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zoom RSS 自閉症早期発見のためのガイドライン

<<   作成日時 : 2007/11/04 01:08   >>

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自閉症の早期発見早期治療のために最前線の小児科医へに対して2つのレポートが米国小児科学会から出された。
(書きかけ)
自閉症の早期徴候
*親や保護者を見つめるときの暖かで嬉しそうな表情が見られない
*生後5ヶ月頃からの子どもと親との間の喃語がみられない
*名前を呼んだときの親の声を認識せず、ふり向かない
*視線を合わせない(アイ・コンタクトがない)
*9ヶ月を過ぎても喃語がない
*指差しなどの発語前の身振り動作が見られない
*反復動作

言語発達における赤信号
*16ヶ月になっても発語がない
*1才になっても喃語がなく、指差し動作などがない
*2才になっても2語文が言えない
*言語能力の欠如

18ヶ月より24ヶ月の間ですべての子どもにたいして、親が問題を認識しているかどうかに関係なく、自閉症のスクリーニングを推奨。

2つ目のレポートでは、診断後にどうするかについて、早期の介入の必要性を強調している。自閉症が疑われ次第なるべく早期に介入が行われるべきで、確定するまで待つべきでないとしている。少なくとも週に25時間以上の介入療法が行われるべきである。

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NEW AAP REPORTS HELP PEDIATRICIANS IDENTIFY AND MANAGE AUTISM EARLIER
http://www.aap.org/advocacy/releases/oct07autism.htm
Identification and Evaluation of Children With Autism Spectrum Disorders
http://www.aap.org/pressroom/AutismID.pdf
Management of Children With Autism Spectrum Disorders
http://www.aap.org/pressroom/AutismMgmt.pdf
-----------------------------------------
Pediatricians' Group Issues New Autism Guidelines
http://health.msn.com/healthnews/articlepage.aspx?cp-documentid=100173143
2 reports detail detection and treatment recommendations
By Serena Gordon, HealthDay Reporter

画像MONDAY, Oct. 29 (HealthDay News) -- In an effort to make it easier for pediatricians to spot and begin early treatment for children with autism spectrum disorders, the American Academy of Pediatrics has released two new reports with recommendations for identifying and managing these conditions.

"Pediatricians are the front line" in identifying autism spectrum disorders, said Dr. Melissa Nishawala, clinical director of the Autism Spectrum Disorders Service at the New York University Child Study Center. "And, the earlier we find out, the swifter we can intervene when the brain is more immature, and we can help to model it in different directions.

"The tendency has been to understand that child development varies widely and to reassure the parents that some children speak late or even if they seem to be off track developmentally, that most children catch up," Nishawala added. "So, if there's a parental concern, they may get a referral, or it may take several months" of waiting to see if the child gets back on track developmentally.

The result can be that it may take a year or more before a child is officially diagnosed with autism, and a critical window in treatment time has been lost.

The reports are published in the November issue of Pediatrics; they were released Monday during the American Academy of Pediatrics annual meeting in San Francisco.

The first report, which details ways to detect autism spectrum disorders, highlights some of the earlier signs that might suggest an autism spectrum disorder. They may include:

* A lack of warm, joyful expressions while gazing at a parent or other caregiver.
* No back-and-forth babbling between the infant and parent beginning around 5 months of age.
* A lack of recognition of a parent's voice or not turning when the parent says the baby's name.
* Failure to make eye contact.
* Delayed onset of babbling past 9 months of age.
* No or few pre-speech gestures, such as waving or pointing.
* Repetitive movements with objects.

Later, as speech develops and these disorders become more apparent, some important red flags are:

* No single words by 16 months of age.
* No babbling, pointing or other communicative gestures by 1 year of age.
* A lack of two-word phrases by 2 years of age.
* A loss of language skills at any age.

The report recommends universal screening of all children for autism between 18 months and 24 months of age, even if parents haven't expressed any particular concerns.

The second report focuses on what to do after autism has been diagnosed and stresses that early intervention is critical. The report recommends that intervention should begin as soon as autism is suspected, rather than waiting until the diagnosis is confirmed. Children with autism spectrum disorders should be involved in intervention therapies for at least 25 hours a week, all year long, according to the report.

The report also suggests that pediatricians familiarize themselves with some of the complementary and alternative therapies that parents may use for their children. For example, some parents feel that when their child is on a casein/glutein-free diet that their symptoms improve. However, such a diet needs to be carefully planned, because nutritional deficiencies can develop. If a pediatrician is aware that the child is on such a diet, he or she can give the parent a referral to a nutritionist to ensure that the child is getting the right nutrients, the report said.

"Pediatricians need to be aware of the alternatives and listen to parents who may want to go down those avenues, and they need to know where to send those families for additional help," said Dr. Cynthia Johnson, director of the Autism Center at Children's Hospital of Pittsburgh at the University of Pittsburgh Medical Center. "If families feel dismissed by their doctor, they may not disclose all the treatments they're trying."

The management report also noted that some medical issues are common in children with autism spectrum disorders, such as sleep disturbances and gastrointestinal trouble, and that pediatricians need to be aware that these may be a problem.

Johnson said both reports were very well done and comprehensive. Nishawala also felt the new recommendations were comprehensive but said it might have been helpful to include additional information about which therapies have been debunked in autism treatment.

More information

To learn more about autism, visit the U.S. National Institute of Neurological Disorders and Stroke.

