兒童問題鑑別診斷的挑戰:注意力缺陷過動症與亞斯伯格症的比較

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ڋ็୰ᚠᠦտຨᘞޟࢅᏽȈݧཎΨીഞ!

ႆଢ଼੿ᇄٳ඼ղਿ੿ޟШၶ!

ሁড়ฦ!

ᇃѕѿҳఀىσᏰЖ౩ᇄᒚ୦Ᏸفఀ௲!

ጾכჿ!

ᇃѕѿҳఀىσᏰЖ౩ᇄᒚ୦Ᏸفंـօ౩!

؇ҝᆊ!

ᇃԊᚂ଱ᖝחЖ౩ৱȃᇃѕѿҳఀىσᏰЖ౩ᇄᒚ୦Ᏸفঙӈᖿৱ! ҏМᕕு୽ऋོȞOTD:6.3524.I.293.113.NZ3ȂOTD:8.3521.I.244.122.!NZ3ȟंـ ငາЛࡻȄ!

Ȫᄢ! ौȫ!

! ! ٥ථդ਱ੱᆶݙཀΚલഐၸ୏ੱԖ೚ӭ࣬՟ޑ੝ቻǴӵǺΓሞ֚ᜤǵݙཀΚ ୢᚒǵჹҥՉࣁǵ௃ᆣୢᚒᆶᏢਠ፾ᔈ֚ᜤ฻Ǵ೭٤࣬՟ೀ٬ளᖏ׉πբޣόܰ բр᠘ձບᘐǴࣗԿ཮ӢԜᇤບ܈ࢂۯᇤݯᕍǶҁЎޑЬाҞޑӧӣ៝Ԗᜢ٥ථ դ਱ੱᆶݙཀΚલഐၸ୏ੱ᠘ձບᘐϐ࣬ᜢЎ᝘Ǵ၂კᙶమԜ᝼ᚒǴ٠ჹࣴزᆶ ჴ୍πբޣගрࡌ᝼Ƕ ᜢᗖຒǺٽูୢᚒǵݙཀΚલഐၸ୏ੱǵ٥ථդ਱ੱǵ᠘ձບᘐ!

൦ȃࠉِ!

! ! ݧཎΨϚ໱ϛȃፐଢ଼ȃৠܾҡ੉ȃΡሬ ᜰ߽৯ȃৠܾଔތஈȃҩҬȃϚᔗுᄆِᢎ Փȃ࡞ᜲᒊΣღᡝȌȂ೻ኺޟࡆυџ૖ෆю ౪ӵձޟ٘᜞ܖ፞ஆΰȂᇳζϚ᠙Ȃᆓζᆓ Ϛଢ଼ȂᡱΡϚ࿱ᛄᅸȈȶт࢐Ϛ࢐ႆଢ଼ ڋȉȷȄڏᄂӵרঈಁϛࣼڗޟ᜸խ՗࣏ߒ ౪Ȃधࡣᗴᙠޟџ૖࢐ӨᆍϚӣޟ੾౩Ȃष ૖ЅԞᚄ఼୰ᚠ๝ϠғጂຨᘞȂଶΟ૖ڞօ ᖝחώհޱஈ՗ࡣ៉ޟݽᕛܖᕛىॎหȂһ ૖ቨё௉็ޟՌרᕣ၌ᇄ௥ઽȂᏰಬ๡ҢՌ Ϗޟᓺ༖پᔔ၄ܖ׽๡ՌϏޟϚٗȂᗗջᎴ ԙϚ࡬࿋ޟфᓻ՗࣏ȇӣਢȂζ૖ᡱ௉็ں ൜ޟড়ΡЅৱߝȃӣᏰ้Ȃ؁Ο၌тঈޟሯ ؑЅ֨ᜲȂоඪټӫۣޟڞօȄ

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! ! ΙૡܚᒝޟɆႆଢ଼ڋɇȂғԒޟᚂᏰຨ ᘞӪᆎ࣏ȶݧཎΨીഞႆଢ଼੿ȷȞAttention Deficit/Hyperactivity Disorder Ȃ о ή ᙏ ᆎ ADHDȟȄкौޟ୰ᚠߒ౪ӵέএቹ७Ȉݧ ཎΨϚيȃࣀଢ଼໔ႆӻȃ՗࣏ፐଢ଼ȄМᝦϛ ࡾ ю ݧ ཎ Ψ ી ഞ ႆ ଢ଼ ੿ ᇄ ٳ ඼ ղ ਿ ੿ ȞAsperger’s DisorderȂоήᙏᆎ AspDȟϞ ໢Ԥ೨ӻࣺխޟ੫኉ȂԃȈΡሬ֨ᜲȃݧཎ Ψ୰ᚠȃᄇҳ՗࣏ȃ௑ᆱ୰ᚠᇄᏰਮᎌᔖ֨ ᜲ้ȞClark, Feehan, Tinline, & Vostanis,1999; Ghaziuddin, Weidmer-Mikhail, & Ghaziuddin 1998; Goldstein & Schwebach, 2004; Lee & Ousley, 2006; Perry, 1998; Yoshida & Uchiyama, 2004; ጾכჿȂ2009ȟȄ๋ޱӵᖝ חώհϛһᢎᄆڗȂ೨ӻӰ࣏ݧཎΨܖ࢐Ρ ሬϣଢ଼୰ᚠࠉپؑຨЅ௥ڧຟեޟএਰ ϛȂԤ೨ӻٮϚ࢐൐સޟ ADHD ௉ޱȂтঈ ζӣਢբᓍԤᄆឈᇄᒱᜋΡሬጣષޟ֨ ᜲȂၶฒݲમӵтΡޟᢎᘈپࡦՃȂ௑ᆱኸ ଔኸဣȂھஈܻ੫ۡޟᑹ፸ܖ༞ԁȂፙၗல ࠁ३ܻ࢚এ੫ۡкᚠΰȂᇄΡᄇፙޟ׬ѽԤ ३้୰ᚠȄ܁܁ӵငႆ؁໌Ι؏ޟຟեࡣȂ ี౪тঈ؁ಒӫ AspD ޟຨᘞȄ ! ! ߖԑپ୽ѴϐԤϚЍԤᜰ ADHD ᇄ AspD ᠦտຨᘞޟंـൢ֙ച៉ีߒȂ୽ϱ Ᏸޱһ໠ۖ๿Й௤ଆԪΙڎԤᏰ೚ᇄᄂ୛ १ौܒޟដᚠȄҏМၐყоМᝦӱ៫ޟП ԒȂ஠ᖝחᇄंـൢ֙ϛԤᜰ ADHD ᇄ AspD ௉ޱӵ՗࣏੫኉ΰޟ౴ӣϞ೎ёоᐌ ౩Ȃהఖ૖ᙤԪඪЀσಀᄇԪដᚠϞᕣ၌ᇄ १ຜȄ

