孩子自閉症怎麼辦？

孤獨症是什麼疾病

孤獨症譜系障礙，簡稱孤獨症或自閉症，是一種腦發育功能障礙性疾病，社會交流溝通和交往互動障礙是最常見的問題。同時，有孤獨症的孩子也經常會有異常的行為方式和興趣活動。孤獨症譜系障礙是一個廣義的術語，包括有孤獨症，廣泛性發育障礙和阿斯伯格綜合症等疾病。

值得注意的是，沒有任何兩個孤獨症的孩子的具有完全一樣的癥狀，他們的表現千差萬別，雖然他們都是存在類似的問題。孤獨症可以是輕度，中度和重度。輕度的孤獨症有時被稱為「高功能「。孤獨症譜系障礙是終身的，目前尚無治癒的療法； 但是，早期干預治療及支持可以成功地幫助孤獨症兒童充分發揮他們的潛力。

孤獨症的癥狀一般在發育早期出現，最常在出生後第2年被發現。但也可能更早，比如1歲以前, 常表現在缺少社會交流互動方面，比如微笑，眼神接觸等。但也有可能直到4-6歲或以上才變得明顯的而被家長或老師發現的，比如孤獨症表現最輕微的兒童。

What is Autism

Autism spectrum disorder (ASD) is a developmental disorder most commonly involving problems with communication and social interactions. Children with ASD also often have abnormal behaviours, interests and play. ASD is an umbrella term that covers classic autism, Pervasive Developmental Disorder (PDD), and Asperger"s syndrome.

It is important to know that no two children with ASD are exactly the same, although they may have similar problems. ASD can be mild, moderate or severe. Children with mild symptoms are sometimes referred to as "high functioning". ASD is a lifelong disorder with no cure. However, early intervention and support can be very successful in helping children with ASD reaching their full potential.

Symptoms of ASD generally present in the early developmental period. They are most commonly recognized in the second year of life, but may be present earlier before one year old. It is also be possible that symptoms in children with the mild phenotypes of ASD may not be apparent to parents or teachers until four to six years of age or later.

關於孤獨症的早期信號

孤獨症的一些早期癥狀常出現於出生後兩年內，有些孩子會表現出較多的這些徵兆，有的則只有數個而已。某些行為表現會隨著時間而改變，或是隨孩子年齡增長而更明顯。而且，如果發現有社交和語言能力的任何缺失都需要引起注意。

根據年齡和疾病程度，每個孤獨症的兒童出現以下列表中出的癥狀數目各不相同。如果爸爸媽媽發現自己的孩子有下面這些孤獨症警示信號中一些或較多的表現，那麼就需要去找兒科醫生幫忙安排進一步的評估， 以便於獲得後續的醫療服務和支持幫助。

About early signs of autism spectrum disorder

Some early signs of autism spectrum disorder (ASD) are usually seen in the first two years.　Some children have many of these early warning signs, whereas others might have only a few. Some behavior signs can change over time, or become clearer as children get older. Also, any loss of social or language skills during this period is cause for concern.

The number of signs a child has from each list below varies according to the age of the child and how severely the child is affected. If your child is showing some or many of the signs from the lists of red flags below, talk to your health professional about a developmental assessment as soon as possible. Getting a diagnosis is the first step towards helping your child and getting services and support.

社會交流溝通和交往互動：孤獨症的警示信號

社會交往互動

不會指物，不會拿起物體展示給他人或分享經歷的興趣快樂，不會表現出自己需要什麼東西－比如，不會指著一條狗，並且回頭注視你，以確保你也在看；或者在你的腿上落下一個玩具後直接就走開了，而不是拿起玩具看向你

