Sanchack Kristian E, Thomas Craig A
Naval Hospital Jacksonville, Jacksonville, FL, USA.
Naval Hospital Pensacola, Pensacola, FL, USA.
Am Fam Physician. 2016 Dec 15;94(12):972-979.
Autism spectrum disorder is characterized by difficulty with social communication and restricted, repetitive patterns of behavior, interest, or activities. The Diagnostic and Statistical Manual of Mental Disorders, 5th ed., created an umbrella diagnosis that includes several previously separate conditions: autistic disorder, Asperger syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified. There is insufficient evidence to recommend screening for autism spectrum disorder in children 18 to 30 months of age in whom the disorder is not suspected; however, there is a growing body of evidence that early intensive behavioral intervention based on applied behavior analysis improves cognitive ability, language, and adaptive skills. Therefore, early identification of autism spectrum disorder is important, and experts recommend the use of a validated screening tool at 18- and 24-month well-child visits. Medications can be used as adjunctive treatment for maladaptive behaviors and comorbid psychiatric conditions, but there is no single medical therapy that is effective for all symptoms of autism spectrum disorder. Prognosis is heavily affected by the severity of diagnosis and the presence of intellectual disability. Children with optimal outcomes receive earlier, more intensive behavioral interventions and less pharmacologic treatment.
自闭症谱系障碍的特征是社交沟通困难以及行为、兴趣或活动模式受限、重复。《精神疾病诊断与统计手册》第5版创建了一个涵盖诊断，其中包括几种先前各自独立的病症：孤独症、阿斯伯格综合征、儿童期崩解症以及未另行说明的广泛性发育障碍。对于未被怀疑患有自闭症谱系障碍的18至30个月大儿童，尚无足够证据推荐进行筛查；然而，越来越多的证据表明，基于应用行为分析的早期强化行为干预可提高认知能力、语言能力和适应技能。因此，早期识别自闭症谱系障碍很重要，专家建议在18个月和24个月的儿童健康检查时使用经过验证的筛查工具。药物可作为对适应不良行为和共病精神疾病的辅助治疗，但没有单一的药物疗法对自闭症谱系障碍的所有症状都有效。预后受到诊断严重程度和智力残疾存在与否的严重影响。预后最佳的儿童接受更早、更强化的行为干预且药物治疗较少。
