孤独症儿童的生物学因素及家庭因素分析和多学科训练

Biological and family factors of children with autism and multidisciplinary training

目的:第五次人口普查显示中国儿童孤独症已成为儿童心理疾病的第一大疾病,目前中国对孤独症的诊断和治疗的专业机构不多。探讨孤独症的病因、诊断、训练方法和治疗效果。方法:2001-11/2004-05,在珠海市妇幼保健院儿童发育行为中心确诊并建立完整病历档案资料的86例儿童孤独症作为研究对象,对其生物学因素、家庭因素、病历主诉、发病年龄、确诊年龄、辅助检查作统计分析,并对其中55例患儿的训练效果进行总结和分析。结果:孤独症在生物学因素中存在的异常较普遍,尤其是父亲内向的性格特点突出。病历主诉以语言障碍和交流障碍为主,脑部CT,EEG,BAEP和SPECT辅助检查中,SPECT异常检出率高,主要表现为大脑局灶性血流灌注量降低。确诊年龄晚于发病年龄29个月,多学科参与是治疗孤独症儿童的有效方法。训练患儿的有效率为100%,效果与年龄有显著性差异(P<0.01),年龄越小、训练时间越长效果越好。结论:异常妊娠史、出生史、家族史和父亲内向的性格特点与孤独症发病有密切关系;临床易误诊,以语言发育迟缓伴非言语性交流障碍为主诉的儿童应考虑孤独症的可能;早期诊断、早期干预、多学科参与的综合训练是目前治疗孤独症的有效方法。

AIM:The results of the fifth Chinese general census shows that autism has became one of the main disorders of the child psychology.There are not many professional institutes that can carry out the diagnosis and treatment of autism in China.The aim of the paper is to investigate the pathogenesis,diagnosis,the training methods and treatment effect of autism.METHODS:From October 2001 to May 2004, 86 autism children with whole medical records diagnosed by the Child Behavior Development Center of Zhuhai Maternal &Child Health Care Hospital were selected as subjects. Data on biologic factors(pregnancy,birth,family,seizure),family factors(parents' characters,family teaching style),chief complaints,onset age, diagnostic age and results of assistant examinations including CT,echoencephalography(EEG),brainstem auditory evoked potential(BAEP) and single photon emission computerized tomography(SPECT) were collected and analyzed.Meanwhile, the effects of treatments on 55 cases were summarized and analyzed.RESULTS:The abnormality in biologic factors was generally seen among the autism children,especially the inner character of fathers. Among the results of assistant examinations, an especially high proportion of abnormality(decreased perfusion of blood stream in parts of the brain) in SPECT was found.Diagnostic age was 29 months older than onset age.Multidisciplinary treatment is an effective method to treat the autism.The effective rate was 100%,and the effects of treatments and child age were related significantly.The younger and longer training time, the better effects of treatments. CONCLUSION:Abnormalities of biologic factors,such as pregnancy,birth,family,father's inner character are highly related with the autism, and it is easy to delay the correct diagnosis.The language development disability with non language communication disability suggests the existence of autism.The synthesized training,which combines several methods,turns out to be the effective method for treating the autism.