07/06/2010

Another improvement!!! hurray~~~

PDD- NOS treatment

On the whole, children with PDDNOS share the social and communicative disabilities found in children with Autistic Disorder. They often need services or treatments similar to those provided to children with autism.

Traditional Methods

No one therapy or method will work for all individuals with Autistic Disorder or PDDNOS. Many professionals and families will use a range of treatments simultaneously, including behavior modification, structured educational approaches, medications, speech therapy, occupational therapy, and counseling. These treatments promote more typical social and communication behavior and minimize negative behaviors (e.g., hyperactivity, meaningless, repetitive behavior, self-injury, aggressiveness) that interfere with the child's functioning and learning. There has been an increasing focus on treating preschool children with PDDNOS by working closely with family members to help the children cope with the problems encountered at home before they enter school. Many times, the earlier these children begin treatment, the better the outcome.

Addressing behavior issues. As children with PDDNOS struggle to make sense of the many things that are confusing to them, they do best in an organized environment where rules and expectations are clear and consistent. The child's environment needs to be very structured and predictable.

Many times a behavior problem indicates that the child is trying to communicate something-- confusion, frustration or fear. Think of the child's behavior problem as a message to be decoded. Try to determine the possible cause of the behavior. Has the child's routine or schedule changed recently? Has something new been introduced that may be distressing or confusing the child? When a child's communication skills improve, behavior problems often diminish-- the child now has a means of expressing what is bothering him or her, without resorting to negative behavior.

The use of positive behavioral support strategies for these children has proved effective. It is important to remember that:

• Programs should be designed on an individual basis, because children vary greatly in their disabilities and abilities. Treatment approaches that work in certain cases may not work in others.
• Children with PDDNOS have difficulty generalizing from one situation to another. The skills they have learned in school tend not to be transferred to the home or other settings. It is very important to be consistent in the treatment of a problem across all areas of the child's life-- school, community, and home. This encourages generalization of behavior changes.
• A home-community-based approach, which trains parents and special education teachers to carry out positive behavioral support strategies, can be instrumental in achieving maximum results.

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Appropriate educational program.

Education is the primary tool for treating PDDNOS. Many children with PDDNOS experience the greatest difficulty in school, where demands for attention and impulse control are virtual requirements for success. Behavioral difficulties can prevent some children from adapting to the classroom. However, with appropriate educational help, a child with can succeed in school.

The most essential ingredient of a quality educational program is a knowledgeable teacher. Other elements of a quality educational program include:

• structured, consistent, predictable classes with schedules and assignments posted and clearly explained;
• information presented visually as well as verbally;
• opportunities to interact with non disabled peers who model appropriate language, social, and behavioral skills;
• a focus on improving a child's communications skills using tools such as communication devices;
• reduced class size and an appropriate seating arrangement to help the child with PDDNOS avoid distraction;
• modified curriculum based on the particular child's strengths and weaknesses;
• using a combination of positive behavioral supports and other educational interventions; and
• frequent and adequate communication among teachers, parents, and the primary care clinician.

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Medical treatment.

The primary aim of medical treatment of children with PDDNOS is to ensure physical and psychological health. A good preventive health care program should include regular physical checkups to monitor growth, vision, hearing, and blood pressure; immunization according to schedule; regular visits to the dentist; and attention to diet and hygiene. An effective medical treatment begins with a thorough medical assessment. The pre treatment assessment is essential for detecting existing medical conditions, such as a seizure disorder.

There is no one specific medication that helps all children with PDDNOS. Some medications have been found to be helpful, but for many children with autism or PDDNOS, medication levels need to be experimented with until the optimal combination and dosage are found. Since this differs with each child, there is no set medical treatment for children with PDDNOS but, rather, an individual medication regimen for each. Because of these complexities, in the eyes of many, medication therapy is viewed as a treatment to be used only when other types of treatment have been unsuccessful. It is important to note that medication can be effective and necessary for conditions that may coexist in children with PDDNOS, such as attention deficit disorder or obsessive compulsive disorder.

Parents' final decision on whether to use medication as part of their child's therapy is a personal one and should be respected and supported. Medication should always be uit. Let conjunction with other therapies, and its effects should be monitored through feedback from the child, parents, and teachers.

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Psychological treatment.

Counseling may be helpful to families to help them adjust to raising a child with a disability. If the child is already attending a school program, both parents and teachers need to be told of the symptoms of PDDNOS and how those symptoms may affect the child's ability to function at home, in the neighborhood, in school, and in social situations. Psychologists can also provide ongoing assessments, school consultation, case management, and behavior training. Some children also benefit from counseling from an experienced practitioner who knows about PDDNOS. Family teamwork can ease the burden on the primary home care giver, who needs a support system.

Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS）

(廣泛性發展障礙症) 　　家屬師長們聽到孩子被診斷為自閉症時，首先必須挺住，讓頭腦還可以思考，即使那非常困難。受震撼的大人彷彿以為對孩子的認識與期望，從此必須 改觀，於是[否認、憤怒、怨懟、悲傷、絕望]種種情緒接踵而來。大人們會有這樣的反應是可理解的，然而孩子還是我們早已熟悉的那個人，並不會因多了個診斷 就變成陌生人。所以，大人自己要先挺住。

　　接下來就會浮現一堆疑惑。什麼是自閉症？孩子看起來很正常，只是說話慢不是嗎？他跟別的自閉 症孩子並不一樣啊？要治療嗎?要怎麼治療?會好嗎?我要怎麼做呢?....首先，了解一段歷史會有幫忙。1943年美國的肯納(Leo Kanner)博士描述了7個具有相似症狀的孩子，例如他們都有與他人溝通的困難、與人互動的困難及有特殊固定的行為與興趣，他用autism這個字來形 容這些呈現孤獨傾向的孩子們，並寫成名為[情感接觸的自閉困擾](autistic disturbances of affective contact)的學術論文發表。隔年，維也納的小兒科醫師艾斯伯格(Hans Asperger)也注意到有些男孩有特殊的行為模式，包括缺乏同理心、很難建立友誼、單邊對話、有強烈特殊的嗜好及動作不靈活等症狀。原來，這樣的孩子 早已被注意到。約半世紀之後，醫療專業人員漸漸採用精神疾病診斷手冊(ICD-10及DSM-IV)中所描述的準則，將這一類在三大核心問題發展上[社交 互動有障礙、溝通有障礙及呈現侷限特定興趣及行為]的人，診斷為有[廣泛性發展障礙症]的精神行為問題。

　　要接受孩子有精神疾病是痛苦 且困難的，大部分家屬知道他們的孩子與其他人有點不一樣，然而那到底是相對慢一點、少一點、偏一點、長大後就好了?還是真正有個嚴重精神病？自閉症與一般 我們熟知的疾病不太相同，它不但疾病名稱多樣化，病因尚未確定，症狀個別之間有差異也會隨著本身心智發展逐漸變化，治療方法多樣化結果也互有差異，預後難 確定又幾乎是不能痊癒需長期治療，這種種的不確定比診斷本身更加令人難以忍受，彷彿家屬也被醫療排除在外，被迫成為自閉與孤獨。孩子就是處在那種不被理解 的感覺。
慢慢條列說明或許可清晰些:

1. 病名: 正式名稱為[廣泛性發展障礙症]。自閉症最廣為所用、艾斯伯格症指語言功能相對無明顯遲緩的個案，近年歐洲傾向用自閉範疇疾患(Autistic Spectrum Disorder)，意圖涵蓋較廣由輕微自閉人格特質到嚴重病態之族群。

2. 病因: 不確定。學者多傾向有遺傳體質存在造成中樞神經病變。

3. 症狀: 三歲前就出現困難，長大後仍可診斷。有三大核心病症
(1)人 際社會互動有障礙: 可從完全不理人、不了解對方的情緒想法，到不能理解社交情境下他人的情緒及溝通行為，以致無法整合並做出適當回應。
(2)) 溝通有障礙: 可以從完全沒語言、音調怪異、缺乏適當手勢，到即使可以使用句子，卻常常是自己單面說、文不對題，內容缺乏彈性想像力或創造力。
(3) 重複固定的行為: 早期可能出現對物品非功能性的操弄如旋轉、製造聲音，或是對光影、氣味、觸感過度偏好。自由遊戲時呈現固定僵化的規則及習慣。生活堅持儀式化常規及拒絕環 境細節改變。

4. 治療: 方法很多，也說明它尚未有定論的現況。行為改變的原理及技巧發展較成熟，多年來蔚為主流也有一定的成效。近來治療觀念強調建立穩固關係協助調節情緒，在孩 子還小的時候(3歲前)，教導主要照顧者有足夠的情感回應力，進而與孩子交互注意共同焦點，再誘發孩子對人的模仿學習動機，希望孩子能漸漸對人有回應感知 的能力，在這個關鍵時刻家庭的重要性無可取代。大一點在孩童及青少年期，需考量孩子要面對知識學習、情緒調節及社會環境適應力等成長中的多元面向，治療著 重在有效整合學校、家庭及社會資源，共同創造最適合孩子能力及發展的成長環境。成年之後，目標多期待能獨立自主生活，找到一個接納其特殊個性的友善生存環 境，進一步協助他發展出一個有意圖的自我，成長為一個有自主性的人。

5. 預後: 個別差異極大。目前仍沒有一種單一方法如藥物、生物療法或行為心理社會治療可使病人痊癒，只能說恰當的治療愈早愈好、家庭優質參與愈多愈好、社會包容尊重 度愈高越好。
自閉症孩子是個理解他人心意有困難的人，需長期陪伴他成長適應。家屬除了耐心陪伴、悉心照料外，若進一步以愛孩子的心尋求專業協助、 善用社會資源，孩子將會因著優質陪伴、慢慢長大。以下一些地方可提供幫忙:
1. 各醫院兒童精神科或心智科
2. 自閉症總會及各地方分會
3. 星兒的天空網站
4. 教育界特教資源系統

　　一個患有自閉症的孩子，並不等於一個自閉的人。家庭中有個病弱兒，並不等於一個生 了病的家庭。只有家人挺住、走出來，接受一種被尊重的協助，孩子將不再孤獨，生命將會寬廣!

	類別：自閉症
	出處：桃園療養院 兒童精神科
	日期：2006/11/6
	作者：李儒卿

文章轉貼自http://www.tscap.org.tw/health/health_info.asp?kind_id=10&paper_id=22