T k: (Autism Spectrum Disorder)

a. nh ngha:

T k l mt dng ri lon trong Ri Lon Pht Trin Lan To (Ri Lon Ph T

K), khi pht sm trong 3 nm u tin ca cuc i, tc ng n s pht
trin ca tr trong 3 lnh vc chnh nh: tng tc x hi, ngn ng, hnh vi. T
k l mt ri lon mn tnh, nh hng nghim trng n s pht trin tr tu v
hnh vi cng nh kh nng hc tp, sinh hot v kh nng thch ng ca tr sau
ny.

b. Lch s nghim cu vn :

Trc y thut ng t k khng thy xut hin trong y khoa, nhng n nm

1943 mt nh tm thn hc ngi o tn l Leo Kanner m t mt nhm 11
tr c nhng biu hin pht trin khng bnh thng nh: c nhng khim
khuyt v tng tc x hi, khim khuyt trong qu trnh pht trin ngn ng, c
nhng hnh vi k l lp i lp li nhiu ln, khi pht sm trc 3 tui v khi
nim t k c ra i t .

Nm 1944, mt bc s Nhi khoa ngi o tn l Hans Asperger m t mt

dng t k nh hn Kanner m t rt nhiu. Sau ny, ngi ta ly tn ng t
cho ri lon ny gi l hi chng Asperger

Ngy nay, ngi ta dng thut ng Ri lon pht trin lan ta hoc Ri lon
ph t k m t cc tr em c cc ri lon pht trin trn 3 lnh vc chnh l:
tng tc x hi, ri lon ngn ng v hnh vi. Ri lon pht trin lan ta gm
c 5 ri lon chnh: T k, Hi chng asperger, Hi chng Rett, Ri lon tan r
tr em, t k khng in hnh. Trong t k (t k khng in hnh) v hi
chng Asperger l nhng ri lon rt thng gp.

c. Nguyn nhn:

Khng c mt nguyn nhn n l no gy ra t k, song nhn chung ngi ta

chp nhn rng T k gy nn bi bt thng v chc nng ca cu trc no
hoc bt thng v chc nng ca no. Chp ct lp vi tnh s no cho thy
mt s bt thng v hnh dng, cu trc ca no tr t k so vi tr bnh
thng.

Gi thuyt cho rng t k c lin quan n di truyn: Nhng nghin cu hin

i tm thy mt s ch bo cho thy nhng nh hng ca gen i vi bnh
t k. Theo cc nh nghin cu th trong s anh em ca cc tr mc chng t k
c gn 3% mc chng t k v gn 3% khc mc cc chng ri lon pht trin
lan ta. Ngoi ra mt cp sinh i ng hp t c nhiu kh nng b t k hn
so vi cp sinh i khc trng.

Gi thuyt v bnh l no: Cc nghin cu cho thy rng cht dn truyn

thn kinh Serotonin rt quan trng i vi s vn hnh ca no c nhiu mt
s nhm t k hn ngi bnh thng. Bn cnh , mt s tr mc chng t
k v nhng ri lon lin quan c nhiu vn v h min dch v sinh ha.

Gi thuyt v ri lon chc nng tm l: Cc nghin cu tin hnh nhiu

cng trnh kho st cc dng ri lon chc nng tm l xc nh cc chng
tt gy hnh vi t k. Cc cng trnh ny kho st v ngn ng, tp trung, ch ,
tr nh v k nng th gic - khng gian. C nhng tr b t k do cch chm sc
ca cha m, c bit l do s thiu quan tm ca ngi m.

Cng c nhng bng chng cho thy virus c th gy ra t k. Nguy c tr mc

chng t k s tng cao nu ngi m b bnh si trong 3 thng u tin ca
thi k mang thai. Virus cytolomegalo cng c lin quan n t k. Ngoi ra hin
nay mt s quan nim tin rng virus lin quan n cc loi vaccin nh vaccin
MMR dnh cho bnh si cng c th gy ra chng t k.

S nhim v cht c trong mi trng cng c coi l nguyn nhn c th

gy ra t k. Nm 2001, cc nh nghin cu bang Texas - M pht hin ra rng
s tr mc bnh t k t l thun vi lng thu ngn c thi ra mi trng.
Mt v d khc l th trn nh Leomenster, Massachusetts vi t l t k cao. Ni
y tng c mt nh my sn xut knh mt. iu c bit l t l t k cao
nht nhng h nm di hng gi t cc ct khi ca nh my.

Tuy nhin, hin nay cng c nhiu bng chng cho rng t k l do nhiu vn
gy nn. Theo mt s chuyn gia trong lnh vc t k v d nh tin s
Edward Ritvo ca i hc California, Los Angeles a ra gi thuyt rng tn ti
mt t bm v gen lin quan n t k. T bm ny c m ha trong mt s
gen nht nh v di s tng tc vi mt s nhn t v mi trng hin vn
cha xc nh v gy nn s thay i ca h thng min dch, h thng thn
kinh cm gic, no v c c quan tiu ha. Nhng s thay i ny gy ra nhng
triu chng lm sng c nhn .

d. Du hiu:

Biu hin trong ri lon T k ni ring cng nh ri lon pht trin lan to ni
chung ngi ta ni n tam chng ri lon. l ri lon cc mi quan h
tng tc x hi, ri lon qu trnh pht trin ngn ng v ri lon hnh vi.

