), 朱慧敏1, 连福鑫2 1浙江师范大学杭州幼儿师范学院, 杭州 311231
2杭州师范大学心理科学研究院, 杭州 311121
收稿日期:2017-11-03出版日期:2018-08-15发布日期:2018-07-02通讯作者:林云强E-mail:skellig@126.com基金资助:教育部人文社会科学研究青年基金项目资助(17YJC880058)Can children with autism spectrum disorder recover? Research evidence based on “optimal outcomes” and residual deficits of individuals in spectrum
LIN Yunqiang1(), ZHU Huimin1, LIAN Fuxin2 1 Hangzhou College for Kindergarten Teachers, Zhejiang Normal University, Hangzhou 311231, China
2 Institutes of Psychology Sciences, Hangzhou Normal University, Hangzhou 311121, China
Received:2017-11-03Online:2018-08-15Published:2018-07-02Contact:LIN Yunqiang E-mail:skellig@126.com摘要/Abstract
摘要： 自闭症谱系障碍预后效果不佳, 通常被认为是一种伴随终生的疾病。不过随着研究的拓展和深入, 部分早期被诊断为自闭症的儿童, 随着年龄增长和相关干预措施的介入, 其认知、适应性等方面均可达到正常发展水平, 并且不再符合自闭症的诊断标准, 即达到了“最佳结果”。但多数个体仍然存在不同程度的剩余缺陷。本文以自闭症预后结果评定和“最佳结果”定义演变为切入点, 分析“最佳结果”个体剩余缺陷的具体表现, 并梳理此类群体的个体特征与结果预测因素, 以期能为自闭症个体的系统干预提供有效依据。
图/表 1
表1自闭症研究之“最佳结果”定义
| 文献 | 历史诊断 | 当前结果 | ||||
|---|---|---|---|---|---|---|
| 诊断与评估 | 教育安置和接受服务 | 认知能力 | 适应性 | |||
| 符合DSM-IV (1994)中PDD的标准。 | 符合DSM-IV (1994)中PDD的标准。 | (1)在与年龄相符的普通班级就读; (2)教师和家长认为和同龄人无差异; (3)不需接受特殊教育支持。 | ||||
| 符合DSM-IV (1994)中PDD-NOS或AD的标准。 | 不符合任何ASD的诊断标准。 | 在认知、语言和适应能力的标准化测试中表现正常。 | ||||
| (1)儿童在童年早期(如5岁)由专家(如至少一半的实践针对自闭症)诊断为ASD; (2)存在早期语言发育迟缓(18个月无单词, 或者24个月无词组); (3)经研究团队对早期报告或视频录像复审, 确认有ASD史。 | (1)不符合任何PDD的诊断标准; (2) ADOS社交和沟通领域分数不符合ASD标准。 | (1)可接受针对注意缺陷、组织困难、特定学习困难的特殊教育服务; (2)无需接受针对自闭症的服务; (3)在普通班级就读并且不接受个人辅助(individual assistant)。 | VIQ、PIQ、FSIQ均在78分及以上。 | VCSS分数在78分及以上。 | ||
| 由专门研究ASD的专家确诊有ASD史, 并且符合ADI-R中关于ASD的诊断标准。 | 不再符合ADOS-G中的ASD诊断标准。 | (1)普通班级就读; (2)学校人员不认为其有自闭症; (3)每周所接受的所有干预或治疗时间不超过1小时, 并且不再接受和学业相关的援助。 | FSIQ大于70分。 | |||
| (1)父母提供5岁之前由专门研究ASD的专家确认为ASD的书面证明; (2)存在早期语言发育迟缓(18个月无单词, 或者24个月无词组)。 | 不符合ADOS中ASD诊断标准。 | (1)普通班级读书; (2)不接受一对一帮助; (3)不接受专门针对ASD的教育服务。 | VIQ、PIQ、FSIQ均大于77分。 | 有正常发展的朋友; VCSS社交和沟通分数大于77分。 | ||
表1自闭症研究之“最佳结果”定义
| 文献 | 历史诊断 | 当前结果 | ||||
|---|---|---|---|---|---|---|
| 诊断与评估 | 教育安置和接受服务 | 认知能力 | 适应性 | |||
| 符合DSM-IV (1994)中PDD的标准。 | 符合DSM-IV (1994)中PDD的标准。 | (1)在与年龄相符的普通班级就读; (2)教师和家长认为和同龄人无差异; (3)不需接受特殊教育支持。 | ||||
| 符合DSM-IV (1994)中PDD-NOS或AD的标准。 | 不符合任何ASD的诊断标准。 | 在认知、语言和适应能力的标准化测试中表现正常。 | ||||
| (1)儿童在童年早期(如5岁)由专家(如至少一半的实践针对自闭症)诊断为ASD; (2)存在早期语言发育迟缓(18个月无单词, 或者24个月无词组); (3)经研究团队对早期报告或视频录像复审, 确认有ASD史。 | (1)不符合任何PDD的诊断标准; (2) ADOS社交和沟通领域分数不符合ASD标准。 | (1)可接受针对注意缺陷、组织困难、特定学习困难的特殊教育服务; (2)无需接受针对自闭症的服务; (3)在普通班级就读并且不接受个人辅助(individual assistant)。 | VIQ、PIQ、FSIQ均在78分及以上。 | VCSS分数在78分及以上。 | ||
| 由专门研究ASD的专家确诊有ASD史, 并且符合ADI-R中关于ASD的诊断标准。 | 不再符合ADOS-G中的ASD诊断标准。 | (1)普通班级就读; (2)学校人员不认为其有自闭症; (3)每周所接受的所有干预或治疗时间不超过1小时, 并且不再接受和学业相关的援助。 | FSIQ大于70分。 | |||
| (1)父母提供5岁之前由专门研究ASD的专家确认为ASD的书面证明; (2)存在早期语言发育迟缓(18个月无单词, 或者24个月无词组)。 | 不符合ADOS中ASD诊断标准。 | (1)普通班级读书; (2)不接受一对一帮助; (3)不接受专门针对ASD的教育服务。 | VIQ、PIQ、FSIQ均大于77分。 | 有正常发展的朋友; VCSS社交和沟通分数大于77分。 | ||
参考文献 49
| 1 | American Psychiatric Association. ( 2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association. |
