Charman Tony, Baird Gillian
Behavioural and Brain Sciences Unit, Institute of Child Health, University College London, UK.
J Child Psychol Psychiatry. 2002 Mar;43(3):289-305. doi: 10.1111/1469-7610.00022.
Progress has recently been made in the earlier identification of children with autism spectrum disorder (ASD). Whilst being welcome, this progress to earlier referral and diagnosis presents new challenges to clinical practice, including the accuracy and stability of early diagnosis, the utility of standardised assessment instruments with young pre-schoolers and the ability to indicate prognosis.
A selective review of recent research literature on the characteristic features of ASD in preschool children.
Multidisciplinary diagnostic assessment should include detailed information on developmental history, parents' descriptions of the everyday behaviour and activities of the child, direct assessment of the child's social interaction style, including where possible with age peers, and formal assessment of communicative, intellectual and adaptive function. Clinical assessments need to concentrate on the identification of impairments in early non-verbal social communication behaviours that characterise children with ASD from the second year of life, including social orienting, joint attention, imitation, play and reciprocal affective behaviour. The particular pattern of symptoms that presents in a 2-year-old with ASD may differ from that seen at the more prototypic age of 4 or 5 years. In particular, overt repetitive and stereotyped behaviours may be less notable, although where these are seen alongside the social and communicative impairments they are highly indicative of ASD. The use of standardised assessment instruments and the strict application of the DSM and ICD diagnostic criteria need to be employed with caution, as an expert clinical view has been shown to be more accurate. An important aspect of early diagnostic consultation is an open and straightforward approach to the negotiation of the diagnostic view with parents over time.
Earlier diagnosis and rising recognition of ASD have significant implications for primary healthcare and specialist diagnostic and therapeutic services.
最近在自闭症谱系障碍（ASD）儿童的早期识别方面取得了进展。尽管这一进展值得欢迎，但早期转诊和诊断给临床实践带来了新的挑战，包括早期诊断的准确性和稳定性、标准化评估工具对学龄前儿童的适用性以及预测预后的能力。
对近期有关学龄前儿童ASD特征的研究文献进行选择性综述。
多学科诊断评估应包括发育史的详细信息、父母对孩子日常行为和活动的描述、对孩子社交互动方式的直接评估（尽可能包括与同龄人的互动）以及对沟通、智力和适应功能的正式评估。临床评估需要专注于识别早期非语言社交沟通行为的障碍，这些障碍是ASD儿童从两岁起的特征，包括社交定向、共同注意、模仿、玩耍和相互情感行为。患有ASD的2岁儿童出现的特定症状模式可能与4岁或5岁这个更典型年龄时所见的不同。特别是，明显的重复和刻板行为可能不太明显，尽管当这些行为与社交和沟通障碍同时出现时，它们高度提示ASD。使用标准化评估工具以及严格应用《精神疾病诊断与统计手册》（DSM）和《国际疾病分类》（ICD）诊断标准时需谨慎，因为专家临床意见已被证明更准确。早期诊断咨询的一个重要方面是随着时间推移与家长就诊断观点进行开放和直接的沟通。
ASD的早期诊断和认知度的提高对初级医疗保健以及专科诊断和治疗服务具有重大影响。
