Publication date September 20, 2019. Updated December 28, 2020.
Publication date September 20, 2019. Updated December 28, 2020.
Definition of the disease. Causes of the disease
Autism (disorder of the autistic spectrum, races) is a neurological violation of development with a variety of symptoms.
How does a child feel with autism
In general, autism is a violation in the perception of external incentives, which causes the child to exacerbate to one phenomena of the outside world and almost not to notice others, causes problems in communications with other people, forms sustainable household habits, causes the difficulty of adapting to new conditions, prevents learning along with peers (including through the imitation of others) [one] .
Signs of autism in children of different ages
The first signs of the violation of the child's development are manifested in the first year of life (for example, the child is late sitting, there is no emotional contact with his parents, interest in toys, does not respond to their name).
The calls of parents calling signals:
- In 8 months - the lack of visual contact and reaction to the name;
- at 12 months - the atypical use of gestures, lack of an index gesture;
- at 18 months - atypical gaming activities, misunderstanding of speech or refusal to entry into the dialogue;
- In 24 months - a whole set of interrelated signs: the absence of imitation of adult and social communication in the game, the slow accumulation of the vocabulary stock  .
More notable signs of autism are becoming two or three years. Cases are also possible when recovery occurs when the skills occurs, and the child ceases to do what he learned earlier. For a child with autism, a later appearance of speech skill is characteristic of either its absence, echolalia (spontaneous repetition of heard phrases and sounds instead of conscious speech), delays in development, lack of joint attention and indicative gestures, stereotypical behavior, the presence of special narrowness of interest.
According to WHO, approximately every 160th child in the world suffers  . In the United States, according to the Information Center for Control and Prevention of Diseases, such a diagnosis is made by one child out of 59, and among boys is four times more often than among girls. [eighteen] .
Disorders of the autistic spectrum Includes such concepts as children's autistic, atypical autism, infantile psychosis, caran syndrome, Asperger syndrome, manifested by symptoms expressed in one degree or another. Thus, Asperger's syndrome can remain undiagnosed in humans all his life without interfering with professional development and social adaptation, while other forms of autism can cause a mental disability (a person is required for lifetime support and support).
Intellect by a child with autism
Contrary to the common stereotype, autism is not associated with a high level of intelligence and genius, although in some cases the disorder can accompany Syndrome Savantea (Savanism) - outstanding abilities in one or several areas of knowledge, for example, in mathematics.
Causes of autistic spectrum disorders
The reasons leading to the development of the disorders of the autistic spectrum are not fully clarified. Since the 70s, various theories of the emergence of the "autism" disease began to appear. Some of them have not justified themselves and were rejected (for example, the theory of "cold mothers").
Currently, it is considered a polyethological disease, which means that several factors may develop. Among the causes are distinguished:
Genetic factors: In recent years, research has been conducted in Russia and abroad to identify genes responsible for the occurrence of races. According to the latest studies, about half of these genes are widespread in the population, but the manifestation of the disease depends on their combination of among themselves and environmental factors  .
Structural and functional brain disorders: With the advent of magnetic resonance tomography (MRI) expanded the possibilities of studying the brain. In the study of the brain of people with races, changes were discovered in the structure of various structures: in frontal fractions, cerebellum, a limbic system, a stem department of the brain. There are data on changing the size of the brain in children with the symptoms of the autistic spectrum compared to healthy children: it is reduced at birth, then increases dramatically during the first year of life.  . With authisme, there is also a violation of the blood supply of the brain, and in part cases of epilepsy is accompanied by disorder.
Biochemical changes: Many studies were devoted to a brain metabolic disorder that participate in the transfer of pulses between nerve cells (neurotransmitters). For example, 1/3 of children with races were revealed to an increase in serotonin in the blood. According to the results of other studies, all children with autism have been observed an increase in glutamate and aspartate in the blood. It is also assumed that autism, as well as a number of other diseases, can be associated with a violation of the assimilation of some proteins: gluten, casein (studies in this direction are still underway).
Contrary to common myth, autism does not develop as a result of vaccination. The study on the relationship of autism with vaccinations from measles was published in the late 90s in the authoritative medical journal Lancet, but after 10 years later it turned out that these studies were sofalsified. After court proceedings, the magazine recalled the article [four] .
When you find similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!
Symptoms of autism
Symptomatics of the autistic spectrum disorder is represented by three main groups ("triad violations"): violations in the sphere of social interaction, in the field of communication and in the field of imagination [five] .
