HNO

, Volume 56, Issue 2, pp 169–176 | Cite as

Autistische Kommunikationsstörungen

Aktueller Wissensstand und Bedeutung für HNO-Ärzte
HNO-Praxis

Zusammenfassung

Autismus ist eine angeborene und/oder früh im Kindesalter manifeste tiefgreifende Entwicklungsstörung, für deren Erkennung der Ausschluss einer relevanten Hörstörung eine große Bedeutung hat. Autistische Kinder zeigen ein charakteristisches Muster von sozialen, kommunikativen und stereotypen, repetitiven Verhaltensweisen. Die Störung persistiert ins hohe Erwachsenenalter, eine kausale Behandlung ist bis heute nicht möglich. Frühkindlicher und atypischer Autismus gehen mit schwerer sprachlicher und nonverbaler Kommunikationsstörung neben Verhaltensstereotypien und Veränderungsangst einher; häufig besteht eine geistige Behinderung. Bei Kindern mit einem Asperger-Syndrom ist eine Spracherwerbsstörung nicht typisch. Wenn sich eine Hörstörung als Ursache von Kommunikations- respektive Sprachentwicklungsproblemen speziell bei Klein- und Kleinstkindern nicht bestätigt und außerdem durch reine Entwicklungsverzögerung nicht erklärliche Verhaltenspathologika beschrieben werden, sollten HNO-Ärzte differenzialdiagnostisch an eine autistische Störung denken. Dieser Beitrag stellt die aktuelle Diagnostik und Therapie vor.

Schlüsselwörter

Autismus Sprachentwicklungsstörungen Pragmatische Kommunikationsstörungen Diagnostik Therapie 

Autism spectrum disorders

Current knowledge and importance for ENT specialists

Abstract

Autism is a behavioural syndrome, present from early life and defined by deficient social interaction, language and communication, and play. Variations in symptomatology and in prognosis among characteristic persons display a variety of other signs such as attention deficits, mental retardation and seizures that are not specific to autism and that denote dysfunction in other brain systems. Its aetiology is unknown in the vast majority of cases. There is a small minority of persons in whom autism has a known aetiology, such as fragile X chromosome abnormality, congenital rubella, tuberous sclerosis and a variety of structural abnormalities and metabolic diseases of the brain. A causal treatment is so far not possible, and there remains a regrettable lack of evaluated treatment standards. Prognosis depends on many factors, most notably the limiting factor provided by the severity of the underlying brain dysfunction and its consequences for communication, cognition and other behaviour. ENT specialists are confronted with children, adolescents and even adults in whom autistic disease has already been diagnosed in the course of investigations/treatment. If the suspicion of hearing impairment as the cause of problems in daily life is not confirmed in a patient not hitherto known to have autism ENT specialists should also consider autism in the differential diagnosis. In this report the diagnostic and therapeutic strategies currently applied for autism and its importance for ENT specialists are presented.

Keywords

Autism spectrum disorders Speech development disorders Diagnostic procedures Therapy 

