NGHIEN cuu Q CAC HOI CHONG ROI LOAN PRO TU K I VA TIEU CHI CHAN DOAN 1 Roi loan p h i tU ki (Autistic Spectrum Disorders ASD] Tg ki l i td tilng Vilt chi hdi chdng Autism, l i khli nl|m ehung ddng di[.]
NGHIEN cuu Q CAC HOI CHONG ROI LOAN PRO TU K I VA TIEU CHI CHAN DOAN ThS NGUYEN VAN HUNG Ififn Khoa hoc Gllo due net Nam Roi loan p h i tU ki (Autistic Spectrum Disorders - ASD] Tg ki l i td tilng Vilt chi hdi chdng Autism, l i khli nl|m ehung ddng di md t l mdt nhdm d e rdl loan v l ning tuong tie xa hdi, v l ngdn ngd giao tiep v i d e hinh vi eda t r i ngln trd vile hoi nhip x l hdi, Inh hudng din tUdng lal eda t r i v i gia tfnh tri B i n nay, trln t h i gidi ngudi ta vln chua tim nguyin nhin chfnh x i c song d e ylu td v l gen, tdn thuong nao v i tflu kiln sdng ed t h i col l i nhdng nguyin nhin nguy CO giy hdi chdng niy Rdi loan phd tg ki bao gdm d e hdi chdng sau: hdi chdng tg ki, h^i chdng Asperger, rdi loan b i t hda tudi l u tho, hdi chdng Rett Tlt el d c rdi loan thudc phd tg ki dlu cd thilu hut chdc nang giao tilp v l x l hdi, nhung chdng khlc v l pham vi, mdc dd ning, khdi phit v i t i l n triln cda trilu chdng theo thdi gian Thuit ngd rdi loan phd tg kf thudng dugc xem l i ddng nghia vdi rdi loan phit triln diln rdng (Pervasive Developmental Disorder - PDD) Nhilu quan tflm cho ring dli ASD bao gdm hdi chdng tg ki (Autistic Disorder - AD) d gida, gdi lln hdi chdng Asperger, rdi loan bit hda tudi l u tho (Childhood Disintegrative Disorder, CDD) v i hdi chdng Rett (RTT) NhCfng bilu hiln cda hdi chdng tg ki rlt da dang, phdc tap v i thudng khiim khuylt ba linh vge eo bin sau: 1.1 Khiim khuyit vituang tdcxd hdi Tri em mie hdi chdng tu kf thudng thfch dupe chcri mdt minh, tich khdi nhdng ngUdi xung quanh, td llnh dam, khdng quan t i m d i n nhCfng ngudi khie thim ehi c l nhdng ngudi thin gia tfnh Tri khdng quan t i m den vile kit ban hole choi vdi ban Nlu tham gia hoat ddng vdi t r i khlc thi chi xem chdng II ngudi trp giup miy mdc hole nhu edng eg choi cda minh Ngay d nhdng t r i em v i ngudi Idn bj mIe hpi chdng tg kf ed sg phit triln chdc nang tdt edng khdng ed hay rlt khd tri quan h i ban b l bin ngoii pham vi gla tfnh v i thudng dugc coi l i kl cue quan h i x l hdi Tri mIe hdi chdng tg kl thilu sg tilp xde blng m i t it dip lai Idi eda cha me (khiln Idc dlu cha me ed t h i lo ling ring minh bj khiim thinh) v i nhdng ngudi xung quanh Tri thudng khdng chd ddng tuong tie vdl ngudi khlc Ddi khi, cd nhdng t r i em mic hdi chdng tu kl ed chd ddng tuong tie vdl ngudi khlc nhung lal theo mdt eleh rlt kl quae khd dupe chip nhin nhU: Tri lilm hay hit ngiJi chin, tay, m l eda ngudi khlc U Khiim khuyet vigiao tiip Tri em mIe hdi chdng tg kl thudng gap khd khin vile hiiu v i sd dgng ngdn ngd v i d c cdng eg phi ngdn ngd, die bilt l i elc tinh hudng giao tilp Tri thudng khdng hllu nhdng dilu ngudi khlc ndi vdl chdng, die bilt l i nhdng clu ndi phdc tap v l d u true v i ngdn td Tri edng thudng gap khd khin vile hllu y nghTa cda cd chi, dilu bd, bilu hiln nit mat ngd dilu gipng ndi v i Idl ndi eda