Filipek Pauline A, Steinberg-Epstein Robin, Book Teri M
Department of Pediatrics, University of California, Irvine, School of Medicine, 92868, USA.
NeuroRx. 2006 Apr;3(2):207-16. doi: 10.1016/j.nurx.2006.01.014.
A comprehensive approach to the assessment of any child with autism must be matched specifically to each individual child and family. This premise holds for medical therapies and special education services as well as psychopharmacologic interventions. Behavioral, as opposed to pharmacologic, treatment is the hallmark of effective intervention for autism. Physicians involved in the care of children with autism need to become familiar with educational law and intervention recommendations. Goals should include improved functional verbal and nonverbal communication and social skills, increased engagement in developmentally appropriate activities, improved fine and gross motor skills, and the development of independent academic and organizations skills, as well as replacement of problem behaviors with developmentally appropriate behaviors.. Medicating children with autism is difficult, but is often necessary for chronic behavioral difficulties. In the absence of clear and present guidelines, we have attempted to use evidence and clinical experience to suggest an algorithm based on symptom clusters. Although children with autism may be responsive to medications at lower doses and more susceptible to side effects than other children, medical intervention can produce a significant improvement in the quality of life for the child and family. Careful thought leading to correct identification of target behaviors can appropriately direct better alternatives for medication. Although these approaches are costly and time-consuming endeavors, the expenditure of such efforts is the only available pathway to improve the potential outcomes for individuals with autism as well as decrease the lifetime societal costs for each individual.
对任何患有自闭症的儿童进行评估时，都必须采用全面的方法，并根据每个孩子及其家庭的具体情况进行调整。这一前提适用于医学治疗、特殊教育服务以及心理药物干预。与药物治疗相对的行为治疗是自闭症有效干预的标志。参与自闭症儿童护理的医生需要熟悉教育法和干预建议。目标应包括改善功能性语言和非语言沟通及社交技能、增加参与适合其发育阶段的活动、提高精细和粗大运动技能、培养独立的学业和组织技能，以及用适合其发育阶段的行为取代问题行为。给自闭症儿童用药很困难，但对于慢性行为问题往往是必要的。在缺乏明确和现成指南的情况下，我们试图利用证据和临床经验，提出一种基于症状群的算法。虽然自闭症儿童可能对较低剂量的药物有反应，且比其他儿童更容易出现副作用，但医学干预可以显著改善儿童及其家庭的生活质量。经过深思熟虑准确识别目标行为，可以恰当地指导更好的用药选择。尽管这些方法成本高昂且耗时，但付出这样的努力是改善自闭症患者潜在预后以及降低每个个体终身社会成本的唯一途径。