ຯȃᖝחຨᘞ኿ྥ!

! ! Ҭࠉᖝחΰᄇڋ็ᆠડ੽੾໌՗ຨᘞ кौ௴Ң୽ሬ੽੾Ϸ᜸಑ΪގȞICD-10; WHO, 1992ȟЅᆠડ੽੾ຨᘞᇄಛॎЙы಑ Ѳގ८ཱིގȞDSM-IV-TR; APA, 2000ȟϛ ޟຨᘞ኿ྥȄҏМਲ਼ᐃ DSM-IV-TR ຨᘞف ಛȂϷտବᄇ ADHD ᇄ AspD ޟкौ੿ޑȃ ౾՗౥ᇄႱࡣᇳ݂ԃήȄ ȞΙȟݧཎΨીഞႆଢ଼੿! ! ! DSM-IV-TR ஠ ADHD ᘪ᜸࣏ݧཎΨી ѶЅؚນܒ՗࣏੽௉ȞAttention- Deficit and Disruptive Behavior DisordersȟޟΙᆍȂӖ юޟ ADHD ᖝחߒ౪ѓࢂоήέএቹ७Ȉ ݧཎΨϚ໱ϛȃࣀଢ଼໔ႆӻȃ՗࣏ፐଢ଼Ȅ 1. ݧཎΨϚ໱ϛ ! ! ฒݲ໱ϛݧཎΨўׇԙΙӇώհܖၽ ᔛȇѴࣨΙԤϧቄᖐॱܖږᐭȂ଻ΰ൷ೝᙽ ಋȇᇄтঈ७ᄇ७ᖿၗਢȂலᡱΡԤΙᆍཐ ឈȶтԁ჋ٮؠԤӵ᠙Ȅȷᗶณζџоᇄӣ ԑឭޟω݉ЄΙଔޖȂծσӻ୑өଢ଼ᄘܒޟ ၽᔛȂՄиலོўϓᘙтΡٺၽᔛؠԤᒲݲ ᝷៉Ȃᄇܻᓗᄘޟၽᔛࠌ܁܁ฒݲׇԙȂୈ ђ፞ܖၽᔛਢШၶϚ૖ݧཎڗಠ࿽ܖலӰ ಗЖσཎՄୈᒿȂՄиϚ૖௃ᓞୈڗ׎Ȃᄇ ܻሯौࡻδ໱ϛᆠડޟٱȂԃୈհཾȂོଠ ᗗܖܢ๘ўୈȇώհܖࣀଢ଼ܚሯޟݍՙȂϚ ޣܹӵ٥၇Ȃᝒ१ޟࣥՍ೿ؐЈலೣޟٱζ ഍ོן଄Ȅ 2. ࣀଢ଼໔ႆӻ ! ! ӵᏰឭࠉȂσഋӋޟΡᄇтঈޟຟᇭӻ

