自閉症小檔案

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1993 / 2月

文‧張瓊方



自閉症是不是精神病?

早期這類病患因找不到身體異常之處,而被歸類為兒童精神分裂症。但近二、三十年來陸續的研究發現,自閉症與精神病不同,應歸屬於「廣泛性發展障礙」。

就疾病發展過程而言,精神病有些可以痊癒,有些屬陣發型,有些則有起伏,會惡化;自閉症則較少惡化現象,多半隨年齡成長而逐漸改善。

就藥物治療反應而言,抗精神病藥物對精神病有幫助,但對自閉症而言,只有在壓制自傷或攻擊行為嚴重時,才選擇性的使用,但要改正或消除此行為要靠「行為治療」。

導致自閉症的因素是什麼?

自閉症的直接致病因素,至今仍是個謎。目前醫學界找到兩個相關因素。生產過程或胚胎發展過程中造成的腦傷,是其中之一。另一個則是遺傳因素,自閉症的男女比例差異很大,約為五比一,而其中百分之廿具有語言發展遲緩、智能不足,或學習障礙的家庭病史。

自閉症有什麼病徵?

絕大多數的自閉症都是先天的,因外表與正常的孩子無異,在襁褓期不容易發現,在十二個至卅個月之間的嬰幼兒期,症狀較顯著。

自閉症的主要症狀如下:

一、人際關係障礙:不理人、不看人、不黏人、不怕生;自己玩自己的,我行我素,對人不感興趣,與親人之間缺乏感情交流與依戀關係。

二、語言障礙:自閉兒語言發展遲緩。有的語法錯誤、腔調異常或咬音不正確;雖有語言,卻不能與人溝通;自言自語,或不斷復誦同一句話,而不知其意,有的甚至沒有語言。

三、知覺障礙:聽而不聞、視而不見,對外界刺激的反應異於常人,對痛、冷、熱也沒有反應。

四、特殊遊戲法:對玩具有自己獨特、一成不變的玩法,如:持續把車子倒過來玩輪子,或把車子排成一排等。

五、行為異常:活動量過高或過低,踮腳尖走路、自己轉圈、撞頭等。手上固定拿著某種東西、只吃固定的食物、抗拒改變固定的行為等。

自閉症有那些併發症?壽命有多長?

一般而言,自閉症兒身體情況均屬正常。但自閉兒罹患多發性結節硬化症和小兒癲癇的比例較正常人高。約有三分之一至五分之一的自閉兒合併有癲癇症。

自閉症患者不知覺危險,發生意外比例較高,再加上部分併發疾病,平均壽命可能較正常人短。如果排除以上兩個因素,自閉症的壽命與正常人無異。

自閉症患者是不是都像電影「雨人」一樣,有超人的記憶力或天賦異稟?

自閉症患者由於人際溝通上的困難,難以測出其潛能。如果以一般的智力測驗標準來衡量,百分之十的自閉症患者智能正常,百分之廿屬輕度智障,百分之七十屬中、重度智能不足。

雖然自閉症患者的智力測驗結果智商偏低,抽象思考和推理能力甚低,卻常有很好的記憶力。但像「雨人」那樣有超人的計算和記憶能力,並不多見。

自閉症患者是「恐怖份子」有攻擊性?

自閉症患者沒有攻擊性,不會無緣無故攻擊人。但由於這類患者缺乏與人溝通的能力,因而在遇到不舒服的刺激或固執性行為被打斷、受挫等情況下,會出現自傷行為,如撞頭、咬手等,有些也會傷及別人,多半是身旁的照顧者。

自閉症的發生率是多少?能否預防?

自閉症的發生率大約是在萬分之四至十五之間,男比女多三至五倍。由於發生原因仍無定論,也無法在產前檢查中預先得知,因而無法預防。

自閉症能不能治癒?

到目前為止,學理及治療方面的醫學文獻顯示,自閉症尚無完全治癒的實例。透過教育和行為治療,雖然可以減輕患者的症狀,功能較高者,甚至可以進展至接近常人的程度,但其某方面的缺損仍會持續性存在,不可能完全正常。

自閉症患者能不能結婚?會不會遺傳?

自閉症患者有正常的性慾求,但因無法與人建立關係,結婚的不多。是否會遺傳,尚無答案。目前僅知英國有自閉症患者結婚,生下正常的孩子。

〔圖片說明〕

P.108

自閉兒常喜歡看旋轉的東西,腳踏車不用來騎,推倒在地上,旋轉車輪,緊盯著轉動的輪子不放,是典型的自閉兒行為。(張良綱攝)

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EN

Autism: Basic Facts

Chang Chung-fang /tr. by Peter Eberly


Is autism a mental disorder?

