자폐증 스펙트럼 장애, Autism spectrum disorder (ASD)

자폐증 스펙트럼 장애, Autism spectrum disorder (ASD) 

 (참고용으로, 2014년 10월 이전 자폐증 제목을 그대로 유지하면서 이 제목을 다시 올립니다.)

ASD (Autistic Spectrum Disorder)의 다른 이름

• 자폐증 스펙트럼 장애
• 자폐 스펙트럼 장애
• Autism spectrum disorder

ASD의 정의

• 자폐증 스펙트럼 장애는 생물학적면에 근거를 두고 정의한다면, 유전성 경향이 있고 다음과 같은 증상이 있는 신경발육 장애(Neurodevelopemental disorders)이다.
• 언어나 문맥의 일부에만 제한되지 않고 광범위하게 사회 의사소통과 사회 상호 작용 장애가 지속적으로 있고 결핍되어 있다.
• 각종 행동이나 흥미 또는 활동이 제한되어 있고 또 반복성이 있고
• 이런 증상 징후가 소아기의 초기 즉 2세 이전에 발병하는 것이 보통이고
• 이런 증상 징후가 있으면 사회적으로, 직업적으로 그 외 다른 여러 영역에서 삶을 정상적으로 영유할 수 있는 능력 장애가 생길 수 있다.
• ASD가 있는 아이들에게 언어 장애와 사회적 행동 장애의 정도는 일률적이 아니고 다를 수 있다. 즉 그런 장애 정도가 아주 심할 수도 있고, 경우에 따라 아주 경미할 수 있다.
• 미 DSM-IV 기준에 따라 도착성 발달 장애(Pervasive developmental disorders/PDD)라고 병명을 부쳤다가 미 DSM-V 기준에 따라 자폐증 스펙트럼 장애(Autism spectrum disorder /ASD)로 병명을 다시 부쳤다.

자폐증 스펙트럼 장애의 유병률

• 최근 미국 68명 출생아들 중 1명꼴
• 2002년 1,000명 아이들 중 6.4명
• 2008년 1,000명 아이들 중 11.3명, 남아 54명 중 1명, 여아 254명 중 1명
• 2011년 1,000명 아이들 중 20명
• 남아: 여아의 발병률은 2:1~6.5:1

ASD의 원인

• 확실한 원인은 모른다.
• 비균질적 유전 요인(Genetically heterogenous)으로 생긴다고 믿는다. Up[date, The New England Journal of Medicine.10/14/2021.It is believed to be caused by genetically heterogenous factors. Update, The New England Journal of Medicine.10/14/2021
• 쌍태아 중 한 쌍태아가 ASD가 있으면 다른 쌍태아에게 ASD가 유발할 가능성이 10명 중 9명이고,
• 친 형제 중 한명이 ASD가 있으면 다른 형제들에게 ASD가 생길 가능성은 35배라고 한다.
• 여린 X 증후군(Fragile X syndrome)이나 결정성 경화증(tuberous sclerosis)이 있는 아이들에게 ASD가 생길 가능성이 많다.
• 돌연변이 유전으로 ASD가 생길 수 있다고 믿는다.
• 먹고 마시는 음식물, 숨 쉬는 공기, 치료에 쓰는 약물, 자궁 내 태아가 엄마의 피를 통해 노출됐던 각종 음식물, 화학물질 성분 또는 약물에 접촉으로 ASD가 생긴다고 믿기도 한다.
• 예방접종 백신으로 인해 ASD가 생긴다고 했지만 확실히 증명할 수 없다.

