자폐증 Autism

 

 

 

 

자폐증

 

 

Kanner의 정의

유아 자폐증은 1943년 Hohns Hopkins대학의 아동 소아정신과 교수였던 Leo Kanner에 의해 처음으로 보고되었다(Aarons and Gittens,1992). 그는 유아 자폐증을 가진 아동이 다음과 같은 10가지 증상을 보인다고 설명했다.

 

 

1. 대인관계 형성을 하지 못한다.(An inability to develop relation - ships)

2. 언어 습득이 지연된다.(Delay in the acquisition of language)

3. 언어 발달상 대화할 수 없는 언어를 사용한다.(Non-communicatiove use of spoken

    language after it develops)

4. 반향어(echolalia), 즉 앵무새처럼 다른 사람의 말을 되풀이하는 경향이 있다.(Delayed

    echolalia)

5. 대명사를 반전하여 사용한다.(Pronominal reversal)

6. 틀에 박힌 놀이를 반복한다.(Repetitive and stereotyped play)

7. 동일성 유지에 대한 강박적인 요구를 가지고 있다.(Maintenance of sameness)

8. 상상력의 결여를 보이고 있다.

9. 기계적 암기력이 좋다.(Good rote memory)

10. 외면상 정상적인 신체 발달을 보인다.(Normal physical appearance) vv

 

 

 

 

미국 주립 자폐아 협회(NSAC)의 정의

이에 비해 미국 주립 자폐아 협회(NSAC)의 정의에 따르면 자폐 아동은 다음과 같은 행동 특성으로 정의된다(E.R. Ritvo and B.J. freeman, 1978).

 

 

기본 특성으로

 

첫째: 전형적으로 출생후 30개월 이전에 나타나고,

둘째: 발 달 속도나 순서에서 장애가 있으며,

셋째: 감각 자극에 대한 장애,

넷째: 언어, 인지에서의 장애,

다섯째: 사람, 사건, 사물에 반응하는 능력에서의 장애를 들고 있다.

 

 

 

 

Wing과 Gould의 정의

 

Kanner가 자폐증의 특징을 제시한 이래 많은 연구자들이 자폐 아동의 행동 특징에 관해 연구를 진행하였으며 이들 연구자들은 증상의 주요 관심을 자폐 아동의 사회적 결손에 두었다. 연구의 주안점은 자폐 아동들이 학습하는 능력의 정도를 알아내는 것보다는 이들이 대인과의 관계를 형성하는데 실패함으로써 발견되는 다른 정상아동과의 차이를 연구하였다. 연구 결과에 의한 행동상의 특징들은 자폐 아동의 증상을 설명하는데 매우 중요한 내용이 되었다.

 

이들 연구자들 중에 특히 Wing과 Gould의 연구는 자폐 아동의 장애에 관한 설명 중에 핵심적인 내용이며 자폐증을 이해하는데 매우 중요한 것이다(Maureen Aarons and Tessa Gittens,1992).

 

 

그들은 다음과 같은 세 가지의 부분으로 자폐 아동의 행동상 특징에 관한 설명을 하고 있다.

 

사회적 대인관계의 손상(An impairment of social relationships)

사회적 의사 소통의 손상(An impairment of social communication)

사회적 이해와 상상력의 손상(An impairment of social understan- ding and imagination)

 

 

 

 

사회적 대인관계의 손상(An impairment of social relationships)

 

 

가. 사람들로부터 혼자 떨어져 있거나 무관심하다.

나. 수동적으로 사회적 접촉을 한다.

다. 다른 사람과의 사회적 접촉이 일방적으로 한 사람에게 치우치며 이상한 곳에 빠져들고 그밖

     에 이상한 곳에 관심을 둔다. 예를 들면 기차 운행 일정 시간, 결백적인 행동, 화장실의 살균

     소독제, X - ray 스캐너, 부서진 공원 의자 등.

라. 사회 접촉을 하더라도 사회행동의 규율과 규범 이해가 부족하다.

 

 

 

 

사회적 의사 소통의 손상(An impairment of social communication)

 

 

가. 상대의 의사 교류 요구에 응하지 않는다.

나. 단지 자신이 필요한 것에서만 제한적으로 의사 교류를 한다.