ngudi khlc Mdt sd t r i mIe hdi chdng tg ki khdng bao gid ndi dupc Nhieu t r i cd t h i ndi duge nhung it ndi v i sd dgng ngdn ngd mdt eleh thu ddng giao tilp vdl ngudi khac Tri cung gap khd khin vdi d e ki ning giao tilp thdng thudng nhU: b i t d l u v i tri cudc hdi thoai, luin philn, ling nghe Bdng eo giao tilp eda t r i Hinh 1:Cdc hdi ehUng phdtuki Hotft dgng chimg nang cap cao hffn HOI CHCTNG ASPERGER PDD Hogt dgng c/iirc ndng cap thap ham AUTISM R I LOijLN BAT HOA TU6lAU THO H O I CHUNG RETT SdB4-TllAN6>/2012>33 E y NGHIENCOU thudng rlt nghio nin, t r i it giao t i l p di biy td nhu clu thich tuong tic vdi ngudi khlc dupe chia s l m i chi giao tilp de t h i hiln nhu clu tdi d n thilt eda b i n thin 13 CCmg nhdc hdnh vi, sd thich vd hanh ddng Tri em mIe hdi chdng tg ki thudng hay cd nhdng bilu hiln rip khudn, tfnh hinh (khdng thay ddi) hinh vl, sd thich v i d c hinh ddng nhU: lie lu thin minh, v l xoay d e ngdn tay, xoay mdt vit lap di, lap lai mdt thdi gian dii, CIe em gap rlt nhilu khd khin vile tflu chinh d c hoat ddng di phu hpp vdl hoin cinh mdi B l ed t h i nhin bilt chinh xle t r i em mic chdng tg ki d n tiln hinh chin doin dga trln d e tilu ehi, d e thang ehuln Tieu chl chan doan cac roi loan phd tU ki theo s l tay chin d o i n v l thdng ke nhufng roi nhieu tinh t h i n IV (Diagnostic and Statistical Manual of Mental Disorders - DSM-iV) 2.1.HdidiCtngtUkl A Mdt t i p hpp gdm siu (hole nhilu hPn) d e tilu chf thudc nhdm (1), (2) v i (3), dd ed ft nhit hai tilu ehi td nhdm (1) v i mdt tilu ehi td mdi nhdm (2)vi(3) (1) Giim ning tUdng tie x l hdi t h i hiln it nhit hai sd d e bilu hiln sau: - Glim ning rd rlt vile sd dgng d e hinh vi phi ngdn ngd da dang nhu Inh m i t n i t mat tu t h i CO t h i v i d e cd chi d l tao sg liln h i mang tfnh chit x i hdi; - Khdng ed ning xly dgng mdi quan he vdl nhdng ban ddng trang Ida phd hpp vdi mde dp phit triln; -Thilu sg ddi hdi tg nhiin ddi vdi vile chia sl nilm vui, sd thfch, d e mdi quan t i m hay d e thinh tfeh dat dupe vdi ngudi khic (vi du nhU khdng bao gid mang hay chi cho ngudi khlc xem nhdng thd minh thich); -Thilu sgtrao ddi qua lai v l tinh d m hole x l hdi , (2) Giim ning glao tilp t h i hiln it nhit mdt sd d e bilu hiln sau: - Chim hole hoin toin khdng phit triln ki ning ndi (khdng cd ham mudn bu d i p iai han chl niy blng d c eleh glao t i l p khlc vl dg nhu nhCfng ed ehi tflu bd thudc kich d m ) ; -Vdi nhdng d nhin cd t h i ndi dupe thi lai giim ning thilt l i p v l tri ddi thoai; -Sddung ngdn ngdtrung lap, rip khudn hole sd dgng ngdn ngd khic thudng; -Thilu sg hoat dpng/dch choi da dang, trd choi ddng vai hole thilu sg hoat ddng/trd choi b i t chgde 34 •KHOAHQCGUODVC mang tinh xa hdi phu hpp vdl mde dd phit triln (3) NhCing kilu hinh vi, nhCmg mdi quan t i m v i d c hoat ddng lap di lap lal hole rip khudn t h i hiln d it nhat mdt d e bilu hiln sau: - Qui bin t i m d i n mdt hole mdt sd nhdng mdi quan he ed tinh chit rip khudn v i bd hep vdi mde dd t i p trung hole cudng dd bit thudng; - Gin k i t edng nhle vdi nhCmg thd tuc hole