증상 징후

• 증상 징후는 ASD가 있는 아이에 따라 다르나 일반적으로 다음과 같은 ASD 주 증상 징후가 있다.
• 사회생활 장애가 있다. 즉 사회적 의사소통 장애가 있다.
• 판에 박힌 행동을 반복하기고 하고 즉 상동행동을 하기도 한다.
• ASD가 있는 아이들은 같은 나이 또래들에 비해 사회적 의사소통 기술 발육이 뒤떨어진다.
• 대개의 경우 부모들은 ASD가 있는 자녀의 행동이 비정상적인 것을 인지할 수 있다.
• 심하게는 영유아기 초기부터 발육이 비정상적이고 한 개의 물체에 과도히 관심을 둔다. 눈길접촉(눈맟춤)이 빈약하거나 없고 피카부(까꿍까꿍) 등 놀이를 할 수 없다. 상호작용이 미약하고 부모와 같이 놀 때도 종알종알 아기 소리를 내지 않는다.
• 일부의 ASD를 가진 아이들은 2세나 3세 될 때 자기 이외 것에 흥미를 잃고 조용하고 위축되고 그 주위 사회에서 일어나는 일들에 무관심하고 위축되기도 한다.
• 사회적 장애가 심하게 생기고
• 그들의 주위에 있는 사람들에게 무관심하거나 귀를 기울이려하지 않고 다른 사람들에게 반응을 하지 않는다.
• 자기들이 좋아하는 장난감이나 행동을 즐거이 혼자하면서 다른 사람들과 서로 같이 즐겨하려 하지 않는다. 그리고 다른 사람에게 자기가 하는 것을 보이려고 하지 않는다. 그러나 다른 사람들이 자기가 하고 있는 그런 것을 보면 화내고 불안하고 고통스러워한다.
• 최근 연구에 의하면 상호 의사소통을 할 때r 상대자의 눈길을 접촉하는 대신 입을 쳐다보는 경향이 있다고 한다. 정상적으로 1세가 되기까지 ASD가 없는 아이들은 적어도 한 두 단어를 써서 말 할 수 있고 그의 이름을 부르면 그 소리가 나는 쪽으로 고개를 돌려 쳐다보는 것이 보통이다. 가지고 싶은 장난감을 보고 달라고 가리킬 수 있다. 가지고 싶지 않은 경우는 확실히 말로 몸짓 말로 얼굴 표정으로 아니라고 표현 할 수 있는 것이 정상이다.
• ASD가 있는 아이는 자기 이름을 불러도 반응하지 않거나 천천히 반응하고 말을 걸어도 주의를 기울이지 않는다.
• 다른 사람들에게 자기가 가지고 놀고 있는 무엇을 보이려고 하지도 않는다.
• 돌 전 영아를 엄마가 안고 사랑하고 조용히 속삭이면 종알종알 지껄이는 것을 볼 수 있지만 ASD가 있는 영유아들은 그런 종알종알 지껄이는 말도 하지 않고 전반적으로 언어 발육이 지연되고 그림 등으로 의사소통을 하거나 한 개 단어로 의사 소통을 하기도 한다. 단 한 개 단어로 말을 하거나 구절을 여러 번 반복해 말을 하기도 한다.
• 자기가 들은 단어나 구절을 반복하기도 한다. 즉 반향언으로 의사소통을 한다든지 자기 자신만 아는 이상한 말을 해서 의사소통을 하기도 한다
• 반복적이고 상동적인 행동을 할 수 있다. 이런 증상이 아주 경미 할 수 있고 아주 심해 쉽게 언어 장애가 있는 지 알아볼 수 있다.
• 어깨 등을 손바닥으로 계속 반복 치기도 하고 이상한 모습으로 걷기도 한다.
• ASD가 있는 아이들은 장난감 바퀴나 차 등에 달린 움직이는 물체에 환상적이고 그것을 좋아하고 그런 장남감 등을 길게 늘어놓고 놀기도 한다.
• 다른 사람이 그렇게 길게 놓은 장난감을 움직이면 골나고 싫어한다.
• 청소기, 전화기. 숫자, 튜브 등에 특별히 강박 관심을 갖기도 한다.
• 매일 같은 음식물을 먹기도 하고
• 변함이 없이 하루 종일 같은 행동을 반복하기도 한다. 그런 루틴을 부모가 바꾸면 화를 낸다.