| 2 | Anderson D. K., Liang J. W., & Lord C . ( 2014). Predicting young adult outcome among more and less cognitively able individuals with autism spectrum disorders. Journal of Child Psychology and Psychiatry, 55( 5), 485-494. doi: 10.1111/jcpp.12178URL |
| 3 | Barbaro, J., & Dissanayake, C . ( 2016). Diagnostic stability of autism spectrum disorder in toddlers prospectively: Identified in a community-based setting: Behavioural characteristics and predictors of change over time. Autism, 21( 7), 830-840. |
| 4 | Botting, N . ( 2002). Narrative as a tool for the assessment of linguistic and pragmatic impairments. Child Language Teaching and Therapy, 18( 1), 1-21. doi: 10.1191/0265659002ct224oaURL |
| 5 | Canfield A. R., Eigsti I. M., de Marchena A., & Fein D . ( 2016). Story goodness in adolescents with autism spectrum disorder (ASD) and in optimal outcomes from ASD. Journal of Speech, Language, and Hearing Research, 59( 3), 533-545. doi: 10.1044/2015_JSLHR-L-15-0022URL |
| 6 | Fein D., Barton M., Eigsti I. M., Kelley E., Naigles L., Schultz R. T., .. Tyson K . ( 2013). Optimal outcome in individuals with a history of autism. Journal of Child Psychology and Psychiatry, 54( 2), 195-205. doi: 10.1111/jcpp.12037URL |
| 7 | Fein D., Dixon P., Paul J., & Levin H . ( 2005). Brief report: Pervasive developmental disorder can evolve into ADHD: Case illustrations. Journal of Autism and Developmental Disorders, 35( 4), 525-534. doi: 10.1007/s10803-005-5066-3URL |
| 8 | Geurts, H. M., & Embrechts, M . ( 2010). Pragmatics in pre-schoolers with language impairments. International Journal of Language & Communication Disorders, 45( 4), 436-447. |
| 9 | Granpeesheh D., Dixon D. R., Tarbox J., Kaplan A. M., & Wilke A. E . ( 2009). The effects of age and treatment intensity on behavioral intervention outcomes for children with autism spectrum disorders. Research in Autism Spectrum Disorders, 3( 4), 1014-1022. doi: 10.1016/j.rasd.2009.06.007URL |
| 10 | Helt M., Kelley E., Kinsbourne M., Pandey J., Boorstein H., Herbert M., .. Fein D . ( 2008). Can children with autism recover? If so, how? Neuropsychology Review, 18( 4), 339-366. doi: 10.1007/s11065-008-9075-9URL |
| 11 | Henninger, N. A., & Taylor, J. L . ( 2013). Outcomes in adults with autism spectrum disorders: A historical perspective. Autism, 17( 1), 103-116. doi: 10.1177/1362361312441266URL |
| 12 | Howlin P., Goode S., Hutton J., & Rutter M . ( 2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45( 2), 212-229. doi: 10.1111/jcpp.2004.45.issue-2URL |
| 13 | Howlin P., Mawhood L., & Rutter M . ( 2000). Autism and developmental receptive language disorder--a follow-up comparison in early adult life. II: Social, behavioural, and psychiatric outcomes. Journal of Child Psychology and Psychiatry, 41( 5), 561-578. doi: 10.1111/1469-7610.00643URL |
| 14 | Howlin, P., & Moss, P . ( 2012). Adults with autism spectrum disorders. Canadian Journal of Psychiatry, 57( 5), 275-283. doi: 10.1177/070674371205700502URL |
| 15 | Irvine C. A., Eigsti I. M., & Fein D. A . ( 2016). Uh, um, and autism: Filler disfluencies as pragmatic markers in adolescents with optimal outcomes from autism spectrum disorder. Journal of Autism & Developmental Disorders, 46( 3), 1061-1070. |
