孩子自闭症怎么办？

孤独症是什么疾病

孤独症谱系障碍，简称孤独症或自闭症，是一种脑发育功能障碍性疾病，社会交流沟通和交往互动障碍是最常见的问题。同时，有孤独症的孩子也经常会有异常的行为方式和兴趣活动。孤独症谱系障碍是一个广义的术语，包括有孤独症，广泛性发育障碍和阿斯伯格综合症等疾病。

值得注意的是，没有任何两个孤独症的孩子具有完全一样的症状，他们的表现千差万别，虽然他们都是存在类似的问题。孤独症可以是轻度，中度和重度。轻度的孤独症有时被称为“高功能”。孤独症谱系障碍是终身的，目前尚无治愈的疗法；但是，早期干预治疗及支持可以成功地帮助孤独症儿童充分发挥他们的潜力。

孤独症的症状一般在发育早期出现，最常在出生后第2年被发现。但也可能更早，比如1岁以前，常表现在缺少社会交流互动方面，比如微笑，眼神接触等。但也有可能直到4-6岁或以上才变得明显而被家长或老师发现的，比如孤独症表现最轻微的儿童。

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.

关于孤独症的早期信号

孤独症的一些早期症状常出现于出生后两年内，有些孩子会表现出较多的这些征兆，有的则只有数个而已。某些行为表现会随着时间而改变，或是随孩子年龄增长而更明显。而且，如果发现有社交和语言能力的任何缺失都需要引起注意。

根据年龄和疾病程度，每个孤独症的儿童出现以下列表中出的症状数目各不相同。如果爸爸妈妈发现自己的孩子有下面这些孤独症警示信号中一些或较多的表现，那么就需要去找儿科医生帮忙安排进一步的评估，以便于获得后续的医疗服务和支持帮助。

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.

社会交流沟通和交往互动：孤独症的警示信号

社会交往互动

不会指物，不会拿起物体展示给他人或分享经历的兴趣快乐，不会表现出自己需要什么东西－比如，不会指着一条狗，并且回头注视你，以确保你也在看；或者在你的腿上落下一个玩具后直接就走开了，而不是拿起玩具看向你。

对别人叫她的名字不是一直有反应

自言自语说话，而不是和你交谈

回声式重复她听到过别人说的话，或电视里的话－比如，当你问她是不是要再多点饮料，他用回声式回答“再多点饮料”。

不理解简单的单步指令－比如，“把积木给我” 或“指给我看狗”。

非语言交流

不会使用和解读手势和身体姿势等非语言行为－比如，不会挥手再见，或不会模仿别人挥手再见的行为。

不会用眼神接触目光注视来获得别人注意－比如，不会看看父母再看向零食以表现他想要。

社会关系和游戏

对其他孩子不感兴趣

不玩捉迷藏游戏

不玩假装游戏 –比如，不会给泰迪熊喂饭。

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.

行为：孤独症的警示信号

局限性兴趣

对某些特定物体有浓厚强烈的兴趣, 常常着迷于特定的玩具或物体-比如，重复按电灯开关，只玩汽车玩具。

反复用同一种刻板的方式玩玩具或物品，而不是玩具原本的游戏方法-比如，只是转动玩具车的轮子，而不是将车放在地板上玩假装开车的游戏。

对不寻常的物体及活动有强烈的兴趣-比如，引流管，金属物体，或特定的电视广告。

对物体及活动局限于狭窄的兴趣-比如，把物品或玩具排列成行。

日常规律

孤独症患儿对于日常规律的改变很难接受，需要每天例行同样的常规。这可能表现在日常生活的各个方面，比如，需要总是按照特定的顺序吃特定的食物，特定的方式入睡，或是从一个地方到另一个地方总是不偏离地遵循相同的路线和方式。当常规发生微小改变时会感到不安及痛苦以至于很难进行改变。

重复刻板的动作和行为

孤独症的患儿常常有重复刻板或不寻常的身体动作，比如，身体后屈，拍手，手指扭转，摇摆，晃动，倾斜，走路掂脚尖。

感知觉异常

对感官体验极端地敏感-比如，容易对特定的声音难过不安，或只吃特定味道和质地的食物。

寻求感官的刺激-比如，嘴上或脸上摩擦物体，或寻找振动的物体，或将手指放在眼睛的一侧，以观察光线的闪烁。

全神贯注于边缘、旋转物体、闪亮的表面、灯、气味、嗅或舔非食物性物体

明显对疼痛淡漠。

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

其他伴随病症

智力损害

孤独症儿童中，智力水平表现很不一致，从严重的智力障碍到高智商都有。大约四分之一智力正常，四分之三的孤独症儿童有不同程度的智力损害。无论总体智力水平如何，其认知技能通常是不均衡的。言语技能通常弱于非言语技能。

语言障碍

孤独症儿童口头语言发育的延迟或完全缺乏。比如，患儿可能对别人叫自己的名字没有回应，直到16个月还不会说一个单字。

口头语言由重复单词(模仿言语)或机械性的模仿单词或对话组成，而没有正常地理解，并未作为交流的工具。

可能不能开始或继续一段谈话。

孤独症儿童可能无法理解简单的问题或指令。他们不进行婴儿期和儿童期早期的简单模仿游戏，或者仅仅在脱离背景的情况下进行或以机械性方式进行。

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，如果家长觉得有点担心宝宝有类似的发育行为问题，与其上论坛和网友们讨论纠结，不如带着宝宝先去咨询一下儿科医生是否需要看专科医生，听力检测，或是语言治疗师。千万不要自己妄下结论。

如前文所述，毕竟孤独症患儿中很多看上去不同寻常的行为在正常的婴幼儿也会经常存在，导致诊断有时会存在一定困难。所以家长还是应该找儿科医生咨询一下宝宝的情况。孤独症是一个谱系障碍疾病，每个患儿所表现的特征各不相同，所以没有一个单一的检查或化验可以明确诊断, 需要有包括儿科医生、心理医生、语言治疗师的多学科的医生团队合作共同参与评估和诊断。

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 | 澳大利亚墨尔本大学医学院儿科博士

百汇医疗（中国）儿科医师

蒋本然