Thực trạng tre mắc hội chứng tự kỷ trên thế giới

THUC TRANG TRE M A C HQI CHL/NG
TUKYTRENTHEGIOI
TS. Nguyen Thj Mai Lan
Hoc vien Khoa hoc xd hoi.

T O M TAT
Hpi chi'fng tifky hien dang duoc nhieu qudc gia quan tdm. Tre' mdc hpi clu'fng
ndy chiem mgt ty le ddng ke trong ddn sd ctia cdc nudc vd ldng ddn theo thai gian.
Cdc nghien cifu cho thdy co stf khdc nhau giffa cdc chdu luc vd cdc qudc gia. giifa khu
vuc ihdnh thi vd nong thon, giifa tre' em nam vd ire' em nu ve sd luang ire mac hpi
chiing ndy. Xu hudng tdng ndy co the phdn dnh sif gia ldng thifc su trong ty le mdc
benh, nhioig cung phdn dnh nhCfng nguyen nhdn khdc nhau nhU lieu chi chudn dodn
hpi chifng tif ky co thay doi; ngdy cdng co nhieu cong cu giiip chud'n dodn chinh xdc
hpi chiing tuky.
Tu khoa: Hoi chifng tuky; Ty le mdc hgi chimg tuky.
Ngdy nhdn bdi: 14/12/2012; Ngdy duyet ddng bdi: 25/12/2012.

1. Dinh nghTa va cac khai niem lien quan
Hdi chflng tu ky la hdi chung rdi loan tam sinh ly d tre em. Dac di^m co
ban cua hdi chflng tu ky la han che' kha nang giao tie'p va tuong tac xa hdi, cung
nhu cd nhfltig hanh vi kem da dang, lap di lap lai (DSM-IV, Hdi Than kinh My.
2004). Hpi chflng tu ky cd th^ dupc chu^n doan chfnh xac cho tre tir 18 thang
tudi trd len (Turner et al, 2006). Tiiy theo trieu chflng, tre cd th^ mac hdi chflng
tu ky d cac mflc dp khac nhau: tir thi^u nang tri tue cho de'n cd mdt sd kha nang
khac thudng; cd nhflng tre di hpc va sinh hoat binh thudng nhung cung co tre
sud't ddi phu thudc vao bd me va ngudi cham sdc (Miles et al, 2005).
Theo Kanner - ngudi tien phong trong ITnh vuc nghien cflu nay, cd ba
da'u hieu chfnh cua hdi chflng tu ky la han che giao tie'p xa hdi, rdi loan ngdn
ngu va cd hanh vi lap di lap lai. Kanner phan biet hdi chflng tu ky vdi benh tam
th^n phan liet d tre em dua tren quan he xa hdi. Tre mSc benh tam th^n phan
liet cd xu hudng cd lap ban than khdi cac mdi quan he hien cd, cdn tre mac hdi

chfltig tu ky thudng bi han che trong giao tie'p vdi nhulig ngudi xung quanh
(Mesibov&Sheai20l6). '

TAPCHITAMLtHOC,Sdl (166), 1-2013

63


Phdt tridn quan didm cia Kanner, nhidu cdng cu chudn dodn da dupc
xdy dung: DSM-IV-R cua Hdi Tdm Vj hpc My; ADI-R cua Rutter, Le Cout;
lCD-10 cua Td chic Y td the gidi; CARS cua Schopler vd ddng nghidp (1980)
Mac di dinh nghTa tu ky khdng thay ddi, mdi cdng cu lai khac nhau ft nhidu vd
phan loai cdc dang tu ky vd cdc tridu ching cia ty ky. Ngay nay, ngoai tu ky
mic dCi nang tuong ing vdi cdc tidu chi cua Kanner, cdn cd cdc dang nhe hon
nhu hdi ching Asperger (tre cd ky nang giao tiep xa hdi kdm, nhung khdng bj
thidu nang tri tud), cham phdt tridn trf tud, hdi ching Rett, bdnh chdm phat tridii
ngdn ngtt va benh rdi loan phat tridn lan tda dang chua xdc dinh (PDDNOS). Vi
the, hidn nay, thay vi dung dd chi mdt hdi ching ridng biet, t i tu ky dupc ding
dd chi nhdm rdi loan phat tridn gdy ban chd kha nang giao tiep vd tuong tdc xa
hpi hay cdn gpi la rdi loan pho ty ky (Yates & Le Couteur, 2008).
Hdi ching ty ky thu&ng keo dai den sud't ddi, dnh hudng nghidm trpng
den sinh boat cia ca ngudi bdnh va nhing ngudi chim sdc ngtrdi ty ky. Nhing
rdi loan vd thdn kinh t i nhung nam phat tridn ddu ddi cd thd anh hudng ddn
nhidu mat trong qua trinh phat tridn cua trd. Kd't cue Id de'n khi Idn, trd thi'ch
ing kem vdi nhttng ddi hdi cia xa hdi. Day cttng Id nguyen nhan vi sao hdi
ching tu ky dupc liet vdo nhdm cac hdi ching rdi loan phdt tridn Ian tda (Miles
et al, 2005).
2. Thdng ke ve tinh hinh mac hpi chimg ttr ky tren the gidri
2.1. Tinh hinh mdc hdi chiing tulcy a My vd cdc nudc chdu Au
Nghidn ciu qui md Idn ddu tidn vd hdi ching ty ky dupc Lptter thuc