자폐증 장애 진단 기준 Autistic Disorder Diagnostic Criteria(DSM_IV)

소스: American psychiatric association DMA-IV

아스퍼거 장애 진단 기준 Asperger disorder Diagnostic Criteria(DSM-IV)

자폐증 스팩트럼 장애 진단 기준 Autistic Spectrum Disorder(ASD) Diagnostic Criteria (DSM-V)

자폐증 스펙트럼 장애 선별검사용 챠트

• Checklist of Autism in Toddlers (CHAT)
• Modified Checklist for Autism in Toddlers (M-CHAT)
• Screening Tool for Autism in Two-Year-Olds (STAT)
• Social Communication Questionnaire (SCQ)
• Communication and Symbolic Behavior Scales (CSBS).
• Autism Spectrum Screening Questionnaire (ASSQ)
• Australian Scale for Asperger’s Syndrome (ASAS)
• Childhood Asperger Syndrome Test (CAST).

영유아, 학령기 아이들에게 다음과 같은 증상 징후 중 하나 또는 그 이상 있으면 자폐증

스펙트럼 장애가 있다고 의심할 수 있다.

소스와 참조 문헌: Hand book of pediatric neurology, Katherine B. Sims and et

자폐증 스펙트럼 장애가 각 항에 따른 증상 징후

미 소아과 학회의 ASD에 관한 선별검사 권장

미국 신경외과 의사 협회와 신경외과의사 위원회의 ASD 두 단계 선별검사 권장

다음과 같이 두 단계로 조사하라고 권장한다.

(1).통상 발육 감시–비정형적 발육이 있는 아이들 중 자폐증이 있나 또는 다른 문제를 가지고 있는 아이가 자폐증이 있나 알아보기 위해 특별 선별검사를 한다.

(2).자폐증을 진단 평가한다. 그리고 다른 발육 장애와 감별 진단 한다.

자폐증 진단

(1) ASD 진단용 DSM-IV와 DSM-V 기준에 따라 임상적 진찰을 한다

(2)1 단계-ASD 위험성이 없으면

생후 18~24 개월 M-CHAT/CHT,

PPD Screening test–II,

Primary Care Screener(PDDST-II PCS)

그 외

2 단계– 다른 발육 장애가 있고 ASD와 감별 진단하기 위해

• Asperger Syndrome Diagnostic Scale
• ASD behavior checklist
• Autism Quation Adolescent Version
• Autism Diagnostic Observation Schedule and Autism Diagnostic Interview

(3) 병력 신경 검사

• 출생전후기, 성장발육, 퇴행, 뇌증, 주의력 결핍 문제, 경련, 우울증, 조급증, 행동이
• 불규칙적이고, 식이 이상, 수면 문제, 신경 피부문제, 구어 언어이상, 비 구어 언어, 놀이, 이상 상태에 관한 병력을 알아본다.

(4) 다른 병과 감별 진단하기 위해

• 청력 검사와 중이 진찰을 받는다. 시력 검사를 받는다.
• 이미증이 있으면 혈중 납 농도 검사를 한다.
• 여린 X증후군, 레트 증후군(Rett syndrome) 등이 있으면 염색체 검사를 한다.
• 대사장애가 있는 것 같으면 대사장애 검사를 한다.
• 퇴행, 경련, 경련을 의심하면 EEG 검사를 한다.
• 신경 영상 검사는 통상적으로 권장 않는다.
• 갑상선 기능 검사 등 혈액검사는 통상적으로 권장하지 않는다.