| 16 | Kanner, L . ( 1943). Autistic disturbances of affective contact. Childhood Psychosis, 2, 217-250. |
| 17 | Kanner, L . ( 1971). Follow-up study of eleven autistic children originally reported in 1943. Journal of Autism & Childhood Schizophrenia, 1( 2), 119-145. |
| 18 | Kelley E., Naigles L., & Fein D . ( 2010). An in-depth examination of optimal outcome children with a history of autism spectrum disorders. Research in Autism Spectrum Disorders, 4( 3), 526-538. doi: 10.1016/j.rasd.2009.12.001URL |
| 19 | Kelley E., Paul J. J., Fein D., & Naigles L. R . ( 2006). Residual language deficits in optimal outcome children with a history of Autism. Journal of Autism and Developmental Disorders, 36( 6), 807-828. doi: 10.1007/s10803-006-0111-4URL |
| 20 | Kirby, A. V . ( 2016). Parent expectations mediate outcomes for young adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46( 5), 1643-1655. doi: 10.1007/s10803-015-2691-3URL |
| 21 | Kleinman J. M., Ventola P. E., Pandey J., Verbalis A. D., Barton M., Hodgson S., .. Fein D . ( 2008). Diagnostic stability in very young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 38( 4), 606-615. doi: 10.1007/s10803-007-0427-8URL |
| 22 | Lake J. K., Humphreys K. R., & Cardy S . ( 2011). Listener vs. speaker-oriented aspects of speech: Studying the disfluencies of individuals with autism spectrum disorders. Psychonomic Bulletin & Review, 18( 1), 135-140. |
| 23 | Levy S. E., Giarelli E., Lee L. C., Schieve L. A., Kirby R. S., Cunniff C., .. Rice C. E . ( 2010). Autism spectrum disorder and co-occurring developmental, psychiatric, and medical conditions among children in multiple populations of the United States. Journal of Developmental and Behavioral Pediatrics, 31( 4), 267-275. doi: 10.1097/DBP.0b013e3181d5d03bURL |
| 24 | Lovaas, O. I . ( 1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting & Clinical Psychology, 55( 1), 3-9. |
| 25 | MacDonald R., Parry-Cruwys D., Dupere S., & Ahearn W . ( 2014). Assessing progress and outcome of early intensive behavioral intervention for toddlers with autism. Research in Developmental Disabilities, 35( 12), 3632-3644. doi: 10.1016/j.ridd.2014.08.036URL |
| 26 | Magiati I., Tay X. W., & Howlin P . ( 2014). Cognitive, language, social and behavioural outcomes in adults with autism spectrum disorders: A systematic review of longitudinal follow-up studies in adulthood. Clinical Psychology Review, 34( 1), 73-86. doi: 10.1016/j.cpr.2013.11.002URL |
| 27 | Matson, J. L., & Goldin, R. L . ( 2014). Early intensive behavioral interventions: Selecting behaviors for treatment and assessing treatment effectiveness. Research in Autism Spectrum Disorders, 8( 2), 138-142. doi: 10.1016/j.rasd.2013.11.005URL |
| 28 | Mayo J., Chlebowski C., Fein D. A., & Eigsti I. M . ( 2013). Age of first words predicts cognitive ability and adaptive skills in children with ASD. Journal of Autism and Developmental Disorders, 43( 2), 253-264. doi: 10.1007/s10803-012-1558-0URL |