Violations in the field of social interaction: Refusal of contact, passive contact acceptance under the initiative by another person, or contact is formal.
Violations in the field of communication: Presented in verbal and non-verbal communication. A child with autism is experiencing difficulties in attracting adults: it does not use an index gesture, instead brings an adult to an object of interest, manipulates his hand to obtain the desired one. Most children with races are developing with a delay in the formation of speech. With this disease, there is no desire to use speech as a means of communication, the understanding of gestures, facial expansion, intonation of the voice is broken. In the speech of people with autism, there is a refusal of personal pronouns, neologisms (independently invented words), also violated the grammar and phonetic system of speech.
Violations in the field of imagination: These signs of the autista are manifested in the form of a limited set of actions with toys or objects, monotonous games, fixing attention on insignificant, small parts instead of perceiving the whole object. Such a sign of autism, as stereotypical (monotonous) actions can wear a widest character: tapping or tapping objects, shocking hands, swinging the body, jumping, repeating shocks, croutons.
More complex stereotypical actions may be aligned with objects in the ranks, sorting objects in color or size, collecting a large number of objects.
Stereotypical behavior can be manifested in everyday actions: the requirement to go the same route in certain places, compliance with a certain waste ritual to sleep, the desire to ask certain issues in many ways and receive answers to them in the same form. Often there are unproductive monotonous interests: excessive passionateness by some cartoon, books on a certain topic, a transport schedule.
In addition to the main signs of autism, there are additional, which may not always be: lack of visual contact, motility disorders, behavior disorders, an unusual response to external stimuli (sensory overload from a large number of incentives, for example, in shopping centers), selectivity  .
Affective disorders are less likely (manic and depressive states, excitation attacks with aggression and autoagression), neurotic reactions and neurosis-like states.
Symptoms of autism in adults
- do not understand what other people think or feel;
- experience difficulties in order to start friends;
- may seem rude or not interested in other people;
- hardly describe their feelings;
- perceive things very literally, badly understand sarcasm;
- Social rules are poorly absorbed;
- Avoid visual contact;
- do not like when someone touches them or is too close;
- Notice small details, patterns, smells or sounds that other people do not pay attention;
- experiencing increased interest in highly specialized classes;
- Carefully plan cases before starting them  .
Pathogenesis of autism
The pathogenesis of autism is currently not studied. Different its forms have their own characteristics of pathogenesis.
In the development of the child there are several critical periods in which the most intense neurophysiological changes occur in the brain: 14-15 months, 5-7 years, 10-11 years. Pathological processes falling over time for critical periods lead to violation of development.
With endogenous (caused by internal factors) child autism, the development of the psyche of the child in the early stages occurs asynchronously. This is manifested in violation of the sequence of motor, speech, emotional maturation. With the normal development of the child, more complex functions of mental activity alternately displace simpler. In the case of autism, there is a "releasing" of simple functions complex - for example, the appearance of the lepture after one year along with the presence of simple words.
The pathogenesis of autistic-like syndrome in chromosomal anomalies, exchange disorders, organic lesions of the brain can be associated with damage to certain structures of the brain.
In some cases, there is a violation of ripening and rearrangement of cells in the crust of large hemispheres, hippocampus and basal ganglia. On computed tomography in children with races, cerebellum, brain barrel, frontal part of the brain cortex, expansion of side ventricles are revealed.
Evidence of the violation of the exchange of dopamine in the brain with autism serve data of positron-tomographic studies, hypersensitivity of dopamine receptors in the structures of the brain in children with autism in some of its forms  .
Classification and stage of development of autism
According to the international statistical classification of diseases of the tenth revision (ICD-10) used in Russia, the disorders of the autistic spectrum is divided into:
- Children's autism;
- Atypical autism;
- Rett syndrome;
- Another disintegrative disorder of children's age (children's dementia, geller syndrome, symbiosis psychosis);
- Hyperactive disorder, combined with mental retardation and stereotypical movements;
- Asperger Syndrome.
