Helt Molly, Kelley Elizabeth, Kinsbourne Marcel, Pandey Juhi, Boorstein Hilary, Herbert Martha, Fein Deborah
Department of Psychology, University of Connecticut, Storrs, CT 06268, USA.
Neuropsychol Rev. 2008 Dec;18(4):339-66. doi: 10.1007/s11065-008-9075-9. Epub 2008 Nov 14.
Although Autism Spectrum Disorders (ASD) are generally assumed to be lifelong, we review evidence that between 3% and 25% of children reportedly lose their ASD diagnosis and enter the normal range of cognitive, adaptive and social skills. Predictors of recovery include relatively high intelligence, receptive language, verbal and motor imitation, and motor development, but not overall symptom severity. Earlier age of diagnosis and treatment, and a diagnosis of Pervasive Developmental Disorder-Not Otherwise Specified are also favorable signs. The presence of seizures, mental retardation and genetic syndromes are unfavorable signs, whereas head growth does not predict outcome. Controlled studies that report the most recovery came about after the use of behavioral techniques. Residual vulnerabilities affect higher-order communication and attention. Tics, depression and phobias are frequent residual co-morbidities after recovery. Possible mechanisms of recovery include: normalizing input by forcing attention outward or enriching the environment; promoting the reinforcement value of social stimuli; preventing interfering behaviors; mass practice of weak skills; reducing stress and stabilizing arousal. Improving nutrition and sleep quality is non-specifically beneficial.
尽管通常认为自闭症谱系障碍(ASD)是终身性的,但我们回顾了相关证据,据报道,3%至25%的儿童失去了ASD诊断,进入了认知、适应和社交技能的正常范围。康复的预测因素包括相对较高的智力、接受性语言、言语和动作模仿以及运动发育,但不包括总体症状严重程度。更早的诊断和治疗年龄以及未特定指明的广泛性发育障碍诊断也是有利迹象。癫痫发作、智力障碍和遗传综合征的存在是不利迹象,而头部生长情况并不能预测预后。报告显示使用行为技术后康复情况最佳的对照研究表明,残留的脆弱性会影响高阶沟通和注意力。抽动症、抑郁症和恐惧症是康复后常见的残留共病。康复的可能机制包括:通过迫使注意力向外转移或丰富环境来使输入正常化;提高社会刺激的强化价值;防止干扰行为;大量练习薄弱技能;减轻压力并稳定唤醒状态。改善营养和睡眠质量具有非特异性益处。