Hội chứng tự kỷ tiêu chí và công cụ chẩn đoán

HOI CHL/NG TIJ KY: TIEU CHI VA
CONG CU CHAN O O A N
TS. Nguyen Thj Mai Lan
Hgc vien Khoa hge .xd hpi.
'

T6MTAT
Tim hie'u sd dung ede lieu chi vd cdng cu chdn dodn tu ky a nude ta hien nay
dttge chiing tdi lien hdnh vdi viic khdo sdt 780 ngudi dang true tie'p diiu tri vd gido
diic lie' lit ky Igi 6 linh Ihdnh tten cd nude: Hd Npi, Qudng Ninh, Dd Ndng, Khanh
Hda, Ihdnh phd Hd Chi Minh, Bd Ria - Vdng Tau cho thdy budc ddu dd cd nhieu
ngudi tie'p can vd su dung lieu chi ddnh gid til ky hien dgi md the gidi dang sti dttng
nhu DSM-IV-TR vd ICD-9. Ve cdng ctf ndy cd du dp tin cdy vd gid Iri khoa hgc.
Tir khoa: Hdi chung nt ky; Tieu ehi; Cdng cu chdn dodn; Cde nhd ehuyen
mdn; DSM - IV- R: M - CHAT: CHAT.
Ngdy nhgn bdi: 7/1/2013; Ngdy duyet ddng bdi: 25/1/2013.
1. Dat vdn de
Nhung tin hieu bdo ddng vi ttt ky trdn the' gidi ndi chung va 6 Viet Nam
ndi ridng da ddn de'n viec nhung nghidn ciu ve ttr ky nd rd va phdt trien nhanh
chdng trdn toan the gidi. 6 nhttng nude cd nin khoa hoc phdt triin nhu My va
chau Au da cd nhieu nghien ciu vi tu ky dat dugc nhiing thanh ttm ndi bat.
Nhin chung, cdc nghidn ctiu ve ttr ky trdn the gidi di sau vao vide nghidn ciu va
chi ra cac yiu td nguy co ddn din tu ky, xay dtmg va ddnh gia hidu qua cac
phuong phdp can thiep tu ky... va dac biet la viec nghidn cim di xac dinh tieu
cht chdn doan tu ky; cdng cii chdn dodn tu ky danh dugc sir quan tam hang ddu
cua cac nha khoa hgc thudc nhieu ITnh vifc khac nhau. Cdc nghien ciJu da cht ra
rdng, tieu chi chan dodn va cdng cii chdn doan ttr ky chi'nh la co set quan trpng
hang ddu trong viec chdn dodn chinh xdc hay khdng chinh xac ttt ky d tre.
Trong nghidn cihi cua minh, Ren (2003) chi ra rdng: "... nhiiu khi, tre chi dugc
chdn dodn diia trdn nhung thang danh gid sic khde so bd, nhiiu tre dugc bac sT
va nha tam ly hgc cd chuyen mdn tham dinh dua trdn bang hoi hay tinh hudng

dinh san. Dd la chua ki cdc tieu cht chdn dodn tu ky d cac qud'c gia cung khac
nhau it nhiiu..."
d Viet Nam, tu ky mdi dugc phdt hien khoang hon 10 nam trd lai day.
Vdi rdt nhiiu cd gdng va nd luc, budc ddu cdc nha chuyen mdn cung da tiip
60

