Autism spectrum disorders

自闭症谱系障碍
  • 文章类型: Journal Article
    大韩民国卫生和福利部,国家自闭症和发育障碍中心正在逐步扩大。国家自闭症和发育障碍中心的总部为教育提供支持,培训,和研究,自2020年以来,几个中心一直在有效运营。这项研究旨在为临床心理学家等专家提供实用的建议和指南,儿童精神科医生,盟军专业人士,社区工作者,和相关管理员。它是作为促进早期诊断的指南而制定的,提供有关综合治疗的重要信息,并帮助韩国有发育障碍的人为他们的生活质量做出最好的决定。
    Under the Ministry of Health and Welfare of the Republic of Korea, the National Autism and Developmental Disorder Centers for people with developmental disabilities are gradually expanding. The headquarters of the National Autism and Developmental Disorder Center provides support for education, training, and research, and several centers have been effectively operating since 2020. This study aimed to provide practical recommendations and guidelines for specialists such as clinical psychologists, child psychiatrists, allied professionals, community workers, and related administrators. It was developed as a guideline to promote early diagnosis, provide important information on integrated treatment, and assist people with developmental disabilities in Korea to make the best decisions for their quality of life.
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  • 文章类型: Journal Article
    目的:有人认为,在自闭症谱系中,青少年对创伤后遗症的认识不足。我们旨在就重要的创伤指标达成专家共识,包括但不限于创伤应激症状,在自闭症青年。
    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。
    It has been suggested that the sequelae of trauma are under-recognized in youth on the autism spectrum. We aimed to generate expert consensus regarding important trauma indicators, including but not limited to traumatic stress symptoms, in autistic youth.
    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.
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  • 文章类型: Journal Article
    UNASSIGNED:患有未确诊的自闭症可能令人痛苦,并可能影响心理健康。自闭症的诊断可以帮助自我意识和自我理解。然而,成年人很难获得自闭症评估。临床医生有时也发现很难识别成人自闭症。这可能意味着自闭症诊断被延迟或错过。在这项研究中,我们问自闭症成年人,亲属和临床医生如何改善这一点。研究分为两个阶段。在第一阶段(阶段1),343名自闭症成年人和45名亲属完成了一项调查。在调查中,我们询问了人们对英国成人自闭症评估服务的体验。35名临床医生完成了类似的调查。临床医生报告说,一些自闭症评估小组缺乏关键的专业人员,例如,心理学家和职业治疗师。我们使用来自三个独立调查的信息来创建13个陈述,描述针对成年人的最佳自闭症评估服务。在第2阶段,我们询问了临床医生对13项声明的看法。临床医生同意其中11项声明。一些自闭症成年人,亲属和临床医生对自闭症评估服务持积极态度,许多人还描述了可以改进的领域。该研究结果可用于改善英国成人自闭症评估服务,并可能对全球服务发展有所帮助。
    UNASSIGNED: Living with undiagnosed autism can be distressing and may affect mental health. A diagnosis of autism can help self-awareness and self-understanding. However, it can be difficult for adults to access an autism assessment. Clinicians also sometimes find it hard to identify autism in adults. This may mean an autism diagnosis is delayed or missed. In this study, we asked autistic adults, relatives and clinicians how to improve this. The study was in two stages. In the first stage (stage 1), 343 autistic adults and 45 relatives completed a survey. In the survey, we asked questions about people\'s experiences of UK autism assessment services for adults. Thirty-five clinicians completed a similar survey. Clinicians reported that some autism assessment teams lacked key professionals, for example, psychologists and occupational therapists. We used the information from the three separate surveys to create 13 statements describing best autism assessment services for adults. In stage 2, we asked clinicians for their views on the 13 statements. Clinicians agreed with 11 of the statements. Some autistic adults, relatives and clinicians were positive about autism assessment services, and many also described areas that could be improved. The study findings can be used to improve UK adult autism assessment services and may be helpful for service developments worldwide.
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  • 文章类型: Journal Article
    Objectives: The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) guidelines provide monitoring recommendations for children who are treated with second-generation antipsychotics (SGAs). The objective of this study was to determine the impact of the CAMESA guidelines on SGA monitoring in children with neurodevelopmental disorders. Methods: A retrospective chart review compared laboratory monitoring in children treated with SGAs who were referred to a tertiary psychopharmacology clinic before (2008-2011) and after (2013-2016) CAMESA publication. Chi-squared tests were used to detect changes in SGA use and monitoring between the two time periods. Results: A total of 345 charts were reviewed (n = 136 pre-CAMESA, n = 209 post-CAMESA). The proportion of children taking an SGA increased significantly (35% vs. 49%; p = 0.02) as did the duration of SGA treatment before tertiary assessment (18.6 months vs. 27.2 months; p = 0.03). SGA monitoring data were missing in 40% of charts pre-CAMESA and in 31% of charts post-CAMESA. The proportion of patients with any available laboratory monitoring did not change between the time periods (35% pre-CAMESA vs. 39% post-CAMESA; p = 0.56). Similarly, the proportion of patients with full laboratory monitoring was not significantly different between time periods (15% pre-CAMESA vs. 25% post-CAMESA; p = 0.23). Conclusions: SGA monitoring rates did not significantly improve after CAMESA guideline publication. To maximize benefit and mitigate risks of these medications, there is a need to identify barriers to SGA monitoring.
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  • 文章类型: Consensus Development Conference
    2013年4月,来自意大利和以色列的自闭症领域的专家在耶路撒冷召开会议,讨论并最终确定早期诊断和干预自闭症谱系障碍(ASDs)的临床建议。在本文中,我们总结了这次意大利-以色列共识会议的结果。ASDs构成了一类严重和异质性的神经发育状况,由在早期出生时开始的非典型大脑发育引起。反映了许多遗传,神经生物学和环境影响。ASD的第一个临床症状在12至18个月大的儿童中开始明显。通常经过一段相对典型的出生后发育。最近的纵向研究表明,在整个童年和青春期的发展轨迹具有很大的多样性。一些干预方法已被证明可有效改善ASD的核心症状,即使该疾病的异质性和发育性使得只有一种特定的治疗方法对所有ASD儿童都是最好的。需要更多关于早期干预的随机对照试验(RCT),以确定最有效的策略,并在关键的早期干预时间段内提供最有效的资源分配。未来的研究应该集中在将生物表型与特定基因型联系起来。从而为诊断筛查工具的开发和治疗的个体化奠定了基础。
    On April 2013 experts in the field of autism from Italy and Israel convened in Jerusalem to discuss and finalize clinical recommendations for early diagnosis and intervention in Autism Spectrum Disorders (ASDs). In this paper, we summarize the results of this Italian-Israeli consensus conference. ASDs constitute a class of severe and heterogeneous neurodevelopmental conditions caused by atypical brain development beginning during early prenatal life, reflecting many genetic, neurobiological and environmental influences. The first clinical signs of ASDs begin to be evident in children between 12 and 18 months of age, often after a period of relatively typical postnatal development. Recent longitudinal studies reveal substantial diversity in developmental trajectories through childhood and adolescence. Some intervention approaches have been demonstrated to be effective in improving core symptoms of ASDs, even if the heterogeneity and developmental nature of the disorder make it implausible that only one specific treatment will be best for all children with ASDs. More randomized control trials (RCTs) on early intervention are needed to identify the most effective strategies and provide the most efficient allocation of resources during the critical early intervention time period. Future research should focus on linking biological phenotypes with specific genotypes, thus establishing a foundation for the development of diagnostic screening tools and individualization of treatments.
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