{"created":"2023-05-25T05:26:08.315632+00:00","id":4819,"links":{},"metadata":{"_buckets":{"deposit":"ff355399-2d82-4977-8dfa-4136dfbe448e"},"_deposit":{"created_by":17,"id":"4819","owners":[17],"pid":{"revision_id":0,"type":"depid","value":"4819"},"status":"published"},"_oai":{"id":"oai:yamagata.repo.nii.ac.jp:00004819","sets":["29:31:176:177"]},"author_link":["14610","14625","14627","14613","14615","14617","14620","14612","14629","14628","14624","14621","14630","14618","14626","14622","14619","14609","14611","14623","13867","14616","14608","14614"],"item_3_alternative_title_18":{"attribute_name":"その他の言語のタイトル","attribute_value_mlt":[{"subitem_alternative_title":"Early treatment for neurodevelopmental disorder by a primary physician before the first visit to an advanced institute"}]},"item_3_alternative_title_19":{"attribute_name":"タイトル（ヨミ）","attribute_value_mlt":[{"subitem_alternative_title":"センモン イリョウ キカン ショシン マデ ノ タイキ キカン チュウ ニ カカリツケイ  ト シテ ノ ソウキ カイニュウ ヲ オコナッタ シンケイ ハッタツショウ  ハッタツ ショウガイ  ノ １ダンジ レイ"}]},"item_3_biblio_info_6":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2020-02-15","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"68","bibliographicPageStart":"63","bibliographicVolumeNumber":"38","bibliographic_titles":[{"bibliographic_title":"山形大学紀要. 医学 : 山形医学 "},{"bibliographic_title":"Bulletin of the Yamagata University. Medical science : Yamagata medical journal ","bibliographic_titleLang":"en"}]}]},"item_3_description_42":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"subitem_description":"論文(Article) ","subitem_description_type":"Other"}]},"item_3_description_5":{"attribute_name":"内容記述","attribute_value_mlt":[{"subitem_description":"【緒言】神経発達症（発達障害）の疑いで専門医療機関を受診する患者は近年増加傾向であり、初診までに数か月以上の待機期間を要することが問題になっている。専門医療機関を初診するまでの６か月の待機期間中にかかりつけ医として早期介入を行い、適応行動が増え、専門医療機関とのスムーズな連携が可能であった症例を経験したので報告する。\n【症例】７歳男児。教員や友人への暴力など行動面の問題、書字の乱れや読み書きの抵抗など学習面の問題があり、教育委員会経由でＡ病院を受診した。親面接式自閉症スペクトラム評定尺度（PARS）は学童期評点23点（７点以上で有意）、ADHD評価スケール改訂第４版（ADHD-RS-IV）は母親評価計41点（＋4.3SD）、担任評価計30点（＋2.3SD）といずれも高値であった。現症・臨床経過とあわせて自閉スペクトラム症（ASD）および注意欠如多動症（ADHD）と診断した。専門医療機関Ｂ施設の初診までの６か月の待機期間中に、Ｂ施設担当医との連携のもと、かかりつけ医として実施可能な早期介入として、簡単な心理療法と環境調整、児と周囲の関係性の調整を早期から行いMethylphenidate徐放錠（MPH-ER）18mg/日を開始した。学校・家庭での問題行動は介入１か月後に、母児間の関係性も次第に改善した。介入６か月後以降のＢ施設との連携もスムーズであった。\n【考察】かかりつけ医が神経発達症に対しできる早期介入は、専門医療機関と相談の上、効率化を工夫して行えば可能であり、自験例でも適応行動の獲得や母児間の関係性の改善が得られ、専門医療機関初診時の連携がスムーズであった。専門医療機関への過剰依存や待機期間の長さが問題となる中、かかりつけ医が早期介入を行うのは重要である。\n【結語】神経発達症に対して非専門医療機関のかかりつけ医は早期の介入が可能であり、専門医療機関への過剰依存を軽減するためにも重要である。","subitem_description_type":"Other"}]},"item_3_full_name_2":{"attribute_name":"著者(ヨミ)","attribute_value_mlt":[{"nameIdentifiers":[{"nameIdentifier":"14616","nameIdentifierScheme":"WEKO"}],"names":[{"name":"アビコ, 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cooperation","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"departmental bulletin paper","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"専門医療機関初診までの待機期間中にかかりつけ医としての早期介入を行った神経発達症（発達障害）の１男児例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"専門医療機関初診までの待機期間中にかかりつけ医としての早期介入を行った神経発達症（発達障害）の１男児例"}]},"item_type_id":"3","owner":"17","path":["177"],"pubdate":{"attribute_name":"公開日","attribute_value":"2020-02-18"},"publish_date":"2020-02-18","publish_status":"0","recid":"4819","relation_version_is_last":true,"title":["専門医療機関初診までの待機期間中にかかりつけ医としての早期介入を行った神経発達症（発達障害）の１男児例"],"weko_creator_id":"17","weko_shared_id":-1},"updated":"2023-05-25T06:19:22.690936+00:00"}