Autism Spectrum Disorder

孤独症谱系障碍

Even though everyone develops at slightly different paces,almost everyone hits the same general developmental milestones and learns the same sets of skills at about the same time,more or less.

尽管每个人发育的进程略有不同，但大多数人都会经历相同的发育阶段，在差不多相同的时间学会相同的技能，或早或晚，大体相同。

These are things like language and communication,socializing,cognitive skills problem solving,and physical milestones like walking,crawling and fine motor skills,all of which progress as the brain develops.

这些技能包括语言交流能力、社交能力、认知能力如问题解决能力，还有躯体运动能力的发育，比如走、爬和精细运动能力等。所有这些能力都会随着大脑的发育而形成。

If one of these doesn't develop as scheduled,depending on the severity,it may be described as a type of neurodevelopmental disorder,neuro referring to the brain.

假如某些能力没能按期形成，根据严重程度，可能会被诊断为神经发育障碍的一种。neuro指大脑。（前缀neuro-）

Especially when certain skills related to socializing and communicating don't proceed as normally,it can result in isolation,which is where the name autism originated,since auto means self,so autism refers to a condition where somebody might be removed from social interaction and communication,leaving them alone or isolated.

如果与社会交往、交流有关的能力没有正常发育，患者将陷入孤立的状态，这也是孤独症名字的由来。auto的意思是自己（前缀aut-），所以孤独症指一个人抽离于社交互动和社交交流，陷入孤立隔离的状态。

Before 2013,the diagnostic and statistical manual for mental disorders,the fourth edition or the DSM-Ⅳ,described autism as one of several pervasive developmental disorders,which also includes Asperger syndrome,childhood disintegrative disorder and those not otherwise specified,or PDD-NOS.

早在2013年以前，《精神障碍诊断与统计手册第四版》，即DSM-Ⅳ，将儿童孤独症归入广泛性发育障碍中。后者还包括了阿斯伯格综合征、儿童期瓦解性障碍和待分类的广泛性发育障碍（简称PDD-NOS）。

Asperger syndrome was used for children that appeared to have characteristics of autism like difficulties with social interactions or non-verbal communication,but don't generally have significant delays in language or cognitive development,and are therefore Asperger's syndrome was sometimes refereed to as a high-functioning form of autism.

患阿斯伯格综合征的孩子具有儿童孤独症的部分特征，如在社交交往和非语言交流中存在困难，但语言和认知能力的发育一般没有明显推迟。因此阿斯伯格综合征有时用来指孤独症的高功能形式。

Childhood disintegrative disorder was used to describe late onset of developmental delays,so these children develop normally for their age,but then they seem to lose the acquired social and communication skills sometime between age 2 and 10.

儿童期瓦解性障碍是一种迟发的发育迟缓，患儿的发育情况一开始与其年龄相符，但在2~10岁的某个时候会丧失已经习得的社交和交流能力。

Pervasive developmental disorder-not otherwise specified is essentially a catch-all category in which patients meet some,but not all features of autism,Asperger's syndrome or childhood disintegrative disorder.

待分类的广泛性发育障碍本质上是一个包罗万象的分类，包括了那些不完全负荷儿童孤独症、阿斯伯格综合征和儿童期瓦解性障碍的情况。

Researchers found,however,that separate diagnoses of these pervasive developmental disorders weren't consistent across different clinics,since they tend to have very similar signs and symptoms.

然而研究者发现，对广泛性发育障碍的单独诊断，在不同诊所并不一致，因为它们有着非常相似的体征和症状。

As of 2013,the DSM-Ⅴ,a new revised edition,removed these terms and replaced them with autism spectrum disorder or ASD which encompasses all the previous pervasive developmental disorders but uses a scale,or a spectrum,that differentiates based on severity of two major areas—social communication and interaction deficits and restrictive or repetitive behavior,interests and activities.

到了2013年，新修订的DSM-Ⅴ删除了这些术语，取而代之的是孤独症谱系障碍，简称ASD，它涵盖了先前所有的广泛性发育障碍，但使用了一个范围，或者说谱系，根据两个主要方面的严重程度对疾病进行区分——社交交流和社交互动缺陷；受限的、重复的行为模式、兴趣或活动。

• For the social and communication area,there are four subcategories that clinicians look for deficits.
• 在社交和交流方面，临床医生可以在四个子方面查看患儿是否存在缺陷。

1.The first is social reciprocity,which refers to how children respond or reciprocate in social interactions.

首先是社交互动，即儿童如何在社交交往中进行反应和互动。

So like how the behavior of one person influences the other,and vice versa.

比如一个人的行为如何影响另一个人，反之亦然。

An example impairment in this area might be preferring to be alone and not taking a role in social games.

在这方面受损的一个例子可能是，患儿更喜欢独处，且不愿在社交游戏中扮演角色。

2.A second area of potential deficit is joint attention,which is the state of wanting to share an interest with someone else,so it's like"Hey!Check out this awesome thing I found".

第二个可能存在缺陷的领域是共同注意，即想要跟别人分享兴趣的状态，比如说：“嘿！你看我找到了什么好东西！”

So an example of impairment might be a child not sharing their interests or amusement in an object with a a parent.

受损的例子可能是孩子不把对事物的兴趣和得到的兴趣与父母分享。

3.Next there's bonverbal communication,which refers to difficulties either using nonverbal communication themselves or interpreting nonverbal cues from someone else.

接下来是非语言交流，即自己难以使用非语言交流，也难以理解别人的非语言提示。

So maybe the child won't put their arms out when they want to be picked up,or they won't be able to tell when a parent's upset,even if the parent's frowning and crossing their arms.

