米国では自閉症は5歳まで診断されないケースが多い

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米国では自閉症は5歳まで診断されないケースが多い

自閉症の症状は通常3歳前に発現するが、米国ではほとんどの自閉症児が5歳以上で診断されることが、患児の両親または保護者対象とした全国代表調査で明らかになった。また自閉症スペクトラム障害児の半数以上は、同疾患のコアとなる症状に対する影響が明らかになっている薬剤はないにもかかわらず、刺激薬や抗不安薬、抗うつ薬、睡眠補助薬、抗けいれん薬、抗精神病薬の薬剤を1つ以上服用していることも判明した。

今回の全国代表調査は、米国立精神衛生研究所（NIMH）臨床・集団疫学研究局責任者のLisa Colpe氏らが、米国疾病対策予防センター（CDC）と協力して、自閉症スペクトラム障害児約1,400人を含む6～17歳の特殊なニーズを要する小児の両親または保護者4,000人超を対象に実施したもの。

今回の報告におけるその他の重要な知見は次のとおり：
・自閉症スペクトラム障害と診断された時の小児の年齢は、2歳以下約19％、3歳17％、4歳13％、5歳11.5％、6歳以上40％近くであった。
・自閉症児の特定は、小児科医、家庭医、ナースプラクティショナー、心理学者、発達心理学者、神経科医、学際的チームなど、さまざまな医療従事者が行っていた。
・就学年齢の自閉症スペクトラム障害児10人中9人が発達のニーズに合うサービスを1つ以上利用し、半数超は3個以上のサービスを利用していた。
・最も一般的なサービスは社会技能訓練であり、次いで言語療法であった。ほかには行動的介入および作業療法を受けていた。

Colpe氏は「これらの調査結果は、米国における自閉症の現況の一端を浮き彫りにしたものである。米国の家族はその経験を他の家族と比較することができる。小児の自閉症には、不安やうつ症状、不安などが伴うことが多く、これらの症状の治療のためにさまざまな薬剤が用いられている。多くの小児（90％以上）が他の治療も受けていることは良い徴候であり、これは医師の監視を受けていることを示している」と述べている。

別の専門医は、早期介入が長期的により良好な状態をもたらす研究が報告されており、小児が早期介入を受けられない障壁に対処することが非常に重要である」と述べている。（HealthDay News 5月24日）

2012年6月 5日 10:00　[子供の健康]

（ 英文原文： Autism Often Not Diagnosed Until Age 5 or Older: U.S. Report
But earlier interventions make a big difference, experts say
Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. Questions about personal health should always be referred to a physician or other health care professional.

By Jenifer Goodwin
HealthDay Reporter
THURSDAY, May 24 (HealthDay News) -- Even though autism symptoms typically emerge before age 3, most children with autism are diagnosed when they're 5 or older, a new snapshot of autism in America shows.
More than half of U.S. children with an autism spectrum disorder are taking at least one psychotropic medicine -- including stimulants, anti-anxiety medications, antidepressants, sleep aids, seizure medications or antipsychotics -- even though there are no drugs that have clearly been shown to impact the core symptoms of the disorder.
The findings are from a nationally representative survey of more than 4,000 parents or guardians of children with special needs aged 6 to 17, including about 1,400 who had an autism spectrum disorder. The report was compiled by researchers from the U.S National Institute of Mental Health in conjunction with the U.S. Centers for Disease Control and Prevention.
"This is a snapshot of what the nation looks like. American families can compare their experience to what others have found," said study co-author Lisa Colpe, chief of the office of clinical and population epidemiology research at the U.S. National Institute of Mental Health.
Among the other key findings:
About 19 percent of kids were diagnosed with an autism spectrum disorder at age 2 or younger; 17 percent were diagnosed at age 3; 13 percent were age 4; 11.5 percent were age 5; and nearly 40 percent were 6 or older when they were diagnosed.
Children were identified by a range of health care professionals, including pediatricians, family physicians, nurse practitioners, psychologists, developmental psychologists, neurologists and multidisciplinary teams.
Nine of 10 school-aged children with an autism spectrum disorder use at least one service to meet their developmental needs, while just over half of the kids use three or more services.
The most common service is social skills training, followed by speech or language therapy. Others include behavioral interventions and occupational therapy.
Geraldine Dawson, chief science officer for Autism Speaks, said findings show the continued need to work toward identifying children earlier.
"Research tells us that children who start intervention earlier do better in the long run. This report found that the majority of children were 5 years or older when they were first identified. We can reliably diagnose autism by 24 months, so professionals need to do a better job, including screening all children at 18 and 24 months," Dawson said.
Only about 40 percent of school-aged children with an autism spectrum disorder receive behavioral intervention, even though research has shown such strategies can "significantly improve outcomes," she added.
Lack of insurance coverage and too few trained providers with expertise in behavioral interventions are reasons why some children aren't getting the services, Dawson noted. "It is critical that we address the barriers that are preventing children from receiving early intervention. Early intervention will result in better outcomes for children and provide substantial cost savings in the long run," Dawson said.
Autism is a neurodevelopmental disorder characterized by problems with social interaction, communication and restricted interests and behaviors. That includes repetitive behaviors, such as arm-flapping or head-banging; having an obsessive interest in one topic; having a need to stick to a specific ritual or routine; and experiencing distress or agitation when that routine gets disrupted.
About one in 88 U.S. children has the disorder, according to the CDC.
Children with autism can also have co-existing conditions, such as anxiety, seizures, depression or attention-deficit/hyperactivity disorder (ADHD). Experts say it's not always easy for parents and doctors to know whether symptoms are autism-related or a co-existing condition, but many will try various drugs to alleviate the symptoms.
"The findings with respect to psychotropic medication use is in line with previous findings," Dawson said. "Children with autism often have co-occurring conditions, such as ADHD and anxiety, which are often helped with medication."
Because some of the drugs to treat those conditions can be powerful, Colpe said it was a good sign that so many children (upwards of 90 percent) were also receiving some other sort of treatment, indicating that they are being monitored by a physician.
"They are getting a multi-mode treatment," Colpe said.
More information
The U.S. National Institute of Mental Health has more on autism.
SOURCES: Lisa Colpe, Ph.D., chief, office of clinical and population epidemiology research, U.S. National Institute of Mental Health; Geraldine Dawson, Ph.D., chief science officer, Autism Speaks; May 2012, U.S. National Center for Health Statistics, NCHS Data Brief
Last Updated: May 24, 2012 ）