Autism Spectrum Disorder

孤獨癥譜系障礙

Even though everyone develops at slightly different paces,almost everyone hits the same general developmental milestones and learns the same sets of skills at about the same time,more or less.

盡管每個人發(fā)育的進程略有不同，但大多數(shù)人都會經(jīng)歷相同的發(fā)育階段，在差不多相同的時間學會相同的技能，或早或晚，大體相同。

These are things like language and communication,socializing,cognitive skills problem solving,and physical milestones like walking,crawling and fine motor skills,all of which progress as the brain develops.

這些技能包括語言交流能力、社交能力、認知能力如問題解決能力，還有軀體運動能力的發(fā)育，比如走、爬和精細運動能力等。所有這些能力都會隨著大腦的發(fā)育而形成。

If one of these doesn't develop as scheduled,depending on the severity,it may be described as a type of neurodevelopmental disorder,neuro referring to the brain.

假如某些能力沒能按期形成，根據(jù)嚴重程度，可能會被診斷為神經(jīng)發(fā)育障礙的一種。neuro指大腦。（前綴neuro-）

Especially when certain skills related to socializing and communicating don't proceed as normally,it can result in isolation,which is where the name autism originated,since auto means self,so autism refers to a condition where somebody might be removed from social interaction and communication,leaving them alone or isolated.

如果與社會交往、交流有關(guān)的能力沒有正常發(fā)育，患者將陷入孤立的狀態(tài)，這也是孤獨癥名字的由來。auto的意思是自己（前綴aut-），所以孤獨癥指一個人抽離于社交互動和社交交流，陷入孤立隔離的狀態(tài)。

Before 2013,the diagnostic and statistical manual for mental disorders,the fourth edition or the DSM-Ⅳ,described autism as one of several pervasive developmental disorders,which also includes Asperger syndrome,childhood disintegrative disorder and those not otherwise specified,or PDD-NOS.

早在2013年以前，《精神障礙診斷與統(tǒng)計手冊第四版》，即DSM-Ⅳ，將兒童孤獨癥歸入廣泛性發(fā)育障礙中。后者還包括了阿斯伯格綜合征、兒童期瓦解性障礙和待分類的廣泛性發(fā)育障礙（簡稱PDD-NOS）。

Asperger syndrome was used for children that appeared to have characteristics of autism like difficulties with social interactions or non-verbal communication,but don't generally have significant delays in language or cognitive development,and are therefore Asperger's syndrome was sometimes refereed to as a high-functioning form of autism.

患阿斯伯格綜合征的孩子具有兒童孤獨癥的部分特征，如在社交交往和非語言交流中存在困難，但語言和認知能力的發(fā)育一般沒有明顯推遲。因此阿斯伯格綜合征有時用來指孤獨癥的高功能形式。

Childhood disintegrative disorder was used to describe late onset of developmental delays,so these children develop normally for their age,but then they seem to lose the acquired social and communication skills sometime between age 2 and 10.

兒童期瓦解性障礙是一種遲發(fā)的發(fā)育遲緩，患兒的發(fā)育情況一開始與其年齡相符，但在2~10歲的某個時候會喪失已經(jīng)習得的社交和交流能力。

Pervasive developmental disorder-not otherwise specified is essentially a catch-all category in which patients meet some,but not all features of autism,Asperger's syndrome or childhood disintegrative disorder.

待分類的廣泛性發(fā)育障礙本質(zhì)上是一個包羅萬象的分類，包括了那些不完全負荷兒童孤獨癥、阿斯伯格綜合征和兒童期瓦解性障礙的情況。

Researchers found,however,that separate diagnoses of these pervasive developmental disorders weren't consistent across different clinics,since they tend to have very similar signs and symptoms.

然而研究者發(fā)現(xiàn)，對廣泛性發(fā)育障礙的單獨診斷，在不同診所并不一致，因為它們有著非常相似的體征和癥狀。

As of 2013,the DSM-Ⅴ,a new revised edition,removed these terms and replaced them with autism spectrum disorder or ASD which encompasses all the previous pervasive developmental disorders but uses a scale,or a spectrum,that differentiates based on severity of two major areas—social communication and interaction deficits and restrictive or repetitive behavior,interests and activities.