치료

• 조기 진단을 해서 조기에 적절한 치료를 시작해서 그 아이가 스스로 자립할 수 있는 기능을 증진시키고 삶의 능력을 발전시키는 것이 주목적이다.
• 여러 가지 치료방법이 있지만 특별한 치료를 받아야 하는 것이 보통이다.
• 그와 동시에 그들의 부모들을 도와주어야 한다.
• 의사소통, 사회적응, 행동교정, 사회적응, 교육 등을 각 면에 증진 개선시키는데 중점을 둔다.
• 부모교육, 정서적지지, 질병특성지지 제공
• 자녀를 양육 방식 장기적 교육 계육 수립
• 특수교육,
• 언어치료,
• 인지치료,
• 사회성기술 훈련
• 운동치료,
• 시력치료, 청력, 소리, 촉각 등에 관한 감각을 탐지하는 직업치료와 감각 통합치료,
• 음악치료
• 자해 위험 방지
• 행동개선 훈련과 관리. 긍정적 행동은 강화시키고 자신이 스스로 생활하고 돕고 사회에 적응할 수 있는 사회기술을 훈련시킨다. 그러기 위해서 올바른 행동과 의사소통 잘 하는 법을 증진시킨다. 즉 행동조절 치료
• 핵심 증상 중증도 완화,
• 운동기술과 운동 조화 결핍을 보강시키기 위해 물리치료
• 의사소통 치료
• 약물 치료
• 공격적이거나 자해, 과민하면 Clonidine 등으로 치료할 수 있고
• 불안하면 buspirone 등으로 치료할 수 있고
• 과다활동, 충동적, ADHD 이면 신경 자극제 등으로 치료할 수 있고
• 수면 문제는 규칙적 수면습관으로 치료하고 멜라토닌 등으로 치료할 수 있다.
• 대체치료도 할 수 있지만 그 치료 방법이 어디에서 어떤 근거에서 나왔는지 확실히 알아보고 그건 치료를 이용해야 한다.
• Update, Oxytocin for Autism Spectrom Disorder – Down, but Not Out-업데이트, 자폐 스펙트럼 장애에 대한 옥시토신 – 다운되었지만 아웃되지 않음

Autism spectrum disorder (ASD)

(For reference, I’m reposting this title, keeping the pre-October 2014 autism title intact.)

Another name for ASD (Autistic Spectrum Disorder)
• Autism Spectrum Disorders

• Autism Spectrum Disorder

What is ASD?

• Autism Spectrum Disorder, defined on a biological basis, is a neurodevelopmental disorder with a hereditary tendency and symptoms such as:

• Persistent and deficient deficits in social communication and social interaction pervasive, not limited to a subset of language or context.

• A variety of behaviors, interests, or activities are limited and repetitive

• The onset of these symptoms is usually early in childhood, before the age of 2 years.

• The presence of these symptoms may impair the ability to lead a normal life socially, professionally, and in many other areas.

• In children with ASD, the severity of speech and social-behavioral disorders is not uniform and may vary. That is, the degree of impairment can be very severe, and in some cases very mild.

• According to the US DSM-IV criteria, the disease was called Pervasive developmental disorders (PDD), and according to the US DSM-V criteria, the disease was renamed to Autism spectrum disorder (ASD).

Prevalence of Autism Spectrum Disorders

• 1 in 68 recent births in the US

• 6.4 out of 1,000 children in 2002

• 11.3 in 1,000 children in 2008, 1 in 54 boys and 1 in 254 girls

• 20 out of 1,000 children in 2011 • Boys: The incidence rate for girls is 2:1 to 6.5:1

Causes of ASD

• The exact cause is unknown.

• It is believed that it is caused by genetic and environmental factors.

• If one of the twins has ASD, there is a 9 in 10 chance that the other twin will have ASD;

• It is said that if one of your siblings has ASD, your other siblings are 35 times more likely to develop ASD.

• Children with Fragile X syndrome or tuberous sclerosis are more likely to develop ASD.

• Beliefs that ASD can be caused by genetic mutations.

• It is believed that ASD is caused by contact with food, chemicals or drugs that you eat and drink, the air you breathe, medications used for treatment, and various foods, chemicals, or drugs that the fetus in the womb was exposed to through the mother’s blood. • Vaccinations have been shown to cause ASD, but cannot be definitively proven.

Symptoms Signs

• Symptomatic signs vary depending on the child with ASD, but in general, the main

Symptomatic signs of ASD are:

• I have a social life disability. That is, there is a social communication disorder.

• Repetition of routine behavior, ie, stereotyped behavior.

• Children with ASD develop less social communication skills than their peers.

• In most cases, parents can recognize that the behavior of a child with ASD is abnormal.

• In the worst case, the development is abnormal from early infancy, and excessive attention is paid to one object. There is poor or no eye contact (eye contact), and he cannot play peek-a-boo (peek-a-boo). The interaction is weak and the baby does not make a bell-bell sound even when playing with parents.

• Some children with ASD lose interest in things other than themselves by the age of 2 or 3, become quiet and withdrawn, indifferent to and withdrawn from the world around them.

