{"id":23816,"date":"2015-12-23T10:01:58","date_gmt":"2015-12-23T09:01:58","guid":{"rendered":"http:\/\/www.invarena.cz\/?p=23816"},"modified":"2015-12-23T18:02:25","modified_gmt":"2015-12-23T17:02:25","slug":"na-autismus-leky-nejsou","status":"publish","type":"post","link":"https:\/\/www.invarena.cz\/?p=23816","title":{"rendered":"Na autismus l\u00e9ky nejsou"},"content":{"rendered":"

D\u011btsk\u00fd autismus nevznik\u00e1 a\u017e po narozen\u00ed, mozek se v n\u011b\u010dem vyv\u00edj\u00ed jinak u\u017e od po\u010det\u00ed. Patrn\u00fd je vliv d\u011bdi\u010dnosti. O jeho vzniku v\u011bd\u00ed l\u00e9ka\u0159i st\u00e1le v\u00edce, ale l\u00e9ky, kter\u00e9 by \u010dlov\u011bka vyl\u00e9\u010dily, nemaj\u00ed.<\/strong><\/p>\n

ilustra\u010dn\u00ed\u00e9 foto: sxc.hu<\/p>\n

Z\u00e1kladem l\u00e9\u010dby je psychoterapie. Jej\u00ed zah\u00e1jen\u00ed je vhodn\u00e9 ji\u017e p\u0159i podez\u0159en\u00ed na poruchy autistick\u00e9ho spektra u d\u00edt\u011bte, ne a\u017e po ukon\u010den\u00ed diagnostick\u00e9ho procesu, doporu\u010duje d\u011btsk\u00e1 psychiatri\u010dka Iva Dudov\u00e1.<\/p>\n

– LN Lid\u00e9 si \u010dasto spojuj\u00ed autismus, zejm\u00e9na jeho leh\u010d\u00ed formy, s ADHD nebo hyperaktivitou. Existuje mezi nimi n\u011bjak\u00e1 spojitost?<\/p>\n

ADHD neboli poruchu pozornosti s hyperaktivitou \u0159ad\u00edme rovn\u011b\u017e k v\u00fdvojov\u00fdm poruch\u00e1m, av\u0161ak je to jin\u00fd typ v\u00fdvojov\u00e9 patologie ne\u017e poruchy autistick\u00e9ho spektra (PAS). Rozd\u00edln\u00e9 jsou jak hlavn\u00ed p\u0159\u00edznaky, tak n\u00e1stup poruchy, pr\u016fb\u011bh a progn\u00f3za. P\u0159esto hyperkinetick\u00e9 poruchy n\u011bkdy b\u00fdvaj\u00ed chybnou prvn\u00ed diagn\u00f3zou p\u0159edev\u0161\u00edm u pacient\u016f s vysoce funk\u010dn\u00edm autismem a Aspergerov\u00fdm syndromem. V\u00fdznamn\u00e1 \u010d\u00e1st pacient\u016f s poruchami autistick\u00e9ho spektra vykazuje klinicky v\u00fdznamn\u00fd hyperaktivn\u00ed syndrom, kter\u00fd se n\u011bkdy mus\u00ed \u0159e\u0161it pomoc\u00ed l\u00e9k\u016f.<\/p>\n

– LN Do poloviny 90. let minul\u00e9ho stolet\u00ed nap\u0159\u00edklad o Aspergerov\u011b syndromu coby jedn\u00e9 z leh\u010d\u00edch forem autismu skoro nikdo nesly\u0161el, dneska je snad v ka\u017ed\u00e9 t\u0159\u00edd\u011b alespo\u0148 jeden takov\u00fd \u017e\u00e1k. Co se zm\u011bnilo?<\/p>\n

Asperger\u016fv syndrom byl poprv\u00e9 zahrnut do ofici\u00e1ln\u00edho klasifika\u010dn\u00edho syst\u00e9mu teprve v roce 1984. Tato porucha autistick\u00e9ho spektra se v literatu\u0159e popisovala pod r\u016fzn\u00fdmi n\u00e1zvy, p\u016fvodn\u011b jako autistick\u00e1 psychopatologie, d\u00e1le pod pojmy schizoidn\u00ed porucha, schizotypn\u00ed porucha osobnosti v d\u011btstv\u00ed nebo atypick\u00fd v\u00fdvoj. Klinicky m\u00e1 mnoho spole\u010dn\u00e9ho s autismem, p\u0159edev\u0161\u00edm s vysoce funk\u010dn\u00edm typem. Ob\u011b diagn\u00f3zy se li\u0161\u00ed nejv\u00fdznamn\u011bji v tom, \u017ee u Aspergerova syndromu nedoch\u00e1z\u00ed k opo\u017ed\u011bn\u00ed v\u00fdvoje \u0159e\u010di. P\u0159ib\u00fdv\u00e1 tak\u00e9 diagnostikovan\u00fdch dosp\u011bl\u00fdch osob se syndromem, kte\u0159\u00ed se o t\u00e9to poru\u0161e dozv\u011bd\u011bli nej\u010dast\u011bji pomoc\u00ed internetu a sami sebe identifikovali jako posti\u017een\u00e9 jedince.<\/p>\n