| 29 | Moulton E., Barton M., Robins D. L., Abrams D. N., & Fein D . ( 2016). Early characteristics of children with ASD who demonstrate optimal progress between age two and four. Journal of Autism & Developmental Disorders, 46( 6), 2160-2173. |
| 30 | Mraz K. D., Dixon J., Dumont-Mathieu T., & Fein D . ( 2009). Accelerated head and body growth in infants later diagnosed with autism spectrum disorders: A comparative study of optimal outcome children. Journal of Child Neurology, 24( 7), 833-845. doi: 10.1177/0883073808331345URL |
| 31 | Mukaddes N. M., Tutkunkardas M. D., Sari O., Aydin A., & Kozanoglu P . ( 2014). Characteristics of children who lost the diagnosis of autism: A sample from Istanbul, Turkey. Autism Research and Treatment, 2014, Article ID 472120. |
| 32 | Mundy, P . ( 1993). Normal versus high-functioning status in children with autism. American Journal on Mental Retardation, 97( 4), 381-384. |
| 33 | Narzisi A., Grossi E., Buscema M., Calderoni S., & Muratori F . ( 2015). Outcome predictors in autism spectrum disorders preschoolers undergoing treatment as usual: Insights from an observational study using artificial neural networks. Neuropsychiatric Disease and Treatment, 11, 1587-1599. |
| 34 | Orinstein A. J., Helt M., Troyb E., Tyson K. E., Barton M. L., Eigsti I., .. Fein D. A . ( 2014). Intervention for optimal outcome in children and adolescents with a history of autism. Journal of Developmental & Behavioral Pediatrics, 35( 4), 247-256. |
| 35 | Orinstein A. J., Suh J., Porter K., De Yoe K. A., Tyson K. E., Troyb E., .. Fein D. A . ( 2015). Social function and communication in optimal outcome children and adolescents with an autism history on structured test measures. Journal of Autism and Developmental Disorders, 45( 8), 2443-2463. doi: 10.1007/s10803-015-2409-6URL |
| 36 | Orinstein A., Tyson K. E., Suh J., Troyb E., Helt M., Rosenthal M., .. Fein D. A . ( 2015). Psychiatric symptoms in youth with a history of autism and optimal outcome. Journal of Autism and Developmental Disorders, 45( 11), 3703-3714. doi: 10.1007/s10803-015-2520-8URL |
| 37 | Perry A., Cummings A., Geier J. D., Freeman N. L., Hughes S., Managhan T., .. Williams J . ( 2011). Predictors of outcome for children receiving intensive behavioral intervention in a large, community-based program. Research in Autism Spectrum Disorders, 5( 1), 592-603. doi: 10.1016/j.rasd.2010.07.003URL |
| 38 | Rutter, M., & Lockyer, L . ( 1967). A five to fifteen year follow-up study of infantile psychosis. I. Description of sample. The British Journal of Psychiatry, 113( 504), 1169-1182. doi: 10.1192/bjp.113.504.1169URL |
| 39 | Sallows, G. O., & Graupner, T. D . ( 2005). Intensive behavioral treatment for children with autism: Four-year outcome and predictors. American Journal of Mental Retardation, 110( 6), 417-438. doi: 10.1352/0895-8017(2005)110[417:IBTFCW]2.0.CO;2URL |
