《自闭症孩子能康复吗？若能的话，是怎么回事？》

amberbrown101

我也看过这篇，再跟qbb贴转个评论。翻译得比较草率哈。

Written by Nestor Lopez-Duran

In this fascinating analytical review of the scientific literature in autism, the authors examined empirical evidence that some people with autism “recover” and no longer meet the diagnosis of autism. The general view in the scientific community has been that autism is a life-long condition and that treatment interventions are most often designed to 1) minimizing maladaptive symptoms (e.g., self-injurious behaviors) and 2) maximizing cognitive/behavioral/social functioning (e.g., increasing adaptive social behaviors or language). But what happens when these interventions are sufficiently effective in minimizing or eliminating symptoms to the extent that the person no longer meets the DSM-IV criteria for autism? Has the person recovered?

文中， 作者对科学文献中的一些自闭症患者后来却不再自闭的经验现象进行了研究。 当前科学界共识是自闭症是伴随终生的， 现有的干预手段通常是为了 1） 削弱不利的症状 （比如，自伤）和 2）增强认知/行为/社交 的功用（比如提高适应性的社交语言和行为）。 然尔当这些干预控制自闭现象到了患者不再符合DSM-IV的自闭诊断标准会怎么样呢？这意味着患者完全康复了吗？

The authors first provided a specific working definition of “recovery” before embarking on an exploration of the available literature. The authors argued that to be considered “recovered” a person:

1. has a clear history of autism
2. must be learning and applying skills at a developmental level that is within the range expected in typically developing persons of the same age.
3. must not meet DSM-IV symptom criteria for ASDs

作者首先提供了这里“康复”的特定定义。 作者强调被认为“康复”了， 一个人必须

1。 曾经是明确的自闭
2。 现在的学习和运用能力和正常的同龄人程度一致
3。 不再符合DSM-IV的自闭评判标准

Based on their current research program, they further expanded this definition to include a more detailed set of criteria, namely, a “recovered” person:

1. must not meet ASD cutoff on social or communication domain on the ADOS
2. must not receive special education services targeted to remediate key features of autism (if any special education services are received they must target non-autism features such as attention, learning disabilities, etc)
3. must be functioning within a regular education classroom WITHOUT individualized assistance
4. IQ must be 80 or greater
5. Vineland communication and socialization scales must be within the normal range (78 or above)

基于他们目前的研究项目，他们把如上几点进一步延展为更为具体的定义。就是说， 一个“康复”的人

1。 必须不再属于ADOS中判断ASD的社交和语言的分界线以内
2。 不再接受针对改善自闭症状的特教服务（如果还在接受特教， 必须是针对非-自闭的特征的比如注意力， 学习障碍等）
3。 必须没有辅助地在正常学校上课
4。 智商必须80以上
5。 必须在Vinland交流和社交量表的正常范围以内（高于78）

A critical component of this definition of recovery is that it is not limited to DSM-IV based symptoms of autism, but it also addresses key areas of functioning. This is critical, because it prevents using the label of ‘recovered’ in cases when the effects of the treatment are limited to reducing symptoms, with little change in the functional limitations of the condition.

The authors then conducted a narrative review of the available scientific literature and concluded that there is compelling evidence showing that between 3% and 20% of children diagnosed with autism may eventually meet the criteria for “recovered”. This wide range is likely the result in differences between the studies in the nature of the population examined, and the presence or absence of factors that are believed to contribute, or hamper, the possibility of recovery. That is, the authors also found that a number of baseline factors (i.e. present while the person met diagnostic criteria) facilitated recovery rates, including:

1. high intelligence
2. presence of receptive language
3. verbal and motor imitation
4. early age of diagnosis
5. PDD-NOS diagnosis

以上定义康复的一个关键要素就是它不再局限在针对自闭现象的DSM-IV， 而是包括日常运用的关键方面。这一点之所以很关键是因为他防止了把“康复”用于虽说自闭现象减少了，但因自闭导致的运用局限没太大改变的情形。