– LN P\u0159ib\u00fdv\u00e1 v populaci autist\u016f? A d\u011bt\u00ed s ADHD?<\/p>\n

Od roku 2000 za\u010daly \u00fadaje o v\u00fdskytu poruch autistick\u00e9ho spektra r\u016fst skute\u010dn\u011b z\u00e1vratn\u00fdm tempem, v\u00fdskyt vzrostl z p\u016fvodn\u00edch 0,0 procenta na 1 a\u017e 1,5 procenta celkov\u00e9 d\u011btsk\u00e9 populace, ale zat\u00edm se nepoda\u0159ilo p\u0159esn\u011b vysv\u011btlit, \u010d\u00edm to je. Jednu z anal\u00fdz p\u0159\u00ed\u010din podala v presti\u017en\u00edm v\u011bdeck\u00e9m \u010dasopise Nature Karin Weintraubov\u00e1. Zhruba z poloviny lze n\u00e1r\u016fst p\u0159\u00edpad\u016f p\u0159i\u010d\u00edst lep\u0161\u00ed diagnostice, zv\u00fd\u0161en\u00e9mu pov\u011bdom\u00ed a znalostem odborn\u00edk\u016f i rodi\u010d\u016f o autismu, zv\u00fd\u0161en\u00e9mu v\u011bku rodi\u010d\u016f p\u0159i zakl\u00e1d\u00e1n\u00ed rodiny a geografick\u00e9mu shlukov\u00e1n\u00ed rodin s posti\u017een\u00fdmi d\u011btmi a odborn\u00e9 pomoci. Polovina n\u00e1r\u016fstu v\u0161ak z\u016fst\u00e1v\u00e1 nevysv\u011btlena. ADHD byla a je \u010dastou poruchou nejen d\u011btsk\u00e9ho v\u011bku. V\u00fdskyt ADHD v d\u011btstv\u00ed se pohybuje v \u0161irok\u00e9m rozmez\u00ed 6 a\u017e 12 procent, porucha \u010dasto pokra\u010duje do adolescence a dosp\u011blosti.<\/p>\n

– LN V\u00edme u\u017e s jistotou, jak tyto poruchy vznikaj\u00ed?<\/p>\n

P\u0159\u00ed\u010diny vzniku poruch autistick\u00e9ho spektra jsou komplexn\u00ed se zastoupen\u00edm jak genetick\u00fdch faktor\u016f, tak faktor\u016f vn\u011bj\u0161\u00edho prost\u0159ed\u00ed. Pod\u00edl genetick\u00fdch faktor\u016f se u autismu odhaduje nad 60 procent. Mechanismus vzniku zahrnuje pravd\u011bpodobn\u011b zm\u011bny v\u00fdvoje mozku z\u00e1hy po po\u010det\u00ed.<\/p>\n

– LN Jak vypad\u00e1 nejmodern\u011bj\u0161\u00ed terapie autismu a co od n\u00ed lze o\u010dek\u00e1vat?<\/p>\n

