all children. At the second stage, perhaps around 30 months, a full diagnostic assessment could be offered to those children who had raised concerns. In fact, a screening instrument has already been developed. Three signs are assessed. First, does the child show ‘joint attention’, such as pointing with a finger. Second, is he or she following an adult’s gaze. Third, does he or she engage in simple pretend play?Most typically developing children aged 18 months can master these things.Most autistic children can’t. However, a number of children who apparently show these key behaviours nevertheless later go on to have an autistic disorder. This is likely to be Asperger syndrome.

许多人认为,尽管存在误报的风险,但尽早诊断是明智的目标。 解决这个问题的一种有趣方法就是分两个阶段进行。 在第一阶段,大约在18个月大时,可以对所有儿童进行筛查。 在第二阶段,大约30个月左右,可以对那些疑似儿童进行全面的诊断评估。 实际上,已经开发了一种筛选工具。用于评估三个迹象:

首先,孩子是否表现出“共同注意力”,例如用手指指向物体。

其次,他或她是否跟随成年人的目光。 

第三,他或她从事简单的假装游戏吗?

大多数发育正常的孩子在18个月时都能掌握这些技能。大多数自闭症儿童则不能。 然而,许多看起来表现出这些关键行为的儿童后来仍患上了自闭症。 这很可能是阿斯伯格综合症。


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