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重新思考孤独症谱系障碍晚发的观点。

Rethinking the idea of late autism spectrum disorder onset.

机构信息

University of California, San Diego.

University of California, Davis.

出版信息

Dev Psychopathol. 2018 May;30(2):553-569. doi: 10.1017/S0954579417001067. Epub 2017 Aug 14.

Abstract

A common theory of autism spectrum disorder (ASD) symptom onset includes toddlers who do not display symptoms until well after age 2, which are termed late-onset ASD cases. Objectives were to analyze differences in clinical phenotype between toddlers identified as ASD at initial evaluations (early diagnosed) versus those initially considered nonspectrum, then later identified as ASD (late diagnosed). Two hundred seventy-three toddlers recruited from the general population based on a failed developmental screening form or parent or physician concerns were followed longitudinally from 12 months and identified as early- and late-diagnosed cases of ASD, language delayed, or typically developing. Toddlers completed common standardized assessments and experimental eye-tracking and observational measures every 9-12 months until age 3. Longitudinal performance on standardized assessments and experimental tests from initial evaluations were compared. Delay in social communication skills was seen in both ASD groups at early-age initial assessment, including increased preference for nonsocial stimuli, increased stereotypic play, reduced exploration, and use of gestures. On standardized psychometric assessments, early-diagnosed toddlers showed more impairment initially while late-diagnosed toddlers showed a slowing in language acquisition. Similar social communication impairments were present at very early ages in both early-detected ASD and so-called late-onset ASD. Data indicate ASD is present whether detected or not by current methods, and development of more sensitive tools is needed.

摘要

自闭症谱系障碍(ASD)发病的一个常见理论包括,一些儿童在 2 岁以后才出现症状,被称为晚发性 ASD 病例。本研究旨在分析在最初评估中被诊断为 ASD(早期诊断)的儿童与最初被认为是非谱系但后来被诊断为 ASD(晚期诊断)的儿童在临床表型方面的差异。本研究从发育筛查失败或家长或医生关注的普通人群中招募了 273 名儿童,从 12 个月开始进行纵向随访,将其分为 ASD、语言发育迟缓或典型发育的早期和晚期诊断病例。儿童在 3 岁之前每 9-12 个月接受一次常见的标准化评估、眼动追踪和观察测试。比较了初始评估时的标准化评估和实验测试的纵向表现。在早期年龄的初始评估中,两组 ASD 儿童的社会沟通技能都存在延迟,包括对非社交刺激的偏好增加、刻板游戏增加、探索和手势使用减少。在标准化心理评估中,早期诊断的儿童最初表现出更多的障碍,而晚期诊断的儿童在语言习得方面则表现出较慢的速度。在早期检测到的 ASD 和所谓的晚发性 ASD 中,都存在类似的社会沟通障碍。这些数据表明,无论目前的方法是否能检测到,ASD 都存在,需要开发更敏感的工具。

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