Otizm mi? Pediatristler için bazı öneriler

Otizm spektrum bozukluğunun zamanında müdahaleye olanak tanıyan erken tanısı, uzun vadede daha iyi bir prognozla ilişkili olup, bazen otizmli kişilerde bulunan komorbiditelerin erken saptanmasına da olanak tanır. Bu nedenle, bu çocuklarda tanısal prosedürün mümkün olduğu kadar erken başlatılması önemli bir sorundur. Geçmişle kıyaslandığında, günümüzde bu açıdan oldukça fazla ilerleme kaydedilmiştir, ama bu konuda halen önemli ölçüde çaba sarfetmek gerekmektedir. Tanısal prosedürün doğru şekilde ve zamanında başlatılması açısından temel rol açık bir şekilde pediatristlere düşmektedir. Günümüzde, genel popülasyonda otizmin erken taraması için birçok araç vardır, ama maalesef bunların gerçek etkinliği henüz belirlenmemiştir. Bu anlatısal derlemede, otizm spektrum bozukluğunun erken tanısı konusunu ele almaktayız ve özellikle ilk uyarı işaretleri olarak kabul edilen bulgulara odaklanmaktayız. Yaşı 18 ay civarında olan bir çocuk pediatriste muayeneye geldiğinde göz önüne alınması gereken en önemli bulgulardan bazılarını üç alt grup şeklinde sıralıyoruz: sosyal-iletişim becerileri; davranış modelleri, ilgi ya da aktiviteler; ve duyusal davranışlar ve tepkisellik/mizaç. Gözden kaçabilecek olan hafif motor bulguların olası varlığı konusunu ayrıca ele alıyoruz. Ancak, bu bulgular muhtemelen sosyal-iletişim kusurlarından bile önce ortaya çıkan çok erken bulgular olarak kabul edilmelidir.

Is it autism? Some suggestions for pediatricians

An early diagnosis of autism spectrum disorder, leading to a timely enabling intervention, is associated with a better long-term prognosis and allows the early detection of any medical comorbidities that are sometimes found in individuals with autism. It is, therefore, an important challenge to begin the diagnostic procedure of these children as soon as possible. Nowadays, much progress has been made in this respect compared with the past, but considerable work remains. A fundamental role in starting a correct and timely diagnostic procedure is obviously played by the pediatrician. Today, many tools are available for the early screening of autism in the general population,but unfortunately, their real effectiveness has yet to be established. In this narrative review, we address the topic of the early diagnosis of autism spectrum disorder, emphasizing, in particular, those that are now considered the first warning signs. We list a few of the most important signs to consider when a child aged around 18 months presents to a pediatrician, subdivided into three subgroups: socialcommunication skills; patterns of behavior, interests, or activities; and sensory behaviors and reactivity/temperament. We deal separately with the possible presence of slight motor signs, which canalso go unnoticed, but probably they should be considered as very early signs appearing even before social-communication deficits.

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