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࢐ȶࣀዑԁଢ଼ȷȂȶ፡Ҫ཯ೖȷȄலலࣼڗ ޟ࢐ؠԤᒲݲԁԁӴֲӵාυΰȂϚ࢐ଢ଼Й ଢ଼ယȂׯଢ଼٘ᡝȂ൷࢐ֲҳϚԊȂΰ፞ਢᚔ ໠৴՝ȄເپເўȂၰΰၰήȇᓗϚήپȂ ࡞ᜲ௃ٱᓗᄘࣀଢ଼ȂԤޟၗ࡞ӻȂலብብ൏ ൏ᖿএϚୄȄ 3. ՗࣏ፐଢ଼ ! ! ܁܁ᗙҐ᠙ׇ୰ᚠ൷ӱ๎Ȃல҈ᘞտΡ ޟፙၗܖࣀଢ଼ȂϚ૖ٯٯӴ௶໥้ঐȄएณ юЙ࿦ΡȂҐငтΡӣཎȂ᏾Ռ਌ڥтΡސ ࠢȂϚᆓ࢐֏ӠᓎȂтདୈ൷ୈȄ ! ! Ϛ࢐ؐΙ՝ႆଢ଼ڋ഍ԤоΰܚԤ੿ ޑȄԤٲࡆυޟߒ౪оݧཎΨϚ໱ϛ࣏кȂ Ԥٲࠌ࢐оࣀଢ଼໔ӻЅፐଢ଼࣏кȂԤٲࠌ࢐ ӣਢӫځоΰέᆍ੫ܒȄ೻ٲ੿ޑӵΜྑϞ ࠉȂ൷ϐԆӵȂՄиலЕีᇯޣᏰಬȃΡሬ ϣଢ଼ȃ՗࣏ᇄ௑ᆱΰޟ୰ᚠȂӰՄॊҡюᏰ ਮᇄҡࣀᎌᔖޟ֨ᜲȞBarkley, 2006ȟȄ ! ! ӵҬࠉҡސᆠડᚂᏰี৤ήȂϐငԤٲ ᜌᐃᡗҰ ADHD ࢐σသޟಠཌђ૖Фٹޟ ๖ݎȂ੫տӵσသࠉ᚞ဨഋӋȄԤџ૖࢐ӑ ЈܖࡣЈӰશഅԙȄӰ࣏೻ᆍ੾ᡐӵҡϽҡ ౩ޟϷυቹ७ȂܚоသݰܖႫသᘞቹᔮࢥ഍ ฒݲጂϸᔮกюپȂᖝחຨᘞкौҥடཾΡ ষٷᐃএਰϞ੾Ѭȃᖝחߒ኉Ѕ՗࣏ߒ౪پ ጂۡȄ ! ! DSM-IV-TR ࡾюᏰឭڋ็ޟ ADHD ౾ ՗౥࣏ 3~7ʦȂظτШ౥घ࣏ 4Ȉ1 ڗ 9Ȉ1Ȅ ୽ϱंـࠌี౪ȂᇃᢊӴୢ ADHD ౾՗౥ घ࣏ 7~12%Ȟቓ࢓ס้ΡȂ2006ȟȄԤٲ ڋ็ڗΟߧЍԑਢ෈Ȃ੿ޑོጥ၌Ȃծϫघ Ԥ 70~80%ޟߧЍԑࡻ៉ю౪ ADHD ޟࣺ ᜰ ੿ ޑ ᇄ ՗ ࣏ Ȟ Barkley, 2000/2002 ȟ Ȃ 25~55%ࣥՍџ૖ю౪Іޥོܒ՗࣏ܖࠢ՗ ੽௉ȞЕՌ Barkley, 2006ȟȄ50~65ʦADHD ௉ޱޟ੿ޑོࡻ៉Սԙԑ෈ȂѫԤ 10~20ʦ ޟ এ ਰ ོ ׇ Ӓ ؠ Ԥ ੿ ޑ Ȟ Barkley, 2000/2002ȟȄଡᙹंـี౪Ȃ30ʦADHD ௉ޱڗԙԑ෈ਢȂᎌᔖђ૖࡞ԁȂघ 50~60 ʦADHD ௉ޱӵԙԑ෈ϫࡻ៉֕౪Ϛட Жȃፐଢ଼ޟ୰ᚠȂघԤ 10~15ʦӵԙԑ෈Ԥ ᆠડ֨ᘙܖІޥོ՗࣏ȞYoung, 2000ȟȄ ! ! ΙૡՄِȂԃݎϚငႆݽᕛܖ੫տ೎ ౩ȂADHD এਰӰ࣏ݧཎΨϚܾ໱ϛȃ՗ ࣏ፐଢ଼ȃࣀଢ଼໔ଽ้੫፴Ȃٺுтঈӵԙߝ ႆแϛȂฒ፣࢐ӵ፞ཾᏰಬܖΡሬᜰ߽П७ ഍Шၶৠܾഅԙ୰ᚠȂٽԃȈԙᕼߒ౪Ϛ౩ དȇΡሬᜰ߽ϚԁȂܾڧӣᏔ௶ᔠȇਢலᎏ ڗЮҔܖՂৱ೰ጪȂીмՌ߬ȇӫځ៉ีޟ ᒑυᜰ߽ȃᏰਮЅޥོᎌᔖϚيȃᏰಬራ ᛤȃЅ௑ᆱ୰ᚠ้Ȅ ȞΠȟٳ඼ղਿ੿! ! ! DSM-IV-TR ஠ AspD ᘪ᜸࣏ᇄՌഖ੿ ӣ Ι ᜸ ޟ ኄ ݿ ܒ ี ৤ ੽ ௉ Ȟ Pervasive Developmental Disorders ȟ ޟ Ι ᆍ Ȃ ᄇ ܻ AspD ޟᖝחߒ౪ජक़ѓࢂޥོϣଢ଼ࠢ፴ ৯Ȃࠁ३Մ१ፒړݖޟ՗࣏ȃᑹ፸Ѕࣀଢ଼዁ ԒȄ! 1. ޥོϣଢ଼ࠢ፴৯! ! ! ᇄΡϣଢ଼ਢȂலಁડឝಋȂຜጣ௥ញ ৯ȂᄇтΡ௑ᆱᒱᜋ৯ȂலฒݲΟ၌тΡߨ ᇭِଉ਀Ȟ٘ᡝ࠼༖ȃЙ༖ܖᇳၗޟᇭ੉้ȟ ޟཎဎȂᡗு࡞ȶҩҬȷȂᄇܻտΡܚᇳޟ