Literatur

  1. 1.
    Bailey A, Luthert P, Dean A et al. (1998) A clinicopathological study of autism. Brain 121: 889–905PubMedCrossRefGoogle Scholar
  2. 2.
    Ballaban-Gil K, Rapin I, Tuchman R, Shinnar S (1996) Longitudinal examination of the behavioural, language and social changes in a population of adolescents and young adults with autistic disorder. Pediatr Neurol 15: 217–223PubMedCrossRefGoogle Scholar
  3. 3.
    Baranek GT (1999) Autism during infancy: a retrospective video analysis of sensory-motor and social behaviours at 9–12 months of age. J Autism Dev Disord 29: 213–124PubMedCrossRefGoogle Scholar
  4. 4.
    Baron-Cohen S (1991) The development of a theory of mind in autism, deviance and delay? Psychiatr Clin North Am 14: 33–51PubMedGoogle Scholar
  5. 5.
    Baron-Cohen S, Allen J, Gillberg C (1992) Can autism be detected at 18 months? The needle, the haystack and the CHAT. Br J Psychiatry 161: 839–843PubMedCrossRefGoogle Scholar
  6. 6.
    Bölte S, Crecelius K, Proustka F (2000) Der Fragebogen über Verhalten und soziale Kommunikation: Psychometrische Eigenschaften eines Autismusscreening-Instruments für Forschung und Praxis. Diagnostica 46: 149–155CrossRefGoogle Scholar
  7. 7.
    Chakrabarti S, Fombonne E (2001) Pervasive developmental disorders in preschool children. JAMA 285: 3093–3099PubMedCrossRefGoogle Scholar
  8. 8.
    Cook EH (1990) Autism: review of neurochemical investigation. Synapse 6: 292–308PubMedCrossRefGoogle Scholar
  9. 9.
    De Myer MK, Barton S, Alpern GD et al. (1974) The measures of intelligence in autistic children. J Autism Child Schizophr 4: 42–49CrossRefGoogle Scholar
  10. 10.
    Fidler DJ, Bailey JN, Smalley SL (2000) Macrocephaly in autism and other pervasive developmental disorders. Dev Med Child Neurol 42: 737–740PubMedCrossRefGoogle Scholar
  11. 11.
    Filipek PA, Accardo PJ, Baranek GT et al. (1999) The screening and diagnosis of autistic spectrum disorders. J Autism Dev Disord 29: 439–484PubMedCrossRefGoogle Scholar
  12. 12.
    Fombonne E (1999) The epidemiology of autism: a review. Psychol Med 29: 769–786PubMedCrossRefGoogle Scholar
  13. 13.
    Fombonne E (2005) Epidemiology of autistic disorder and other pervasive development disorders. J Clin Psychiatry 66: 2–8Google Scholar
  14. 14.
    Gallese V, Faddiga L, Fogassi L, Rizzolatti G (1996) Action recognition in the premotor cartex. Brain 119: 593–609PubMedCrossRefGoogle Scholar
  15. 15.
    Gillberg C, Steffenburg S (1987) Outcome and prognostic factors in infantile autism and similar conditions: a population-based study of 46 cases followed through puberty. J Autism Dev Disord 17: 273–287PubMedCrossRefGoogle Scholar
  16. 16.
    Gillberg C, Ehlers S, Schaumann H et al. (1990) Autism under age of 3 years: a clinical study of 28 cases referred for autistic symptoms in infancy. J Child Psychol Psychiatry 31: 921–934PubMedCrossRefGoogle Scholar
  17. 17.
    Gillberg C (1991) Outcome in autism and autism-like conditions. J Am Acad Child Adolesc PsychiatryGoogle Scholar
  18. 18.
    Gillberg C, Coleman M (2000) The biology of the autistic syndromes. Mac Keith Press, LondonGoogle Scholar
  19. 19.
    Goode S, Rutter M, Howlin P (1994) A twenty year folly up of children with autism. Vortrag 13th biannual meeting of ISSBD, Amsterdam, NiederlandeGoogle Scholar
  20. 20.
    Happé F (1999) Autism: cognitive deficit or cognitive style? Cogn Sci 3: 216–222Google Scholar
  21. 21.
    Heller T (1908) Dementia infantilis. Z Erforschung Behandlung Jugendlichen Schwachsinns 2: 141–165Google Scholar
  22. 22.
    Jacobson JW, Mulick LA, Schwartz AA (1995) A history of facilitated communication. Am Psychologist 9: 750–765CrossRefGoogle Scholar
  23. 23.
    Jolliffe T, Baron-Cohen S (1999) A test of central coherence theory; linguistic processing in high-functioning adults with autism of Asperger Syndrome: is local coherence impaired. Cognition 71: 149–185PubMedCrossRefGoogle Scholar
  24. 24.
    Kaye JA, del Mar Merelo-Montes, Jick H (2001) Mumps, measles and rubella vaccine in the incidence of autism recorded by general practisoners. A time trend analysis. BMJ 322: 460–463PubMedCrossRefGoogle Scholar
  25. 25.
    Kemper TL, Bauman ML (1993) The contribution of neuropathologic studies to the understanding of autism. Neurol Clin 11: 175–187PubMedGoogle Scholar
  26. 26.
    Kezuka E (1997) The role of touch in facilitated communikation. J Autism Dev Disord 27: 571–593PubMedCrossRefGoogle Scholar
  27. 27.
    Klin A (1991) Young autistic children’s listening preferences in regard to speech: a possible characterisation of the symptom of social withdrawal. J Autism Dev Disord 21: 29–42PubMedCrossRefGoogle Scholar