다. 사실적인 것에서는 설명을 하나 사회적 변화에 관해서는 설명하지 못한다. 그리고 상호간의

     대화를 기대하기 어렵다.

라. 많은 이야기를 하지만 듣는 사람들의 반응에 주의를 두지 않고 상호간에 대화가 계속되지 않

     는다.

 

 

 

 

사회적 이해와 상상력의 손상(An impairment of social understan- ding and imagination)

 

 

가. 모방하거나 하는 척하는 것이 없다.

나. 다른 사람의 행동을 모방하더라도 행동의 의미와 목적의 실제적인 이해가 없다.

다. 생활 규칙을 고정적으로 반복한다. 어떤 역할을 해내기는 하지만 변화와 감정이입이 없다.

라. 때로는 타인의 마음이 어디에 있는가를 자각하지만, 타인의 감정을 인식하지 못한다.

마. 때로는 타인의 마음이 어디에 있는지를 자각하지만, 타인의 감정을 인식하지는 못한다.

     최소한의 타인을 지각하는 능력을 가지고 있으나, 이것은 감정이입이라기보다는 학습되어진

     것이다.

 

 

 

 

Asperger의 정의

 

Wing이 범주한 비정상적인 행동은 이러한 사회적 기능의 수준을 지닌 자폐 아동에게서 보이고 있다. Wing의 자폐 아동의 결손에 관한 연구는 또한 에스퍼거 증후군(Asperger Syndrom)의 실체를 설명하는데 기여했다. Asperger는 자폐 아동의 결손 특징을 유목하고 개인이 갖고 있는 증상의 하위그룹을 다음과 같이 설명하였다. 타고난 부적절한 사회적 접촉(Make naive and inappropriate social approaches) 극히 제한적인 사물에 대한 관심(Have narrow circumscribed interests) 운동 협응기능의 부족(Have poor motor no-ordination) 오래 지속되는 반복적인 언어(Have long-winded repetitive speech)

 

 

 

 

 

http://www.autismcenter.or.kr

 

 

 

Autism

 

 

 

What is autism?

 

Autism is a brain disorder that often interferes with a person's ability to communicate with and relate to others.

 

Signs of autism almost always develop before a child is 3 years old, although the condition is sometimes not diagnosed until later. Typically, parents first become concerned when they notice that their toddler does not begin to talk or does not respond and interact like other children of the same age. Toddlers with autism do not usually develop speech normally and may seem to be deaf although hearing tests are normal.

 

Autism also affects how a child perceives and processes sensory information.

The severity of autism varies. Some individuals need assistance in almost all aspects of their daily lives, while others are able to function at a very high level and can even attend school in a regular classroom. While this is a lifelong condition that typically results in some degree of social isolation, treatment can make a major difference in the lives of people with autism. Early diagnosis and comprehensive treatment has resulted in increasing numbers of people with autism being able to live independently as adults..

 

 

 

 

What causes autism?

 

 

Autism tends to run in families, suggesting a genetic link. Because people with autism can be vastly different, scientists suspect a number of genes are responsible. ongoing research is targeted at pinpointing these genes. Some experts also believe that environmental factors may play a part in causing autism, although scientists have studied several factors, including vaccines, and have yet to identify such a cause.

 

Brain scans of people with autism have shown abnormalities in several areas of the brain, including those responsible for emotion and social relations. Other studies suggest that people with autism have high levels of the neurotransmitter serotonin, a chemical that sends messages in the brain. However, these findings are preliminary, and ongoing studies seek to explain the brain and autism. ¹

 

 

 

 

What are the symptoms?

 

 

All people with autism have difficulty with social interactions and relationships. Parents often describe their child with autism as preferring to play alone and making little eye contact with other people. Other symptoms of autism include:

• Difficulties with verbal and nonverbal communication. Language development in children with autism is almost always delayed.
• Limited, repetitive, and overused (stereotyped) patterns of behavior, interests, and play. Many typical behaviors—such as repetitive body rocking, unusual attachments to objects, and holding fast to routines and rituals—are driven by the need for sameness and resistance to change.

There is no “typical” person with autism. Although autism is defined by the above characteristics, people with autism can have many different combinations of behaviors in mild to severe forms.

 

 

 

 

Do any other conditions occur with autism?