hidn nam 1966. Trong 78.000 trd em t i 8 de'n 10 tudi d Middlesex, Vuong qud'c
Anh. Lotter phat hidn ra mdt didu la c i 10.000 tre cd mpt tre mdc ty ky vd ty le
nay P tre em nam cao ban nhieu so vdi tre em ntt (Holaday, 2012). Ty le nay
tang nhe thdnh 2/10.000 tre trong thdp ky 70 (Kawamura, Takahashi & Ishii,
2008). Tuy nhien, de'n cudi the ky XX thi thdng kd vd tinh hlnh mdc hdi ching
ty ky tang vpt.
^ cd cdi nhln bao qudt hdn vd xu hudng tang gidm cua hdi ching ty ky
qua thdi gian, Fombonne (2002) da tdng hop td't cd cac nghidn ciu dupc dang
tren cdc tap chi tidng Anh vd tinh hinh mdc hdi ching ty ky vd cdc benh rdi
loan phdt tridn lan tda. Tinh de'n nam 2Ppi, cd 32 de tai thudc loai ndy. Ty 14
mdc tu ky trung binh la 8,7/10.000, trong dd mdi nghidn ciu tim duoc mdt ty le
khdc nhau: thdp nha't la 0,7/10.000, cao nhdt la 72,6/10.000. Nghien ciu cd
nhdm khdch thd cang nhd vd dupc thyc hien cdng gdn ddy thi ty le tim dupc
cang cao. Ne'u loai ra nhttng nghien ciu cd dp chfnh xdc thd'p (do nhdm khdch
thd nhd hon 10.000), cdn Iai 19 dd tai, vdi ty Id mdc tu ky trung binh la
10/10.000.

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TAP CHI TAM LY HOC, Sd 1 (166), 1-2013


Ngoai ra, rdt nhidu trd cd bidu hien cua tu ky nhung khdng dap ing d i
tdt ca cdc tidu chuan dd dupc chudn dodn mdc hdi ching ty ky. Theo tieu chudn
hien nay, nhttng tre nay rd't cd the dupc chudn dpan mdc benh rdi loan phdt
tridn lan tda dang chua xac djnh (PDDNOS). Ty le tre thudc nhdm nay cao gdp
1,5 Idn ty Id tre mdc ty ky (tic Id 15/10.000). Trong khi dd, ty Id tre mdc hdi
ching Asperger thd'p ban 4 Idn so vdi ty Id tre mdc ty ky.
Nghidn cihi tren cua Fombonne dupc cdng bd nam 2002 vd chi trong vdi
ndm cud'i thd ky XX ddu thd ky XXI, Fombonne da quan sdt thdy xu hudng

tdng bd't thudng len 40 - 60 trd mdc hdi ching ty ky va cdc bdnh rdi loan phat
tridn lan tda so vdi ly Id I - 2/10.000 tre nhu trudc ddy (xem bang I).
Bdng 1: Thd'ng ke linh hinh Ire mdc hfli chi'fng luky
qua mol so'nghien cdu gdn ddy
(theo Fombonne, 2002)
PDDNOS '' + hoi chftng
Asperger