作者然后对当前的文献进行了细致的调研，得出结论3-20%的自闭孩子最终“康复”了。这个范围很大可能是因为每项研究用的样板不同， 采用的手段也各异，各种因素都可能增大或削减康复的可能。 作者发现影响“康复”率的一些有利基准因素如下

1。高智力
2。存在语言接受能力
3。口头和动作模仿能力
4。低龄被诊断
5。诊断为广泛发育障碍 （PDD-NOS）

A number of factors limited the possibility of recovery, including:
1. seizures
2. mental retardation
3. genetic syndromes

限制康复的因素包括
1。 癫痫
2。 智障
3。 遗传综合症、

Although these findings are interesting, I believe an additional contribution of this study is their presentation of the possible mechanisms by which treatment interventions may lead to recovery in autism. These mechanisms can be seen as a road map that helps parents, educators, and clinicians better understand how treatment modalities can be targeted to the specific deficits of each child. These mechanisms include:

1. Normalizing input through attention
2. Promoting the reinforcement value of social stimuli
3. Early intervention provides enriched environments
4. Early intervention provides mass practice and trials
5. Compensatory processes
6. Suppression of interfering behaviors

这些发现很有意思， 但这项研究更大的贡献是它还提供了可能的干预机制。这些机制可以引导家长，老师，和医生更好地理解怎么有针对性地训孩子。

1。通过引导使外界输入正常化
2。增强社交刺激的强化价值
3。早期干预时提供丰富的环境
4。早期干预时大量演练
5。补偿程序
6。压制干扰行为
  
1. Normalizing input through attention
The general concept here is that some of the deficits in autism are due to limitations in attention or distraction that limits the child’s exposure to key stimuli (language, eyes, faces) that are critical for normal development. By redirecting the child’s attention to key stimuli via specific treatment interventions (e.g., ABA), it may be possible to help the child return to a more typical developmental trajectory.

1。通过引导使外界输入正常化
常识是，自闭的部分缺陷是由于孩子对一些关键的刺激（语言，目光，面部表情）缺乏应有的体验，这可能是因为缺乏应有的注意力或有其他干扰。而这些刺激对正常发育是很必要的。通过特定的训练干预（比如，ABA），我们可以把孩子的注意力引向这些刺激因子，从而可能帮助孩子回到正常的发育轨道。

2. Promoting the reinforcement value of social stimuli
This mechanism assumes that we are social because we are rewarded for being social. It is possible that children with autism lack the ability to experience internal rewards from social interactions, thus limiting the occurrence of such behaviors. By promoting such reinforcement (providing external rewards) we may be able to increase social behaviors by fostering the natural reinforcing properties of such behaviors

2。增强社交刺激的强化价值
这个机制认为我们和人交往是因为我们在社交中得到奖励（感到愉悦？）。 自闭的孩子有可能在社交时缺乏这种内在反馈的体验， 由此缺乏社交行为。 通过加强对社交的强化（可以通过外界的奖励），我们有可能培养内在的自我强化，从而达到增加社交行为的目的。

3. Early intervention provides enriched environments
Whether as the result of attention/distraction difficulties, or problems with the mechanisms that control the feelings of reward we experience during social interactions, one theory of autism suggests that limited environmental input contributes to the development of autistic symptoms. For example, children exposed to severe sensory deprivation (such as children in Eastern European orphanages), are at an increased risk for developing autism symptoms. Animal models have also shown that environmental deprivation leads to disruption in typical development, especially in the social realm. Therefore, early interventions may increase environmental sensory exposure (“enriched environmental opportunities”) facilitating a return to typical developmental trajectories among some children.

