Cook E H, Kieffer J E, Charak D A, Leventhal B L
Department of Psychiatry, University of Chicago, IL 60637.
J Am Acad Child Adolesc Psychiatry. 1993 Nov;32(6):1292-4. doi: 10.1097/00004583-199311000-00025.
The present case study examined an adolescent boy who initially was evaluated at our clinic and was found to meet DSM-III-R criteria for autistic disorder. After placement in a residential school using Daily Life Therapy for autistic disorder, the subject reported being physically abused by a staff member. Additional psychiatric evaluation revealed post-traumatic stress disorder (PTSD) including symbolic anxiety and repetition of the trauma. The diagnosis of PTSD should be considered in children with autistic disorder and other severe developmental disorders who have experienced physical and sexual abuse. Furthermore, parents, professionals, educators, and child care workers struggle with emotional reactions to children with severe developmental disorders and may have difficulty accepting the reality of the child rather than the fantasy of the "wished-for child." The disappointment of this fantasy and the equating of the child's weaknesses as one's own may lead to personal devaluation and increase the risk of abusive behavior.
本案例研究考察了一名青少年男性，其最初在我们诊所接受评估，被认定符合《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）中自闭症障碍的标准。在被安置到一所采用针对自闭症障碍的日常生活疗法的寄宿学校后，该受试者报告称遭到一名工作人员的身体虐待。进一步的精神病学评估显示存在创伤后应激障碍（PTSD），包括象征性焦虑和创伤重现。对于患有自闭症障碍及其他严重发育障碍且遭受过身体和性虐待的儿童，应考虑PTSD的诊断。此外，父母、专业人员、教育工作者和儿童护理工作者在面对患有严重发育障碍的儿童时会产生情绪反应，并且可能难以接受孩子的现实状况而非“理想中孩子”的幻想。这种幻想的破灭以及将孩子的弱点等同于自身的情况可能导致自我贬低，并增加虐待行为的风险。