V posledn\u00edch letech doch\u00e1z\u00ed k v\u00fdrazn\u00e9mu rozvoji na poli behavior\u00e1ln\u00edch intervenc\u00ed (ty se zam\u011b\u0159uj\u00ed na vn\u011bj\u0161\u00ed zm\u011bnu podm\u00ednek u\u010den\u00ed a chov\u00e1n\u00ed \u010dlov\u011bka), kter\u00e9 spole\u010dn\u011b s komunika\u010dn\u00edmi a speci\u00e1ln\u011b pedagogick\u00fdmi postupy z\u016fst\u00e1vaj\u00ed hlavn\u00edmi metodami ovliv\u0148uj\u00edc\u00edmi projevy autismu. Stejn\u011b jako diagnostika, tak\u00e9 aplikace behavior\u00e1ln\u00edch intervenc\u00ed se p\u0159esunuje do co nejran\u011bj\u0161\u00edho v\u011bku d\u00edt\u011bte. Zah\u00e1jen\u00ed \u010dasn\u00e9 intervence se doporu\u010duje ji\u017e p\u0159i podez\u0159en\u00ed na poruchy autistick\u00e9ho spektra u d\u00edt\u011bte, ne a\u017e po ukon\u010den\u00ed diagnostick\u00e9ho procesu. Vyu\u017eit\u00ed l\u00e9k\u016f u poruch autistick\u00e9ho spektra je limitov\u00e1no t\u00edm, \u017ee dosud bohu\u017eel nikdo nena\u0161el l\u00e9\u010dbu typick\u00fdch p\u0159\u00edznak\u016f autismu. Psychofarmaka z\u016fst\u00e1vaj\u00ed dopl\u0148kovou intervenc\u00ed pro ovliv\u0148ov\u00e1n\u00ed n\u011bkter\u00fdch probl\u00e9mov\u00fdch symptom\u016f.<\/p>\n

– LN Pokud v\u00edm, v USA se nap\u0159\u00edklad projevy hyperaktivity hodn\u011b tlum\u00ed l\u00e9ky, co\u017e se v Evrop\u011b tolik ned\u011bje. Jak\u00e9 maj\u00ed oba p\u0159\u00edstupy v\u00fdhody a nev\u00fdhody?<\/p>\n

Podle sou\u010dasn\u00fdch n\u00e1zor\u016f pat\u0159\u00ed k nej\u00fa\u010dinn\u011bj\u0161\u00ed l\u00e9\u010db\u011b ADHD farmakoterapie a n\u011bkter\u00e9 psychoterapeutick\u00e9, behavior\u00e1ln\u00ed techniky. Optim\u00e1ln\u00edm zp\u016fsobem l\u00e9\u010dby pak je spojen\u00ed obou t\u011bchto p\u0159\u00edstup\u016f. Farmakologick\u00e1 l\u00e9\u010dba ADHD m\u00e1 celosv\u011btov\u011b bohatou tradici, l\u00e9ky prvn\u00ed volby (psychostimulancia) jsou v\u016fbec nejl\u00e9pe prov\u011b\u0159enou l\u00e9\u010dbou v d\u011btsk\u00e9 psychiatrii. Mo\u017enost l\u00e9\u010dby v\u0161ak m\u016f\u017ee b\u00fdt negativn\u011b ovlivn\u011bna neinformovanost\u00ed rodi\u010d\u016f, jejich r\u016fzn\u00fdmi p\u0159edsudky a obavami z kontaktu s psychiatri\u00ed \u010di z u\u017e\u00edv\u00e1n\u00ed l\u00e9k\u016f.<\/p>\n

– LN Na koho se vlastn\u011b maj\u00ed rodi\u010de d\u011bt\u00ed s autismem nebo ADHD obr\u00e1tit? Pokud se o to za\u010dnou zaj\u00edmat, brzy zjist\u00ed, \u017ee maj\u00ed volbu mezi l\u00e9ka\u0159i a mezi p\u0159\u00edstupem zahrnuj\u00edc\u00edm sp\u00ed\u0161e psychoterapii. Lze oba p\u0159\u00edstupy kombinovat?<\/p>\n

Pokud maj\u00ed rodi\u010de \u010di r\u016fzn\u00ed odborn\u00edci podez\u0159en\u00ed, \u017ee by se u d\u00edt\u011bte mohlo jednat o poruchy autistick\u00e9ho spektra nebo ADHD, m\u011bli by hned nav\u0161t\u00edvit d\u011btsk\u00e9ho psychiatra. S podez\u0159en\u00edm na diagn\u00f3zu, nebo je\u0161t\u011b l\u00e9pe s ji\u017e stanovenou diagn\u00f3zou pak mohou podle dostupnosti vyu\u017e\u00edvat celou \u0159adu terapeutick\u00fdch a interven\u010dn\u00edch mo\u017enost\u00ed. Farmakologickou l\u00e9\u010dbu poskytuj\u00ed l\u00e9ka\u0159i, psychoterapeutickou a interven\u010dn\u00ed m\u016f\u017ee nab\u00edzet v\u00edce odborn\u00edk\u016f. V ide\u00e1ln\u00edm p\u0159\u00edpad\u011b je l\u00e9\u010dba komplexn\u00ed a zahrnuje i pr\u00e1ci s rodinou d\u00edt\u011bte.<\/p>\n