• Severe social disability

• They are indifferent to, unwilling to listen to, and unresponsive to those around them.

• They enjoy playing alone with their favorite toys or activities and do not try to share them with others. And he doesn’t try to show other people what he’s doing. But when he sees other people doing what he is doing, he becomes angry, anxious, and in pain.

• A recent study found that when communicating, we tend to look at the other person’s mouth instead of making eye contact.

Children who do not normally have ASD by the age of 1 can speak using at least one or two words, and when their name is called, they usually turn their heads to look at the sound. You can point to a toy you want to have. If you don’t want to have it, it’s normal to be able to clearly say no with words, body language, and facial expressions.

• A child with ASD does not respond to calls by name or responds slowly and does not pay attention to conversations.

• He doesn’t even try to show others what he’s playing with.

• If a mother hugs and loves an infant before birth and whispers quietly, it can be seen that the infants and toddlers with ASD do not say such chirping, but overall language development is delayed, and they communicate with pictures or use only one word. also communicate. They may say a single word or repeat a phrase several times.

• Sometimes repeats words or phrases they hear. In other words, they communicate with echo language, or they communicate by saying strange words that only themselves know. • Can engage in repetitive and stereotyped behaviors. These symptoms can be very mild and can be so severe that it is easy to tell if you have a speech impairment.

• Repeatedly hitting the shoulder and back with the palm of the hand or walking in a strange way.

• Children with ASD are fantastic with moving objects such as toy wheels and cars, and they like to play with them and play with such toys.

• I hate it when other people move toys that are too long.

• Cleaners, telephones. He has a special obsessive interest in numbers, tubes, etc.

• Eat the same food every day

• Sometimes repeating the same behavior throughout the day with no change. They get angry when their parents change that routine.

Autistic Disorder Diagnostic Criteria (DSM_IV)

6 or more of 3 categories – 3 categories 1. Category-1 social interaction disorder (two or more are present)

• A variety of nonverbal gesture communication disorders are severe (eye contact, facial expression, body posture, and gesture are necessary for social interaction).

• Fails to properly form peer relationships.

• Refusal to voluntarily share pleasure, interest, or fulfillment with others.

• Cannot share social problems or emotions such as pleasure and joy.

2. Category –2 communication disorder (One or more appears.)

• Oral language development is delayed or not fully developed.

• If there is language development, there is an impairment in the initiation of communication and impairment in the ability to sustain communication.

• Repetitive or stereotyped use of common or special languages.

• inappropriate for their developmental level, they play a variety of voluntary lies. Or play social imitation.

3. Category-3 Restricted behaviors, interests, and activities appear in repetitive, stereotyped patterns. (one or more appears)

• Stereotyped or restricted to one or more interesting behaviors. Its intensity or focus is abnormal.

• Indomitable preoccupation with specific, non-functional, routine or intentional tasks.

• Stay focused on one part of an object.

4. Appearance age Delayed or abnormal functioning in one or more areas before 3 years of age. social interaction Language needed for social communication symbolic or imaginary play 5. Exclusion Criteria Rett Disorder or Childhood Disintegration Disorder Source: American psychiatric association DMA-IV

Asperger’s Disorder Diagnostic Criteria (DSM-IV)

2 categories – 3 or more of the 2 main categories 1. Category 1 social interaction disorder (two or more are present)

• A variety of nonverbal gesture communication disorders are severe (eye contact, facial expression, body posture, and gesture are necessary for social interaction).

• Fails to properly form peer relationships.

• Refusal to voluntarily share pleasure, interest, or fulfillment with others.

• Cannot share social problems or emotions such as pleasure and joy. 2. Category 2 Restricted behaviors, interests, and activities appear in repetitive, stereotyped patterns. (one or more appears)

• Stereotyped or restricted to one or more interesting behaviors. Its intensity or focus is abnormal.

• Indomitable preoccupation with specific, non-functional, routine or intentional tasks.

• Consistently preoccupied with parts of an object.

3. Disability criteria Causes disability in social, occupational or other domains.

4. Exclusion Criteria Clinically, when there is no apparent general language delay When the cognitive development of age-appropriate self-help skills and adaptive behaviors is not clinically definitively delayed.