到了2013年，新修訂的DSM-Ⅴ刪除了這些術(shù)語，取而代之的是孤獨癥譜系障礙，簡稱ASD，它涵蓋了先前所有的廣泛性發(fā)育障礙，但使用了一個范圍，或者說譜系，根據(jù)兩個主要方面的嚴重程度對疾病進行區(qū)分——社交交流和社交互動缺陷；受限的、重復(fù)的行為模式、興趣或活動。

• For the social and communication area,there are four subcategories that clinicians look for deficits.
• 在社交和交流方面，臨床醫(yī)生可以在四個子方面查看患兒是否存在缺陷。

1.The first is social reciprocity,which refers to how children respond or reciprocate in social interactions.

首先是社交互動，即兒童如何在社交交往中進行反應(yīng)和互動。

So like how the behavior of one person influences the other,and vice versa.

比如一個人的行為如何影響另一個人，反之亦然。

An example impairment in this area might be preferring to be alone and not taking a role in social games.

在這方面受損的一個例子可能是，患兒更喜歡獨處，且不愿在社交游戲中扮演角色。

2.A second area of potential deficit is joint attention,which is the state of wanting to share an interest with someone else,so it's like"Hey!Check out this awesome thing I found".

第二個可能存在缺陷的領(lǐng)域是共同注意，即想要跟別人分享興趣的狀態(tài)，比如說：“嘿！你看我找到了什么好東西！”

So an example of impairment might be a child not sharing their interests or amusement in an object with a a parent.

受損的例子可能是孩子不把對事物的興趣和得到的興趣與父母分享。

3.Next there's bonverbal communication,which refers to difficulties either using nonverbal communication themselves or interpreting nonverbal cues from someone else.

接下來是非語言交流，即自己難以使用非語言交流，也難以理解別人的非語言提示。

So maybe the child won't put their arms out when they want to be picked up,or they won't be able to tell when a parent's upset,even if the parent's frowning and crossing their arms.

這樣的孩子可能在想被抱起的時候卻不伸出雙手，或者看不出父母正在生氣，即使父母皺著眉頭叉著雙手。

4.The last subcategory of communication deficits is in social relationships,so the children have trouble developing and maintaining relationships.

最后一個子方面是在社會關(guān)系中的交流缺陷，這些孩子在發(fā)展、維持人際關(guān)系上存在困難。

So maybe the child has a hard time making friends,or they're able to make friends but their behavior tends to drive them away.

他們可能很難交到朋友，或者交到了朋友，但他們的行為卻傾向于把朋友趕走。

• The other major area of deficit is called restricted and repetitive behaviors—and this category's category's pretty broad and can include a whole bunch of behaviors.
• 另一個主要方面的缺陷叫做受限、重復(fù)的行為模式。這是一個十分廣泛的分類，包括一大堆行為模式。

Some being more well-known or characterized than others,like lining up toys in a ritualistic sort of way or flapping one's hands,or imitating words or phrases.

有些廣為人知、容易辨認，比如用固定的、儀式化的方式排列玩具，或者拍打自己的手，模仿單詞或短語。

The child might be fixed on certain routines,like taking the same route every day to school or they might have restricted patterns of interest,like having a very specific and in-depth knowledge of the Titanic or vacuum cleaners.

這些孩子可能會固守一些慣例，比如說每天走同樣的路線去學校，或者可能有高度受限、固定的興趣，比如對泰坦尼克號或真空吸塵器有十分詳細、深入的了解。

Children with autism spectrum disorder might exhibit one or more of these deficits,and vary in how severe the deficit is.

患有ASD的兒童可能有一種或多種上述的缺陷，缺陷的嚴重程度也各異。

It's important to remember that each child with autism spectrum disorder is going to have a different spectrum of symptoms and deficits.

重要的是要記住，每個患有ASD的兒童都會有不同的癥狀和缺陷。

Typically clinicians will try to observe these behaviors in the child,looking for these possible deficits.