對別人叫她的名字不是一直有反應

自言自語說話，而不是和你交談

回聲式重複她聽到過別人說的話，或電視里的話－比如，當你問她是不是要再多點飲料，他用回聲式回答「再多點飲料」

不理解簡單的單步指令－比如，「把積木給我」 或「指給我看狗」。

非語言交流

不會使用和解讀手勢和身體姿勢等非語言行為－比如，不會揮手再見，或不會模仿別人揮手再見的行為

不會用眼神接觸目光注視來獲得別人注意－比如，不會看看父母再看向零食以表現他想要。

社會關係和遊戲

對其他孩子不感興趣

不玩捉迷藏遊戲

不玩假裝遊戲 –比如，不會給泰迪熊喂飯。

Social communication: red flags for autism spectrum disorder

Social interaction

·doesn』t point to or hold up objects to show people things, share an experience or show that she wants something – for example, she doesn』t point to a dog and look back at you to make sure you』ve seen it too, or she drops a toy in your lap and walks away instead of holding it up and looking at you

·doesn』t consistently respond to her name

·doesn』t sound like she』s having a conversation with you when she babbles

·copies what she hears from others or from the TV – for example, when you ask if she wants more drink, she echoes back 『more drink』

·doesn』t understand simple one-step instructions – for example, 『Give the block to me』 or 『Show me the dog』.

Nonverbal communication

·doesn』t use gestures on his own – for example, he doesn』t wave bye-bye without being told to, or without copying someone else who is waving

·doesn』t use eye contact to get someone』s attention – for example, he doesn』t look at a parent then at a snack to show he wants it.

Relationships and play

·doesn』t show interest in other children

·doesn』t start games like peekaboo or pat-a-cake

·doesn』t do pretend play – for example, she doesn』t feed her teddy bear.

行為：孤獨症的警示信號

局限性興趣

對某些特定物體有濃厚強烈的興趣, 常常著迷於特定的玩具或物體 - 比如，重複按電燈開關，只玩汽車玩具

反覆用同一種刻板的方式玩玩具或物品，而不是玩具原本的遊戲方法 - 比如，只是轉動玩具車的輪子，而不是將車放在地板上玩假裝開車的遊戲

對不尋常的物體及活動有強烈的興趣 - 比如，引流管，金屬物體，或特定的電視廣告

對物體及活動局限於狹窄的興趣 -比如，把物品或玩具排列成行。

日常規律

孤獨症患兒對於日常規律的改變很難接受，需要每天例行同樣的常規。這可能表現在日常生活的各個方面，比如，需要總是按照特定的順序吃特定的食物，特定的方式入睡，或是從一個地方到另一個地方總是不偏離地遵循相同的路線和方式。當常規發生微小改變時會感到不安及痛苦以至於很難進行改變。

重複刻板的動作和行為

孤獨症的患兒常常有重複刻板或不尋常的的身體動作，比如，身體後屈 ，拍手，手指扭轉，搖擺，晃動，傾斜，走路掂腳尖。

感知覺異常

對感官體驗極端地敏感 -比如，容易對特定的聲音難過不安，或只吃特定味道和質地的食物

尋求感官的刺激 -比如，嘴上或臉上摩擦物體，或尋找振動的物體，或將手指放在眼睛的一側，以觀察光線的閃爍

全神貫注於邊緣、旋轉物體、閃亮的表面、燈、氣味、嗅或舔非食物性物體

明顯對疼痛淡漠。

Behaviour: red flags for autism spectrum disorder

Restricted interests

·has an intense interest in certain objects and gets 『stuck』 on particular toys or objects – for example, he』ll flick the light switch off and on repeatedly, or will play only with cars

·interacts with toys and objects in only one way, rather than more broadly or in the way toys were intended to be played with – for example, he only turns the wheels of a toy car rather than pretending to drive the car along the floor

·is very interested in unusual objects or activities – for example, drains, metal objects or specific TV ads

·focuses narrowly on objects and activities, like lining up objects.

Routines

·Children with ASD have significant difficulty with changes of routine. They need to follow same routine identically every day which may present in various aspects of daily life - for example, they need to always eat particular foods in a specific order, sleep in the same way, or to follow the same route from one place to another without deviation. They may easily upset and distress by small changes in routines and difficulty with transitions.