TAP CHITAM LY HOC. Sd 2 (167), 2 - 2013


can va k i thtta nhiing thanh tttu nghien ciu vi tu ky tren thi gidi di xac dinh
dttge cac tidu chf chdn dodn tu ky, cdng cu sdng lgc, ddnh gid di chdn doan tu
ky... Tuy nhidn, cho den thdi diim hidn nay nhttng vdn di ndy vdn dang gay
nhieu tranh cai.
2. Phirong phap nghidn ciiu
Di tim hiiu thtrc trang su dung tidu cht vd cdng cu chdn dodn tu ky d
nude ta hien nay, chung tdi da tidn hanh khao sat bdng bang hdi 780 ngudi
dang true tiip lam nhiem vu diiu tri va giao due tri tu ky (ggi tdt la ede nhd
chuyen mdn) tai 6 tinh thanh tren ca nude: Ha Ndi, Quang Ninh, Da Ndng,
Khdnh Hda, thdnh phd Hd Chi Minh, Bd Ria - Vung Tau.
Day la nhiing thanh phd ldn cua nude ta, noi cd sd lugng tre mdc tu ky
kha cao vd eung la noi cd nhiiu cdc Khoa Tam ly, Khoa Phuc hdi chie nang
eua cac Benh vidn Nhi ddng; cde trung tam can thidp sdm tri khuyit tat; Khoa
Nhi cua Bdnh vidn Ttai thdn (hoac trung tam sic khoe tam thdn), cac trung tam
gido due dac bidt danh cho tre khuyit tat va nhiiu trudng giao due chuyen bidt
danh cho tre tu ky.
3. Thuc trang sii dttng tieu chi va cdng cti chan doan tti ky d tre
3.1. Thuc trang su dung tieu chi chdn dodn tu ky a tre
De tim hiiu thuc trang s i dung cac tidu chi di chdn doan tre tu ky,
ching tdi da dua ra cSu hoi sau: "Trong thdi gian qua, de chdn dodn ttf ky d tre
dnglbd dd sic dung tiiu ehi chdn dodn ttf ky ndo dudi ddy?". Kit qua thu dugc

nhu sau:
Bdng 1: Sd difng cdc tiiu chi chdn dodn tifky
Cac tieu chi chdn doan ttr ky

Ty Id %

1. Si tay thdng ke va chdn doan cac rdi loan tam thin. Hoi Tam
thdn hoc Hoa Ky, phien ban 111 (DSM-111 -R)

9,8

2. Sd tay thing kd va chdn doan cac rii loan tSm thin. Hoi Tam thin
hoc Hoa Ky, phien ban IV (DSM-IV-TR)'

65,3

3. Thong kd phan loai qudc te vi benh va cac van di sic khoe (tai
ban ldn 9, ICD-9)

4,1

4. Si dung kd't hgp DSM-IV va ICD-9
5. Si dung cac tidu chi chdn doan khac ngoai cac tieu chi chan doan
tren

TAP CHfTAM LY HOC, Sd 2 (167), 2-2013

20,0
0,8

61


Phdn ldn nhttng ngudi dang diiu trj va gido diic tre tii ky tliu d^a vao
cdc tidu chf dugc xay dung d Sd tay chdn doan va thd'ng ke nhttng rd'i nhidu tinh
thdn eua Hdi Tam thdn My - phidn ban IV lam tidu chf d i chan doan lit ky d tre
(65,3%). Cd 20% sd ngudi dugc hdi cho rdng sit dung kit hgp DSM-IV va ICD-9,
cdc tidu chf cdn lai fl dugc s i dung.
Nhu vay. xu hudng chung cho tha'y, budc ddu cac nha chuydn mdn true
tiip chdn dodn tu ky da tiip can dugc cdc tieu chf ddnh gia tit ky trdn thi gidi
hidn da va dang s i dung. Dac biet, phdn Idn cdc nhd chuyen mdn true tiep chdn
doan ty ky d ire diu dya vao cac tieu chf dugc xay dyng trong cudn Sd tay chdn
doan va thd'ng ke nhung rdi nhiiu tinh thdn cua Hdi Tdm thdn My (DSM-fVTR). Day la tin hieu dang mttng, bdi trdn thi gidi hidn nay ddi vdi cdc nha
chuydn mdn vide chan dodn ty ky phai dya tren cac tidu chf ciia DSM-lV".
Klin (2000) trong nghidn ciu cia minh da ching minh cdc tieu chf cua DSMIV-TR cd dp tin cay cao, khdng cd tieu chf ndo bi thtta. Vi the, DSM-IV-TR rdt
hieu qua trong vide chdn doan benh ty ky ngay ca khi mdt bdc si chua cd kinh
nghiem chiu trdch nhiem chan doan. Tuy nhien, vdi hdi ching Asperger*^' va
PDDNOS'^', cdc tieu chi nay lai khdng mdy huu dung (Tidmarsh & Volkmar,
2003). Theo nghien ciu eua Tryon vd ddng nghiep (2006), ne'u dung cdc tidu
chf cua DSM-IV-TR di chan doan hdi ching Asperger, S.^Vc tre cd bdnh se
dugc chdn doan la khdng cd bdnh. Nhu vay, cdc tidu chi danh cho hpi ching
Asperger trong DSM-IV-TR chua phu hop. Thyc ti, cdc bdc sT thudng chdn
doan hdi ching Asperger nd'u tri cd cac ddu hieu cua hpi ching ty ky nhung
khdng bi cham ndi.
Trong ldn tdi ban thi 5 sdp tdi dy kid'n vdo thdng 5/2013, Hpi Thdn kinh
My dy dinh dua ra nhiiu thay ddi trong cdch phan loai bdnh ty ky. Thay vl 5
bdnh ridng bidt thudc nhdm bdnh rdi loan phat trien lan tda, cac bdnh nay se
duge xip vao rd'i loan phd ty ky vdi nhiiu mic dd nang nhe khac nhau. Vf du,
hpi ching Asperger dugc coi la ty ky dang nhe (khdng bi thieu nang trf tud
nhung vdn ban chi vi kha nang tugng tdc xa hdi). Them nua, hai nhdm tridu

