Waizbard-Bartov Einat, Fein Deborah, Lord Catherine, Amaral David G
Department of Psychology, University of California Davis, Davis, California, USA (Waizbard-Bartov); The MIND Institute and Department of Psychiatry and Behavioral Sciences, University of California Davis, Davis, California, USA (Waizbard-Bartov, Amaral); Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA; Department of Pediatrics, University of Connecticut, Farmington, Connecticut, USA (Fein); Departments of Psychiatry and Human Development and Psychology, University of California, Los Angeles, California, USA (Lord).
Focus (Am Psychiatr Publ). 2024 Apr;22(2):252-262. doi: 10.1176/appi.focus.24022007. Epub 2024 Apr 10.
Autism severity is currently defined and measured based exclusively on the severity levels of the two core symptom domains: social-communication and restricted or repetitive patterns of behaviors and interests. Autistic individuals, however, are often diagnosed with other medical, developmental, and psychological co-occurring conditions. These additional challenges such as intellectual disability, limited expressive and/or receptive language, and anxiety disorders, can have a tremendous impact on the day-to-day lives of autistic individuals, for both their adaptive functioning as well as their sense of wellbeing. Furthermore, the initial presentation of core symptoms and their likelihood of changing over time are influenced by the presence of such co-occurring conditions. In order to truly understand how a person's autism impacts their life, both core symptoms as well as other challenges should be considered. This approach was recently taken by , which proposed the term "profound autism" for a subgroup of individuals presenting with high core symptom severity, co-occurring intellectual disability, and little or no language, who require extensive long-term care. Considering other individual factors such as daily living skills, specific support needs and environmental resources would also enhance the evaluation of disability in autistic individuals. As currently employed in the assessment of intellectual disability, a multidimensional approach to autism could provide a more comprehensive system for classification of impairment. At present, however, there is no formal way to designate the combined effect of these different aspects of autism on a person's life. A comprehensive outlook that acknowledges impairments, capabilities, co-occurring conditions, and environmental factors would be useful for identifying subgroups of individuals as well as for determining individual needs and strengths in clinical assessments. The severity of a person's autism is currently defined based on the severity of their core autism symptoms: impaired social-communication and the presence of restricted or repetitive patterns of behaviors and interests. But autistic people often face additional challenges such as intellectual disability, epilepsy, and anxiety disorder, that considerably impact their everyday life, wellbeing, and the need for support. A more complete view of autism severity, one that includes core symptoms as well as additional challenges, could help identify meaningful sub-groups of autistic individuals and could be useful in clinical care. Appeared originally in 2023; 16:685-696.
目前，自闭症严重程度仅根据两个核心症状领域的严重程度来定义和衡量：社交沟通以及行为和兴趣的受限或重复模式。然而，自闭症患者常常还被诊断出患有其他共病的医学、发育和心理状况。这些额外的挑战，如智力残疾、表达性和/或接受性语言受限以及焦虑症，会对自闭症患者的日常生活产生巨大影响，无论是在他们的适应性功能还是幸福感方面。此外，核心症状的初始表现及其随时间变化的可能性会受到这些共病状况的影响。为了真正理解一个人的自闭症如何影响其生活，应同时考虑核心症状以及其他挑战。最近 采取了这种方法，该方法针对一组核心症状严重、伴有智力残疾且几乎没有语言或无语言能力、需要长期广泛护理的个体提出了“重度自闭症”这一术语。考虑其他个体因素，如日常生活技能、特定支持需求和环境资源，也将加强对自闭症患者残疾情况的评估。如同目前在智力残疾评估中所采用的那样，一种多维的自闭症评估方法可以提供一个更全面的损伤分类系统。然而，目前尚无正式方法来确定自闭症这些不同方面对一个人生活的综合影响。一种承认损伤、能力、共病状况和环境因素的全面观点，对于在临床评估中识别个体亚组以及确定个体需求和优势将是有用的。目前，一个人自闭症的严重程度是根据其核心自闭症症状的严重程度来定义的：社交沟通受损以及存在行为和兴趣的受限或重复模式。但自闭症患者常常面临额外的挑战，如智力残疾、癫痫和焦虑症，这些会对他们的日常生活、幸福感以及支持需求产生重大影响。对自闭症严重程度更全面的看法，包括核心症状以及其他挑战，有助于识别有意义的自闭症个体亚组，并在临床护理中发挥作用。最初发表于2023年；第16卷：685 - 696页。
