Curran Laura K, Newschaffer Craig J, Lee Li-Ching, Crawford Stephen O, Johnston Michael V, Zimmerman Andrew W
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Pediatrics. 2007 Dec;120(6):e1386-92. doi: 10.1542/peds.2007-0360.
Clinical case reports have suggested that the behaviors of children with autism spectrum disorders may improve with fever. The purpose of this study was to investigate the effect of illness on behaviors of children with autism spectrum disorders. Understanding the role of fever, if any, may be informative regarding causative mechanisms of and treatment opportunities for autism.
We conducted a prospective study of 30 children (aged 2-18 years) with autism spectrum disorders during and after an episode of fever. Parent responses to the Aberrant Behavior Checklist were collected during fever (body temperature > or = 38.0 degrees C/100.4 degrees F), when fever had abated and the child was asymptomatic, and when the child had been fever-free for 7 days. Data were compared with those collected from parents of 30 age-, gender-, and language skills-matched afebrile children with autism spectrum disorders during similar time intervals.
Fewer aberrant behaviors were recorded for febrile patients on the Aberrant Behavior Checklist subscales of irritability, hyperactivity, stereotypy, and inappropriate speech compared with control subjects. Per expectation, lethargy scores were greater during fevers, and all improvements were transient. Data from patients with fever were stratified on variables related to illness severity. In the majority of these subgroup comparisons, the data suggested that effects from fever persisted in the less sick patients as well as in those with more severe illness.
We documented behavior change among children with autism spectrum disorders during fever. The data suggest that these changes might not be solely the byproduct of general effects of sickness on behavior; however, more research is needed to prove conclusively fever-specific effects and elucidate their underlying biological mechanisms (possibly involving immunologic and neurobiological pathways, intracellular signaling, and synaptic plasticity).
临床病例报告表明，自闭症谱系障碍儿童的行为可能会随着发热而改善。本研究的目的是调查疾病对自闭症谱系障碍儿童行为的影响。了解发热（如果存在这种影响的话）的作用，可能有助于深入了解自闭症的致病机制和治疗机会。
我们对30名年龄在2至18岁之间的自闭症谱系障碍儿童在发热期间及之后进行了一项前瞻性研究。在发热期间（体温≥38.0摄氏度/100.4华氏度）、发热消退且儿童无症状时以及儿童体温正常7天后，收集家长对异常行为检查表的反馈。将这些数据与在相似时间间隔内从30名年龄、性别和语言技能匹配的无发热自闭症谱系障碍儿童的家长那里收集的数据进行比较。
与对照组相比，发热患者在异常行为检查表的易怒、多动、刻板行为和不当言语子量表上记录的异常行为较少。不出所料，发热期间嗜睡得分更高，且所有改善都是短暂的。发热患者的数据根据与疾病严重程度相关的变量进行分层。在大多数这些亚组比较中，数据表明发热的影响在病情较轻的患者以及病情较重的患者中都持续存在。
我们记录了自闭症谱系障碍儿童在发热期间的行为变化。数据表明，这些变化可能不仅仅是疾病对行为的一般影响的副产品；然而，需要更多的研究来确凿地证明发热的特定影响，并阐明其潜在的生物学机制（可能涉及免疫和神经生物学途径、细胞内信号传导和突触可塑性）。
