Tanguay P E, Robertson J, Derrick A
Department of Psychiatry, University of Louisville School of Medicine, KY, USA.
J Am Acad Child Adolesc Psychiatry. 1998 Mar;37(3):271-7. doi: 10.1097/00004583-199803000-00011.
To investigate whether "social communication" could be used to assess severity of symptoms in autism spectrum disorder. Social communication refers to the communication of cognitive and emotional information through facial expression, gesture, and prosody and through implicit understanding of pragmatics and of theory of mind.
Subjects were evaluated by raters using the Autism Diagnostic interview-Revised and either the Autism Diagnostic Observation Schedule or the Pre-Linguistic Autism Diagnostic Observation Schedule. Two investigators independently diagnosed autism, Asperger's disorder, or pervasive developmental disorder-not otherwise specified in 63 subjects. Items from the Autism Diagnostic Interview-Revised that were judged to represent social communication behaviors were factor-analyzed.
Three factors were identified: affective reciprocity, joint attention, and theory of mind. Comparing this new classification approach to DSM-IV led to suggestions for possible changes in the latter: (1) Vocabulary and grammar deficiencies in autistic persons should be coded under developmental language disorder, (2) The diagnosis of Asperger's disorder may not be needed. (3) Requiring that all persons with autism spectrum disorder have a symptom from the "restrictive, repetitive, and stereotypic" list may need to be reconsidered.
The DSM-IV category of pervasive developmental disorder may be ideal for diagnosing "classic" autism, but it may be inadequate for diagnosing less severe forms of the disorder.
研究“社交沟通”是否可用于评估自闭症谱系障碍的症状严重程度。社交沟通是指通过面部表情、手势、韵律以及对语用学和心理理论的隐性理解来传递认知和情感信息。
评估者使用修订版自闭症诊断访谈量表以及自闭症诊断观察量表或语言前自闭症诊断观察量表对受试者进行评估。两名研究者独立诊断了63名受试者是否患有自闭症、阿斯伯格综合征或未特定的广泛性发育障碍。对修订版自闭症诊断访谈量表中被判定代表社交沟通行为的项目进行了因子分析。
确定了三个因素：情感互惠、共同注意和心理理论。将这种新的分类方法与《精神疾病诊断与统计手册》第四版（DSM-IV）进行比较，对后者提出了可能的修改建议：（1）自闭症患者的词汇和语法缺陷应归类为发育性语言障碍；（2）可能不需要诊断阿斯伯格综合征；（3）可能需要重新考虑要求所有自闭症谱系障碍患者都有“局限的、重复的和刻板的”症状清单中的一项症状这一规定。
DSM-IV中的广泛性发育障碍类别可能非常适合诊断“典型”自闭症，但可能不足以诊断该障碍的较轻形式。