 

 

Although it is difficult to determine, studies show that below-normal intelligence occurs in about 70% of children with autism. ² Teenagers with autism often become depressed and have increased anxiety, especially if they have average or above-average intelligence. In addition, about a third of children with autism develop a seizure disorder (such as epilepsy) by their teen years. ³

 

 

 

 

How is autism diagnosed?

 

 

Your health professional will use diagnostic guidelines, established by the American Academy of Child and Adolescent Psychiatry (AACAP), to determine whether your child has core symptoms. ⁴ A child may also have hearing and other tests to make sure developmental delays aren't the result of another condition with similar symptoms. Early diagnosis and treatment of autism is important to make the most of the child's potential.

 

 

 

 

How is it treated?

 

 

Behavioral training, speech and occupational therapy, and parent education and support can often improve a child's problem behaviors, communication skills, and socialization. Medications are sometimes helpful as well. A child with autism responds best to a highly structured, specialized educational program tailored to his or her individual needs. However, specific treatment varies depending on the range of individual symptoms, which can combine in many different ways and change over time.

Parents, school staff, and health professionals are usually all involved in planning a child's treatment.

 

 

Frequently Asked Questions

Learning about autism:	What is autism? What causes autism? What are the symptoms? Who is affected? What are other types of developmental disorders? What is the difference between autism and Asperger's syndrome? Can vaccinations cause autism?
Being diagnosed:	How is autism diagnosed? Are there any tests to screen for general developmental disorders? What questions are asked regarding my child's medical history? Are there any diagnostic guidelines specifically for autism? How is behavior assessed? What will my child's doctor look for during a physical examination for autism?
Getting treatment:	What are the general treatment goals for autism? What are some steps parents can take to help a child with autism? Are there any medications to help treat autism? How do I know if an alternative therapy is good for my child?
Ongoing concerns:	What kinds of training programs can help a child with autism? Are there any specific therapies to help a child with autism?
Living with autism:	What kind of support will I need? How can I help my child in school? What kind of care is available for adults with autism?

 

 

 

 

 

References

Citations

1. Volkmar FR, Pauls D (2003). Autism. Lancet, 362(9390): 1133–1141.
2. Volkmar FR, Klin A (2000). Pervasive developmental disorders. In BJ Sadock, VA Sadock, eds., Kaplan and Sadock's Comprehensive Textbook of Psychiatry, vol. 2, pp. 2659–2678. Philadelphia: Lippincott Williams and Williams.
3. Teplin SW (1999). Autism and related disorders. In MD Levine et al., eds., Developmental-Behavioral Pediatrics, 3rd ed., pp. 589–605. Philadelphia: W.B. Saunders.
4. American Psychiatric Association (2000). Autistic disorder. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 70–75. Washington, DC: American Psychiatric Association.
5. Filipek PA, et al. (2000). Practice parameter: Screening and diagnosis of autism, Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society. Neurology, 55: 468–479.
6. Committee on Children with Disabilities, American Academy of Pediatrics (2001). Technical report: The pediatrician's role in the diagnosis and management of autistic spectrum disorder in children. Pediatrics, 107(5): 1–18.
7. Wilson K, et al. (2003). Association of autistic spectrum disorder and the measle, mumps, and rubella vaccine. Archives of Pediatrics and Adolescent Medicine, 157: 628–634.
8. Volkmar F, et al. (1999). Practice parameters for the assessment and treatment of children, adolescents, and adults with autism and other pervasive developmental disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 38(12, Suppl): 32S–54S.

Other Works Consulted

• Filipek PA, et al. (1999). The screening and diagnosis of autistic spectrum disorders. Journal of Autism and Developmental Disorders, 29(6): 439–484.
• Piven J (1997). The biological basis of autism. Current Opinion in Neurobiology, 7: 708–712.
• Vastag B (2001). Congressional autism hearings continue: No evidence MMR vaccine causes disorder. JAMA, 285(20): 2567–2569.

 

 

 

 

 

 

 

Author:	Nancy Reid
Medical Review:	Michael J. Sexton, MD - Pediatrics Fred Volkmar, MD - Child Psychiatry
Last Updated:	August 10, 2004

 

 

 

 

 

http://health.yahoo.com/ency/healthwise/hw152184

 

 

 

 

 

 

 

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