Criteria not included in the diagnostic criteria for PPD or schizophrenia Autistic Spectrum

Disorder (ASD) Diagnostic Criteria (DSM-V)

2 main categories 1.

Category-1 social interaction disorder (There should be three items

• There is a deficit in social and emotional sharing.

• Defects in nonverbal communication behaviors used in social interactions. • Deficits in developing or maintaining adequate developmental stages. 2. Category –2 Restrictive repetition of behaviors, interests, and activities (Section 2 or higher • Use of stereotyped or repetitive words, moving movements, or objects

• Excessive clinging to, or excessive resistance to change, routines or conscious patterns of verbal or nonverbal behavior.

• Has unusually limited and fixed interests in intensity or focus.

• Overreacting or underreacting to sensations. Pain, cold and hot sensations respond abnormally. Excessive sensitivity to odors and abnormal reactions to specific sounds or touches.

• Fantastic in circles or any lights.

3. Onset Age Symptoms appear in early childhood and may not appear completely until there are social demands beyond unmanageable.

4. In addition to the symptoms of disability, all functions are limited and impaired.

5. Severity 1 – Requires support.

Step 2 – You need significant support. We need more support than Step 3 and Step 2.

Autism Spectrum Disorder Screening Chart

• Checklist of Autism in Toddlers (CHAT)

• Modified Checklist for Autism in Toddlers (M-CHAT)

• Screening Tool for Autism in Two-Year-Olds (STAT)

• Social Communication Questionnaire (SCQ) • Communication and Symbolic Behavior Scales (CSBS).

• Autism Spectrum Screening Questionnaire (ASSQ)

• Australian Scale for Asperger’s Syndrome (ASAS)

• Childhood Asperger Syndrome Test (CAST). Infants and school-age children have autism if they have one or more of the following symptoms: You may suspect that you have a spectrum disorder.

One or more of the following symptoms should suggest that you have an autism spectrum disorder: Lack of or poor eye contact When not seeing or pointing where parents or guardians are pointing When communicating with each other, say atypical words, repeat atypical words, have difficulty communicating with each other, or Inability to speak using first-class nouns, performing stereotyped actions such as hitting each other with both hands, spinning and hitting the head repeatedly on the floor, etc.

You are abnormally obsessed with If you have a strong interest in dinosaurs or the climate, have no affinity with other people, They may overreact to scoops or food or cloth, may have delayed intelligence in some areas, may have advanced skills in others, or otherwise. You are very likely to have an autism spectrum disorder if you have the following symptoms: by 12 months of age, unable to chime, or failing to point accordingly, not seeing where to point, unable to speak by using a single meaningful word by 16 months of age, or unable to speak on their own using phrases with two words by 24 months of age; At any age, lack of social skills or the inability to speak or otherwise Sources and references: Handbook of pediatric neurology, Katherine B. Sims and et Autism Spectrum Disorder Symptoms Signs According to Each Section

1. The sensory organs may exhibit the following symptoms: The following sensory symptoms are common in children with ASD: Excessive sensitivity to certain noises and sounds They are also less sensitive to voices other than the cock. Abnormally less sensitive to painful sensations They can react quite sensitively to the slightest touch.

2. There is an attention deficit and activity may be abnormal. Being underactive or withdrawn Conversely, they are overactive.

3. Movement disorders may occur. I can work out hard motor coordination disorder may occur There may be difficulties with behavior May have hypotonia

4. May have low intelligence. 38% of children with ASD have an IQ of 70 or less 24% IQ is between 71 and 85. 38% have an IQ of 85 or higher (Source: 2008 ADDM NETWORK)

5. Language development is delayed, and there may be a regression of language development. About 25% to 30% of children with ASD may have some language development, but there may be a gradual regression of language development between 15 and 24 months of age. Nonverbal communication and social skills, such as waving or pointing, may be absent or poor. These symptoms may appear gradually or suddenly. The severity of such symptoms is greatly affected by the stress caused by the surrounding environment.