3。早期干预时提供丰富的环境
无论是由于注意力困难，还是缺乏内在反馈，自闭的一个理论认为削弱的外界输入导致自闭症状的发生。 例如，小孩生活在严重感觉缺乏的环境（比如东欧孤儿院的孩子），更容易有自闭症状。动物模式也显示环境因素的剥夺可以导致正常发育，尤其是社交方面，的中断。因此，早期干预把孩子暴露在丰富的环境因素下可以让一部分小孩回到正常的发育轨道。

4. Early intervention provides mass practice and trials
This mechanism is based on the concept of neuro-cognitive rehabilitation. That is, that intensive repetition facilitates recovery of brain function, likely by facilitating the creation of new neural pathways. Therefore, this mechanism assumes that autism is at least partially due to problems during neural development that leads to an atypical neural organization. The mass repetition provided by intensive intervention would facilitate the development of new neural connections that normalize neural functioning, leading to a decrease in symptoms and neuro-cognitive deficits.

4。早期干预时大量演练
这个机制是依据神经-认知康复的原则。就是说， 强化的反复导致大脑功能的恢复，有可能是通过调节新的神经通路的建立。因此，这个机制假设自闭至少部分是因为神经发育时出了问题导致的非正常的神经结构。强化干预的大量重复可以帮助建立新的神经联接，从而使神经功能正常化，减少神经-认知缺乏导致的现象。

5. Compensatory processes
Similarly to #4, this mechanism suggests that even when brain organization can not be changed (as in irreversible brain damage), early intervention can lead to the development of compensatory behaviors or mechanisms that help the child “bypass” the original deficits. A simple example in physical rehabilitation is the case of right-handed person that suffers a stroke and loses functioning of his right hand. This person may, via intensive training, learn how to write well with his left hand, therefore compensating for the original deficit. In the case of autism, an example would be the case of implicit vs. explicit recognition of emotional facial expressions. Typically developing kids implicitly recognize facial expressions without necessarily needing to “break down” the components of such facial expression (e.g., shape of mouth, tears, etc). However, children with autism may have a deficit in this implicit system, but may learn to compensate for this deficit by developing explicit strategies (e.g., tears most often means sad) that would result in the same outcome: recognition of facial expressions.

5。补偿程序
如同4，这个机制认为即使大脑结构变不了， 早期训练也可以导致形成一些补偿行为或机制帮助孩子绕过原本的器官缺陷。一个例子就是，物理康复训练可以帮助右手中风的患者学会用左手很好地写字。 回到自闭的例子，正常小孩自然会区分表情，不会这个的自闭孩子可以学习一些具体的策略来区分（比如， 眼泪通常意味伤心）从而到达一样的效果。

6. Suppression of interfering behaviors
This is conceptually related to #1. Early interventions lead to suppression of behaviors that interfere with attentional focus to key environmental stimuli. For example, repetitive behaviors limit environmental input to usually one key non-social stimulus. Treatment interventions that reduce repetitive behaviors also result in an increase in behaviors that facilitate typical brain development, such as social interactions.

6。压制干扰行为
这是和 1 相关的，是为了把注意力引到关键的环境因素上来。 比如，限制异常重复行为可以增加正常的行为如和人交往等。

7. Limiting stress and arousal
Also conceptually related to #1 and #6, this mechanism indicates that early interventions reduces emotional arousal facilitating attentional focus to key environmental stimuli and also preventing the damaging effects of exposure to chronic stress.


和1和6相关

8. Boosting recovery via biological treatments
Finally, biological interventions may facilitate recovery by enhancing the effects of the previously described mechanisms. For example, anti-anxiety medications may lead to a reduction of stress and arousal, thus facilitating the effectiveness of other behavioral interventions in promoting attentional focus, compensatory mechanisms, etc.

最后， 生物疗法可能通过对以上机制的增强辅助康复， 比如， 抑制焦虑的药物可能减少压力和兴奋，因此使干预训练更有效。

A final comment, please note that the mechanisms described above are simply the authors’ interpretation of what could be the underlying mechanisms for recovery. Although there is evidence to support these processes, these are entirely theoretical mechanisms, and the research on their validity is ongoing.

最后加一句， 以上都是作者阐述的可能导致康复的机制，它们还都在理论阶段，虽说有一些证据支持，是不是正确还有待将来的研究考证。