Benh tu ky
Tuoi

Berlrand el
al., 2001
Baird el al.
2000
Chakrabarli

&

Fombonne,
2001

Tyle
(tren
10.000)

PDD"
noi
chung

Tyle
nam/
nit

Khong bi
thieu
n^ng tri
tue %

Tyle
(tren
10.000)

Tyle
nam/
nit

Khong
bi thieu
nang tri
tue %

Tyle
(tren
10.000)

51

67.5

3 - 10

40.5

2.2

37

27.0

3.7

7

30.8

15.7

60

27.1

4.5

4-7

16.8

3.3

29

44.5

4.3

57.9

94

61.3

'PDD (Pervasive DevelopmeiUal Disorder): Benh rdi logn phdl trid'n lan loa.
''PDDNOS (Pen'asive Developmental Disordei. Not Olhern'ise Specified). Benh roi loan phdt li lai lan
toa dgng chua xdc dinh

Ndi tie'p nghien cuu ciia Fombonne, Catherine Rice (2006) va nhdm
nghien ciiu thupc Trung tam Y te' du phdng My da so sanh ty le tre mac tu ky
nam 2002 vdi nam 2006 qua sd lieu trung tam thu thap dupc. Neu nam 2002,
cfl 10.000 tre cd 64 tre bi tu ky, thi de'n nam 2006, con sd nay tang len thanh
91/10.000 tre. Khdng nhflng the, ty le mac tu ky tang tren mpi phuong dien:
gidi tfnh (cfl 10.000 tre nam va 10.000 tre nfl thi cd 143 tre nam va 32 tre nfl
mdc tu ky), ve sac tdc (ty le tre da trang mac tu ky tang 55%, tre da den mac tu
ky tang 41%). Cung trong nam 2006, Baird va ddng nghiep cung da thdng ke
dupc 6 Anh cd 116/10.000 tre mac hpi chflng tu ky.

TAP CHI'TAM Ly HOC, Sd 1 (166), 1 - 2013

65

Nguydn nhdn nao ddn tdi xu hudng tdng bd't thudng nay? Mdt Id, do
nhttng tie'n bd trong ITnh vyc nghidn ciu hdi ching ty ky da cho phdp viec
chuan dodn dupc tidn hanh sdm hPn va chfnh xdc hem. Hai la, do nhttng thay
ddi trorig each djnh nghTa hdi ching ty ky va cdc dd'u hieu nhan biet ty ky.
Nhidu tre trudc day dupc chudn dodn la khdng mic tu ky, gid cd thd dupc liet
vdp hdi ching rdi loan phdt tridn lan tda dang chua xac dinh hoac thdm chf du
tieu chudn dd chudn dodn la mdc hdi ching ty ky. Nguydn nhdn t h i ba la do
mic sd'ng tang cao khidn cho ca bdc sT va ngudi ddn deu chu trpng den viec
phdt hien sdm va chua tri sdm hdi ching ty ky nay. Di the nao di ntta, ching ta
khdng thd phi nhdn rdng ty le tre ty ky dang thyc sy tang trong thdi gian gdn
ddy (Tanoue el al, 1988).
Vd mat gidi linh, tre em nam mdc ty ky nhidu gdp 4,2 ldn so vdi tre em
ntt. Ty Id nay dupc khdng dinh qua nhidu nghidn ciu. d) tre vtta bi ty ky vtta hi
thidu nang trf tue, khdng cd md'y chdnh Idch trong ty Id nam n i (ci 2 tre nam
mdc ty ky thi cd 1 trd n i mdc ty ky), nhung nd'u tre khdng bi thidu ndng trf tud
hoac bl nhe thi ty Id chdnh lech nam ntt tang vpt. Nhin chung, chi cd 30% tre ty
ky phdt tridn tri tud binh thudng, cdn lai 30% bi thidu nang mic dp nhe va 40%
bi thidu nang mic dd nang de'n rdt ndng. Vi thd sp lupng trd nam mdc ty ky cao
hpn ban sp vdi trd ntt (Fombonne, 2002). Ngoai thidu nang trf tud, tre ty ky cdn
thudng xuydn mdc phai mdt sd bdnh khac nhu ddng kinh (17% tre ty ky mdc
benh nay), hdi ching nhidm sdc thd X dd gay, rubella bdm sinh (Fombonne,
2002).
Dia vj xa hdi khdng anh hutjng dd'n ty Id tre mdc ty ky. Mdt sd nghidn
ciu qui md nhd phdt hien ty le tu ky cao d ngudi nhap cu vd mdt sd nhdm dan
tdc, nhung nhing nghidn ciu qui md Idn khdng tim thd'y md'i lidn he nay.
2.2. Tinh hinh mdc hdi chdng tu Icy a chdu A
Hien vdn cd rdt ft cac nghien ciu vd hdi ching ty ky d chdu A, mac di
chau luc nay ddng gdp mdt phdn ddng kd vao ddn sd the gidi. Theo thd'ng ke
cua Xiang Sun vd Carrie Allison (2008), t i nam I97I de'n nam 2008, cd 26

