孤独症70年:从Kanner到DSM-V  

Seventy years autism: from Kanner to DSM-V

作　　者：陈文雄 

机构地区：[1]广州市妇女儿童医疗中心神经康复科,广东广州510623

出　　处：《临床儿科杂志》2013年第11期1001-1004,共4页Journal of Clinical Pediatrics

摘　　要：2013年美国精神疾病诊断标准(DSM-V)的孤独症诊断标准再次修订,同时今年也是Kanner首次临床描述孤独症的70周年。70年来孤独症诊断标准的变迁折射出孤独症诊断的困难性与挑战性。最新修订的DSM-Ⅴ将孤独症谱系障碍(Autism spectrum disorder)归到神经发育障碍(Nuerodevelopmental disorders)范畴,取消广泛性发育障碍概念;强调其具有持续的社会沟通及社会交往缺失,以及限制性的、重复的行为模式;症候必须发生在早期发育时期。相比DSM-Ⅳ,DSM-Ⅴ将其中的"非连续"的亚分类,孤独症、Asperger障碍、儿童瓦解综合征及未分类广泛性发育障碍移除,归为单一分类,孤独症谱系障碍;总的诊断条目减为7条,需要诊断的最小条目减为5条。DSM-V以单一分类概念定义孤独症谱系障碍将对孤独症的发病率、诊断、治疗、预后及其他相关领域产生深远影响。The diagnostic criteria for autism was revised in the 5th edition of Diagnostic and Statistical Manual of Mental Disorders （DSM-Ⅴ） in 2013. This year also marks the 70th anniversary of psychiatrist Leo Kanner’s ifrst clinical description of autism. The great changes in the diagnostic criteria within the 70 years relfect the challenge and dififculty of the diagnostics of autism. In DSM-Ⅴ, autism spectrum disorder is under the category of neurodevelopmental disorder, with the cancellation of the deifnition of pervasive developmental disorder;“persistent impairment in social communication and social interaction”plus“restricted, repetitive patterns of behavior”;the symptoms have to be present in the early development period. Compared with DSM-Ⅳ, DSM-Ⅴis justiifed to remove the“discrete”sub-categories including autistic disorder, Asperger disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified in DSM-Ⅳ, and the deleted ones are absorbed into a single category, autism spectrum disorder;the numbers of general items of diagnostic criteria are reduced to 7, while the number of minimal items for diagnostics are decreased to 5. The concept of DSM-Ⅴdeifning autism spectrum disorder as a single category will profoundly result in changes of prevalence, diagnostics, intervention, prognosis, and other related regions of autism.

关 键 词：孤独症 诊断标准 儿童 

分 类 号：R749.94[医药卫生—神经病学与精神病学]