ching 1 va 2 se dugc ghep chung vao thdnh 1 nhdm tridu ching: han chi kha
nang giao tiip va tuong tdc xa hpi. Tre dugc chdn doan la ty ky niu cd ft nhdt 3
hanh vi thi hien ban che vi kha nang giao tiip, tugng tdc xa hpi vd cd ft nhdt 2
hanh vi thudc nhdm han chi ve sg thfch vd cd hanh vi lap di lap lai. Cud'i cung,
vdi PDDNOS, niu trudc .day tre cd trieu ching ty ky nhung khdng cd hdnh vi
lap di lap lai se dugc chan doan la PDDNOS, thi gid tre budc phai cd ft nhit 2
hanh vi lap di lap lai hoac thi hien sd thi'ch ban chi di dugc chdn dodn la
PDDNOS. Vdi nhttng tieu chudn khdt khe hon nay, nhiiu trudng hgp dugc cho
la mdc bdnh tu ky theo DSM-IV-TR se khdng nhan dugc chan doan tuong tU
theo DSM-V. Dieu nay ddng nghTa vdi vide it ngudi se nhan dugc hd trg vi
gido due va y te hgn (Matson et al, 2012).

62

TAP CH(TAM Lt HOC, Sd2 (167), 2 - 2013


Kit qua nghidn ciu nay eung cho thdy, edn mdt ty Id nhd cdc nhd
chuydn mdn vdn s i dyng tidu chf ddnh gid cu nhu DSM-IIl-R, chua tiip can va
s i dyng cae tidu chf chdn dodn hien dai nhu DSM-IV-TR ma thi gidi hien dang
s i dung va dac biet chua cd sy thd'ng nhdt chung vi tieu ehi xac djnh ty ky d tre,
mdi mdt nhd chuydn mdn, bdnh vien, trudng chuyen bidt day tre ty ky... lai ty
lua chgn va s i dung tidu chf xdc dinh ty ky ndng. Do vay, di chdn dodn chfnh
xdc ty ky d tri, ttm ra sd lieu thye ti, chinh xdc vd khoa hgc vi ty Id mdc hdi
ching ty ky d tri em Vidt Nam chung ta cdn phdi di din sy thd'ng nhat chung
vi tidu chf chdn doan ty ky d tre vd ndn chang cd mdt quy dinh chung va su bdt
budc dd'i vdi tdt ca nha chuyen mdn, cdc don vi cd chic nang chan tlodn ty ky
trdn ca nude phai s i dung tidu chf chdn doan ty ky theo tieu chudn chung da
dugc thd'ng nha't.
3.2. Thuc trgng suf dung cdng cu chdn dodn tu ky

