152 Early Diagnosis for Autistic Infants and Toddlers Before 2-year-old Chwen-chyong Tsau* Abstract The Prevalence of autism increased rapidly and bec

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1 * ( ) ~ DSM-IV-TR ICD-10 CARS ADI-R CHAT CESIA *

2 152 Early Diagnosis for Autistic Infants and Toddlers Before 2-year-old Chwen-chyong Tsau* Abstract The Prevalence of autism increased rapidly and became one of public health problems. To solve the severity of this problem, early diagnosis and intervention from the birth should be executed. Yet autistic children were usually undiagnosed until age 4 or even later, though parents actually noticed children s symptoms earlier before one-year-old. The purpose of this study was therefore to understand early symptoms of autism and the early diagnosis before 2-year-old, and to clarify what the most sensitive differentiating index within those designed diagnosis items were. Researches analysis was used and the results indicated that early diagnosis questionnaires such as CARS and ADI-R were based on parents remembering reports or family movies analysis. Their sensitivity of differentiation and data s preciseness were under suspicion. CHAT and CESIA designed through national infants and toddles health screen system were much reliable. Early symptoms such as eye contact, difficult to play with peers, pretend play, and specific language regression could be sensitive differentiating index. As to joint attention and response to name-calling needed further research to clarify their differentiating sensitivity. Key wordsautism, early diagnosis, early symptoms * Chwen-chyong Tsau: Assistant professor of Dep. of Early Child Care and Education of Fooyin University

3 153 Kanner 1943 (early infantile autism) 2~5 4~6( 91)7 (Painter, 2003) 1 (Humphries, 2000) 14 1 (Constantino & Todd, 2003) (Blaxill, Baskin, & Spitzer, 2003) (Bryson, Zwaigenbaum, & Roberts, 2004) DSM-IV (APA, 1994)DSM-IV-TR (APA, 2000) ICD-10 (WHO, 1992) (Ruble & Brown, 2003; Wolraich, 2003) 18 (Coonrod & Stone, 2004; Humphries, 2000) ( 88Blackwell & Niederhauser, 2003; Coonrod & Stone, 2004; Humphries, 2000) (Cumine, Leach, Stevenson, 2000) (Howlin & Moore, 1997) (Howlin & Moore, 1997) ( 88Attwood, 1993; Blackwell & Niederhauser, 2003; Humphries, 2000)

4 154 (2/3 ) (Rogers, 1998) ( 2001Coonrod & Stone, 2004; Cumine et al., 2000) Goin & Myers(2004) (Lovaas & Smith, 1989; Perry, Cohen, & DeCarlo, 1995) (Azar, 1998; Humphries, 2000; Kope, Eveas, & Ho, 2001) () 0 Wing & GouldWing (Autistic Spectrum Disorders, ASDs) Kanner(1943) ( 91Cumine et al.,

5 )Wing (American Psychiatric Association, APA) ( DSM-III, 1980)( 91) DSM-III(1980)DSM-III-R (1987)DSM-IV (1994) DSM-IV-TR(2000) ( PDD) (Autistic Spectrum Disorders, ASDs) ( 2001) ( 91) ( 2001) (Infants Behavioral Summarized Evaluation Scale, IBSE) Bathelemy (1990) ( ) ( Goin & Myers, 2004)Filipek(1999) 8

6 156 65% (Goin & Myers, 2004)79%~81%(Filipek et al., 2000) (Goin & Myers, 2004) (Childhood Autism Rating Scale, CARS) (Autism Diagnostic Observation Schedule, ADOS) (Autism Diagnostic Interview-Revised, ADI-R) ( ) (8 1 1 ) 30 Baron-Cohen (1992) 18 歩 (Checklist for Autism in Toddlers, CHAT) (2001) (Checklist of Early Symptoms in Infants with Autism, CESIA) Skuse, Warrington, Bishop, Chowdhury, Lau, Mandy, Place(2004) ADI-R (Lord, Le Counter, & Rutter, 1989) 45

7 157 e (The Developmental, Dimensional and Diagnostic Interview, 3di)3di Skuse 6 16 () 1. Schopler (CARS) CARS Schopler, Reichler, & Rochen- Renner(1988) TEACCH (The Treatment and Education of Autistic and Communication Handicapped CHildren) CARS 15 CARS ( ) ( )(Cumine et al.,2000) (Blackwell & Niederhauser, 2003; Tidmarsh & Volkmar, 2003) 2. Lord (ADOS) (ADI-R) Le Counter, Rutter & Lord(1989) ADOS (point) (showing) DSM-IV ICD-10