nghidn ciu qui md ldn ve hdi ching ly ky dupc thyc hidn d chau A (xem bang 2).
Trong 26 nghidn ciu dupc chpn, cdc nghien ciu d Nhdt Ban chiem phdn
ldn (13 nghien ciu), cdn lai cd 7 nghien ciu d Trung Qud'c, 2 p Israel, 1 diran,
I d Ddi Loan vd I d Indonesia. Cd 2/3 cdc nghidn cttu tap trung vdo ddn cu dd
thj, sd cdn Iai nghien ciu ca khu vyc dd thi va khu vyc ndng thdn. Nhdm khdch
thd nghien ciu cua mdi de tai cung khac nhau ft nhidu ve dd tudi, ty Id nam n i
vd dp Idn cua nhdm khach thd. Tfnh trung binh, cdc nghidn ciu o Trung Qud'c
cd khpang 25.521 khach the, nhing nghien ciu a Nhdt cd khoang 597.003
khach thd.

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TAP CHI TAM Lf HOC, Sd 1 (166), 1 - 2013


Bdng 2: Thong ke cdc nghien cAu d chdu A ve ty le mdc tix ky
tinh de'n ndm 2008
(theo Sun & Alison, 2008)

Tuoi

Tyle
mic
benh
(tren
10.000)

Kanner "

2 - 12

2.6

Nhai

Kanner

0 - 15

1,7

Nhai

Kanner

5 - 14

I.l

Nhai

Kanner

Sd
luong
khach
the

Tyle
nam/

ntt

TT

Ndm

Chu nhiem de
tai

Quoc
gia

Tieu clll/
Thang du

1

1971

Yamazaki

Nhai

2

1971

Haga
Miyamolo

3

1971

Nakai

4

1971

Tanino

5

1980

Hoshino

Nhai

Kanner

609.848

0 - 18

2.3

6

1983

Ishii &
Takahashi

Nhai

DSM-III'

35.000

6 - 12

16.0

7

1987

Maishuishi

Nhai

DSM-III

32.834

4 - 12

16.4

8

1988

Tanoue

Nhai

DSM-III

507.003

0-7

13.8

4.1/1

9

1989

Sugiyama

Nhat

DSM-III

12 263

0-5

13.0

2.1/1

10

1992

Ohlaki

Nhat

DSM-III-R

35.366

6 - 14

11.7

11

1996

Honda

Nhai

ICD-10'

8 537

0-5

21.1

2.6/1

12

2005

Honda

Nhai

ICD-10

35,716

0-5

19.0

2,5/1

13

2008

Kawamura

Nhai

DSM-IV

12,263

5

13.0

2,8/1

14

1987

Taokuo Tai

Trung
Qudc

RuIIer"

457.200

0.32

6.5/1

CCMD-2R'. DSM-IIIR. DSM-IV

10.802

0 - 14

2.8

4.1/1

U -

D

15

2000

Weiwu Luc

Trung
Qudc

16

2002

Weiwu LUG

Trung
Qudc

CARS' +
Ihang danh
gia Chung vfi
mijc dp phai
Irien

3.978

2-6

17.9

2.5/1

17

2txa

Weihua Wang

Trung
Qudc

CCMD-2-R.

CARS

7.488

2-6

12.3

2/1

18

2003

Luzhong Ren*

Trung
Qudc

19

2004

Rong Guo

Trung
Qudc

CCMD-2-R.
CARS

3.606

2-6

13.8

Toin
nam

20

2007

Shuguang Yang

Trung
Qudc

DSM-IV

10.412

3 - 12

5.6

5/1

250.0

TAP CHI'TAM Lt HOC, Sd 1 (166), 1-2013

67


21
22
23

2008
1992
2001

Feng Zhang
Wignyosumarlo
Davidovilch

CARS.
DSM-IV

25.521

1-6

9.8

Indones
ia

CARS

5.I20..