Tinh din thdi diim hien tai, tren thi gidi da cd rat nhiiu cdng cu chan
dodn ty ky khac nhau. Di chdn doan chfnh xac ty ky d tre cdn phdi s i dung cdc
cdng cu chdn dodn khdc nhau nhu: cdc cdng cu sang lgc ty ky; cac cdng cu
chdn dodn ty ky vd cdn phai s i dung thdm mdt so trdc nghiem khdc nhu trdc
nghidm trf tue; trdc nghidm kha nang phat triin; trdc nghiem vi hanh vi thfch
nghi. Do vay, vdi nghien ciu ndy chung tdi tiin hanh tim hiiu xem hidn tai cdc
td chic cd chic nang chdn doan tu ky, cac nha chuydn mon thudc ddi tugng
khao sat cia de tai da su dung nhung cdng cu nao di chan doan ty ky, ly do nao
khiin hg lya chpn vd su dung cdng cu chdn dodn ty ky dd. Kit qua thu dugc
nhu sau:
- Ve cdng cu sdng lgc tif ky a tre
Cdng cu sang lgc ty ky dugc s i dung nhiiu nhdt dd la phidn ban sia ddi
cua CHAT (M - CHAT) vdi 52,2% sd ngudi dugc hdi, tiip din la bang sang lgc
nhttng vdn di ve phat triin va hanh vi (PEDS) vd bd can hdi sang lgc rd'i loan
phat triin theo tudi va giai doan d tri em (ASQ Viet Nam) Cac cdng cu sdng
lgc ty ky cdn lai ft dugc cdc khdch thi khao sat s i dung.
Nhu vay, cdc nha chuydn mdn, cdc td chic cd chic nang chdn doan ty
ky d tre duge khao sat budc ddu da tiip eta dugc cac cdng cu sang loc ty ky d
tre ma hidn tai tren thi gidi dang s i dung va da dugc kiim ching dp tin cay, gia
tri khoa lipc. Dd la bang kiim sang ipc ty ky tre nhd cd sia ddi (M - CHAT).
CPng cu M- CHAT"' dugc xem nhu la cdng cu sang lgc chinh cho tre ty ky d
do tuoi ttt 16 din 30 thdng (Robins & Dumont-Mathieu, 2006). M - CHAT bao
gdm 23 can hdi cd/khdng cho cha me. Thdi gian thyc hidn bang hdi nay mdt
khoang 5 phit. M - CHAT cd dd phan bidt cao tdi 99% vd do nhay 85%. Qua
viec khao sdt 1.293 tre, M - CHAT dang la mdt cdng cu sang Ipc hia hen va
phd biin vdi ban chi la se "bd sdt" 15 trong 100 tre ty ky. M - CHAT dugc coi
la cdng cu sang lgc d cdp dp 1 (Al-Qabandi, Gorter&Rosenbaum,2011).

TAP CHiTAM LY HOC, Sd 2 (167), 2-2013

63


Bdng 2: Sd dung cdc cdng cti sang loc tt/ ky
Cac cong cti sdng loc tu ky

Ty le %

1. Bang kiim sang loc tu ky d tre 18 - 24 thang tuii (CHAT)

7,9

2. Bang kiim sang loc tu ky d tre nhd cd sia dii (M - CHAT)

52,2

3. B6 cau hoi sang loc rdi loan phat triin theo tuii va giai doan d tre
em - ASQ Viet Nam (Bo Y td)

14,2

4. Bd cau hoi sang loc rdi loan phat triin theo tuii va giai doan d tre
em - ASQ (My)

3,4

5. Bang hoi vi giao tie'p xa hpi (SCQ)

1,4

6. Bang kiim tra kha nang giao tie'p va tudng tugng cho tre dudi 24
thang (CSBS - Communication and Symbolic Behavior Scales)

