孤独症儿童共同注意的神经基础及早期干预

The Neural Basis of Joint Attention and Early Intervention in Children with Autism

共同注意是指两个人共同对某一事物加以注意,分享对该事物的兴趣,它是儿童社会认知发展的奠基性能力。首先,孤独症儿童共同注意发展主要体现在注视转换、主动展示、分享等能力发展滞后及缺陷;孤独症儿童共同注意的神经基础:应答性共同注意主要涉及后部皮层注意网络(如颞上沟后部、顶内沟等),自发性共同注意涉及前部皮层注意网络(如前扣带皮层、背内侧额叶等);最后,以回合式教法和关键反应训练为基本方法,论述了共同注意干预的新近模式和效果评估。未来研究应在孤独症儿童的共同注意发展的年龄特征及机制、共同注意的脑区可塑性及脑网络的发展以及开发更有效的干预方法等方面展开大量研究。

Autism spectrum disorders are viewed as a pervasive developmental disorder with complex neural basis, displayed marked deficits in joim attention in early infancy. Joint attention （JA） is a skill in which two people share attention with respect to interesting objects or events, and it is crucial for social cognitive development. Firstly, we compared the developmental characteristics of joint attention in autistic and typical developing children from the perspective of social cognitive development. The differences are mainly embodied in behavioral deficits, such as gaze shifting, showing and sharing. Based on the parallel and distributed information processing model of JA, we focused on the neural basis of two types of joint attention in autism： responding to joint attention （RJA） involves the posterior cortical attention network （parietal and temporal cortex mostly, e.g. pSTS and IPS）; Initiating joint attention （IJA） involves the anterior cortical attention network （frontal cortex mostly, e.g. cingulate cortex and MPFC）. In addition, we summarized two basic approaches： discrete trail teaching （DTT） and pivotal response training （PRT）, and discussed the advanced model and effectiveness evaluation of joint attention intervention. Future studies should focus on the development, brain networks and functional connections of joint attention in children with autism, as well as providing useful early interventions.