nghi thde rilng bilt v i khdng mang tinh ehde ning; - Cd bilu hiln vln dpng mang tinh rip khudn (vl du nhu gd tay hay van tay, hole ed kilu di chuyin d thin ngudi mpt d c h phdc tap, di trln d e dlu ngdn chin ); - Bin t i m dai ding vdi d e bd phin cda co thi B Chim hole thgc hiln khdng binh thudng elc chdc ning d ft nhit mdt elc linh vge sau, vdl mdc khdi dlu trUde tudi lln ba: (1) Tuong tic x l hdi; (2) Sddung ngdn ngd glao tilp x l hdi; (3) Choi/hoat ddng mang tfnh bilu tupng hole tudng tupng C Hpi chdng khdng bao gdm rdi loan Rett hay rdl loan bit hda tudi l u tho 2a.HdidtCtngRett A Bao gdm t i t c l d c tilu chf sau: (1) Khi cdn bung me v i sinh t r i cd vl binh thadng; (2) Trong nlm thing d l u tiln sau sinh ed sU phat trien binh thudng v l t i m van ddng; (3) Chu vi dlu sinh binh thudng B Nhdng biln ddi manh me sau giai doan phit trien binh thudng: (1 )Tdc dp p h i t t r i i n cda dlu glim manh td thing thd d i n thing thd 48; (2) Glim mdt d c h ding k l d c ki ning thao tic blng tay d l ed trude t d thing thd d i n thing thd 30 cdng vdi vile xult hiln mdt d c h thudng xuyin d c cd ddng rap khudn cQa b i n tay (cd ddng tay gidng nhU rda tay hole gilt quin lo ); (3) Giim d c ki r i n g x l hdi dng xd (mac dii thudng phit triln tUong tie x l hdi sau); (4) Giim d c ed ddng eda thin minh; (5) Khiim khuylt sg phit triln ngdn ngO tilp nhan v i ngdn ngd diln dat cdng vdi sg ehlm tri nhilu d c ki ning tim, vln ddng 23 Hdi chCfng rdi loan bdt hda tuoi tha A Sg phit triln b l ngoii hoin toin binh thgdng td Ide mdi sinh cho d i n it nhit l i tudi, t h i hiln d ngdn ngd ndi v i giao tilp khdng Idl, quan h i x i hdi, choi v i hinh vi thich dng phu hpp vdi tudi B VI phuong diln lim sing cd t h i quan sit thly NGHIEN cuu Q D Khdng ed sg thilu hgt v l ning ngdn ngfl thdng thudng (nhu sd dung tddon tudi v i ddng dugc elc cum td tudi) E Khdng ed thilu hgt sg phat trien nhin thde v i d c ki nang tg phuc vu, hinh vi thich dng (trd (4) Choi; tuong tie x l hdi) phu hpp vdi dp tudi v i sg td md v l mdi trudng eda tudi l u tho (5) Kinlng vln ddng C Cd chdc ning khlc thudng d it nhit l i hai F Rdi loan niy khdng bao gdm d c rdl loan thudc sd d e linh vge sau: rdi loan phit triln diln rdng hole t i m thin phin l i l t Ket luan (1) Khiim khuylt v l tuong tie x l hdi (nhu khiim Binh g l l mdt dda t r i ed mIe hdi chdng tg ki khuylt v l hinh vi giao tilp khdng Idi, d e quan h i vdi tri eung Ida, thilu hgt d e tuong tie xa hdi v i d m hay khdng v i bj tg ki d mdc dd nio cd vai trd rlt quan trpng ddi vdi gia tfnh t r i v i nhdng gllo vlln xde qua lai); (2) Khiim khuylt v l giao tilp (nhu tri hoin hole lim cdng tie can thiip sdm NhUng thgc t l hiln nay, thilu hgt v l ngdn ngd, khdng ed ning khdi dlu ed nhilu ble phg huynh q u i lo ling v l cd v i tri hdi thoai, sd dung ngdn ngd miy mdc v i nhdng bilu hiln khlc thudng lal eho l i eon minh bj tu ki v i ed nhdng quylt djnh chua phu hpp nhu cho lip lai, thilu hgt ki ning choi gii vd); (3) Cd hoat ddng, sd thich v i hinh vi han hep, rip ddng mdt sd loai thudc bd nao, thudc