1,8

7. Bang sang Ipc nhttng va'n di vi phat triin va hanh vi (PEDS Parents' Evaluation of Developmental Status)

15,1

8. Cac cpng cu sang loc khac

4,0

Kit qua nghien ciu cung chi ra rang: cd tdi gdn mdt nia sd khdch thi
nghien ciu s i dyng cdc cdng cy sang lgc ty ky cdn lai. Trong dd, mdt ty le nho
cdn s i dung cdc cdng cu sang lgc cu ma hidn tai tren the gidi khdng cdn si
dung nua nhu bang liet kd rdi loan phd tu ky d tre tap di (CHAT") da dugc xay
dyng di sang Ipc chu yd'u eho tre 18 thang tudi 6 Anh. CHAT cd tfnh phan biet
cao, ty Id sang Igc tdi 98% (tic la nd loai tri hdu hit nhiing tre khdng bj ty ky
ra khdi nhdm nguy co, ndi each khdc la nd giip xdc dinh dung nhttng tre khdng
phai ty ky), nhung lai cd dp nhay thdp, chi ttt 20% den 30% (tic lam khdng tdt
viec xac dinh nhttng tre cd ty ky). Khi thyc hidn tren 16.235 tre 18 thdng tudi,
CHAT khdng thi xdc dinh nhiing tre cd trieu ching nhe va vdi sy thodi lui.
Hon ntta, CHAT cung khdng giip phan biet dugc giua tre cham ndi va tre tu ky.
Dd nhay cua CHAT tang Idn vdi tre 24 thdng tudi, nhtmg ndi chung vdi dd
nhay thdp va viec phai quan sdt 5 hanh vi cua tre lam cho CHAT khdng phai la
cdng cy sang lgc ty ky hull hieu. Do dd, phien ban siia ddi cua CHAT (M CHAT"") da ra ddi, nhu la cdng cy sang Ipc chinh cho tu ky (Baird, Charman,
Baron-Cohen va cdng sy, 1997).
Mat khdc, mdt sd cdng cu sang Ipc dugc nhieu nha chuydn mdn trdn thi
gidi kiem ching va tin dung thi hien tai cdn ft dugc sii dung 6 nude ta nhu:

Bang hdi vi giao tiep xa hdi (SCQ); Bang kiem tra kha nang giao tiip va tudng
tugng cho tri dudi 24 thang (CSBS - Communication and Symbolic Behavior Scales).

64

TAP CHITAM LV HOC, Sd 2 (167), 2-2013


Tfnh din thdi diim hien tai tren thi gidi da cd rdt nhiiu cdng cu sang Ipc
tu ky da dugc kiim ching dp tin cay, tfnh chinh xac khd cao trong sang loc ty
ky nhu; Bang hdi sang Ipc phd tu ky ASSQ (Autism Spectrum Screening
Questionnaire); Thang do cua tJc cho Hdi ching Asperger (Australia Scale for
Asperger's Syndrome) vd Trdc nghidm Hpi ching Asperger tte nhd (Childhood
Asperger Syndrome Test). Ba trdc nghidm nay dugc dung cho tre ty ky chic
nang cao va Asperger. Ngoai ra, cac trdc nghiem sang lgc rdi loan phdt triin lan
tda 2 ("pie Pervasive Developmental Disorders Screening Test-2); Thang do
phat triin tre nhd (The Child Development Inventory) cung Id nhttng cdng cu
sang lgc cd hidu qua td't. Do viy, vide tiip cSn nhttng cdng cu sang lgc ty ky
mdi nay, dp dung va chudn hda cdng ey sang Igc nay di dp dung vdo vide sang
Ipc trdn tre tu ky d nude ta hidn nay la vide cdn phai nghidn cttu.
- Ve cdng cu chdn dodn tit ky d tre
Sd lidu khdo sdt b bang 3 cho thdy: trong sd cac cdng cu chdn doan ty
ky ma ching tdi dua ra thi thang danh gia mic dp tu ky d tre em (The
Oiildhood Autism Rating Scale - CARS) cd ty Id phdn tram sd khdch thi dugc
khao sdt s i dung nhiiu nhat (65,4%), tiip din Id bang phdng vin chin doan tu
ky cd diiu chinh (Autism Diagnostic Interview - Revised - ADI-R). Cac cdng
cu chdn dodn ty ky cdn lai ft dugc s i dung. Thip nhit la thang do ddnh gia ty
ky GilUam - GARS. Chi cd 1,5% sd ngudi dugc hdi tra ldi da s i dung thang do nay.
Bdng 3: Cdc cdng cu chdn dodn ttf ky d tre dang duac sd dung (%)
Cac cong cij chan doan tu ky d tre