--------------------------------------
Below is a news release on a press briefing at the 2007 National Conference and Exhibition (NCE) of the American Academy of Pediatrics (AAP). Co-authors Chris Johnson, MD, MEd, FAAP, Clinical Professor of Pediatrics at University of Texas Health Science Center at San Antonio and Scott Myers, MD, FAAP, neurodevelopmental pediatrician at the Janet Weis Children’s Hospital/Geisinger Medical Center in Danville, Pennsylvania, will present the new AAP clinical reports, “Identification and Evaluation of Children With Autism Spectrum Disorders” and “Management of Children With Autism Spectrum Disorders” on Monday, October 29, at 10:00 a.m. (PT) in Hall E of the Moscone Center.
Andy Shih, PhD, vice president of scientific affairs for Autism Speaks, will join Drs. Johnson and Myers for the press briefing.

For Release: Monday, October 29, 2007 12:01 am ET
http://www.aap.org/advocacy/releases/oct07autism.htm

NEW AAP REPORTS HELP PEDIATRICIANS IDENTIFY AND MANAGE AUTISM EARLIER

SAN FRANCISCO – Two new clinical reports from the American Academy of Pediatrics (AAP) will help pediatricians recognize autism spectrum disorders (ASDs) earlier and guide families to effective interventions, which will ultimately improve the lives of children with ASDs and their families. The first clinical report, “Identification and Evaluation of Children With Autism Spectrum Disorders,” provides detailed information on signs and symptoms so pediatricians can recognize and assess ASDs in their patients. Language delays usually prompt parents to raise concerns to their child’s pediatrician – usually around 18 months of age. However, there are earlier subtle signs that if detected could lead to earlier diagnosis. These include:

* not turning when the parent says the baby’s name;
* not turning to look when the parent points says, “Look at…” and not pointing themselves to show parents an interesting object or event;
* lack of back and forth babbling;
* smiling late; and
* failure to make eye contact with people.

Most children, at some time during early development, form attachments with a stuffed animal, special pillow or blanket. Children with ASDs may prefer hard items (ballpoint pens, flashlight, keys, action figures, etc.). They may insist on holding the object at all times.

The report advises pediatricians to be cognizant of signs of ASD, as well as other developmental concerns, at every well-child visit by simply asking the parents if they or their child’s other caregivers have any concerns about their child’s development or behavior. If concerns are present that may relate to ASD, the clinician is advised to use a standardized screening tool. The report also introduces universal screening, which means pediatricians conduct formal ASD screening on all children at 18 and 24 months regardless of whether there are any concerns.

“Red Flags” that are absolute indications for immediate evaluation include: no babbling or pointing or other gesture by 12 months; no single words by 16 months; no two-word spontaneous phrases by 24 months; and loss of language or social skills at any age. Early intervention can make a huge difference in the child’s prognosis. “Autism doesn’t go away, but therapy can help the child cope in regular environments,” said Chris Plauche Johnson, MD, MEd, FAAP, and co-author of the reports. “It helps children want to learn and communicate.”

Educational strategies and associated therapies, which are the cornerstones of treatment for ASDs, are reviewed in the second AAP clinical report, “Management of Children With Autism Spectrum Disorders.” Early intervention is crucial for effective treatment. The report strongly advises intervention as soon as an ASD diagnosis is seriously considered rather than deferring until a definitive diagnosis is made. The child should be actively engaged in intensive intervention at least 25 hours per week, 12 months per year with a low student-to-teacher ratio allowing for sufficient one-on-one time. Parents should also be included.

Pediatricians who treat children with ASDs should recognize that many of their patients will use nonstandard therapies. The report says it’s important for pediatricians to become knowledgeable about complementary and alternative medicine (CAM) therapies, ask families about current and past CAM use, and provide balanced information and advice about treatment options, including identifying risks or potential harmful effects. They should avoid becoming defensive or dismissing CAM in ways that convey a lack of sensitivity or concern, but they should also help families to understand how to evaluate scientific evidence and recognize unsubstantiated treatments.

“Many parents are interested in CAM treatments such as various vitamin and mineral supplements, chelation therapy, and diet restrictions. It’s important for pediatricians to maintain open communication and continue to work with these families even if there is disagreement about treatment choices, ” said co-author of the reports Scott M. Myers, MD, FAAP. “At the same time, it’s also important to critically evaluate the scientific evidence of effectiveness and risk of harm and convey this information to the families, just as one should for treatment with medication and for non-medical interventions.”

Although use of the gluten-free/casein-free diet for children with ASDs is popular, there is little evidence to support or refute this intervention. More studies are in progress, and it is anticipated that these studies will provide substantially more useful information regarding the efficacy of the gluten-free/casein-free diet.

Tantrums, aggressive behaviors, and self-injury are common among children with ASDs, and medical factors may cause or exacerbate these behaviors. Behavior management strategies are often the most effective treatment for challenging behaviors. In some children, medications are effective in addition to the behavioral strategies. The report addresses the medical issues that some children with ASDs encounter such as seizures, gastrointestinal problems, and sleep disturbance, and provides guidance for medication management.

Both reports will also be part of the new AAP practical resource for pediatricians "AUTISM: Caring for Children with Autism Spectrum Disorders: A Resource Toolkit for Clinicians,” which includes screening and surveillance tools, guideline summary charts, management checklists, developmental checklists, developmental growth charts, early intervention referral forms and tools, sample letters to insurance companies and family handouts.

The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults.

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