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ၗலѫ૖౩၌ԅ७ޟཎࡦȂலװտΡᇳޟޖ રၗܖ੉ၗ࿋ઍȇڷтঈޟϣଢ଼ϛலឈு܄ Ԫޟ௑ᆱ࢐ؠԤҺࢺޟȂΡሬϣଢ଼׬ѽᡗு ҂࿵ȃϚԙዣȂтঈᇄၶԑ҂ޱܖၶԑߝޱ ໢ޟϣଢ଼ІইШӣᏔԁȄڷΡޟϣଢ଼லѫࠁ ३ܻՌϏԤᑹ፸ޟٱސȂٽԃȈтঈџ૖ོ ΙޢᇳএϚୄȂѫፙՌϏདᇳܖ๿ଜޟٱ ௑ȂฒݲܖϚў౩ོᄇПޟཐڧȂζҐՃ໔ ᄇၗਢΙپΙ܁ޟೣࠌȄ 2. ࠁ३Մ१ፒړݖޟ՗࣏ȃᑹ፸Ѕࣀଢ଼዁Ԓ! ! ! ӵРலҡࣀޟࣀଢ଼ܖ՗࣏ΰࣺ࿋ړݖ ՄھۡȂٽԃȈࣀଢ଼ޟਢ໢ᇄϱৠΙԙϚ ᡐȃીмኆܒȂΙҍԤܚᡐଢ଼ོᜲо௥ڧܖ Ԥ஼੨ޟ௑ᆱІᔖȇтঈᄇܻՌϏ๿ଜޟٱ ސலོ׹ݧσ໔ޟਢ໢ȃᆠΨᢣंڏϛȂܚ ๿ଜޟٱސζ܁܁౴ܻӣᏔȂٽԃȈЬٙ࠮ ဴȃਢړߒȃ௦ၼၯጣყ้ȄԤਢζོᢎᄆ ڗтঈԤٲ܏౴Մ१ፒޟ٘ᡝଢ଼հȂ჋࢐Ȉ ܯיήБȃརਓ՘ُ้ȇӵଢ଼հΰȂζலོ ᡱΡឈுтঈ࢐ၶ࣏ಏܭՄಗᏇޟȄӵޖޖ ڎܖᢎᄆݍՙਢȂтঈலོ܇౱ΟސӇޟђ ૖ȂՄѫடݧӵ࢚এഋ՝ܖႭӇΰȂٽԃȈ ػ๿ᙽଢ଼ޟٙᎈȂᐠడԒӴ௶ӖᑖУ้Ȅ ! ! ᜰܻ AspD ޟ੾ӰȂҬࠉۦҐׇӒΟ ၌Ȃџ૖ޟনӰѓࢂࢗՓᡝܖஅӰޟ౴லȂ ડငفಛޟཬ༌ȞԃȈωသȃ᜞ጢفಛȟܖ ડင༈Ᏺސ፴ϷݪѶ࿋ȞԃȈӻБₕᇄՖ఼ શ౴லȟȂӵড়ఊԙষ໢ζலَོڗ᜸խ੿ ޑю౪Ȃ೨ӻंـ෉өஅӰ୰ᚠ໌՗Ȃծᕗ ცӰυޟኇ៪ζϚৠω㐀Ȅ ! ! оΰ੿ޑٮߨؐΙ໶഍ོӵএਰޟҡ ࣀϛᢎᄆڗȂؐ՝এਰζϚོ഍Ԥࣺӣޟ੿ ޑߒ౪ȄΙૡՄِȂӵӱྗএਰޟี৤ᐣแ ЅᏰಬငᡛਢȂඁнϚོี౪݂ᡗဣࡣޟޑ ݷȂծᓍ๿ԙߝȂ੿ޑளپޟኇ៪ംᅚᡗ ౪ȂٽԃȈӵΡሬϣଢ଼ΰȂтঈৠܾӰ࣏Ϛ ԙዣޟޥҺ׬ѽՄೝӣᏔቛરܖ௶Ҍȇ܏౴ ޟِ՗ᖞХலЕΡ୏Ҭȇᐭ੨Մᛖีܒޟ௑ ᆱᡐϽலٺσড়ཱՄሉϞȄӵᏰಬΰȂтঈ ོ஠ݧཎΨѫܹӵՌϏԤᑹ፸ޟٱސܖऋ ҬΰȂσ໔ޟਢ໢ȃᆠΨႆ࡙׹ݧܻএΡᑹ ፸џ૖ኇ៪Ᏸཾߒ౪Ȅᓍ๿ԙߝтঈџ૖ം ᅚᄆឈՌϏᇄӣᏔ໢ޟϚӣȂՄю౪Ιٲф ᓻЅ፡ᎌޟ๊౱ȂٽԃȈ֏ᇯȃՌσȃϚ࡬ ࿋ޟ዁ҽȃІᔖܒ኏᢮੿ܖ࢐ၵڗՌϏޟད ჋жࣨ၇ȞAttwood, 2007ȟȄ ! ! AspD এਰٮؠԤӈդ٘ᡝܖ࢐ҡ౩ΰ ޟ੫኉џоୈ࣏րᘞޟྥࠌȂтঈғலޟᇯ ޣђ૖ζலོٺտΡᄇܻтঈޟޥҺ׬ѽ ܲࡻଽ࡙ޟ෈࡟Ȅ ! ! ӵᖝחΰȂAspD ৠܾᇄڏтڋ็෈ᆠ ડ੽௉౅౒Ȃ೨ӻ௉ޱӵጂҳ࣏ AspD ຨᘞ ࠉȂෆငᐣႆޟޑݷџ૖ѓࢂȈӵᔉ҂ڋਢ ෈ ೝ ຨ ᘞ ࣏ Ռ ഖ ੿ Ȃ ܖ ӑ ࠉ ೝ ຨ ᘞ ࣏ ADHDȃᇭِራᛤȃଢ଼հራᛤȃ௑ᆱራᛤȃ ໽ ॵ ራ ᛤ ȃ ܖ ࢐ ߨ ᇭ ِ ޟ Ᏸ ಬ ራ ᛤ ้ ȞAttwood, 2007ȟȂ௉ޱζོӰ࣏ຨᘞΰޟ ৯౴ȂՄೝࢊоϚӣޟݽᕛПਰȂޢڗጂᇯ ڏ AspD ޟຨᘞࡣȂϗବᄇڏ੫Ԥޟ֨ᜲ໌ ՗ݽᕛȄԪѴȂҬࠉ AspD Ԇӵӻৈຨᘞྥ ࠌȂಀӻຨᘞྥࠌϞ໢ϣԤΙमᇄݢ౴Ϟ ೎ȂиӨຨᘞྥࠌᜲоᐌӫ࣏Ιএџೝӓӣ ᇯۡޟຨᘞفಛȞMayes, Calhoun, & Crites, 2001ȟȄ

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! ! ंـࡾюȂAspD ௉ޱޟຨᘞᐣแҁ֯ ᐣਢ 5.5 ԑȞHowlin & Asgharian, 1999ȟȂ ؑ ຨ ႆ Ѳ ڗ Ϥ ՝ Ϛ ӣ ޟ ᚂ ৱ Ѕ ட ড় Ȟ Goin-Kochel, Mackintosh, & Myers, 2006ȟȄAspD ௉ޱ೽லఏՍᏰឭ෈ϗШၶ џ૖ೝี౪Ԥ౴Ȃᗶณߖԑپ AspD ޟҁ֯ ຨ ᘞ ԑ ឭ ϐ ௃ 11 ྑ ം ᅚ ६ ڗ 6 ྑ ȞGoin-Kochel et al., 2006ȟȂծϫ࡞ᜲӵ໌ ΣωᏰࠉᑢᔮюپȂ೨ӻΡ࢐ӵߧЍԑ෈ܖ ԙΡ෈ϗೝᄆឈȂиघԤ 50%ޟ AspD ௉ޱ ӵԙԑ෈ϞࠉҐෆೝຟեȃຨᘞܖ࢐ݽᕛႆ ȞKhouzam, El-Gabalawi, Pirwani, & Priest, 2004ȟȄ