Ty le %

1. Bang phong vin chdn doan tu ky cd dieu chinh (Autism Diagnostic
Interview - Revised - ADI-R)

14,5

2. Thang quan sat chdn doan tu ky (Autism DiagnosticObservation
Schedule - ADOS)

5,3

3. Thang danh gia mic dp tu ky 6 tre em (The Childhood Autism
Rating Scale - CARS

65,4

4. Thang do danh gia tu ky Gilliam - GARS

1,5

5. Tu thid't k i cdng cu sang loc dua tren cac bang sang loc da cd
6. Cac cdng cu khac

7,4
5,9

Thang CARS la cPng cu truyin thd'ng, dugc s i dung t i liu vd phd bidn
trdn todn thi gidi, phu hgp vdi tre tren 2 tudi. Thang CARS cd mic dp tin cay

TAP CHfTAM LY HOC, Sd 2 (167), 2 - 2013

65


cao: Cronbach alpha = 0,94 (Schopler et al, 1980). Thang nay cung chi mit 10
phut di hoan thdnh. Tuy nhidn, nhugc diim cua thang nay Id phu thudc hodn
loan vdo ddnh gia chu quan cua bdc si va nha tdm IJi hpc. Thang CARS mang
tfnh chil quan cao ndn cdng ngay cdng it dugc s i dung d My. Khi so sdnh
CARS vdi ADI-R (bang phdng vdn chdn dodn ty ky cd diiu chinh - Autism
Diagnostic Interview - Revised) vd ADOS-G (thang quan sat chdn dodn ty ky Autism DiagnosticObservation Schedule) dua trdn cac tidu chf trong DSM-IV,
Klose va nhdm nghidn ciu (2012) cho thdy, CARS giup chdn doan d mic trung
btnh trong khi 2 thang cdn lai chdn dodn d mic tdt va rdt td't. Do vay, hidn nay
trdn thi gidi, ADOS va ADI dugc s i dung nhiiu nhdt. ADOS thucmg dugc coi
la "tidu chudn vang", mang tfnh quyd't djnh kit ludn chdn doan (Van
Bourgondien, 1992). Tuy nhidn, kd't qua nghidn ciu cho thiy, chi cd mdt ty Id
rit ft sd khdch thi dugc nghidn ciu cho rdng da s i dung cdng cu chdn dodn tu
ky nhu la ADOS va ADI.
Di tim hieu siu ban vi vi'n di nay ching tdi tim hiiu IJ do cdc nha
chuydn mdn, cdc don vi cd chic nang chdn dodn tu ky d tre lua chpn va si
dyng cdng cu sdng loc, chdn dodn ty ky 6 tre.
- Ly do sit dung cdng eu sdng lgc vd chdn dodn lit ky
Bdng 4: Ly do su dung cdng cu sdng lgc vd chdn dodn tu ky
Ty le (%)

Cac ly do
1. De tiep can, de sii dung

6,0

2. Mien phi hoac re, co the mua dupc

50,0

3. Yeu cau tuong dO'i it siic luc, thcri gian va su co gang tii nhom dupc
sang loc
4. Ket qua cua cac cong cu nay co gia tri, co d6 tin cSy
5. Ket qua cua cac cong cu giiip xac dinh dung ngucfi bj tu ky, xac
dinh diing ngucri kh6ng bi tu ky va miic do tu ky cua tCmg ngucri
6. Cong cu sang Ipc va ch^n doan co quy trinh, diem chu^n... thuSn
loi cho viec chan doan
7. Cong cu bao quat dupc ca cac roi loan thu6c ph6 tu ky cung nhu
danh cho tre cf cac do tu6i khac nhau

7,0
15.2
11,3
5.5
5,0

Cd rat nhieu ly do ddn din vide quyet djnh lua chgn cdng cy sdng lgc va
chdn dodn ty ky cua cac nha chuyen mdn va cdc don vi cd chic nang chdn doan
ty ky d tre. Tuy nhidn, "Mien phi hogc re', cd thi' mua dugc" la mdt trong