6. You may have acephaly. In general, it is common for children with ASD to have a normal or smaller-than-average head circumference in their newborn. During the first year after birth, the head circumference becomes larger than normal, which can lead to the development of microcephaly. In 20-30% of children with ASD, the head circumference becomes larger than normal, resulting in microcephaly, but it is common for the brain size to decrease after childhood.

7. May have seizures The incidence of epilepsy is 1.8% in children under 12 years of age with ASD who do not have an intellectual disability.

The incidence of epilepsy in children with ASD under the age of 12 and with intellectual disabilities is 6.1%. The incidence of epilepsy in children 12 years of age or older, without intellectual disability, and ASD is 8.9%. The incidence of epilepsy in children with ASD over the age of 12 and with intellectual disabilities is 23.7%.

8. Gastrointestinal symptoms may occur. Constipation, diarrhea, abdominal pain, ichthyosis, gastroesophageal reflux, and gastrointestinal inflammation may occur.

9. You may have sleep problems. In 40 to 86% of children with ASD, sleep problems such as: Difficulty falling asleep, anxiety, frequent waking during the night insomnia sleep disturbance breathing difficulties Problems with melatonin production and regulation can occur.

10. Psychopsychological and emotional problems may arise. Anxiety, depression, sensitivity, and agitation may occur.

11. Children with ASD may be accompanied by the following diseases: fragile X syndrome tuberous sclerosis Angelman Syndrome Rett syndrome Smith-Lemley-Opitz syndrome down syndrome CHARGE syndrome neonatal alcohol syndrome PKU, etc. Screening for ASD recommended by the American Academy of Pediatrics

If you have one or more of the following, we recommend that you get an ASD special screening test. If any of your siblings have ASD When a parent asks for a screening test for ASD When a caregiver asks for a screening test for ASD If your pediatrician suspects you have ASD, it is recommended that you get an ASD screening test. The American Academy of Pediatrics recommends that you routinely be screened for ASD. It is recommended that all infants between the ages of 18 and 24 months be routinely screened for ASD at regular health screenings. The American Association of Neurosurgeons and the Council of Neurosurgeons recommend a two-stage screening test for ASD.

We recommend that you investigate in two stages:

(1). Normal developmental monitoring-special screening is done to determine if children with atypical development have autism or if children with other problems have autism.

(2). Diagnosis and evaluation of autism. and differentially diagnosed with other developmental disorders.

Autism Diagnosis

(1) Conduct a clinical examination according to the DSM-IV and DSM-V standards for ASD diagnosis

(2) Stage 1 – if there is no risk of ASD 18-24 months M-CHAT/CHT, PPD Screening test–II, Primary Care Screener (PDDST-II PCS), etc Stage 2 – To make a differential diagnosis from ASD with other stunting disorders

• Asperger Syndrome Diagnostic Scale

• ASD behavior checklist

• Autism Quation Adolescent Version

• Autism Diagnostic Observation Schedule and Autism Diagnostic Interview

(3) history neurological examination

• Postnatal, growth and development, degeneration, encephalopathy, attention deficit problems, convulsions, depression, impatience, behavioral problems

• Get a medical history of irregularities, eating disorders, sleep problems, neuroskin problems, oral and non-verbal language disorders, play, and abnormal conditions.

(4) for differential diagnosis from other diseases

• Get a hearing test and a middle ear exam. Get an eye exam

• If you have anemia, have your blood lead level tested.

• If you have fragile X syndrome or Rett syndrome, do a chromosome test.

• If you think you have a metabolic disorder, do a metabolic disorder test.

• If regression, convulsions, or convulsions are suspected, an EEG test is performed.

• Neuroimaging is not usually recommended.

• Blood tests such as thyroid function tests are not usually recommended.

Treatments

• The main goal is to improve the child’s ability to become independent and develop life skills by starting appropriate treatment at an early stage through early diagnosis.

• There are several treatment options, but it is common to require special treatment.

• At the same time, help their parents.

• Focus on promoting and improving communication, social adaptation, behavior correction, social adaptation, and education in each aspect.