Employees of the NCPZ RAM (scientific center of mental health at the Russian Academy of Medical Sciences) proposed the following classification of races [eight] :
- Children's autism of endogenous genesis;
- Kanner syndrome (evolutionary procedural, classic version of child autism);
- infantile autism (constitutional-proceeding), aged 0 to 12-18 months;
- Children's autism (procedural);
- under the age of 3 years (with early child schizophrenia, infantal psychosis);
- at the age of 3-6 years (with early children's schizophrenia, atypical psychosis);
- Asperger syndrome (constitutional);
- autistic-like syndromes with organic damage to the central nervous system;
- autistic-like syndromes for chromosomal, exchange and other disorders (under Down syndrome, at x-fraction, phenylketonurium, tuberous sclerosis and other types of mental retardation);
- Rett syndrome;
- Auto-like exogenous genesis syndromes (psychogenic paralyticism);
- Autism of unclear origin.
When discussing the classification, it is important to note that autism is not a form of schizophrenia, although up to the 80s of the last century there were theories about it.
After the publication of the ICD-11, it is assumed that the disorders of the autistic spectrum will be divided as follows:
- disorders of the autistic spectrum without disrupting intellectual development and with an easy or without a violation of the functional language;
- disorders of the autistic spectrum with impaired intellectual development and with easy or without violation of the functional language;
- disorders of the autistic spectrum without disrupting intellectual development and with violations of the functional language;
- disorders of the autistic spectrum with impaired intellectual development and with violations of the functional language;
- disorders of the autistic spectrum without disrupting intellectual development and the lack of a functional language;
- disorders of the autistic spectrum with impaired intellectual development and lack of functional language;
- Other refined disorders of the autistic spectrum;
- Autistic spectrum disorders, unspecified [sixteen] .
Than the light shape of autism is different from severe
The races covers a wide range of symptoms with varying degrees of gravity - the ease and severe forms doctors do not distinguish. Also not allocated and Stages of the development of autism.
Complications of autism
Among the complications of races, the following can be distinguished:
Violations of behavior, self-damage: Because of inflexible behavior and inability to adequately expressing their emotions, the child can start screaming, crying for insignificant occasion or laugh without a visible cause. Often there is also a manifestation of aggression towards others or self-performing behavior.
Violations in the cognitive sphere: In most children, the intellect (with the exception of Asperger's syndrome) is observed in one degree or more  . The degree of reduction in intelligence varies from uneven delay in intellectual development to heavy mental retardation. Throughout life can be maintained by speech violations from a simple identity of speech to severe underdevelopment or complete absence. This imposes a restriction on education and further employment.
Neurotic symptoms: Many people with races are developing alarming, depressive manifestations, obsessive-compulsive syndrome, sleep disorders.
Facility attacks: Approximately about a third of children with autism suffer from epilepsy, which begins in children's or adolescence.
Digestive disorders: Due to selectivity in food and unusual food habits during autism, various disorders of digestion, the disease of the stomach and the deficiency of vitamins are found.
Problems with the diagnosis of other diseases: The high pain threshold prevents the timely diagnosis of complications of the infection of the nose and throat (OTIDI), which in turn leads to a decrease in hearing, and the lack of speech does not give the child to correctly report pain and their localization.
Social deadaptation: With a rant-turn, children with races are experiencing difficulties with adaptation in the team. In adulthood, only 4-12% of people with races are ready for independent independent life, 80% continue to live with their parents under their care, or fall into psycho-neurological boarding school after the death of parents [fifteen] .
Diagnosis of autism
When a psychiatrist needs consultation
To the psychiatrist should be applied when the child appears from the child of autism from the "Triad of violations": violations in the sphere of social interaction (refusal of contact), in the field of communication (difficulties in attracting adults, delay in the formation of speech, violations of the grammatical and phonetic system of speech) and In the field of imagination (stereotypical monotonous games and actions).
At what age can be diagnosed with autism
At the age of 12 months, accuracy and further confirmation of the diagnosis of "autism" is about 50%. By 14 months, this indicator grows up to 80%, and by 16 months to 83%  . However, it is often diagnosed with races for 2-3 years.  .
Is it possible to test at home
Independent formulation of the diagnosis of races at home is impossible. Parents may be tested according to the methods described below and make a decision on the need for examination in profile specialists. The diagnosis of authis is a psychiatrist on the basis of parental complaints, collecting information about the early development of a child, a clinical examination (identifying symptoms of violation of social cooperation, communication and recurring behavior), as well as data of clinical examinations (consultation of a medical psychologist, medical and speech therapy examination, EEG data, ECG, blood tests, urine) [eleven] .
In the presence of indications, consultations of the neurologist, genetics doctor, neuropsychological examination, magnetic resonance imaging, computed tomography, deployed biochemical blood test, cytogenetic study are held.
