Hobson R Peter, Bishop Martin
Developmental Psychopathology Research Unit, Tavistock Clinic and Department of Psychiatry and Behavioural Sciences, University College London, 120 Belsize Lane, London NW3 5BA, UK.
Philos Trans R Soc Lond B Biol Sci. 2003 Feb 28;358(1430):335-44. doi: 10.1098/rstb.2002.1201.
There is substantial heterogeneity in the aetiology and clinical presentation of autism. So how do we account for homogeneity in the syndrome? The answer to this question will be critical for any attempt to trace the links between brain pathology and the psychological disabilities that characterize autism. One possibility is that the source of homogeneity in autism is not to be found 'in the child', but rather in dysfunction of the system constituted by child-in-relation-to-other. We have been exploring this hypothesis through the study of congenitally blind children, among whom features of autism, and the syndrome of autism itself, are strikingly common. To justify such an approach, one needs to establish that the clinical features in blind children have qualities that are indeed 'autistic-like'. We conducted systematic observations of the social interactions of two matched groups of congenitally blind children who do not have autism, rating their social engagement, emotional tone, play and language during three sessions of free play in the school playground. The qualities of social impairment in the more disabled children were similar to those in sighted children with autism. Additional evidence came from independent ratings of the children in a different play setting: on the childhood autism rating scale (CARS), the socially impaired children had 'autistic-like' abnormalities in both social and non-social domains. If we can determine the way in which congenital blindness predisposes to features of autism, we shall be in a better position to trace the developmental pathways that lead to the syndrome in sighted children.
自闭症的病因和临床表现存在很大的异质性。那么，我们如何解释该综合征中的同质性呢？对于任何试图探寻大脑病变与自闭症所特有的心理障碍之间联系的尝试而言，这个问题的答案都至关重要。一种可能性是，自闭症同质性的根源并非在于“儿童本身”，而是在于由儿童与他人的关系所构成的系统功能失调。我们一直在通过对先天性失明儿童的研究来探索这一假设，在这些儿童中，自闭症特征以及自闭症综合征本身都极为常见。为了证明这种方法的合理性，需要确定失明儿童的临床特征确实具有“类自闭症”的特质。我们对两组匹配的、未患自闭症的先天性失明儿童的社交互动进行了系统观察，在学校操场的三次自由玩耍过程中，对他们的社交参与度、情绪基调、玩耍和语言进行评分。残疾程度较重的儿童的社交障碍特质与患有自闭症的视力正常儿童相似。另外的证据来自于在不同玩耍场景下对这些儿童的独立评分：在儿童自闭症评定量表（CARS）上，社交障碍儿童在社交和非社交领域都有“类自闭症”异常表现。如果我们能够确定先天性失明导致自闭症特征的方式，我们就能更好地探寻导致视力正常儿童出现该综合征的发育途径。