4-7

11.7

Israel

DSM-III-R.
DSM-IV

Trung
Qudc

26,160

0- 12

9.9

1,113,90
0

0- 14

9.0

24

2004

Kamer

Israel

25

2007

Almad
Ghanizadch

Iran

DSM-IV

2.000

5- 10

190.0

Chuanyu Chen

Dai
Loan

ICD-9

328.802

u-12

40.7

26

2008

3,2/1

CliTi Mcli:
* Ngltieii cicii nay ciu diing lliaiig daiili gia sa bd de plidn logi Ire mac lie ky va khdng mdc III ky:
" Kanner Ddnli gid ctia bac si dua Iri'u cdc lien chi Leo Kanner dita ra:
'' DSM-rtl/lll-R/li^ (Diagnostic and Slalislical Manniiat of Mental Disorder - lU/llI.Revised/tV')- Cam
nang plidn loai va clmdn dodn benh lain Iv. tdi bdn ldn 3. Idn 3 co ciiinh sua vd Idn 4:
' lCD-9/10 (Inlernalional Classification of Diseases) • He IhO'ng phdn loai benh ldl qudc te, ldi bdn tdn
9 rd 10.
^ Rimer Ddnli gtd ci'ia bdc si dua tren c dc lien chi Michael Riiltcr dua ra:
'CCMD-2-R (Chinese Classification of Menial Disorder - 2 - Revised): He Ihdng phdn togi benh tdm
ihdndlreeni Trnng Qudc (chi diing lgi Trung Quoc). tdi bdn ldn 2 co chinb sua:
^ CARS (Childlwod Antisni Rating Scale) Tliang ddnh gid tir ky d lie em

Nhin chung, ty le tre ttt 2 - 6 tuoi mdc tu ky cao hon so vdi cdc nhdm
tudi khac. Tuang ty nhu d phuang Tay, tre em nam mdc ty ky nhidu hon tre em
ntt. Do ke't qud thd'ng kd phy thudc vdo tidu chf vd cdng cu chuan dodn bdnh
nen Sun vd Allison loai bd nhttng nghien ciu chi ding thang do so bd ma
khdng cd danh gid chuydn mdn cua bdc sT hoac nha tdm ly. Kdt qua Id khi so

sdnh hai nudc duac nghidn ciu nhidu nhd't - Nhdt Ban va Trung Qudc thi ty Id
tre mdc bdnh b Nhdt Ban (15,5/10.000) cao hon so vdi d Trung Qudc
(10,4/10.000). Tfnh chung, ty 16 mdc ty ky dchdu A la 11,6/10.000.
Cung theo tdng kd't cua Sun vd Allison (2008), vd gidi tfnh, tre em nam
dd mdc ty ky han tre em ntt, mac du ty le chfnh xdc thay ddi qua ting nghien
ciu. Vd mic dp phat tridn tri tue cia trd tu ky, 66,4% tre ty ky d Nhat Ban cd
chi sd IQ binh thudng, trong khi dd ta't ca cdc trudng hop tu ky d Trung Qud'c
deu bj cham phdt tridn tri tud. Hai nha nghidn ciu Zhang va Ji (2005) ly giai
rang, nhing tre bj ty ky nhung khdng bi cham phdt tridn trf tud cd the thfch ing
vdl mdi trudng gia dinh vd trudng hpc td't hon, nen kha nang thdy cd va bd me
nhan ra benh cua tre thap hpn. Do Nhat Bdn cd didu kien chdm sdc y te tdt hdn
va dan trf cao hon d Trung Qud'c ndn bd me cua tre bi tu ky d Nhdt nhdn ra
benh va dua tre di khdm sdm han d Trung Qud'c, ngay cd khi tre thfch ing td't

