An 11-year-old boy with Asperger's disorder presenting with aggression.
An 11-year-old boy with Asperger's disorder presenting with aggression.
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一名患有阿斯伯格症的 11 岁男孩，表现出攻击性。
DOI：
10.1176/appi.ajp.2013.12121611
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Frank,GuidoKW
中科院分区：
文献类型：
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作者：
Frank,GuidoKW
“艾伦”是一名 11 岁男孩，3 年前首次来我们诊所就诊。入院时，父母的主要抱怨是艾伦在家里的身体攻击行为，尤其是对他的母亲，以及在学校与孩子和老师打架。据报道，艾伦达到了他早期运动和认知发展的里程碑，但他在幼儿时期表现出控制脾气和忍受挫折的困难，有“严重痉挛”并咬其他孩子。在学前班，艾伦的行为通常没有明显的攻击性，除非他的母亲在那里做志愿者。据他的父母报告，在幼儿园，他的行为是在一位非常遵守纪律和结构的老师的帮助下管理的，但第二年，他的一年级老师提供的结构要少得多，艾伦开始再次与其他孩子打架。他在家里的行为也变得更糟。例如，他会和邻居男孩打架，“孩子们会互相抓伤。”父母当时就开始了家庭咨询，但这并没有减少问题行为。 据报道，在二年级的第一个三个月结束时，艾伦“失去了它”。家庭会议结束后，他“清理了治疗师的整个办公桌”并“威胁要伤害治疗师”。在家里，他会从厨房抽屉里拿出刀来威胁家人。他会“关闭”，不谈论他的感受或想法。门诊心理治疗师将他转介到急诊科，随后在日间医院接受治疗，这确实减少了他的爆发。他没有接受药物治疗。出院诊断为未另有说明的情绪障碍，排除抑郁症，并排除焦虑症。出院后，艾伦被转诊到我们的诊所。他继续与攻击性的爆发作斗争。当他被告知要做一些小家务或家庭作业时，他“永远不会做”。有时早上他会“很好”，但他的心情通常会很烦躁，一点小事就会引发爆发性的爆发，
“Alan” is an 11-year-old boy who was first seen in our clinic 3 years ago. His parents’ chief complaint at admission was Alan’s physically aggressive behavior at home, in particular toward his mother, as well as fights with children and teachers at school. Alan reportedly met his early developmental motor and cognitive milestones, but he showed difficulties with temper control and frustration tolerance as a toddler, having “significant fits” and biting other children. In preschool, Alan’s behavior was generally without significant aggression except when his mother was there to volunteer. In kindergarten, his parents reported, his behavior was managed with the help of a teacher who was very consistent with discipline and structure, but the following year, his first-grade teacher provided much less structure, and Alan started getting into fights again with other children. His behavior also worsened at home; for instance, he would fight a neighbor boy and “the kids would scratch each other bloody.” The parents started family counseling at that time, which did not reduce the problem behaviors.In second grade, at the end of the first trimester, Alan reportedly “lost it.” After a family session, he “cleared the entire desk of the therapist” and “threatened to hurt the therapist.” At home, he would take knives from kitchen drawers and threaten family members. He would “shut down” and not talk about his feelings or thoughts. He was referred by the outpatient psychotherapist to the emergency department and was subsequently treated in a day hospital program, which did reduce his outbursts. He was not put on medication. Discharge diagnoses were mood disorder not otherwise specified, rule out depressive disorder, and rule out anxiety disorder. After discharge, Alan was referred to our clinic. He continued to struggle with aggressive outbursts. When he was told to do minor chores or homework, he “would never do it.” Sometimes he would be “good” in the morning, but his mood was usually irritable, and little things would set off explosive outbursts, with