正常來說臨床醫(yī)生會通過觀察孩子的行為，尋找可能存在的缺陷。

Since these behaviors are often well-known by the child's caretakers than they are by the clinicians,like their parents or their teachers,a meaningful diagnosis of autism spectrum disorder relies heavily on listening to what other's are observing at home or in school.

由于患兒的看護者往往比臨床醫(yī)生更清楚其行為表現(xiàn)，比如患兒的父母、老師，因此對ASD正確的診斷，十分依賴于傾聽他們在家里或?qū)W校觀察到的東西。

They might be given severity scores in each area,which can help determine how much support the child's going to need.

醫(yī)生可能會給每個主要方面的嚴重程度評分，以幫助決定歡而需要多大程度而支持。

For example,a severity level 1 would indicate the child needs some support.

舉個例子，嚴重程度處于水平1意味著患兒需要一些支持。

For social communication,they might speak in full sentences and engage in communication,but normal back and forth conversation with others just doesn't seem to work.

在社交交流方面，他們可能可以說出完整的句子，能夠參與交流，但是沒辦法進行正常的往來對話。

For repetitive and restrictive behaviors,they might have difficult switching between activities.

在受限、重復(fù)的行為模式方面，他們可能難以在不同的活動間切換。

On the other side of the spectrum,a level 3 severity means the child needs very substantial support and on the social communication side,they might display few words of intelligible speech and rarely initiate interaction with others.

在譜系的另一端，嚴重程度水平3意味著患兒需要大量支持，在社交交往方面，他們可能只會講幾個能被聽懂的字， 并且很少啟動社交互動。

For repetitive behaviors,they might be extremely resistant to change,and their behaviors seriously interfere with daily life.

在重復(fù)行為模式方面，他們可能極度拒絕改變，并且其行為嚴重阻礙了正常生活。

It's thought that using this scale of symptoms,as opposed to differentiating between pervasive developmental disorders,will help give a more accurate and medically useful way to diagnose individuals,for example,those with what was previously described as Asperger's syndrome would likely fall closer to severity level one than severity level three.

人們認為使用這樣的癥狀范圍，而非使用廣泛性發(fā)育障礙，將有助于提供更準確、更有臨床意義的個體診斷，比如先前被診斷為阿斯伯格綜合征的孩子，將更接近嚴重程度水平1而非水平3。

Generally speaking,ASD's thought to have a genetic cause,which ultimately affects brain development,specifically areas that affect social and communication behaviors.

一般認為ASD的發(fā)病具有遺傳因素，后者從根本上影響了大腦發(fā)育，特別是與社交和交流行為有關(guān)的區(qū)域。

Which genes or combination of genes that are affected in ASD,though,is still very much a mystery.

但哪些基因或基因組合會影響ASD的發(fā)病仍然是一個謎。

In addition,there are many environmental triggers that have been explored,but at the moment,there are no clear risk factors that have been identified.

此外，人們探索了許多環(huán)境誘因，但就目前來說，還沒有發(fā)現(xiàn)明確的風險因素。

With that said,there's also no cure for ASD,and treatment or management has to be specifically and carefully tailored to each child,and this includes things like specialized educational programs and behavior therapy that all seek to maximize quality of life and functional independence.

這也意味著目前ASD沒有治愈手段，而對患兒的治療和管理，需要為每個孩子量身定做，包括專門的教育計劃和行為療法，以期最大化地提高生命質(zhì)量和實現(xiàn)功能獨立。

注：

孤獨癥，即自閉癥。

在我國，其精神病學專業(yè)規(guī)范名詞為孤獨癥，

香港和臺灣地區(qū)習慣稱其為自閉癥。

國際上將典型孤獨癥、不典型孤獨癥和阿斯伯格綜合征等統(tǒng)稱為孤獨癥譜系障礙。

目前孤獨癥的診斷標準有：

• 國際的診斷標準DSM-Ⅴ
• WHO的診斷標準ICD-Ⅺ
• 中國的診斷標準CCMD-Ⅲ

國內(nèi)一般采用DSM-Ⅴ進行診斷