! ! DSM-IV-TR ϛٮҐ݂ጂࡾю AspD ޟ ౾՗౥Ȃਲ਼ᐃߖԑپޟंـեॎȂAspD ౾ ՗౥घ௃࿲ϷϞ 2-4 Ս࿲ϷϞ 60 Ϛ้Ȃٮ Ԥംԑቨёޟᗍ༖ȞWing & Potter, 2002ȟȂ DSM-IV-TR ࡾюظτШ౥घ࣏ 5Ȉ1Ȅଡᙹ ंـี౪ȂAspD ੿ޑޟኇ៪೽லོࡻ៉ತ ҡȇ։ٺؠԤᇯޣ૖ΨીཬܖԞ෈ᇭِี৤ ᒶጥޟ௑לȂAspD ௉ޱӵ໌ΣߧЍԑ෈Ѕ ԙԑ෈ࡣȂҡࣀᎌᔖϫϚ౩དȞKhouzam, et al., 2004ȟȄ50%ޟ௉ޱҡࣀՌ౩૖ΨЅӄ ໣ҡࣀԊ௶૖ΨϚٹȂ95%Ԥޥོϣଢ଼֨ ᜲȄԪѴȂAspD ԙΡԤၶӻᆃ઎֨ᜲȃ஼ फ़༊өȃ׻ڙ૖ΨϚٹ้୰ᚠȂघԤ 35% ོю౪኏᢮੿ȃᚖྃܒ௑ཐ੽௉ڷ஼फ़੿้ ᆠડ੽௉ȞЕՌ Khouzam et al. 2004ȟȄ ! ! ᆣ ӫ Մ ِ Ȃ ADHD ޟ ౾ ՗ ౥ ଽ ܻ AspDȂڍᆍ੽௉֯࢐ظӻܻτȂтঈޟ੿ ޑᇄ՗࣏੫኉ᄇܻএΡี৤ᐣแޟኇ៪σ ӻࡻ៉ತҡȂࣥՍԤٲ௉ޱџ૖ӣਢԤڏт ᆠડ੽௉ܖ࢐ҡࣀᎌᔖΰޟ֨ᜲȄӰԪȂᄇ ௉ޱҏ٘ᇄ٘᜞ல௥ញޟΡȞٽԃȈড়Ρȃ ৱߝȃӣᏔȃ໲к้ȟȂܚ७ᄇޟ࢐Ιࢲᅞ ߝޟӰᔖᇄ፡ᎌᐣแȄ

୤ȃᠦտຨᘞޟ֨ᜲ!

! ! ҥоΰ DSM-IV-TR ޟຨᘞ኿ྥپࣼȂ AspD ᇄ ADHD ᔖ࢐ᄠณϚӣޟڋ็෈ᆠ ડ੽௉ȂՄи DSM-IV-TR ϛ݂МೣۡȂष ௉ ޱ ϐ Ԥ ኄ ݿ ܒ ี ৤ ੽ ௉ Ȟ Pervasive Developmental DisorderȂоήᙏᆎ PDDȟ ޟຨᘞȂࠌϚӔ๝Ϡ ADHD ޟຨᘞȂһ։ ष࢚ڋ็ϐೝຨᘞ࣏ AspDȂᄇܻܚю౪ޟ ݧཎΨЅႆଢ଼੿ޑȂ஠Ϛ๝Ϡ ADHD ޟຨ ᘞȄณՄȂӵᖝחΰ AspD ௉ޱю౪݂ᡗ ADHD ੿ޑޟ௑ݷٮϚЍَȂࣥՍԤٲ AspD ௉ޱӵጂҳ AspD ຨᘞࠉȂෆೝຨᘞ ࣏ ADHDȞAttwood, 2007ȟȂџَԞ෈ᠦ տ AspD ᇄ ADHD ޟϚܾȄ ! ! ႆўШၶ AspD ᇄ ADHD ౴ӣޟМᝦ σӻ࢐஠ AspDȃଽђ૖Ռഖ੿ȞHFAȟЅ Ґຝ݂Ϟ PDDȞPDD-NOSȟএਰઽ࣏ΙಢȂ ಛᆎ࣏ PDD ܖݿՌഖ੿ȞAutism Spectrum DisordersȂоήᙏᆎ ASDȟಢȄ੫տܣ༓ AspD এਰ൐ᐿԙಢȂᇄ ADHD ಢёоШၶ ޟंـϚӻȄӰԪȂҏМ஠Ԫڍ᜸Мᝦޟӱ ៫Ϸտ֕౪Ȅ

ȞΙȟQEE ܖ BTE ᇄ BEIE ޟШၶ!

! ! Ԟӵ 1970-80 ԑфȂCampbell ้Ρᇄ Geller ้Ρࣺ߯᝷ඪю ASD ௉ޱӣਢζԤ ADHD ੿ޑޟ౪ຫȞЕՌ Lee & Ousley,