Repetitive and stereotyped behaviors

·The child repeats body movements or has unusual body movements, like back-arching, hand-flapping, finger twisting, rocking, swaying, dipping, and walking on his toes.

Sensory sensitivities

·is extremely sensitive to sensory experiences – for example, she gets easily upset by certain sounds, or will eat only foods with a certain texture and taste

·seeks sensory stimulation – for example, she rubs objects on her mouth, or face, or seeks vibrating objects like washing machines, or flutters her fingers to the side of her eyes to watch the light flicker.

·focus on edges, spinning objects, or shiny surfaces, lights, odors, sniffing or licking nonfood objects

·apparent indifference to pain

其他伴隨病症

智力損害

孤獨症兒童中,智力水平表現很不一致，從嚴重的智力障礙到高智商都有。大約四分之一智力正常，四分之三的孤獨症兒童有不同程度的智力損害。無論總體智力水平如何，其認知技能通常是不均衡的。言語技能通常弱於非言語技能。

語言障礙

孤獨症兒童口頭語言發育的延遲或完全缺乏。比如，患兒可能對別人叫自己的名字沒有回應，直到16個月還不會說一個單字。

口頭語言由重複單詞(模仿言語)或機械性的模仿單詞或對話組成， 而沒有正常地理解，並未作為交流的工具。

可能不能開始或繼續一段談話。

孤獨症兒童可能無法理解簡單的問題或指令。他們不進行嬰兒期和兒童期早期的簡單模仿遊戲，或者僅僅在脫離背景的情況下進行或以機械性方式進行。

Associated conditions

Intellectual ability

·Children with ASD can range from being severely disabled through to highly intelligent. About one child in four with ASD has an IQ in the normal range or above, but three out of four children with ASD will have some intellectual disability. The child"s level of ability is often uneven, with areas of strength and weakness. Verbal skills are usually weaker than nonverbal skills.

Language impairment

·delay in, or total lack of, the development of spoken language. For example, child may not respond to the calling of his name, doesn"t say single words by 16 months.

·repeat exactly what others say (echoing) or imitation of words or dialogue without understanding the meaning or use as a tool for communication.

·don"t start or can"t continue a conversation.

·may be unable to understand simple questions or directions. They don"t use toys or other objects to represent people or real life in pretend play, or do only out of context or in a mechanical way.

值得注意的是, 如果家長覺得有點擔心寶寶有類似的發育行為問題,與其上論壇和網友們討論糾結, 不如帶著寶寶先去諮詢一下兒科醫生是否需要看專科醫生, 聽力檢測，或是語言治療師。千萬不要自己妄下結論。如前文所述，畢竟孤獨症患兒中很多看上去不同尋常的行為在正常的嬰幼兒也會經常存在, 導致診斷有時會存在一定困難, 所以家長還是應該找兒科醫生諮詢一下寶寶的情況。 孤獨症是一個譜系障礙疾病, 每個患兒所表現的特徵各不相同，所以沒有一個單一的檢查或化驗可以明確診斷, 需要有包括兒科醫生, 心理醫生, 語言治療師的多學科的醫生團隊合作共同參與評估和診斷。

If you are concerned about aspects of your child"s behaviour and development, see your paediatrician and ask for a referral to a specialist pediatrician, audiologist, speech pathologist or psychologist. Do not try to make a diagnosis yourself. Many of the unusual behaviours that occur with ASD are often seen in normal toddlers, which makes the diagnosis quite difficult at times, but you should discuss this with your child"s doctor. The diagnosis of ASD requires a multi-disciplinary assessment. This means a team – consisting of a pediatrician, psychologist and/or speech pathologist – will assess your child. As features vary so much between children, there is no single or simple test for ASD.

作者：澳大利亞墨爾本大學醫學院兒科博士

百匯醫療（中國）兒科醫師

蔣本然

部分圖片摘自網路，如有侵權請告知，予以刪除。

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