giim ting khudn v i lip di lip lai, bao gdm nhdng cd ddng v i ddng, Nhdng tilu chf eda DSM-IV dinh gii v l d c hdi chdng rdi loan phd tg ki gidp chdng ta cd t h i eleh cU xd r|p khudn; D Rdl loan niy khdng bao gdm elc rdi loan khlc sing Ipe nhdng t r i em ed bieu hiln eua hdi chdng tg thudc rdl loan phit triln diln rdng hole t i m thin kL Nhung di dinh gii v l mde dp eda hdi chdng niy cung nhu nhdng ning v i nhu clu chfnh xle eda phin l l | t mdi t r i thi d c ble phg huynh v i giio viln chi dung 2,4, Hdi chCfng Asperger A Khiim khuylt v l tUOng tic x l hdi, t h i hiln d bing t i l u chi trln thi ehUa du B l dinh gii chinh xle v l hdi chdng niy, cdn cin dpi ngu d e ehuyin gia v l sg thilu hgt ft nhit hai sd d c tilu chf sau: hdi chdng tU kl tai nhdng co sd ed uy tin nhU khoa (1) Khiim khuylt vi§c sd dung d e hinh vi Tim binh - Benh viln Nhi Trung Uong, Trung t i m khdng Idi phdc tap nhu giao t i l p mit - m i t diln t l Nghiin edu Gilo dgc die bilt - V i l n Khoa hpc Gilo blng nit mat cd chi eo t h i v i d e dlu hllu dung d l due Vilt Nam, d l hp ed t h i thgc hiln khim sing tuong tie x l hdi thdng thudng; lpc cho t r i tg ki, nhlm dUa d e tu vln v i nhCfng (2) G|p khd khin vile phat triln d c mdi can thiep kjp thdi v l gllo due gidp cho gia tfnh eda quan h i ddng Ida phu hpp; nhCfng t r i em mic hdi chdng niy (3) Thilu hgt ning tim kilm sg chia s l nilm vui, sd thIch hole thinh edng mdt d c h nglu nhiin TAI Lifu THAM KHAO vdi ngudi khlc (nhu thilu hut sg trinh diln hole chl Ddnh gid vd trj lieu cho tri tU kl vd tri khuyit trd nhdng v|t ylu thfch vdi ngudi khlc); (4) Thilu hgt cic tuong tic x l hdi v i d m xde tdt phdt triin, Tii lieu Trung t i m Bio tao v l phit triln giio dgc Ble b i l t Bai hpc Sg pham H i Ndi, 2007 qua lai Z VuThi Bfch Hanh, Tritt/ki, NXBY hpe Hi Ndi, 2007 B Hoat ddng, sd thich v i hinh vi han hep, rip Nguyen Vln Thinh, Tri em tuki, NXB Tdn giio, khudn t h i hi|n d it nhit mdt cie t i l u chi sau: (1) Bin t i m dai ding vdl mdt hole nhilu hon 2006 nhdng sd thfch rip khudn hole han hep khdng phu hpp; SUMMARY (2) Bl ngoii edng nhle d l tri nhCfng hinh vi The article has described three signals for v i thdi quen khdng phd hpp; (3) NhCfng edddng v i cd chi rip khudn, lap tf lap identifying a child with autism, i.e the child having lai (nhu v6 tay, xoln cic ngdn tay hole ed nhCfng ed difficulty in social interactions, defidency in communication and rigidity in behaviors, hobbies and ddng CO the phdc tap); actions In addition, the author has also mentioned the (4) Bin t i m dai ding vdl cic chi tilt cda dd vat C Rdi loan d i n d i n nhCfng khiim khuylt v l x l criteria for diagnosing symptoms within autism range, hdi, hoat ddng v i nhdng linh vge ehde ning quan induding RETT syndrome, Asperger syndrome, autism syndrome and childhood disharmony syndrome trpng khlc glim d c ki ning da ed td tnfdc (trUde 10 tudi) d it nhit hai tinh vge sau: (1) Ngdn ngfl diln dat v i ngdn ngd tilp nhin; (2) Ki ning x l hdi v l hinh vi thich dng; (3) Tg chd dai tiln v i tilu tiln; SliM-TlUlNl/2012