The misnomer of 'high functioning autism': Intelligence is an imprecise predictor of functional abilities at diagnosis
The misnomer of 'high functioning autism': Intelligence is an imprecise predictor of functional abilities at diagnosis
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DOI：
10.1177/1362361319852831
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发表时间：
2020-01-01
期刊：
影响因子：
5.2
通讯作者：
Whitehouse, Andrew J. O.
中科院分区：
文献类型：
--
作者：
Alvares, Gail A.;Bebbington, Keely;Whitehouse, Andrew J. O.
“高功能自闭症”是一个术语，通常用于没有智力残疾的自闭症谱系障碍患者。随着时间的推移，尽管临床观察结果相互矛盾，但这个术语已经成为对更强的功能技能和更好的长期结果的期望的代名词。本研究探讨自闭症谱系障碍患者的适应行为、认知评估（智商）与诊断年龄之间的关系。参与者（n = 2225，年龄1-18岁）在诊断时被告知前瞻性登记，并根据存在智力残疾（n = 1041）或不存在智力残疾（n = 1184）分组。使用Vineland适应行为量表报告功能能力。回归模型表明，在控制了性别之后，智商是一个弱预测因子。而智障组的适应行为估计值接近报告的智商，Vineland适应行为量表得分明显低于无智障儿童的智商。随着诊断年龄的增加，所有儿童的智商和适应行为量表得分之间的差距仍然很大。这些数据表明，在诊断自闭症谱系障碍时，仅从智商来估计功能能力是不准确的，特别是对于那些没有智力残疾的人。我们认为，“高功能自闭症”是一个不准确的临床描述，如果仅仅基于智商的划分，这个术语应该在研究和临床实践中被放弃。
'High functioning autism' is a term often used for individuals with autism spectrum disorder without an intellectual disability. Over time, this term has become synonymous with expectations of greater functional skills and better long-term outcomes, despite contradictory clinical observations. This study investigated the relationship between adaptive behaviour, cognitive estimates (intelligence quotient) and age at diagnosis in autism spectrum disorder. Participants (n = 2225, 1-18 years of age) were notified at diagnosis to a prospective register and grouped by presence (n = 1041) or absence (n = 1184) of intellectual disability. Functional abilities were reported using the Vineland Adaptive Behaviour Scales. Regression models suggested that intelligence quotient was a weak predictor of Vineland Adaptive Behaviour Scales after controlling for sex. Whereas the intellectual disability group's adaptive behaviour estimates were close to reported intelligence quotients, Vineland Adaptive Behaviour Scales scores fell significantly below intelligence quotients for children without intellectual disability. The gap between intelligence quotient and Vineland Adaptive Behaviour Scales scores remained large with increasing age at diagnosis for all children. These data indicate that estimates from intelligence quotient alone are an imprecise proxy for functional abilities when diagnosing autism spectrum disorder, particularly for those without intellectual disability. We argue that 'high functioning autism' is an inaccurate clinical descriptor when based solely on intelligence quotient demarcations and this term should be abandoned in research and clinical practice.