[Psychiatric issues of children and adults with autism spectrum disorders who remain undiagnosed].
[Psychiatric issues of children and adults with autism spectrum disorders who remain undiagnosed].
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[尚未确诊的患有自闭症谱系障碍的儿童和成人的精神问题]。
DOI：
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
T. Nakahachi
中科院分区：
文献类型：
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作者：
Y. Kamio;A. Moriwaki;Reiko Takei;N. Inada;Eiko Inokuchi;Hidetoshi Takahashi;T. Nakahachi
智力正常的自闭症谱系障碍(ASD)患者往往在童年后期或有时在成年后被诊断为自闭症谱系障碍，尽管有持续的症状。当这些患者去精神科诊所就诊时，由于缺乏准确的发育信息和混合的临床表现，诊断程序可能具有挑战性。对于那些有阈值以下自闭症症状的人来说也是如此。尽管阈值下ASD患者也有与ASD患者相似程度的社会适应困难，但这一群体的相对临床意义尚不清楚。在这里，来自全国学龄儿童的大量人口样本的数据被检查，以确定有阈值和阈值以下自闭症症状的儿童的精神需求。首先，社会反应性量表(SRS)评估的自闭症症状或特征在一般儿童群体中呈连续分布(n=22,529)，这表明没有证据表明自然差距可以将被诊断为自闭症的儿童与阈值以下或未受影响的儿童区分开来。其次，来自25,075名儿童的数据表明，有阈值的自闭症症状预示着高精神风险，如强项和困难问卷(SDQ；优势比[OR]200.52，95%可信区间[CI]：152.12-264.33)上的较高分数所表明的，而具有阈值以下自闭症症状的儿童表明相同(OR12.78，95%CI：11.5214.18)。有阈值自闭症症状预示情绪问题(OR 20.19，95%CI：17.00~24.00)，有阈值以下自闭症症状预测情绪问题(OR 5.90，95%CI：5.29~6.58)。第三，在2250名精神高危儿童中，大多数都有门槛或门槛下的自闭症症状(分别为21%和44%)。这些发现对这一患者群体的全面精神和发育评估和治疗具有重要意义，他们的诊断和治疗经常被推迟，有必要进行进一步的深入研究。
Individuals of normal intelligence with autism spectrum disorders (ASD) tend to be diagnosed with ASD late in childhood or sometimes in adulthood, despite a persistent symptomatology. When such patients visit psychiatric clinics for co-occurring psychiatric symptoms, the diagnostic procedure can be challenging due to a lack of accurate developmental information and a mixed clinical presentation. The same is true for those with subthreshold autistic symptoms. Although individuals with subthreshold ASD also have social adjustment difficulties of a similar degree to those with ASD, the relative clinical significance of this population is unclear. Here, data from a large national population sample of schoolchildren were examined to determine the psychiatric needs of children with threshold and subthreshold autistic symptoms. First, autistic symptoms or traits assessed by the Social Responsiveness Scale (SRS), a quantitative behavioral measure, showed a continuous distribution in the general child population (n = 22,529), indicating no evidence of a natural gap that could differentiate children diagnosed with ASD from subthreshold or unaffected children. Second, data from 25,075 children demonstrated that having threshold autistic symptoms predicted a high psychiatric risk, as indicated by higher scores on the Strengths and Difficulties Questionnaire (SDQ; odds ratio [OR] 200.52, 95% confidence interval [CI]: 152.12-264.33), and that having subthreshold autistic symptoms indicated the same (OR 12.78, 95% CI: 11.52-14.18). Having threshold autistic symptoms predicted emotional problems (OR 20.19, 95% CI: 17.00-24.00), as did having subthreshold autistic symptoms (OR 5.90, 95% CI: 5.29-6.58). Third, among 2,250 children at a high psychiatric risk, most had threshold or subthreshold autistic symptoms (21 and 44%, respectively). These findings have important implications for the comprehensive psychiatric and developmental evaluation and treatment of this patient population, whose diagnosis and treatment are often delayed, and a further in-depth study is warranted.