  28. 28.
    Kobayashi R, Murata T, Yoshinaga K (1992) A follow up study of 201 children with autism in Kuyushu and Yamaguchi areas, Japan. J Autism Dev Disord 22: 395–411PubMedCrossRefGoogle Scholar
  29. 29.
    Liss M, Fein D, Allen D et al. (2001) Executive functioning in high-functioning children with autism. J Child Psychol Psychiatry 42: 261–270PubMedCrossRefGoogle Scholar
  30. 30.
    Lovaas OI (1987) Behavioural treatment and normal educational and intellectual function in young autistic children. J Consult Clin Psychol 55: 3–9PubMedCrossRefGoogle Scholar
  31. 31.
    Mawhood L (1995) Autism and developmental language disorder: implications from a follow-up in early adult life. Unpublished PhD Thesis, University of LondonGoogle Scholar
  32. 32.
    Minshew N, Sweeney J, Baumann M (1997) Neurological aspects of autism. In Cohen DJ, Volkmar DR (eds) Handbook of autism and pervasive development disorders. Wiley, New York, pp 344–369Google Scholar
  33. 33.
    Mostert MP (2001) Facilitated Communication since 1995: a review of published studies. J Autism Dev Dis 31: 287–313CrossRefGoogle Scholar
  34. 34.
    Rehfeld N (2007) Niemand ist eine Insel. In: Sonntags-FAZ, Bilder und Zeiten, Verlag Frankfurter Allgemeine Zeitung Nr. 197: Z3Google Scholar
  35. 35.
    Poustka F, Bölte S.(2004) Autistische Störungen. In: Döpfner M, Lehmkuhl G, Petermann F (Hrsg) Leitfaden Kinder- und Jugendpsychotherapie, Band 5. Hogreve Verlag Psychologie, Göttingen Bern Toronto SeattleGoogle Scholar
  36. 36.
    Premack D, Woodruff G (1978) Does the chimpanzee have a theory of mind? Behav Brain Sci 1: 515–526CrossRefGoogle Scholar
  37. 37.
    Ptok M (2005) Pragmatische Kommunikationsstörungen bei Kindern. HNO 53: 978–982PubMedCrossRefGoogle Scholar
  38. 38.
    Remschmidt H, Becker I (2005) Neuropsychologie autistischer Störungen. Fortschr Neurol Psychiatr 73: 654–663PubMedCrossRefGoogle Scholar
  39. 39.
    Remschmidt H, Becker I (2006) Das Asperger-Syndrom. In: Remschmidt H, Schmidt M (Hrsg) Manual psychischer Störungen bei Kindern und Jugendlichen. Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  40. 40.
    Remschmidt H, Becker IK (2007) Das Asperger-Syndrom – eine Autismus-Spektrum-Störung. Dtsch Ärztebl 104(13): B772–B781Google Scholar
  41. 41.
    Rett A (1966) Über ein eigenartiges hirnatrophisches Syndrom bei Hyperammonamie im Kindesalter. Wiener Med Wochenzeitschr 118: 723–726Google Scholar
  42. 42.
    Rühl D, Bölte S, Feineis-Matthews S, Proustka F (2003) Autismus Diagnostische Beobachtungsskala (ADOS). Huber, Bern Google Scholar
  43. 43.
    Rutherford MD, Baron-Cohen S, Wheelright S (2002) Reading the mind in the voice: a study with normal adults and adults with Asperger Syndrome and high functionating autism. J Autism Dev Disord 32: 189–194PubMedCrossRefGoogle Scholar
  44. 44.
    Rutter M (1983) Cognitive deficitsd in the pathogenesis of autism. J Child Psych Psychiatry 24: 513–531CrossRefGoogle Scholar
  45. 45.
    Schmötzer G, Rühl D, Thies G, Proustka F (1993) Autismus Diagnostisches Interview – Revision. Deutsche Übersetzung. Universität Frankfurt (Eigendruck), Frankfurt/MainGoogle Scholar
  46. 46.
    Shavelle RM, Strauss DJ, Pickett J (2001) Causes of death in autism. J Autism Dev Disord 31: 569–576PubMedCrossRefGoogle Scholar
  47. 47.
    Stevens JA, Fonlupt P, Shiffrar M, Decety J (2000) New aspects of motion perception: a selective neural encoding of apparent human movements. Neuroreport 11: 109–115PubMedCrossRefGoogle Scholar
  48. 48.
    Szatmari P, Bartolucci G, Bremner R et al. (1990) Asperger’s syndrome and autism: neurocognitive aspects. J Autism Dev Disord 19: 213–225CrossRefGoogle Scholar
  49. 49.
    Tsai LY (1996) Brief report: comorbid psychiatric disorders of autistic disorders. J Autism Dev Dis 26: 159–163CrossRefGoogle Scholar
  50. 50.
    Volkmar F, Carter A, Grossmann J, Klein A (1997) Social development in Autism. In: Cohen D, Volkmar F (eds) Autism and pervasive developmental disorders. Wiley, New York, pp 173–194Google Scholar
  51. 51.
    Werner E, Dawson G, Osterling J, Dinno N (2000) Brief report: recognition of autism spectrum disorder before one year of age: a retrospective study based on home videotapes. J Autism Dev Disord 30: 157–162PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Phoniatrie und PädaudiologieMedizinische Hochschule HannoverHannoverDeutschland
  2. 2.Kinder- und Jugendpsychiatrie, Psychiatrie und Psychotherapie, SozialmedizinVersorgungsamt WürzburgWürzburgDeutschland

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