自閉患者在不同發展階段之臨床表現及神經心理功能

Clinical Manifestations and Neuropsychological Functions in Patients with Autism Spectrum Disorder Across Lifespan

自閉症常與其他精神科診斷共同發生，包含注意力不足過動症，注意力與執行功能缺損也常出現在自閉症患者。長期追蹤研究顯示，自閉症狀隨著年齡往往未發現有顯著改善，其生活適應能力也隨著基礎能力差異而有不同的發展，幼時認知及語言不佳者，在成年後大多仍有適應功能障礙。認知執行功能與社會認知功能，彼此之間有高度相關性，追蹤研究顯示，早期的認知執行功能可以預測日後的心智理論能力。自閉患者的認知執行功能與注意力功能，隨著年齡增長，亦與一般發展者同樣有進步，在兒童期尤為顯著。在青少年期自閉患者執行功能控制仍有顯著缺損，反應抑制能力較一般發展者進步少，在視覺－空間連結記憶，則有停滯退化現象。認知介入訓練初步在工作記憶、認知功能、日常生活功能與自閉症狀有成效，長期效益仍待追蹤。

Autism often co-occurs with other psychiatric diagnoses, including attention-deficit/ hyperactivity disorder, and there are often attentional and executive function impairments as well. In longitudinal studies, autistic symptoms are often stable with age, and adaptive functioning varies depending on baseline abilities: individuals with poor cognitive and language skills during childhood often continue to experience functional impairments into adulthood. Cross-sectionally, executive functions and social cognition are highly correlated, and early executive function predicts later theories of mind abilities. The executive function and attentional abilities of individuals with autism show improvements with age, similar to typically developing individuals, particularly notable in childhood compared to adolescence. Compared to typically developing peers, autistic adolescents are still impaired in executive functions, have less improvement in response inhibition, and have a stagnation or regression in their visuospatial binding memory. Preliminary studies of computerized and non-computerized cognitive training targeting executive functions have shown some effectiveness in working memory, cognitive ability, daily functions, and autistic symptoms. Long-term benefits require further studies.