Autism was once categorized as child schizophrenia because no physical abnormalities could be detected. During the past 20 or 30 years, however, studies have found that autism should be characterized instead as an "extensive developmental disability."

As far as their course of development is concerned, some mental disorders can be cured, some are permanent disabilities, some recur intermittently and some gradually worsen. Autism rarely worsens. It usually improves gradually with age.

As for response to drug therapy, antipsychotic medication can be helpful in treating mental disorders, but it is used for autism sufferers only as an option to suppress severe behavior that might cause injury to themselves or others--improving or eliminating the behavior depends on behavioral therapy.

What factors lead to autism?

The direct pathogenic factors of the condition remain a riddle. Two related factors have been discovered. One is brain damage caused during delivery or fetal development. The other is the factor of heredity. The ratio of incidence between boys and girls is about five to one, and around 20 percent have a family history of language development retardation, inadequate intelligence or learning disabilities.

What are the symptoms of autism?

The vast majority of autism cases are congenital. Because sufferers are no different from normal children in appearance, the condition is difficult to discover during early infancy. The symptoms become more apparent at the age of 12 to 30 months.

The main symptoms of autism are as follows:

1. Emotional disabilities: ignoring people, not looking at them, keeping a distance, not fearing strangers, masturbating, persisting in fixed behavior regardless of others, a lack of interest in others, a lack of emotional exchange with family members or a lack of emotional dependence.

2. Language disabilities: slow language development, marred by grammatical mistakes, odd inflection or indistinct pronunciation; inability to communicate despite possessing language abilities; talking to themselves or constantly repeating the same words; some possess no language ability at all.

3. Perceptual disabilities: hearing or seeing without perceiving, reacting differently to outside stimuli than normal people do; no reaction to pain, cold or heat.

4. Odd ways of playing: having an odd, unvarying way of playing with toys, such as turning a toy car over and constantly spinning the wheels or lining cars up in a row.

5. Abnormal behavior: hyper-or hypoactive, walking on tiptoe, turning in circles, banging head, constantly holding a certain object or eating only certain foods, refusing to change fixed behavior.

What complications does autism entail? How long is life expectancy?

Generally speaking, autistic children are normal physically, although they do suffer from a higher than normal incidence of tubercular sclerosis and epilepsy. About one third to one fifth of autistic children suffer from epilepsy.

Given these complications and the fact that they lack a sense of danger and are rather prone to accidents, autistic people have a lower than normal life expectancy. Those two factors set aside, their life expectancy would be no different from that of normal people.

Are autistic people blessed with photographic memories or natural gifts like those of the character portrayed in the film Rain Man?

Due to their difficulties in communicating with people, their intelligence is hard to measure. Judged by the criteria of standard intelligence tests, 10 percent have normal IQs, 20 percent are slightly retarded and 70 percent are severely retarded.

Despite scoring low on intelligence tests and being poor at abstract thinking and reasoning, autistic people often have very good memories. But very few have the superhuman memories and calculating abilities of the character portrayed in Rain Man.

Are autistic people hostile or aggressive?

No. They will not attack people for no reason. Because they are poor at communicating, however, if they encounter uncomfortable stimuli, interruption of persistent behavior or other setbacks, they may try to harm themselves by bumping their head or biting their hands or try to hurt those around them.

What is the incidence of autism? Can it be prevented?

The rate is about 4 to 15 cases per 10,000 births. It occurs three to five times more frequently in boys than in girls. Since its causes have not been determined and there is no way to check for it during prenatal examinations, there is no way to prevent it.

Can autism be cured?

There are still no documented cases of autism being completely cured. Education and behavioral therapy can diminish the symptoms, and those who have been effectively treated can progress nearly to the level of a normal person, but deficiencies persist in certain areas and complete normality is impossible.

Can autistic people marry? Will they pass the condition on to their children?

Autistic people have normal sexual drives, but being unable to establish interpersonal relationships very few of them marry. There are only a handful of instances in the whole world. There is still no answer as to whether or not they will pass the condition on. An autistic person in Britain who married is known to have produced a normal child.

[Picture Caption]

p.108

Autistic children like to watch things rotate. Instead of riding it, they prefer to turn over a bicycle and watch one of the wheels spin. (photo by Vincent Chang)

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