8 158 Lord ADOS 3 (Cumine et al., 2000) Lord, Rutter, & Le Couteur(1994) ADOS ADI-R (1) (2) (3) 势 (4) (5) ; ADI-R DSM-IV-TR (APA, 2000) 90 ADI-R (Cumine et al., 2000; Skuse et al., 2004; Tidmarsh & Volkmar, 2003) 3. Baron-Cohen (1992) 歩 (CHAT)Fein (2001) 歩 (M-CHAT) CHAT (A ) (B B (gaze monitoring) (proto-declarative pointing) A (5 ) (4 ) 9 (1) : /

9 159 (2) / 9 (Baron-Cophen, Allen, & Gillberg, 1992) CHAT DSM ICD-10 Baron-Cohen (1992) CHAT 16, (12 ) (22 ) 18 A B / CHAT 18 (Baron-Cohen et al., 1992) Baron-Cohen (1996) ADI-R(Lord et al., 1994) CHAT Baird (2000)Baron-Cohen (2000) Kope (2001)CHAT 38% 75% (Medical Research Council, 2001) CHAT (ASDs) 2% Filipek (2000) CHAT (PDDNOS) 歩 Robin, Fein, Barton, & Green(2001) CHAT 23 (The Modified Checklist for Autism in Toddlers, M-CHAT) 6

10 160 ( ) Dumont-Mathieu, Fein, & Kleinman(2005) 4200 M-CHAT M-CHAT M-CHAT CHAT (Bryson et al., 2004; Dumont-Mathieu et al., 2005) 4. (CESIA) CESIA (2001) Gillbert (1990) Baron-Cohen (1992) ( ) ( , 11.06) ( ) ( ) 38 CESIA : (1) (2) (3) (4) 23 PDDNOS

11 161 CHAT CESIA () (Constantino & Todd, 2003) 1. (Coin & Myers, 2004; Constantino & Todd, 2003; Coonrod & Stone, 2004; Skuse et al., 2004) 2 Baron-Cohen (1992)Gillberg (1990) (2001) PPDNOS CARS M-CHAT Werner, Dawson, Osterling,

12 162 & Dinno(2000) Robins (2001) M-CHAT (2001) (Charman, Swettenham, Baron-Cohen, Cox, Baird, & Drew, 1997; Goin & Myers, 2004; Coonrod & Stone, 2004) CHATM-CHAT PLADOS 20 ( 91)Baron-Cohen (1992) (2000) (91) Landry & Loveland(1988)Baron-Cohen ( 1996) (2000) (2003)Mundy (1994)

13 (86%) (91%) (Coonrod & Stone, 2004; Goin & Myers, 2004) (Wetherby & Woods, 2003) 0 (Goin & Myers, 2004)Wetherby & Woods(2003) Coonrod Stone(2004) (88) 2 3 (2000) 7.8 (3.0 ) (2.6 ) (0 Williams & Ozonoffs(2001)Werner & Munson(2001) ( Goin & Myers, 2004)Tidmarsh & Volkar(2003) 52%(31/61 )27%(17/64 )50%(118/473) CESIA

14 164 ( 2001) (Goin & Myers, 2004) (Coonrod & Stone, 2004) (Humphries, 2000) (Evers, 1986) ( 2001Baron-Cohen et al., 1992 ; Humphries, 2000) ( 2001Humphries, 2000) ( 2001) Charman (1997) ( ) (19 鹷 20.3) (9 鹷 21.1) Charman (1997) CHAT Mundy, Sigman, & Kasari(1994) 2 8 Baron-Cohen (1992)16000 (theory of mind) (Goin & Myers, 2004) (Wetherby & Woods, 2003)

15 165 ( 89) ( 89) DSM-IV(1994, APA) ( ) (Wing & Gould, 1979) (2001) PPDNOS ADHD (Baron- Cohen et al., 1992; Cumine et al., 2000; Humphries, 2000; Lord, 1989) DSM-IV(APA, 1994) DSM-IV-TR(APA, 2000,) ICD-10(WHO, 1992) ( ) ( )

16 166 (Azar, 1998) (APA) ( 93Wetherby & Woods, 2003) DSM-IV DSM-IV-TR ICD-10 (Humphries, 2000) (Azar, 1998) CHAT CESIA CHAT M-CHAT ( 91Cumine et al., 2000; Humphries, 2000; Ruble & Brown, 2003)

17 167 (Coonrod & Stone, 2004; Wetherby & Woods, 2003) (Humphries, 2000) (Humphries, 2000; Coonrod & Stone, 2004) 0 3 (91) (91) 15(1)26-46 (89) (93) NSC H (88) (2003) 对 -- 宝 (2000) 41(1)57-70

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(10) CS - Breakthrough of Self-boundary

(10) CS - Breakthrough of Self-boundary 衝破自我的界限 : 自閉症兒童的心智解讀引言臨床心理學家羅澤全 / 實習臨床心理學家鄒凱詩根據美國精神醫學會精神疾病診斷與統計手冊 (DSM-IV-TR)(APA, 2000), 自閉症兒童在社交溝通及行為方面, 表現均與同齡兒童的不同在