TAP CHI TAM Lf HOC, Sd 1 (166), 1 - 2013


vdi mdi trudng binh thudng. Ung hd hudng giai thich nay, ngbtea ciu ,tai tinh
Thidn Tan, Trung Qud'c do Zhang vd Ji (2005) thyc hidn thd'ng ke dupc ty le
mdc tu ky d tre thdnh thi cap hdn hdn tre ndng thdn. Do cdc gia dinh d thdnh
phd thudng cd hpc vdn cao hon va thu nhdp td't hon, trd mdc ty ky d khu vyc
thanh thi thudng sdm nhan dupc sy cham sde y td va tdm ly t i gia,dinh vd cac
CP sd y te.
Dd udc luong ding ty Id mdc ty ky d chdu A (hay bd't ky chdu luc ndp),
vdn dd ddt ra la Idm sap dd bd me sdm nhan bie't ddu hieu tu ky p tre vd dua tre
di kham sdm. 6 chau A, thd'ng ke cho thdy bd me thudng dua tre. dep khdm vd
chudn dodn bdnh ty ky ndu tre cham ndi hoac cd khd nang ngdn ngu kdm.
Ngoai ra, nhidu bd me cung lo ldng ndu tre ft giao tie'p xa hdi hoac van ddng
qud mic, nhung md'i quan tdm Idn nha't vdn Id kha nang ngdn ngtt. Vi the, da sd
tre d chau A duac chudn dodn tu ky vao khoang 3 - 6 tudi (Juneja et al, 2004;

Kalra et al, 2005).
2.3. Tinh hinh mdc benh tren the gidi ndi chung
Di tdng cdng sd lupng nghidn ciu vd hpi ching ty ky Id rdt Idn, nhung
mdi nghidn ciu lai cd nhung each dinh nghia tu ky vd su dung nhttng cdng cu
chudn dodn khdc nhau, nen viec so sdnh va tdng kdt cdc nghien ciu la rdt khd
khan, ding nhu Sun vd Allison (2008) da chi ra.
Trong mdt nd lyc tdng hpp them nhidu nghien ciu mdi sau 2008,
Elsabbagh vd cpng sy (2012) dua ra con sd thdng kd la 17/10.000 cho hdi
ching ty ky vd 62/10.000 cho cac benh rdi loan phat trien lan tda sau khi tham
khao hon 600 nghidn ciu tren toan the gidi. Ngodi ra, nhdm nghien ciu khdng
tim ra md'i lidn he ndo gitta cac dieu kien kinh te, xa hdi, van hda vd dia Iy vdi
mic dd mdc ty ky. Didu ndy ching td rdng, hdi ching ty ky khdng phu thudc
vao cdc ye'u to ben ngodi md cd nguydn nhan sinh hpc. Chi cd gidi tfnh va kha
nang phdt trien trf tue Id hai yeu td dn dinh nhat qua cdc nghien ciu: tre nam
mdc hdi ching ty ky nhieu hon trd nu va rdt ddng tre tu ky bi thidu nang trf tue.
Tuy nhien, khd cd thd dua ra mdt con sd chfnh xdc vd ty le nam/ntt hay ty le
thidu nang trf tud binh thudng bdi con sd ndy thay ddi qua ting nghien ciu.
Tinh ttt nam 1960 dd'n nay, ty le tre mdc hdi ching ty ky tang ddn theo
thdi gian. Xu hudng tang nay cd thd phdn dnh sy gia tang thuc su trong ty le
mdc hpi ching ty ky, nhung nhdm nghien ciu cua Elsabbagh cho rdng hai van
de khdc cung cdn duoc quan tdm. Mdt la, hdi ching ty ky khdng cdn chi mdt
hpi ching rieng biet ma chi mdt nhdm hdi ching vdi nhung mic dp nang nhe
khdc nhau, vi the sd lupng ngudi dap ing cdc tidu chf hdi ching ty ky tang. Hai
Id, cdng ngdy cdng cd nhidu cdng cu giup chuan doan chfnh xac hdi ching ty ky.

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Tai lieu tham khao
1. Juneja M., Mukherjee S.B., & Sharma S., A descriptive hospital based study of
children wiih auiism, Indian Pediatrics, 42, tr. 453 - 458, 2004.
2. Miles J.H., Takahashi T.N., Bagby S., Sahota P.K., Vaslow D.F., Wang C.H.,
Hillman R.E. & Farmer J.E., Essential versus complex aiaism: Definition of
fuiidameiilal prognoslic suhslyles, Americal Journal of Medical Genetics, 135, tr. 171
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