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跨诊断考量对于理解儿童神经发育障碍至关重要。

Transdiagnostic considerations are critical to understanding childhood neurodevelopmental disorders.

作者信息

Hoza Betsy, Shoulberg Erin K

机构信息

Department of Psychological Science, University of Vermont, Burlington, VT, United States.

出版信息

Front Hum Neurosci. 2024 May 7;18:1385873. doi: 10.3389/fnhum.2024.1385873. eCollection 2024.

Abstract

Growing dissatisfaction with the current categorical diagnostic systems has led to a movement toward transdiagnostic dimensional approaches to assessment of childhood mental health disorders. We argue that a transdiagnostic approach is especially important and appropriate when screening for neurodevelopmental disorders during early childhood. In the early childhood years, symptoms often appear in the form of developmental delays that could portend a variety of different disorders. Early intervention at this point is critical, even though a final endpoint disorder is not yet apparent. Intervening early has the potential to grow the area of weakness, possibly correcting or at least ameliorating these delays. Early intervention requires a multidisciplinary approach integrating efforts across settings and providers that monitor the development of young children. We argue here that young children's language ability is central to the development of social cognition, and a prerequisite for adequate social functioning. Social deficits are defining features of a subset of neurodevelopmental disorders such as autism spectrum disorder and social (pragmatic) communication disorder. Critically, impairment in social functioning is common in additional neurodevelopmental disorders such as attention-deficit/hyperactivity disorder (ADHD), learning disorders, and even motor disorders. For this reason, we argue that, at the earliest sign of a possible neurodevelopmental disorder, children should be screened for language deficits prior to initiating a focused assessment for a specific type of neurodevelopmental disorder such as ADHD. Any detected language deficits should be considered in the design and implementation of the assessment, as well as the ultimate intervention plan.

摘要

对当前分类诊断系统日益增长的不满,引发了一场朝着采用跨诊断维度方法来评估儿童心理健康障碍的运动。我们认为,在幼儿期筛查神经发育障碍时,跨诊断方法尤为重要且恰当。在幼儿期,症状通常以发育迟缓的形式出现,这可能预示着多种不同的障碍。即便最终的终点障碍尚不明显,但此时进行早期干预至关重要。早期干预有可能扩大薄弱领域,或许能够纠正或至少改善这些迟缓。早期干预需要一种多学科方法,整合跨环境和提供者的努力,以监测幼儿的发育情况。我们在此认为,幼儿的语言能力是社会认知发展的核心,也是充分社会功能的先决条件。社交缺陷是诸如自闭症谱系障碍和社交(语用)沟通障碍等部分神经发育障碍的典型特征。至关重要的是,社交功能受损在诸如注意力缺陷多动障碍(ADHD)、学习障碍甚至运动障碍等其他神经发育障碍中也很常见。因此,我们认为,在出现可能的神经发育障碍的最早迹象时,在针对特定类型的神经发育障碍(如ADHD)展开重点评估之前,就应对儿童进行语言缺陷筛查。在设计和实施评估以及最终的干预计划时,应考虑任何检测到的语言缺陷。

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