| 40 | Steinhausen H. C., Mohr Jensen C., & Lauritsen M. B . ( 2016). A systematic review and meta-analysis of the long-term overall outcome of autism spectrum disorders in adolescence and adulthood. Acta Psychiatrica Scandinavica, 133( 6), 445-452. doi: 10.1111/acps.2016.133.issue-6URL |
| 41 | Suh J., Eigsti I. M., Naigles L., Barton M., Kelley E., & Fein D . ( 2014). Narrative performance of optimal outcome children and adolescents with a history of an autism spectrum disorder (ASD). Journal of Autism and Developmental Disorders, 44( 7), 1681-1694. doi: 10.1007/s10803-014-2042-9URL |
| 42 | Suh J., Orinstein A., Barton M., Chen C. M., Eigsti I. M., Ramirez-Esparza N., & Fein D . ( 2016). Ratings of broader autism phenotype and personality traits in optimal outcomes from autism spectrum disorder. Journal of Autism and Developmental Disorders, 46( 11), 3505-3518. doi: 10.1007/s10803-016-2868-4URL |
| 43 | Sutera S., Pandey J., Esser E. L., Rosenthal M. A., Wilson L. B., Barton M., .. Fein D . ( 2007). Predictors of optimal outcome in toddlers diagnosed with autism spectrum disorders. Journal of Autism and Developmental Disorders, 37( 1), 98-107. doi: 10.1007/s10803-006-0340-6URL |
| 44 | Tek S., Mesite L., Fein D., & Naigles L . ( 2014). Longitudinal analyses of expressive language development reveal two distinct language profiles among young children with autism spectrum disorders. Journal of Autism & Developmental Disorders, 44( 1), 75-89. |
| 45 | Troyb E., Orinstein A., Tyson K., Eigsti I. M., Naigles L., & Fein D . ( 2014). Restricted and repetitive behaviors in individuals with a history of ASDs who have achieved optimal outcomes. Journal of Autism and Developmental Disorders, 44( 12), 3168-3184. doi: 10.1007/s10803-014-2182-yURL |
| 46 | Troyb E., Orinstein A., Tyson K., Helt M., Eigsti I. M., Stevens M., & Fein D . ( 2014). Academic abilities in children and adolescents with a history of autism spectrum disorders who have achieved optimal outcomes. Autism, 18( 3), 233-243. doi: 10.1177/1362361312473519URL |
| 47 | Tyson K., Kelley E., Fein D., Orinstein A., Troyb E., Barton M., .. Rosenthal M . ( 2014). Language and verbal memory in individuals with a history of autism spectrum disorders who have achieved optimal outcomes. Journal of Autism and Developmental Disorders, 44( 3), 648-663. doi: 10.1007/s10803-013-1921-9URL |
| 48 | Young E. C., Diehl J. J., Morris D., Hyman S. L., & Bennetto L . ( 2005). The use of two language tests to identify pragmatic language problems in children with autism spectrum disorders. Language Speech & Hearing Services in Schools, 36( 1), 62-72. |
| 49 | Zwaigenbaum L., Bryson S. E., Brian J., Smith I. M., Roberts W., Szatmari P., … Vaillancourt T . ( 2016). Stability of diagnostic assessment for autism spectrum disorder between 18 and 36 months in a high-risk cohort. Autism Research, 9( 7), 790-800. doi: 10.1002/aur.1585URL |
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| [1] | 常欣;刘雨; 王沛; 张佳玮. 音乐干预对自闭症儿童语言障碍的影响[J]. 心理科学进展, 2016, 24(9): 1391-1397. |
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