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2006ȟȄPerryȞ1998ȟࡾю PDD ᇄ ADHD ڎԤ೨ӻࣺխϞ೎Ȃڏᖝחᢎᄆᇄंـ֯ี ౪ȂPDD ৠܾೝᇲຨ࣏ ADHDȂӰ࣏ڍᆍ ੽௉഍џ૖ю౪ࣀଢ଼໔ЅݧཎΨޟ୰ᚠȂ࿋ ᖝחώհޱܖᚂৱ༊өܻႆ࡙ᜰݧ ADHD Ϟ੿ޑᇄ᛾ސݽᕛਢȂࠌৠܾ܇౱ PDD ޟ џ૖ܒȂӰՄᏲमᒿᇲܖϚᎌ࿋ޟݽᕛȄ Clark, Feehan, Tinline ᇄ VostanisȞ1999ȟо Ռഖ੿኿ྥᔮਯߒᑢᔮؑຨএਰȂี౪ӵ 78 Ӫಒӫ ADHD ຨᘞ኿ྥޟএਰϛȂघԤ 65~80%ೝЮҔൢ֙юԤޥҺЅྜ೽ΰޟ֨ ᜲȂЎڏӵӣ౩ЖȃӣᏔᜰ߽ȃད჋Ψȃߨ ᇭِྜ೽ᇄᆰࡻᄇၗ้П७Ԥᡗ๿ၶ৯ޟ ௑לȂӰԪ௰፣࡞џ૖ڏϛԤٲ PDD এਰ ೝຨᘞԙ ADHDȂࡾюڍᆍຨᘞџ૖ࣺϣ ౅౒Ϟ౪ຫȄ ! ! Lee ᇄ OusleyȞ2006ȟޟفಛܒ੾ᐣӱ ៫ंـี౪Ȃ83 Ӫ PDD এਰϛȂԤ 78%ޟ এਰಒӫ ADHD ຨᘞȂӵ ADHD ຟ໔ߒ Ȟ Attention Deficit Hyperactivity Disorder Rating Scale, ADHD RSȟϞுϷһଽܻᖝח ϸᄠϷኵȞԻϷ้઻ 93ȟȄġ ȞΠȟBtqE ᇄ BEIE ޟШၶ! ! ! Ghaziuddin, Weidmer-Mikhail Ѕ GhaziuddinȞ1998ȟี౪ȂAspD Ϟڋ็ߧ Ѝԑघ 65%Ԥڏтӓ੾Ϟᆠડ੽௉ຨᘞȂ ڏϛӓ੾Ш౥ശଽޟ੽௉ؚ࣏ນܒ՗࣏੽ ௉Ȟѓࢂ ADHDȃᄇҳܒІת੽௉Ѕࠢ՗ ੽௉ȟȂӓ੾౥घ 61.7%Ȃтঈ೤ፙ 35 Ӫ AspD এਰȂڏϛԤ 29%Ȟ10 Ӫȟӣਢζಒ ӫ ADHD ޟຨᘞ኿ྥȄ၎ंـζี౪ȂϚ ӣԑឭቹޟ AspD ௉ޱၶலю౪ޟӓ੾ຨ ᘞϚӣȂ6~12 ྑ AspD ڋ็ശலю౪ޟӓ ੾ຨᘞ࣏ ADHDȞघլ 50%ȟȂ13 ྑоΰ AspD ௉ޱശலю౪ޟӓ੾ຨᘞࠌ࣏኏᢮ ੿Ȅġ ! ! ᆣᢎԤᜰ PDD ܖ AspD ௉ޱӓ੾ ADHD ੿ޑޟМᝦี౪Ȃӓ੾౥घ௃ 17.2% Ս 85% Ϛ ้ Ȟ Ghaziuddin et al., 1998; Goldstein & Schwebach, 2004; Lee & Ousley, 2006; Yoshida & Uchiyama, 2004ȟȂᗶณӨ ंـեॎϞӓ੾౥Ԥܚ৯౴Ȃծ೻ٲंـ֯ ΙमࡾюȂPDD ܖ AspD ӵຨᘞΰৠܾᇄ ADHD ࣺ౅౒Ȃܖ܄Ԫ໢Ԇӵӓ੾Ϟ௑ݷȄ

ဓȃᖝחຟեߒ౪ޟШၶ!

! ! ࣏Οᚄ఼ AspD ᇄ ADHD ڍᆍຨᘞ໢ ޟ৯౴ܒȂଶΟᖝחᚂৱޟߞຨఐፙᇄຨᘞ ϞѴȂһԤϚЍंـޱᙤҥ໌Ι؏ޟᖝחຟ եܖЖ౩ᒋᠦپ௤ଆڍ੽௉໢ޟ౴ӣϞ೎Ȅ ȞΙȟBEIE ੿ޑᇄ՗࣏੫኉ޟຟե! ! ! ӵ੿ޑߒ౪П७ȂPerryȞ1998ȟٺҢ ΙᄇΙޟఐፙᇄຟեȂၐყᚄ఼ PDD ڷ ADHD ޟຨᘞȂтี౪ڍᆍ੽௉ӵԞ෈഍ џ૖ю౪ࣀଢ଼໔ЅݧཎΨޟ୰ᚠȂծ PDD ڋ็խнԤ؁ӻޟᄇҳ՗࣏ܖኸΨ՗࣏ȇڍ ޱ഍ԤҺЄޟ֨ᜲȂծ PDD ڋ็ޟޥོϣ ଢ଼֨ᜲแ࡙ၶଽȂиၶીмᚖөޟϣଢ଼Ȃᇄ ЮҔ໢ޟٷߣᜰ߽ζၶ৯ȇࣺᄇӴȂADHD ڋ็ޟၽᔛПԒၶԤഺཎȂζၶ૖௥ڧҡࣀ հ਀ܖಬᄛޟ׽ᡐȂ݂ᡗϚӣܻ PDD ڋ็ ھۡи१ፒޟ዁ԒȄጾכჿȞ2009ȟһี౪Ȃ

