We recruited 72 experts in autism and/or childhood trauma. Via a 2-round Delphi survey, experts commented on and rated the importance of 48 potential indicators, drawn from PTSD criteria and a broader literature on traumatic sequelae in autism. A revised list of 51 indicators, 18 clinical guidelines developed from expert comments, and summaries of expert qualifications and ratings from Round 1 were submitted to a second round (n = 66; 92% retention) of expert review and rating.
Twenty-two indicators reached consensus (>75% round 2 endorsement). Many, but not all, reflected PTSD criteria, including intrusions (e.g., trauma re-enactments in perseverative play/speech), avoidance of trauma-reminders, and negative alterations in mood/cognition (e.g., diminished interest in activities) and in arousal/reactivity (e.g., exaggerated startle). Experts also identified increased reliance on others, adaptive and language regressions, self-injurious behavior, and non-suicidal self-injury as important indicators. Consensus guidelines emphasized the need for tailored measures, developmentally informed criteria, and multiple informants to increase diagnostic accuracy.
Expert consensus emphasizes and informs a need for tailored diagnostic guidelines and measures to more sensitively assess traumatic reactions in autistic youth.
方法:我们招募了72名自闭症和/或儿童创伤方面的专家。通过两轮德尔福调查,专家对48项潜在指标的重要性进行了评论和评级,来自创伤后应激障碍标准和更广泛的自闭症创伤后遗症文献。修订后的51项指标清单,根据专家意见制定的18个临床指南,第1轮的专家资格和评级摘要已提交给第二轮(n=66;保留率92%)的专家审查和评级。
结果:22项指标达成共识(>75%的第2轮认可)。许多,但不是全部,反映了创伤后应激障碍标准,包括侵入(例如,坚持不懈的游戏/演讲中的创伤重演),避免创伤提醒,和情绪/认知的负面改变(例如,对活动的兴趣减弱)和对唤醒/反应性(例如,夸张的惊吓)。专家们还发现对他人的依赖增加,自适应和语言回归,自我伤害的行为,并将非自杀自我伤害作为重要指标。共识准则强调需要采取量身定制的措施,发展知情标准,和多个线人,以提高诊断的准确性。
结论:专家共识强调并告知需要量身定制的诊断指南和措施,以更敏感地评估自闭症青年的创伤反应。