66

TAP CHfTAM LV HOC, Sd2 (167), 2 - 2013

nhu:ng ly do diu tidn dugc cdc nhd chuyen mdn vd cdc don vi cd ehttc nang
chdn dodn ty ky 6 tre quyd't dinh lya chgn su dyng cdng cu sang lgc vd chin
doan ty ky nao. Diiu ndy phai chang Xudt phdt chinh t i nhung khd khan nhit
dinh ve mat tai chi'nh cua cdc td chic cd ehttc nang chdn dodn ty ky. Do vay,
chung ta rit cin cd nhung chfnh sach hd trg chfnh thic cia Nha nude di cac
don vi cd chic nang chdn dodn ty ky cd thi cd dugc cdc cdng cy sang Ipc, chdn
dodn ty ky hidn dai, tidn tiin nha't md thi gidi hien dang s i dung.
- Cdc trdc nghiem hd tra ttong chdn dodn tu ky
Bdng 5: Cdc trdc nghiem hdtrg trong chdn dodn tif ky
Cdc trdc nghiem hi tra chdn dodn tu ky

Ty le %

1. Trdc nghidm vi trf tud

18,2

2. Trdc nghiem vd kha nang phat triin

15,1

3. Trdc nghidm vi hanh vi thich nghi

13,0

4. Si dung kd't hop cac trdc nghiem tren

53,0

5. Si dung cac trdc nghidm khac

0,7

Kit qua nghidn ciu vi vide s i dung cdc trdc nghiem hd trg trong chdn
dodn tu ky thi hidn d bang sd lidu trdn cho thay: di giup cho vide chdn doan ty
ky dugc chfnh xac cac nha chuydn mdn cdn s i dung them cac trdc nghiem tri
tue; trdc nghiem kha nang phdt triin; trdc nghiem vi hanh vi thfch nghi. Dac
biet, nhiiu y kiin cho rdng hp s i dung kit hgp cdc trdc nghidm trdn di hd trg
vide chdn dodn ty ky d tre. Tim hiiu cdc nghidn ciu vi vin di nay d nude ngoai
cung cho thiy: ngoai cdc trdc nghidm vi ty ky, cac chuydn gia chan doan cung
thudng xuyen s i dyng them ft nhdt mpt trdc nghiem vi trf tud hoac kha nang
phdt triin. Vi du, nhu ngudi ta s i dung thang ddnh gia Mullen di ddnh gid IQ
va ft nhdt mpt trdc nghidm vi hanh vi thfch nghi nhu la thang danh gia Vineland
di danh gid trf tue ciia tre. Ddnh gid vi tiim nang trf tue (IQ) va kha nang hidn
tai (hanh vi thfch nghi) giup ngudi ddnh gia cd cdi nhin toan didn hon vi tre,
ddng thdi hd trg vide chdn dodn td't hon (Stahmera, Schreibmanb, &
Cunninghamb, 2011).
Chung tdi cung tim hiiu nhan thic cia cac nhd chuydn mdn khi s i dung
cdc cdng cu hd trg. Kd't qua khao sat qua can hdi md cho thiy cd cac ly do chi
yiu sau di cdc nhd chuyen mdn s i dung cac cdng cu hd trg chdn doan ty ky:
1) Gitip ngudi ddnh gia cd cai nhin loan didn hon vi tre;
2) Hd trg vide chdn dodn tdt ban.
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Nhu viy, bdn canh vide s i dung cdc cdng cu sang lgc vd chdn doan ty ky
khdc nhau, dya trdn nhttng dac diim ridng cita tttng dtta tre ma cdc nhd chuydn
mdn tryc tidp chdn dodn ty ky d tri quyit djnh lya chgn s i dung thdm cdc trie