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ࣺᄇܻ ADHD ಢȂAspD ಢԤၶӻޟ AspD ੿ޑᇄޥҺ୰ᚠȂиΡሬϣଢ଼׬ѽၶ৯Ȅ ! ! 1998 ԑ Ghaziuddin, Weidmer-Mikhail Ѕ Ghaziuddin о๖ᄺܒఐፙȞK-SADSȟ೤ ፙ 35 Ӫ AspD এਰȂڏϛԤ 29%Ȟ10 Ӫȟ ӣਢζಒӫ ADHD ޟຨᘞ኿ྥȄLee Ѕ OusleyȞ2006ȟٺҢ ADHD ຟե໔ߒȞADHD Rating Scale, ADHD RSȟຟե 83 Ӫҥ੾ᐣ ӱ៫ᑢᒵюϞ PDD এਰȂڏϛ 78%ޟএਰ ಒӫ ADHD ຨᘞȂڏӵ ADHD RS ϞுϷ ଽܻᖝחϸᄠϷኵȞԻϷ้઻ 93ȟȄ ! ! Hattori ้ΡȞ2006ȟٺҢ ADHD RS ᇄ ݿ Ռ ഖ ੿ ᑢ ᔮ ໔ ߒ Ȟ Autism Spectrum Screening Questionnaire, ASSQȟᔮก 15 Ӫ PDD ڋ็ȃ20 Ӫ ADHD ڋ็ᇄ 40 ӪΙૡ ڋ็ȂݧཎΨຟեϞ๖ݎี౪ȂPDD ڋ็ ᇄ ADHD ڋ็ࣱԤၶᝒ१ޟݧཎΨ୰ᚠȂ ߒ౪ၶΙૡಢڋ็৯ȄTani ้ΡȞ2006ȟ ࠌᄇ 20 Ӫ AspD ԙΡ௉ޱٺҢྣኈนт໔ ߒȞWender-Utah Rating Scale for ADHDȟȂ ҥএਰӱ៫ωਢঐޟ ADHD ࣺᜰ੿ޑߒ ౪ȇंـ๖ݎี౪Ȃ70%ޟ AspD এਰڎԤ ӓ੾ ADHD ੿ޑޟ౪ຫȂӵ ADHD ੿ޑு ϷΰȂADHD ԙΡல዁ޟҁ֯ுϷ࣏ 62 ϷȂAspD ԙΡএਰޟҁ֯ுϷ࣏ 46 ϷȂ ሉଽܻΙૡΡޟҁ֯ுϷȞ16 ϷȟȄ ! ! Schatz, Weimer Ѕ TraunerȞ2002ȟо TOVA ݧཎΨกᡛᔮก 8 Ӫ AspD এਰᇄғ லޱޟݧཎΨߒ౪Ȃี౪ 62.5ʦޟ AspD এ ਰߒ౪ၶ༊өܻ ADHD ᖝחএਰϞߒ౪Ȃ ໌Ι؏ШၶϷ໶ுϷี౪Ȃڍಢӵᒸᅓ౥ȃ ᒿᇲ౥ᇄҁ֯Іᔖਢ໢ΰࣱฒ৯౴ȂծӵϚ ӣږᐭୢࢲ໢ޟІᔖᡐ౴ܒΰȂࠌԤᡗ๿৯ ౴ȄጾכჿȞ2009ȟоஶઽЪ೿៉ߒ౪กᡛ ȞCPT-IIȟຟեݧཎΨȂี౪ AspD ᇄ ADHD ڍಢڋ็ӵݧཎΨߒ౪ΰฒᡗ๿৯౴ȂՄڍ ಢ ড় ߝ ବ ᄇ ADHD ੿ ޑ ޟ ຟ ໔ ȞSNAP-IVȟȂฒ፣࢐ݧཎΨȃႆଢ଼ፐଢ଼ܖ ᄇҳІת՗࣏֯ฒᡗ๿৯౴Ȅ ȞΠȟBtqE ੿ޑᇄ՗࣏੫኉ޟຟե! ! ! Luteijn ้ΡȞ2000ȟٺҢڋ็՗࣏ᔮ ਯߒȞCBCLȟȃՌഖ੿՗࣏໔ߒȞAutism Behaviour Checklistȟᇄڋ็ޥོ՗࣏໔ߒ Ȟ C h i l d r e n ’ s S o c i a l B e h a v i o u r Questionnaireȟຟե PDD-NOS ᇄ ADHD ڋ ็Ȃ๖ݎี౪ PDD-NOS ڋ็ӵ CBCL ᖂϷ ЅޥҺ୰ᚠᝒ१࡙֯ᡗ๿ଽܻ ADHD ڋ ็ȇӵՌഖ੿੿ޑᇄޥོ՗࣏П७Ȃᗶณڍ ಢڋ็഍ೝЮҔൢ֙юڎԤϚӫۣޟޥོ ϣଢ଼Ȃծ PDD-NOS ڋ็ӵޥོϣଢ଼ȃޥོ ଝᕻȃྜ೽୰ᚠᇄՌഖ੿੿ޑࣱႀڗ१࡙ી ཬޟแ࡙Ȃᝒ१࡙֯ᡗ๿ଽܻ ADHD ڋ็Ȅġ ! ! Hattori ้ΡȞ2006ȟᔮก PDD ڋ็Ȟ15 ӪȟȃADHD ڋ็Ȟ20 ӪȟᇄΙૡڋ็Ȟ40 ӪȟޟݿՌഖ੿੿ޑȂ๖ݎี౪ PDD ڋ็ ޟϷኵᡗ๿ଽܻ ADHD ಢȂծ ADHD ڋ็ ޟݿՌഖ੿੿ޑߒ౪แ࡙ζᡗ๿ଽܻΙૡ ڋ็Ȅ ! ! ӵЖස౩፣П७ȂAspD ௉ޱӵЖස౩ ፣૖ΨȞ౩၌тΡޟདݲᇄཎყȟޟี৤ၶ ࣏ᒶጥȂΙૡڋ็ܻέྑ߯ี৤юپϞЖස ౩፣ߑۖ૖ΨȂAspD ௉ޱڗѲՍϲྑਢϗ ໠ۖี৤ȂΙૡڋ็ܻϲྑџี৤юޟЖස

