自閉症嬰幼兒的早期診斷：文獻回顧

Diagnosis of Autism in Infants and Toddlers: A Literature Review

10.6550/ACP.200506_2(1).0001

姜忠信(Chung-Hsin Chiang)；宋維村(Wei-Tsuen Soong)

自閉症嬰幼兒 ； 心理病理學 ； 篩檢 ； 診斷 ； Infants and Toddlers with Autism ； Psychopathology ； Screening ； Diagnosis

臨床心理學刊

2卷1期（2005 / 06 / 01）

1 - 10

繁體中文

目的：本文主要回顧零到三歲自閉症嬰幼兒的心理病理及早期診斷。 方法：本文依(1)零到三歲自閉症心理病理學；(2)國際通用的自閉症幼兒期代表性篩檢與診斷工具；(3)工具發展的優勢及其限制；(4)台灣未來發展自閉症工具的建議等四部份內容加以整理與分析。 結論：回顧當代自閉症嬰幼兒心理病理學，文獻一致指出自閉症幼兒之相互注意協調能力、模仿、表徵遊戲和情緒分享等有障礙，但有關感覺、運動、反覆行為等障礙之研究結果並不一致。基於這些研究發現，國際上已發展多項適用於嬰幼兒篩檢和診斷自閉症的工具，篩檢工具包括CHAT(checklist for Antism in Toddlers)、M-CHAT(Modified-CHAT)、STAT(screening Tools for Autismin Toddlers)、CSBS DP(Communication Symbolic Behavior Scales: Developmental Profile)等，診斷工具包括ADI-R(Autism Diagnostic Interview-Revised)、ADOS(Autism Diagnostic Observation Schedule)、和CARS(Childhood Autism Rating Scale)等。這些工具都已建立不錯的信、效度，這種發展立下了從自閉症心理病理學研究的結果推展到診斷工具應用上的良好典範，對臨床工作者帶來相當大的助益。作者亦對現有於英語系國家發展的自閉症篩檢及診斷工具提出批判及建議。作者認為應用這些自閉症衡鑑工具，應充分理解診斷自閉症嬰幼兒的心理病理學知識。最後，作者也提出台灣未來發展自閉症篩檢及診斷工具的可能方向。

Objective: This paper reviewed the current understanding of the psychopathology of autism in very young children. Tools that were developed based on this psychopathology profile, and used for screening and diagnostic assessment in this age group, were also introduced. Method: Literature reviews and research comparisons were conducted. Four topics were reviewed in this paper: (1) the psychopathology in young children with autism below age of three; (2) representative screening and diagnostic assessment tools for young children with autism; (3) the strength and weakness of these tools; and (4) suggestions for future development of these tools in Taiwan. Conclusion: Literature on psychopathology in 0 to 3 year-old children with autism repetitively demonstrated the impairment of several socio-communicative abilities. Among them, joint attention, imitation, pretend play and emotional sharing were consistently found to be impaired in young children with autism. While the abnormality of the sensory reaction, and the restricted repetitive and stereotyped behaviors in the first three years of age were not consistently reported. Based on the research findings of socio-communicative deficits in very young children with autism, some screening and diagnostic assessment tools were developed for research and clinical use. CTAT (Checklist for Autism in Toddlers), M-CI-IAT (Modified-CHAT), STAT (Screening Tools for Autism in Toddlers), and CSBS DP (Communication and Symbolic Behavior Scales: Developmental Profile) are for screening, and CARS (Childhood Autism Rating Scale), ADI-R (Autism Diagnostic Interview-Revised), and ADOS (Autism Diagnostic Observation Schedule) are for diagnostic assessment[AC1]. Most of these instruments have adequate reliability and validity. Clinicians can selectively use them to meet their clinical needs. The development of these screening and diagnostic assessment instruments is a good example connecting theoretic research and clinical application. However, some shortcomings of these instruments are noteworthy. First, all of the screening tools screen for the impairment in social reciprocity and communication but not the abnormality in sensory response and the restricted repetitive stereotyped behaviors which are one of the three main features of autism. Second, all of the diagnostic instruments, i.e., ADOS and ADI-R do not provide a clear subclassification of the autism spectrum disorders, i.e., Aspergers disorder or the PDDNOS [AC2] (Pervasive Developmental Disorders Not Otherwise Specified). Third, all of the previous instruments were developed by the classical test theory; new methodology from modem test theory needs to be used for solving the scaling issues. Forth, certification training workshops for the diagnostic tools, i.e., ADI-R and ADOS, are being provided to clinicians and researchers with high fees. The promotion for the use of ADI-R and ADOS is very much commercialized and monopolized, which is not consistent with the academic tradition. Modifications of the available tools or the development of new tools are necessary to overcome the first two weaknesses. While the nonprofit use of the tools shall be publicized to overcome the third weakness. Taiwan is in the beginning phase of developing early screening and identification tools for very young children with autism. Suggestions for the development of such tools in the future are provided.

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