—<\/p>\n

Kolik je d\u011bt\u00ed s autismem<\/p>\n

Studie uv\u00e1d\u011bj\u00ed 1% v\u00fdskyt poruch autistick\u00e9ho spektra v populaci. Spadaj\u00ed sem lid\u00e9 s diagn\u00f3zou d\u011btsk\u00e9ho, atypick\u00e9ho autismu i Aspergerova syndromu. V \u010cesk\u00e9 republice se v sou\u010dasn\u00e9 dob\u011b narod\u00ed ro\u010dn\u011b okolo 100 000 d\u011bt\u00ed, u 1000 z nich se projev\u00ed ve v\u00fdvoji porucha autistick\u00e9ho spektra. Jde o mnohem vy\u0161\u0161\u00ed po\u010det, ne\u017e kolik je d\u011bt\u00ed nap\u0159\u00edklad s Downov\u00fdm syndromem nebo cukrovkou.<\/p>\n

Zab\u00fdv\u00e1 se ur\u010dit\u00fdmi v\u011bcmi st\u00e1le dokola. Chod\u00ed po \u0161pi\u010dk\u00e1ch. Neobvykl\u00e1 fixace na ur\u010dit\u00e9 hra\u010dky (neust\u00e1le s sebou nos\u00ed n\u011bjak\u00fd p\u0159edm\u011bt). \u0158ad\u00ed v\u011bci do \u0159ad.<\/p>\n

\u010ceho si mohou rodi\u010de v\u0161\u00edmat P\u0159\u00edznak\u016f, kter\u00e9 mohou, ale v\u016fbec nemus\u00ed sv\u011bd\u010dit o autismu, je mnoho. Plat\u00ed, \u017ee \u010d\u00edm v\u00edce jich je, t\u00edm vy\u0161\u0161\u00ed je pravd\u011bpodobnost posti\u017een\u00ed. Uv\u00e1d\u00edme nejtypi\u010dt\u011bj\u0161\u00ed z nich. Nereaguje na sv\u00e9 jm\u00e9no. Ne\u0159\u00edk\u00e1, co chce.<\/p>\n

Zd\u00e1 se, \u017ee sly\u0161\u00ed, ale nikoli ostatn\u00ed osoby. Neukazuje a nem\u00e1v\u00e1 na rozlou\u010denou. \u0158\u00edkal\/a n\u011bkolik slov, ale nyn\u00ed p\u0159estal\/a. Chyb\u00ed soci\u00e1ln\u00ed \u00fasm\u011bv. Je velmi samostatn\u00fd\/\u00e1. N\u011bkter\u00e9 v\u011bci d\u011bl\u00e1 velmi „brzy“. \u0160patn\u00fd o\u010dn\u00ed kontakt. P\u016fsob\u00ed, \u017ee \u017eije ve vlastn\u00edm sv\u011bt\u011b. Hyperaktivita \/ neschopnost spolupracovat \/ negativismus. Nev\u00ed, jak si hr\u00e1t s hra\u010dkami.<\/p>\n

Doc. MUDr. Iva Dudov\u00e1, Ph. D.<\/p>\n

(1969) Pracuje jako z\u00e1stupkyn\u011b p\u0159ednosty D\u011btsk\u00e9 psychiatrick\u00e9 kliniky 2. l\u00e9ka\u0159sk\u00e9 fakulty Univerzity Karlovy a Fakultn\u00ed nemocnice Motol v Praze. Je \u010dlenkou odborn\u00e9 skupiny pro autismus p\u0159i Vl\u00e1dn\u00edm v\u00fdboru pro zdravotn\u011b posti\u017een\u00e9 ob\u010dany.<\/p>\n

Lidov\u00e9 noviny<\/p>\n","protected":false},"excerpt":{"rendered":"

D\u011btsk\u00fd autismus nevznik\u00e1 a\u017e po narozen\u00ed, mozek se v n\u011b\u010dem vyv\u00edj\u00ed jinak u\u017e od po\u010det\u00ed. Patrn\u00fd je vliv d\u011bdi\u010dnosti. O jeho vzniku v\u011bd\u00ed l\u00e9ka\u0159i st\u00e1le […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":14126,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[9],"tags":[],"class_list":["post-23816","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zpravy"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/23816","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=23816"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/23816\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/14126"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=23816"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=23816"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=23816"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}