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౩፣໌໦૖ΨȂAspD ௉ޱࠌڗΪྑѾѡϗ ໠ۖี৤ȞFlavell, 1999ȇGillberg, 2002ȟȄ Ҭࠉ୽ϱѴࣺᜰंـϛȂޢ௥Шၶ ADHD ڋ็ᇄ AspD ڋ็Жස౩፣૖ΨޟंـϚ ӻȄंـี౪ȂADHD ڋ็ޟ௑ᆱᒱᜋ૖ Ψ ߒ ౪ ᇄ Ι ૡ ӣ ឭ ڋ ็ ฒ ౴ Ȟ Strange, 1999ȟȂӵ؁ଽ໦ޟЖස௰ก૖ΨȞٽԃȈ ౩၌ᒞږȃ୅၆ȃޖરЅᇳᗀ้ȟޟߒ౪ζ ڷΙૡӣឭڋ็ฒ౴ȞCharman, Carroll, Sturge, 2001; Sodian, Hulsken, 2005ȟȇ೨֗ ಫȞ2007ȟһี౪ ADHD ڋ็ӵЖස౩፣ กᡛ໌໦ގޟߒ౪ᇄΙૡڋ็ฒ৯౴Ȅ AspD ڋ็ࠌ࢐ӵਲ਼ᐃಁડ௰กтΡ௑ᆱᇄ དݲޟ૖ΨΰȞһ։ಁડᒱᜋกᡛߒ౪ȟȂ ߒ౪ᡗ๿ճܻΙૡڋ็ȞKaland & Callescen, et al., 2008ȟȇ༁МܑȞ2009ȟี౪ AspD ಢڋ็ӵಁડᒱᜋกᡛޟߒ౪Ш ADHD ಢ ЅΙૡಢڋ็৯Ȃծ AspD ಢᇄ ADHD ಢ ޟ৯౴Ґႀᡗ๿ȄጾכჿȞ2009ȟһี౪ AspD ಢᇄ ADHD ಢޟಁડᒱᜋกᡛߒ౪ Ґႀᡗ๿৯౴Ȃծ AspD ಢڋ็ޟЖස౩፣ กᡛߒ౪Ш ADHD ಢᡗ๿ၶ৯Ȅ

ӂȃ๖ᇭ!

! ! ADHD ᇄ AspD ڍᆍ੽௉ӵഋϷ੿ޑ ߒ౪ΰޟࣺխܒȂഅԙᖝחᠦտຨᘞޟ֨ ᜲȄ௃ӱ៫ޟМᝦϛȂี౪ҬࠉၶЍंـޢ ௥Шၶ AspD ᇄ ADHD ௉ޱޟ੿ޑߒ౪ᇄ ՗࣏੫኉Ȃӻኵंـ஠ AspD এਰᇄڏт PDD ܖ ASD এਰᘪ࣏Ιಢپᇄ ADHD ಢ ШၶȄӣਢȂӨंـ๖ݎۦԤތដᇄϚΙम Ϟ೎Ȃӵຨᘞΰـത ADHD ᇄ AspD ڍᆍ ੽௉ᔖӣਢٮҳܖ࢐ԃդୈ؁఼ཿȃ݂ጂޟ ୢᒱȂ഍ϫሯ؁໌Ι؏ޟंـȂี৤ڎᡝޟ ຟե๊౱Ѕᠦտࡾ኿Ȃپᚄ఼ڍ੽௉໢ޟ౴ ӣϞ೎ȄΙૡՄِȂӓ੾౪ຫᄇܻ੽੾ޟݽ ᕛᇄႱࡣԤ१σኇ៪ȂԤ ADHD ӓ੾ຨᘞ Ϟ ASD এਰȂШଔؠԤӓ੾ຨᘞޟএਰȂ ڏޥོЅྜ೽֨ᜲޟᝒ१࡙ࣺᄇၶଽȞde Bruin et.al., 2007ȟȂҡࣀᎌᔖ֨ᜲһၶᝒ१ ȞGoldstein & Schwebach, 2004ȟȄස૖ғ லޟ ASD এਰȂषӣਢԤ ADHD ੿ޑਢȂ ড়ߝᇄᚂৱலܾݧཎڗ ADHD ੿ޑȂІՄ ོ܇౱ၶϚᡗ๿ܖၶϚܾᄆឈޟՌഖ੿ࣺ ᜰ੿ޑȞPerry, 1998ȟȄӰԪ࡚ដӵຨᘞܖ ຟե AspD ᇄ ADHD ਢȂᔖӣਢବᄇՌഖ ੿ࣺᜰ੿ޑᇄݧཎΨ/ࣀଢ଼໔໌՗ຟեȄฒ ፣Ҭޟ࢐ौᠦտ AspD ᇄ ADHDȂܖ࢐Ճኌ ๝Ϡӓ੾ຨᘞȂष૖ӣਢବᄇڍᆍ੽௉ޟ੿ ޑհᔮกȂׇᐌиғጂӴᕣ၌এਰޟ୰ᚠȂ П૖ٺএਰᕕு؁ӫᎌԤਝޟݽᕛᇄڞօȄ

ചȃ୤ՃМᝦ!

೨֗ಫȞ2007ȟȄݧཎΨીѶ/ႆଢ଼੽௉ڋ ็ᇄଽђ૖Ռഖ੿ڋ็ӵЖස౩፣૖ Ψΰޟ৯౴ȄሄϦσᏰЖ౩Ᏸंـܚᖝ חЖ౩ಢᆈρ፣МȂҐюގȂᇃѕȄ ༁МܑȞ2009ȟȄಁડᒱᜋกᡛڋ็ގޟ߬ ਝ࡙ंـȈ௤ଆᇃᢊᏰ็Жස௰ก૖ ΨȄߝ۸σᏰᖝח՗࣏ऋᏰंـܚᖝח Ж౩ಢᆈρ፣МȂҐюގȂੀ༪ᑪȄ ጾכჿȞ2009ȟȄᇃᢊٳ඼ղਿ੿ᇄݧཎΨ ીѶ/ႆଢ଼੽௉ڋ็ޟᖝח੫኉ϞШ ၶȄߝ۸σᏰᖝח՗࣏ऋᏰंـܚᖝח

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Ж౩ಢᆈρ፣МȂҐюގȂੀ༪ᑪȄ ቓ࢓סȃቓρཟȃ୦ՍႦȃݓ୊ұȃ؇ߝឭȃ

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