- Nhng vn trong thit lp tng tc x hi: khim khuyt trong tng tc x

hi mang tnh qua li c th c biu hin trong cc tnh hung nh khng
thch c u ym, th hoc ght tip xc c th (khng hng ng khi b
m b ln), thiu s tip xc bng mt, khng p ng li li ca cha m (khin
lc u cha m c th lo lng rng con mnh b ic). Cc tr ny thng c
cch x s vi ngi ln mt cch my mc, khng c kh nng v cng khng
quan tm ti vic thit lp cc mi quan h tay i ph hp vi tui pht trin
(ch khng phi l tui i). t hoc khng quan tm ti vic kt bn. Thch ngi
xa cc tr khc, thch cc hot ng mt mnh, hoc nu tham gia hot ng vi
tr khc th ch xem chng l ngi tr gip my mc hoc nh cng c chi
ca mnh (v d nh y bn ch v mun nhn thy bn khc hay ng). Khi mun
chi cng cc bn th li khng hiu lut chi v cch phi hp qua li. Khng
nhn thc c vic cn giao tip vi ngi xung quanh v cng khng nhn
thc c s au kh ca ngi khc.

- Nhng vn trong giao tip: nhng vn trong giao tip c th c biu

hin nh chm hoc hon ton khng c ngn ng (khng i km vi n lc s
dng cc phng php thay th, v d nh c ch. Nhng c nhn ni c th
li gp kh khn trong vic bt u v duy tr cuc hi thoi (thng ch ni
chuyn theo cch rt hn ch, v d nh i vt g bng cch gi tn vt,
phn i bng cch ni khng nhng li khng a ra cc dng giao tip qua
li), mc chng nhi li (ch nhi li ng nhng g chng va nghe c mt
cch v ngha). V d, khi ngi khc hi: Con c mun ung nc khng?,
thay v tr li mt cu c ngha, cc tr ny thng tr li bng cch lp li ng
cu hi va ri. Ngoi ra, chng thng nhi li mt bi bo no hoc mt
on qung co. Ging ca chng thng cao mt cch bt bnh thng v
khng c kh nng hiu nhng cu hi, cc ch dn hay nhng cu chuyn ci
n gin. ng thi, chng thiu cc k nng bt chc x hi, thiu nhng k
nng a dng d to lng tin.

Ti M, nhng cuc nghin cu gn y cho thy 83% s tr em T k c th c

ngn ng v cc nh khoa hc nc ny cho rng con s ny s ngy cng
tng v ngy cng c nhiu tr T k nhn c s gio dc v o to c
cu trc ho v c cht lng ngay t khi cn nh.

- Nhng kiu hnh vi s thch hay mi quan tm v nhng hot ng rp khun

hoc lp li: v d nh: bn tm qu mc ti cc b phn ca mt vt th no
(v d nh chic cc o, hoc mt chic bnh xe t chi), thch th s
chuyn ng v kin nh vi mt hot ng lp i lp li (v d nh ch n mt
mn n hay mc ch mt b qun o), c nhng c ng rp khun (v d nh
lc ngi lin tc, hoc lin tc a tay di mt), c nhng t th bt thng
(mt v mt chuyn ng bt thng), c cc k nng vn ng ton thn cng
nhc, i trn cc u ngn chn, kin nh vi s ging nhau v phn i hoc
ni cn gin d thi qu mi khi c s thay i, chm ch nhn vo mt vt bt
ng no .

Khi tr c nhiu biu hin ri lon ca t k nhng khng mang tt c cc tiu

ch trn th tr thng c chn on l Ph t k (autistic - like) hoc thng
thng gi l ri lon pht trin din rng cha xc nh (pervasive
developmental disorder not otherwise specified, vit tt l PDD - NOS).

a. Phn loi:

Theo phn loi quc t DSM - IV v ICD - 10 t k c chia thnh 2 loi:

- T k in hnh: T k bm sinh (pht hin ngay sau sinh hoc rt sm sau

sinh) chm pht trin v c cc triu chng xut hin ngay sau sinh n trc 3
tui.
- T k khng in hnh: Tin s pht trin bnh thng ti 12 - 30 thng tui,
sau ngng pht trin t ngt hoc thoi trin (mt cc k nng c) v cc
triu chng khc ca t k xut hin.

Nu xt gc mc ch ng trong giao tip ca tr t k, chng ta c th

chia thnh ba nhm tr t k.

- Nhm khng phn ng: hon ton t chi giao tip, k c giao tip ngn ng
v giao tip phi ngn ng.

- Nhm th ng: chp nhn giao tip nhng khng bao gi ch ng.

- Nhm ch ng nhng k quc: c th ch ng trong giao tip nhng li giao

tip mt cch ht sc k quc, lp d.

f. Chn on phn bit:

- Tm thn phn lit khi pht tr em: him gp v ch pht bnh sau 5 tui

- Chm pht trin tm thn c ri lon hnh vi: nhng tr ny khc tr t k

ch vn c giao tip v tng tc vi cc tr cng tui pht trin.

- Mt ngn ng mc phi do ng kinh: c nhng biu hin ca bnh l ng

kinh v c biu hin sng ng kinh.

- ic bm sinh.

g. iu tr:

C rt nhiu phng php can thip c a ra nhm gip tr ci thin cc k

nng b thiu st, hn ch cc ri lon hnh vi trong qu trnh pht trin, gip
tr pht trin v ha nhp x hi tt hn. Mun tr c pht trin tt, iu trc
tin l pht hin sm, chn on sm v c nhng bin php can thip ph
hp. Cc phng php can thip chnh v c hiu qu c ghi nhn hin nay:

Can thip gio dc: c rt nhiu cc phng php gio dc tc ng n tr t

k, nhng sau y l nhng phng php gio dc c chng minh l c
hiu qu tc ng tch cc n tr t k:

- Phn tch hnh vi (ABA)

- Tr liu ngn ng

- Hng dn cc k nng x hi

- Tr liu ho hp gic quan

Dng thuc