• Providing parental education, emotional support, and disease-specific support

• How to Raise Children Long-Term Education Establishment of Nursing

• special education;

• speech therapy;

• cognitive therapy;

• Social skills training

• exercise therapy;

• Occupational therapy that detects the senses of sight, hearing, sound, touch, etc. and sensory integration therapy;

• Music therapy

• Avoiding the risk of self-harm

• Behavior improvement training and management. Positive behavior reinforces and trains social skills that enable one to live, help, and adapt to society. To do this, promote good behavior and good communication skills. i.e. behavioral therapy

• Relief of key symptom severity;

• Physical therapy to reinforce motor skills and motor coordination deficits.

• Communication therapy

• Medication

• If you are aggressive, self-harm, or hypersensitive, you can treat it with Clonidine, etc.

• Anxiety can be treated with buspirone, etc.

• Hyperactivity, impulsivity, and ADHD can be treated with nerve stimulants, etc.

• Sleep problems can be treated with regular sleeping habits, such as melatonin.

• Alternative treatment is also available, but you must find out where the treatment method came from and on what basis and use that treatment.

Update, Oxytocin for Autism Spectrom Disorder 

출처와 참조 문헌 Sources and references

• NelsonTextbook of Pediatrics 22ND Ed
• The Harriet Lane Handbook 22ND Ed
• Growth and development of the children
• Red Book 32^nd Ed 2021-2024
• Neonatal Resuscitation, American Academy Pediatrics

• Oxytocin for Autism Spectrom Disorder – Down, but Not Out, The New England Journal of Medicine.10/14/2021
• Slideshow: A Visual Guide to Autism

• Treating Autism: One Child’s Story
• Early Autism Treatment
• Finding the Right Autism Treatment utism Therapies: ABA, RDI, and Sensory Therapies
• Benefits of Occupational Therapy for Autism
• Benefits of Speech Therapy for Autism

• See All Autism Treatments Topics

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  • Red book 29th-31st edition 2021
  • Nelson Text Book of Pediatrics 19^th- 21st Edition
  • The Johns Hopkins Hospital, The Harriet Lane Handbook, 22nd edition
  • 응급환자관리 정담미디어
  • Pediatric Nutritional Handbook American Academy of Pediatrics
  • 소아가정간호백과–부모도 반의사가 되어야 한다, 이상원 저
  • The pregnancy Bible. By Joan stone, MD. Keith Eddleman, MD
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  • Preparation for Birth. Beverly Savage and Dianna Smith
  • 임신에서 신생아 돌보기까지. 이상원
  • Breastfeeding. by Ruth Lawrence and Robert Lawrence
  • Sources and references on Growth, Development, Cares, and Diseases of Newborn Infants
  • Emergency Medical Service for Children, By Ross Lab. May 1989. p.10
  • Emergency care, Harvey Grant and Robert Murray
  • Emergency Care Transportation of Sick and Injured American Academy of Orthopaedic Surgeons
  • Emergency Pediatrics A Guide to Ambulatory Care, Roger M. Barkin, Peter Rosen
  • Quick Reference To Pediatric Emergencies, Delmer J. Pascoe, M.D., Moses Grossman, M.D. with 26 contributors
  • Neonatal resuscitation Ameican academy of pediatrics
  • Pediatric Nutritional Handbook American Academy of Pediatrics
  • Pediatric Resuscitation Pediatric Clinics of North America, Stephen M. Schexnayder, M.D.
  • Pediatric Critical Care, Pediatric Clinics of North America, James P. Orlowski, M.D.
  • Preparation for Birth. Beverly Savage and Dianna Smith
  • Infectious disease of children, Saul Krugman, Samuel L Katz, Ann A.
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  • Neurology in Pediatrics, P. F. Bray, Yearbook Medical Publishers
  • Behavior Disorders in Children, Bakwin and Bakwin
  • 소아과학 대한교과서
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Copyright ⓒ 2014 John Sangwon Lee, MD., FAAP

“부모도 반의사가 되어야 한다”-본 사이트의 내용은 여러분들의 의사로부터 얻은 정보와 진료를 대신할 수 없습니다.

“The information contained in this publication should not be used as a substitute for the medical care and advice of your doctor. There may be variations in treatment that your doctor may recommend based on individual facts and circumstances.

“Parental education is the best medicine.”