Gilmour J, Hill B, Place M, Skuse D H
Sub-Department of Clinical Health Psychology, University College London, UK.
J Child Psychol Psychiatry. 2004 Jul;45(5):967-78. doi: 10.1111/j.1469-7610.2004.t01-1-00289.x.
Increasing numbers of children are referred to Child and Adolescent Mental Health Services because of disruptive behaviour. Recent reviews on the origins of conduct problems indicate that the most severe and persistent forms are found predominantly among males with a range of neurodevelopmental vulnerabilities, which are likely to have biological substrates. In this study, we tested the hypothesis that many children who are identified with conduct disorder actually have a primary deficit in pragmatic language skills, of a quality and degree that is similar to children on the autistic spectrum. We hypothesised that pragmatic difficulties may underlie the antisocial behaviour in a proportion of children who are labelled as conduct disordered.
Using the Children's Communication Checklist (Bishop, 1998), we surveyed 142 children who had been referred for clinical investigation, with a predominant diagnosis of either an autistic spectrum condition (n = 87) or conduct disorder (n = 55), and 60 typically developing comparison children. Among children with conduct disorders, males predominated 9:1.
On the basis of parent and teacher ratings, two-thirds of those with conduct disorders had pragmatic language impairments and other behavioural features similar in nature and degree to those of children with autism, independent of IQ. In a further study, we surveyed 54 children who had been excluded from elementary schools in a socio-economically disadvantaged inner-London borough and found over two-thirds to have comparable deficits.
These findings have both theoretical and practical implications. First, they indicate the presence of communicative problems in a sub-group of children in whom conduct rather than language had been the major concern. Second, they indicate that severe deficits in pragmatic abilities and autistic-like behaviours can coexist with psychiatric conditions other than autism, especially in boys. Third, they imply that the management of many disruptive children could profitably be addressed to ameliorating their social and communicative skill deficits.
因行为障碍而被转介至儿童及青少年心理健康服务机构的儿童数量日益增多。近期有关品行问题根源的综述表明，最严重且持续存在的形式主要见于具有一系列神经发育易损性的男性，这些易损性可能具有生物学基础。在本研究中，我们检验了这样一个假设，即许多被确诊患有品行障碍的儿童实际上存在语用语言技能的原发性缺陷，其性质和程度与自闭症谱系儿童相似。我们假设语用困难可能是一部分被诊断为品行障碍儿童反社会行为的潜在原因。
我们使用儿童沟通检查表（毕晓普，1998年），对142名被转介进行临床调查的儿童进行了调查，这些儿童主要诊断为自闭症谱系障碍（n = 87）或品行障碍（n = 55），以及60名发育正常的对照儿童。在患有品行障碍的儿童中，男性占比为9:1。
根据家长和教师的评分，三分之二患有品行障碍的儿童存在语用语言障碍以及与自闭症儿童在性质和程度上相似的其他行为特征，且与智商无关。在另一项研究中，我们对伦敦市中心一个社会经济地位不利地区被小学开除的54名儿童进行了调查，发现超过三分之二的儿童存在类似缺陷。
这些发现具有理论和实际意义。首先，它们表明在一群主要关注行为而非语言的儿童亚组中存在沟通问题。其次，它们表明语用能力的严重缺陷和类似自闭症的行为可以与自闭症以外的精神疾病共存，尤其是在男孩中。第三，它们意味着对许多有破坏行为的儿童的管理可以通过改善他们的社交和沟通技能缺陷而受益。