There are a number of auxiliary standardized techniques to identify the presence and degree of severity of symptoms of the RAS:
- ADOS (Autism Diagnostic Observation Schedule) - Observation scale for the diagnosis of autism symptoms used in various age groups, at any level of development and speech skills. It consists of four blocks that evaluate speech, communication, social interaction, game.
- Cars (Childhood Autism Rating Scale ) - A scale based on the observation of the child's behavior aged 2 to 4 years. The following features are estimated: relationship with people, imitation, emotional reactions, motor agility, use of objects, adaptive changes, visual flavoring, olfactory, tactile perception, alarming reactions, fears, verbal and non-verbal communication, general level of activity, level and sequence of cognitive activity, Overall impression  .
- M-Chat (Modified Checklist for Autism In Toddlers) - Screening test to assess the risk of races. Consists of 20 questions for parents about the behavior of the child.
- Test ASSQ - It is used to diagnose asperger syndrome and other autistic spectrum disorders in children aged 6 to 16 years.
- Test AQ (Symon Baron Cogan Scale) - Used to identify symptoms of races in adults. Consists of 50 questions.
Attractions and syndromes with similar autism are manifestations:
- Congenital Reduce Syndrome:
- Cornelia de Lange syndrome;
- Down syndrome;
- Broke X-chromosome syndrome;
- Clever - Bewsi syndrome;
- Landau Syndrome - Clefner;
- Lesha's syndrome - Nihana;
- phenylketonuria (FKE) without treatment;
- Prader - Willy syndrome;
- Rett syndrome;
- turret syndrome;
- tuberous sclerosis;
- Williams syndrome  .
Treatment of autism
Is it possible to recover from autism
Autism is a disorder that is not amenable to complete cure, but at a timely launched integrated therapy, it is possible to reduce the severity of its symptoms.
Treatment in children
Speech therapy treatment. Special attention under therapy is paid to correctional and developing classes with a speech therapist, a teacher-defectologist and a psychologist. They should be conducted by specialists with experience in interaction with such children, as in working with autism there is its own specificity: the need to adapt the child to new conditions, involvement in the work of all analyzers (tactile, auditory, taste, visual, olfactory), attracting a child to occupation Motivation, testing of the index gesture  . A positive result is achieved only with regular classes with the inclusion in the process of the whole family of the child: parents, brothers and sisters.
Among modern approaches to correctional work, the following can be distinguished:
ABA therapy (Applied Behavior Analysis, applied analysis of behavior) - a complex of technician aimed at the correction of the child's behavior and Acquisition of self-service skills and location in society. Applying a system of encouragements, a child with autism is taught missing domestic and communication skills. A tasty food, praise, tokens are used as a promotion. Each simple action is learned separately, then they are combined into a sequence. For example, at the beginning of the child, a simple task is given (for example, "raise the hand"), immediately gives a tip (the specialist raises the hand of the child), then the child is encouraged. After several such attempts, the child is already performing an action without a hint, waiting for a remuneration. Gradually, the tasks are complicated, given in any order, in different situations, different people, family members to secure skills. At some point, the child begins to understand independently and perform new tasks.
Similarly, the skills of the game, constructive activities, training, and undesirable behavior is also corrected. The effectiveness of applied analysis of behavior was confirmed by scientific research. [twenty] . The earlier the use of the method (in preferably from 3-4 years), the more intensive classes will be conducted (at least 20-40 hours per week with a total duration of 1000 hours) and the more active the method of the child's daily life (its use of parents At home and for a walk, teachers at school, educators in kindergarten), especially more efficiently it will work.
On ABA-therapy methods built Denver model - A comprehensive approach for children from 3 to 5 years old, training a child with all the necessary skills for this age, which suggests significantly increase its adaptation abilities.
PECS (Picture Exchange Communication System) - Alternative communication system using cards with images. On cards depicts objects or actions with which the child can turn to an adult to obtain the desired one. Training in this technique is carried out using ABA-therapy tactics. And although it does not teach oral speech directly, some children with autism engaged in this program appear spontaneous speech.
Thessna (Treatment and Education for Autistic and Related Communication Handicapped Children ) - A program based on the idea of structured learning: the separation of space into separate zones intended for a certain type of activity (areas of work, recreation area), schedule planning on visual schedules, a task presentation system, visualization of the task structure.
