Karande Sunil
Developmental Clinic, Division of Pediatric Neurology, Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai - 400 022, India.
Indian J Med Sci. 2006 May;60(5):205-15.
Autism is a complex neurodevelopmental disorder characterized by qualitative impairments in social interaction and communication, with restricted, repetitive, stereotyped patterns of behavior, interests and activities. These behaviors manifest along a wide spectrum and commence before 36 months of age. Diagnosis of autism is made by ascertaining whether the child's specific behaviors meet the Diagnostic and Statistical Manual of Mental Disorders-IV-Revised criteria. Its etiology is still unclear but recent studies suggest that genetics plays a major role in conferring susceptibility. Recent neuroimaging research studies indicate that autism may be caused by atypical functioning in the central nervous system, particularly in the limbic system: amygdala and hippocampus. In a third of autistic children, loss of language and/or social skills occurs during the second year of life, usually between 15 and 21 months of age. Comorbidity with mental retardation, epilepsy, disruptive behaviors and learning difficulty is not uncommon. Although there is currently no known cure for autism there is evidence to suggest that early intervention therapy can improve functioning of autistic children. Judicious use of psychotropic drugs is necessary to manage associated aggression, hyperactivity, self-mutilation, temper tantrums; but drugs are not a substitute for behavioral and educational interventions. The family physician can play an important role in detecting autism early, coordinating its assessment and treatment, counseling the parents and classroom teacher, and monitoring the child's progress on a long term basis.
自闭症是一种复杂的神经发育障碍，其特征是社交互动和沟通存在质性缺陷，伴有行为、兴趣和活动的受限、重复、刻板模式。这些行为表现范围广泛，且在36个月龄之前就已出现。自闭症的诊断是通过确定儿童的特定行为是否符合《精神疾病诊断与统计手册》第四版修订标准来进行的。其病因仍不清楚，但最近的研究表明，遗传学在赋予易感性方面起主要作用。最近的神经影像学研究表明，自闭症可能是由中枢神经系统，特别是边缘系统（杏仁核和海马体）的功能异常引起的。三分之一的自闭症儿童在生命的第二年，通常是15至21个月龄时，会出现语言和/或社交技能丧失的情况。合并智力障碍、癫痫、破坏性行为和学习困难并不罕见。虽然目前尚无已知的自闭症治愈方法，但有证据表明早期干预治疗可以改善自闭症儿童的功能。明智地使用精神药物对于控制相关的攻击行为、多动、自残、发脾气是必要的；但药物不能替代行为和教育干预。家庭医生在早期发现自闭症、协调其评估和治疗、为家长和课堂教师提供咨询以及长期监测儿童的进展方面可以发挥重要作用。
