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[儿童、青少年及成人自闭症谱系障碍的诊断:德国 AWMF-S3 临床指南第一部分关键问题及主要结果概述]

[The diagnostics of autism spectrum disorder in children, adolescents and adults: Overview of the key questions and main results of the first part of the German AWMF-S3 - clinical guideline].

作者信息

Vllasaliu Leonora, Jensen Katrin, Dose Matthias, Hagenah Ulrich, Hollmann Helmut, Kamp-Becker Inge, Lechmann Claus, Poustka Luise, Sinzig Judith, Spitzcok von Brisinski Ingo, van Elst Ludger Tebartz, Will Diana, Vogeley Kai, Freitag Christine M

机构信息

1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Autismus-Therapie- und Forschungszentrum, Universitätsklinikum Frankfurt, Goethe Universität.

2 Institut für Medizinische Biometrie und Informatik, Universitätsklinikum Heidelberg.

出版信息

Z Kinder Jugendpsychiatr Psychother. 2019 Jul;47(4):359-370. doi: 10.1024/1422-4917/a000621. Epub 2018 Oct 17.

Abstract

The diagnostics of autism spectrum disorder in children, adolescents and adults: Overview of the key questions and main results of the first part of the German AWMF-S3 - clinical guideline Autism spectrum disorders (ASD) include ICD-10 diagnoses of childhood autism, Asperger syndrome, and atypical autism; there is a lifetime prevalence of ~1 %. The aim of the evidence-based clinical guideline (AWMF-S3-Guideline) is to summarize the current evidence concerning diagnostic and therapeutic processes for professionals working in healthcare and social welfare and to provide consensus on clinical recommendations. The present study summarizes the most important results of the diagnostic part of this guideline. The guideline group comprised 14 clinical and scientific expert associations from the German healthcare system, in addition to representatives of relatives and patients. Recommendations were based on results of a systematic literature search, data extraction, the evaluation of study quality, and, if possible, meta-analytic aggregation of included data in combination with the clinical expertise of the respective representatives. Consensus-based recommendations were determined via nominal group technique. The AWMF-S3-Clinical Guideline, Diagnostic Part, summarizes current research on this topic. The main focus is put on the question of obligatory versus redundant diagnostic procedures. After a general introduction to the clinical picture of ASD, essential aspects like obtaining the medical history, the effective use of screening and diagnostic instruments, medical examination, the full diagnostic work-up as well as communicating the diagnostic results to relatives and patients are described in detail. We also conducted a meta-analysis on the stability of early diagnosis. This first part of the ASD guideline offers users the opportunity to inform themselves about the background of ASD as well as evidence-based and broadly consented information on the correct diagnostic process of ASD from infancy to adulthood.

摘要

儿童、青少年及成人自闭症谱系障碍的诊断:德国 AWMF-S3 临床指南第一部分关键问题与主要结果概述 自闭症谱系障碍(ASD)在国际疾病分类第十版(ICD-10)中包括儿童自闭症、阿斯伯格综合征和非典型自闭症的诊断;终生患病率约为1%。循证临床指南(AWMF-S3 指南)旨在总结目前关于医疗保健和社会福利领域专业人员诊断及治疗过程的证据,并就临床建议达成共识。本研究总结了该指南诊断部分的最重要结果。指南制定小组除了包括亲属和患者代表外,还由德国医疗系统的14个临床和科学专家协会组成。建议基于系统文献检索结果、数据提取、研究质量评估,并在可能的情况下,结合纳入数据的荟萃分析汇总以及各代表的临床专业知识。基于共识的建议通过名义群体技术确定。AWMF-S3临床指南诊断部分总结了关于该主题的当前研究。主要重点放在强制性诊断程序与冗余诊断程序的问题上。在对ASD临床表现进行一般性介绍后,详细描述了获取病史、有效使用筛查和诊断工具、医学检查、全面诊断评估以及向亲属和患者传达诊断结果等重要方面。我们还对早期诊断的稳定性进行了荟萃分析。ASD 指南的这第一部分为用户提供了一个机会,使其能够了解 ASD 的背景信息,以及关于从婴儿期到成年期 ASD 正确诊断过程的循证且广泛认可的信息。

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