这样的孩子可能在想被抱起的时候却不伸出双手，或者看不出父母正在生气，即使父母皱着眉头叉着双手。

4.The last subcategory of communication deficits is in social relationships,so the children have trouble developing and maintaining relationships.

最后一个子方面是在社会关系中的交流缺陷，这些孩子在发展、维持人际关系上存在困难。

So maybe the child has a hard time making friends,or they're able to make friends but their behavior tends to drive them away.

他们可能很难交到朋友，或者交到了朋友，但他们的行为却倾向于把朋友赶走。

• The other major area of deficit is called restricted and repetitive behaviors—and this category's category's pretty broad and can include a whole bunch of behaviors.
• 另一个主要方面的缺陷叫做受限、重复的行为模式。这是一个十分广泛的分类，包括一大堆行为模式。

Some being more well-known or characterized than others,like lining up toys in a ritualistic sort of way or flapping one's hands,or imitating words or phrases.

有些广为人知、容易辨认，比如用固定的、仪式化的方式排列玩具，或者拍打自己的手，模仿单词或短语。

The child might be fixed on certain routines,like taking the same route every day to school or they might have restricted patterns of interest,like having a very specific and in-depth knowledge of the Titanic or vacuum cleaners.

这些孩子可能会固守一些惯例，比如说每天走同样的路线去学校，或者可能有高度受限、固定的兴趣，比如对泰坦尼克号或真空吸尘器有十分详细、深入的了解。

Children with autism spectrum disorder might exhibit one or more of these deficits,and vary in how severe the deficit is.

患有ASD的儿童可能有一种或多种上述的缺陷，缺陷的严重程度也各异。

It's important to remember that each child with autism spectrum disorder is going to have a different spectrum of symptoms and deficits.

重要的是要记住，每个患有ASD的儿童都会有不同的症状和缺陷。

Typically clinicians will try to observe these behaviors in the child,looking for these possible deficits.

正常来说临床医生会通过观察孩子的行为，寻找可能存在的缺陷。

Since these behaviors are often well-known by the child's caretakers than they are by the clinicians,like their parents or their teachers,a meaningful diagnosis of autism spectrum disorder relies heavily on listening to what other's are observing at home or in school.

由于患儿的看护者往往比临床医生更清楚其行为表现，比如患儿的父母、老师，因此对ASD正确的诊断，十分依赖于倾听他们在家里或学校观察到的东西。

They might be given severity scores in each area,which can help determine how much support the child's going to need.

医生可能会给每个主要方面的严重程度评分，以帮助决定欢而需要多大程度而支持。

For example,a severity level 1 would indicate the child needs some support.

举个例子，严重程度处于水平1意味着患儿需要一些支持。

For social communication,they might speak in full sentences and engage in communication,but normal back and forth conversation with others just doesn't seem to work.

在社交交流方面，他们可能可以说出完整的句子，能够参与交流，但是没办法进行正常的往来对话。

For repetitive and restrictive behaviors,they might have difficult switching between activities.

在受限、重复的行为模式方面，他们可能难以在不同的活动间切换。

On the other side of the spectrum,a level 3 severity means the child needs very substantial support and on the social communication side,they might display few words of intelligible speech and rarely initiate interaction with others.

在谱系的另一端，严重程度水平3意味着患儿需要大量支持，在社交交往方面，他们可能只会讲几个能被听懂的字， 并且很少启动社交互动。

For repetitive behaviors,they might be extremely resistant to change,and their behaviors seriously interfere with daily life.

在重复行为模式方面，他们可能极度拒绝改变，并且其行为严重阻碍了正常生活。

It's thought that using this scale of symptoms,as opposed to differentiating between pervasive developmental disorders,will help give a more accurate and medically useful way to diagnose individuals,for example,those with what was previously described as Asperger's syndrome would likely fall closer to severity level one than severity level three.

人们认为使用这样的症状范围，而非使用广泛性发育障碍，将有助于提供更准确、更有临床意义的个体诊断，比如先前被诊断为阿斯伯格综合征的孩子，将更接近严重程度水平1而非水平3。

Generally speaking,ASD's thought to have a genetic cause,which ultimately affects brain development,specifically areas that affect social and communication behaviors.

一般认为ASD的发病具有遗传因素，后者从根本上影响了大脑发育，特别是与社交和交流行为有关的区域。

Which genes or combination of genes that are affected in ASD,though,is still very much a mystery.

但哪些基因或基因组合会影响ASD的发病仍然是一个谜。

In addition,there are many environmental triggers that have been explored,but at the moment,there are no clear risk factors that have been identified.

此外，人们探索了许多环境诱因，但就目前来说，还没有发现明确的风险因素。

With that said,there's also no cure for ASD,and treatment or management has to be specifically and carefully tailored to each child,and this includes things like specialized educational programs and behavior therapy that all seek to maximize quality of life and functional independence.

这也意味着目前ASD没有治愈手段，而对患儿的治疗和管理，需要为每个孩子量身定做，包括专门的教育计划和行为疗法，以期最大化地提高生命质量和实现功能独立。

注：

孤独症，即自闭症。

在我国，其精神病学专业规范名词为孤独症，

香港和台湾地区习惯称其为自闭症。

国际上将典型孤独症、不典型孤独症和阿斯伯格综合征等统称为孤独症谱系障碍。

目前孤独症的诊断标准有：

• 国际的诊断标准DSM-Ⅴ
• WHO的诊断标准ICD-Ⅺ
• 中国的诊断标准CCMD-Ⅲ

国内一般采用DSM-Ⅴ进行诊断