University of Utah, Salt Lake City, UT 84108, USA.
Am Fam Physician. 2010 Feb 15;81(4):453-60.
The earliest sign of autism in children is the delayed attainment of social skill milestones, including joint attention, social orienting, and pretend play. Language impairment is a common, but less specific, sign of autism. Repetitive behaviors and restricted interests may not be noted until after social skill and communication impairments are exhibited. Physicians should perform developmental surveillance at all well-child visits, and the American Academy of Pediatrics recommends administering an autism-specific screening tool at the 18- and 24-month visits. A referral for comprehensive diagnostic evaluation is appropriate if concerns arise from surveillance, screening, or parental observations. The goals of long-term management are to maximize functional independence and community engagement, minimize maladaptive behaviors, and provide family and caregiver support. Physicians play an important role in coordinating care through an interdisciplinary team; referring families for specialized services; and treating children's associated conditions, including sleep disturbances, gastrointestinal problems, anxiety, and hyperactivity. Autism is a lifelong condition, but early recognition, diagnosis, and treatment can improve the prognosis, whereas associated medical conditions, psychiatric conditions, and intellectual disability can worsen the prognosis.
自闭症患儿最早出现的症状是社会技能里程碑式的延迟发展，包括共同注意、社会定向和假装游戏。语言障碍是自闭症的一个常见但不那么具体的特征。重复行为和兴趣受限可能要等到社会技能和沟通障碍表现出来后才会被注意到。医生应在所有儿童健康检查中进行发育监测，美国儿科学会建议在 18 个月和 24 个月检查时使用自闭症专用筛查工具。如果在监测、筛查或父母观察中出现问题，就应进行全面诊断评估。长期管理的目标是最大限度地提高功能独立性和社区参与度，最大限度地减少适应不良行为，并为家庭和照顾者提供支持。医生通过跨学科团队在协调护理方面发挥着重要作用；为家庭提供专门服务；并治疗儿童的相关疾病，包括睡眠障碍、胃肠道问题、焦虑和多动症。自闭症是一种终身疾病，但早期识别、诊断和治疗可以改善预后，而相关的医疗状况、精神疾病和智力残疾会恶化预后。
