自闭症儿童能否痊愈?——来自谱系个体“最佳结果”及剩余缺陷研究的证据分析

doi:10.3724/SP.J.1042.2018.01465

摘要/Abstract

摘要：

自闭症谱系障碍预后效果不佳, 通常被认为是一种伴随终生的疾病。不过随着研究的拓展和深入, 部分早期被诊断为自闭症的儿童, 随着年龄增长和相关干预措施的介入, 其认知、适应性等方面均可达到正常发展水平, 并且不再符合自闭症的诊断标准, 即达到了“最佳结果”。但多数个体仍然存在不同程度的剩余缺陷。本文以自闭症预后结果评定和“最佳结果”定义演变为切入点, 分析“最佳结果”个体剩余缺陷的具体表现, 并梳理此类群体的个体特征与结果预测因素, 以期能为自闭症个体的系统干预提供有效依据。

关键词: 自闭症儿童, 痊愈, 最佳结果, 剩余缺陷

Abstract:

Autism Spectrum Disorders (ASD) are generally assumed to be lifelong due to its poor prognosis. However, more sophisticated research has shown that autistic children diagnosed and treated at earlier ages are able to enter the normal range of cognitive and adaptive skills. With proper intervention, meanwhile, they lose their autism diagnosis and achieve “optimal outcomes.” That said, most of them still display varying degrees of residual deficits. This paper first describes ASD outcomes and traces the definitional evolution of “optimal outcomes.” It then analyses the distribution of optimal outcome children, with a particular focus on residual deficits. In so doing, the paper teases out individual characteristics and predictors of outcome in this group to provide empirical and effective evidence for systematic intervention in children with ASD.

Key words: children with autism spectrum disorder, recovery, optimal outcomes, residual deficits

中图分类号:

B845
R395

林云强, 朱慧敏, 连福鑫. (2018). 自闭症儿童能否痊愈?——来自谱系个体“最佳结果”及剩余缺陷研究的证据分析. 心理科学进展 , 26(8), 1465-1474.

LIN Yunqiang, ZHU Huimin, LIAN Fuxin. (2018). Can children with autism spectrum disorder recover? Research evidence based on “optimal outcomes” and residual deficits of individuals in spectrum. Advances in Psychological Science, 26(8), 1465-1474.

图/表 1

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文献	历史诊断	当前结果
文献	历史诊断	诊断与评估	教育安置和接受服务	认知能力		适应性
Kelley et al. (2006)	符合DSM-IV (1994)中PDD的标准。	符合DSM-IV (1994)中PDD的标准。	(1)在与年龄相符的普通班级就读; (2)教师和家长认为和同龄人无差异; (3)不需接受特殊教育支持。
Sutera et al. (2007)	符合DSM-IV (1994)中PDD-NOS或AD的标准。	不符合任何ASD的诊断标准。		在认知、语言和适应能力的标准化测试中表现正常。
Helt et al. (2008)	(1)儿童在童年早期(如5岁)由专家(如至少一半的实践针对自闭症)诊断为ASD; (2)存在早期语言发育迟缓(18个月无单词, 或者24个月无词组); (3)经研究团队对早期报告或视频录像复审, 确认有ASD史。	(1)不符合任何PDD的诊断标准; (2) ADOS社交和沟通领域分数不符合ASD标准。	(1)可接受针对注意缺陷、组织困难、特定学习困难的特殊教育服务; (2)无需接受针对自闭症的服务; (3)在普通班级就读并且不接受个人辅助(individual assistant)。	VIQ、PIQ、FSIQ均在78分及以上。	VCSS分数在78分及以上。
Kelley et al. (2010)	由专门研究ASD的专家确诊有ASD史, 并且符合ADI-R中关于ASD的诊断标准。	不再符合ADOS-G中的ASD诊断标准。	(1)普通班级就读; (2)学校人员不认为其有自闭症; (3)每周所接受的所有干预或治疗时间不超过1小时, 并且不再接受和学业相关的援助。	FSIQ大于70分。
Fein et al. (2013)	(1)父母提供5岁之前由专门研究ASD的专家确认为ASD的书面证明; (2)存在早期语言发育迟缓(18个月无单词, 或者24个月无词组)。	不符合ADOS中ASD诊断标准。	(1)普通班级读书; (2)不接受一对一帮助; (3)不接受专门针对ASD的教育服务。	VIQ、PIQ、FSIQ均大于77分。	有正常发展的朋友; VCSS社交和沟通分数大于77分。

文献	历史诊断	当前结果
文献	历史诊断	诊断与评估	教育安置和接受服务	认知能力		适应性
Kelley et al. (2006)	符合DSM-IV (1994)中PDD的标准。	符合DSM-IV (1994)中PDD的标准。	(1)在与年龄相符的普通班级就读; (2)教师和家长认为和同龄人无差异; (3)不需接受特殊教育支持。
Sutera et al. (2007)	符合DSM-IV (1994)中PDD-NOS或AD的标准。	不符合任何ASD的诊断标准。		在认知、语言和适应能力的标准化测试中表现正常。
Helt et al. (2008)	(1)儿童在童年早期(如5岁)由专家(如至少一半的实践针对自闭症)诊断为ASD; (2)存在早期语言发育迟缓(18个月无单词, 或者24个月无词组); (3)经研究团队对早期报告或视频录像复审, 确认有ASD史。	(1)不符合任何PDD的诊断标准; (2) ADOS社交和沟通领域分数不符合ASD标准。	(1)可接受针对注意缺陷、组织困难、特定学习困难的特殊教育服务; (2)无需接受针对自闭症的服务; (3)在普通班级就读并且不接受个人辅助(individual assistant)。	VIQ、PIQ、FSIQ均在78分及以上。	VCSS分数在78分及以上。
Kelley et al. (2010)	由专门研究ASD的专家确诊有ASD史, 并且符合ADI-R中关于ASD的诊断标准。	不再符合ADOS-G中的ASD诊断标准。	(1)普通班级就读; (2)学校人员不认为其有自闭症; (3)每周所接受的所有干预或治疗时间不超过1小时, 并且不再接受和学业相关的援助。	FSIQ大于70分。
Fein et al. (2013)	(1)父母提供5岁之前由专门研究ASD的专家确认为ASD的书面证明; (2)存在早期语言发育迟缓(18个月无单词, 或者24个月无词组)。	不符合ADOS中ASD诊断标准。	(1)普通班级读书; (2)不接受一对一帮助; (3)不接受专门针对ASD的教育服务。	VIQ、PIQ、FSIQ均大于77分。	有正常发展的朋友; VCSS社交和沟通分数大于77分。