nghiem ndo di hd trg cho vide chdn dodn ty ky d tri.
4. Ket luin
Kit qua nghidn ciu budc ddu vi tidu chi va cdng cu chdn doan ty ky cho
phip ta rut ra mdt sd nhan xit sau:
- Phdn ldn cdc nha chuydn mdn tryc tid'p chdn doan ty ky 6 tre da tiip
can va s i dung cdc tidu chf chdn doan ty ky tren thi gidi hidn da, dang s i dung
cd dd tin cay, cd gid tri khoa hgc cao. Tuy nhidn, cdn mdt ty Id nhd cdc nha
chuyen mdn vdn sir dyng tieu chf chdn dodn cu, chua tid'p can vd s i dung cac
tidu chi chdn dodn cd dp tin cay cao ma thi gidi hien dang s i dung. Dac bidt
chua cd sy thP'ng nha't chung vi tidu chi xdc dinh ty ky cia tre d cac td chic cd
chic nang chdn dodn ty ky. Day cung Id mpt trong nhttng nguyen nhin ddn tdi
vide khd xac dinh chfnh xdc ty Id tre mdc ty ky hidn nay cua nude ta.
- Kd't qua nghien ciu vi cdng cy chdn dodn ty ky cho thdy, mdt so nha
chuydn mdn da tid'p can dugc cdc cdng cu chdn dodn ty ky cd dp tin cay va gia
tri khoa hpc tdt, dugc nhiiu nude trdn thi gidi su dung. Tuy nhidn, hien tugng
s i dung nhutig cdng cy chdn doan ty ky cu va lac hau khdng cd du dp tin cay
vdn cdn kha phd bien vd hipn tupng ty xay dyng cong cu chdn doan ty ky dua
trdn nhimg cdng cy chdn doan da cd vdn cdn.
Vdi nhiing kit qua nghidn cttu budc ddu nay ching tdi cho rdng cdn phai
cd nhttng nghidn ciu tid'p theo sau hon vi tidu chf vd cdng cu chdn doan tu ky d
tre em Viet Nam nhdm di dd'n mdt sy thd'ng nhit chung trdn loan qud'c ve tidu
chf chudn di ddnh gid ty ky d tre tai Viet Nam. Cdn cd sy quan tim nhiiu hon
cua cdc ea'p quan ly di cdc td chic cd chic nSng chdn doan tu ky d tre, cdc nha
chuydn mdn tryc tid'p chan doan ty ky d tre cd dugc nhiing cdng cy chdn doan
ty ky d tre cd du dp tin cay vd dugc kiim ching vi gid trj khoa hgc ma cdc
nude tidn tiin trdn the gidi hien dang s i dung.
Chii thich
1. Si tay tho'ng ke va chdn doan cac rii loan tam thdn, Hpi Tam thdn hpc Hoa Ky,
phidn ban IV.
2. Tre co ky nang giao tie'p xa hpi kem nhung khdng hi thiiu nang tri tud.

3. Benh rdi loan phat triin lan toa dang chua xac djnh.
4. Modified CHAT
5. Checklist for Autism Spectrum Disorder in Toddle.
6. Modified CHAT.

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TAP CHfTAM Lf HOC, Sd 2 (167), 2 - 2013


Tai lieu tham khao
1. Charman T., Swettenham J., Baron-Cohen S., Cox A., Baird 0. & Drew A., Infants
with autism: An investigation of empathy, pretend play, joint attention and imitation.
Developmental Psychology, 33. tr. 781 - 789, 1997.

2. Matson J.L., Belva ^.C, Horovitz M., Kozlowski A.M., & Bamburg J.W.,
Comparing Symptoms of Autism Spectrum Disorders in a Developmentally Disabled
Adult Population Using the Current DSM-IV-TR Diagnostic Criteria and the
Proposed DSM-5 Diagnostic Crderia, Journal of Developmental and Physical
Disabilities, 24, tr. 403 - 414, 2012.
3. Ren, Luzhong, Duan, Zongzhi, & Xu, Jin., An analysis on positive of rale autism
among preschool children in city, Chinese Journal of Child Care, 2, tr. 105 -107,2003.

4. Stahmera A.C, Schreibmanb L., Cunninghamb A.B., Toward a technology of
treatment individualization for young children with autism spectrum disorders. Brain
Research, 1380. tr. 229 - 239, 2011.
5. Tidmarsh L. & Volkmar F.R., Diagnosis and epidemiology of autism spectrum
disorders, Canadian Jou mai of Psychiatry, 48, tr. 517-525,2003.
6. Van Bourgondien ME, Marcus LM, Schopler E., Comparison of DSM-IU-R and
Childhood Autism Rating Scale diagnoses of autism. Journal of Autism and

Developmental Disorders, 22 (4), tr. 493 - 506, 1992.

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