DIR (Developmental Individual Differences Relationship-Based) - The concept of providing comprehensive care for children with various developmental impairments, taking into account individual features and based on building relationships between family members. One of the components of this program is the Floortime technique, learning parents to interact and develop a child's child by inclusion in his game and gradually engaging in a joint "space".
Emotional-level approach - developed by domestic psychologists (Lebedinskaya, Nikolskaya, Baenskaya, Liboning) and is widely used in Russia and the CIS countries. It is based on ideas about the levels of emotional regulation of the body, which are broken during autism. This approach involves therapy through the establishment of emotional contact with the child. In the future, work is carried out on overcoming feasibility and aggression, focusing is formed in activities.
Sensory integration - Method aimed at streamlining sensations derived from its own movements and the outside world (tactile, muscular, vestibular). According to the theory of sensory integration, in violation of the ability to perceive and handle the sensations from the movements of their body and external influences may violate the processes of learning and behavior. Performing certain exercises improve the processing of sensory incentives with a brain, which leads to improved behavior and training. Alone This type of therapy does not apply, it can be a supporting method within ABA-therapy.
Medical therapy Appointed as a rule during periods of exacerbation of the state, taking into account the ratio of benefit and risk, is carried out under the supervision of the doctor [nineteen] . Preparations can reduce some types of behavioral problems: hyperactivity, hysterics, sleep disorders, anxiety, autoadagression. It can facilitate the participation of the child in the life of the family, visiting public places, school training. After the rescue is achieved by the remission, the drug is gradually canceled. Medical treatment is used in cases where the remaining therapy methods are not effective.
Nevertheless exist Symptoms and problems that cannot be affected by drugs:
- failure to comply with oral instructions;
- Problem behavior in order to refuse some lessons;
- Low learning speed;
- Lack of speech and other communication problems;
- Low social skills.
In the presence of concomitant diseases (for example, epilepsy), in addition to the doctor's psychiatrist, a neurologist and pediatrician should observe.
Treatment of adults
You can adjust the races in adulthood with the help of cognitive-behavioral psychotherapy. Specific treatment methods are selected depending on the problems faced by a person with races (for example, social insulation or problems in relationships). Reception of prescription drugs, which reduce the manifestations of anxiety and depression, which may arise against the background of races. Medicines are selected individually by a psychiatrist.
How to live with a child with autism
The child with races requires attention and care, therefore, as a rule, one of the parents have to quit, most often such a decision takes the mother. It is important to be a clear distribution of the roles of family members when careing the child is directly affecting its quality of life. Before the family in which the child grows with races is growing, it is an important task: you need to create such an environment where development prospects will not only have a child with races, but also in all family members. In the case when the parent receives effective psychological assistance, it has a positive effect on the state of the child with races, as the parent's well-being helps him better support the child  .
Can autoists have healthy children
The manifestation of the disease depends on the combination of genetic factors and the impact of the medium, but the risk of birth of children with races of parents with this disorder is significantly higher than on average in the population.
According to the NIH study (US National Health Institutions), there are approximately 3-5% of children who have a tender or uncle suffer from such a disorder. For comparison - in the overall population of RAS is detected in 1.5% of children  .
The forecast depends on the type of disorder and symptoms. Under late formulation of the diagnosis and the absence of a timely initiated medical and correctional work in most cases, a deep disability is formed [fourteen] . The treatment helps compensate the difficulties in behavior and problems in the communications of the child, but some symptoms of autism remain with a person throughout life. In adolescence, symptoms can increase.
A relatively favorable forecast is observed in Asperger syndrome (high-functional autism): a part of children with this form of autism can learn in secondary schools, to further receive higher education, marry and work. With the Rett syndrome, the prognosis is unfavorable, since the disease leads to severe mental retardation, neurological violations, there is a risk of sudden death (for example, from a heart stop).
Primary prevention is difficult to make data on the causes of its occurrence. There are research on the connection of autism from a child with bacterial and viral infections of the mother during pregnancy  , disadvantage of the organism of the mother of folic acid at the moment of conception  But the data is not enough for unambiguous conclusions.
The secondary prevention can be attributed to the timely identification of symptoms of races by parents, a pediatrician, a children's neurologist and an appeal to a psychiatrist to clarify the diagnosis.
Whether disabled in autism
The disability can be obtained with a full or partial absence of a child with Self-service skills, the ability to move independently, communicate, control their behavior and learn. Symptoms of autism are a combination of causes and factors leading to various changes in the human body, more often in childhood, which may indicate the emergence and development of this disease. Autism and autistic disorders are a disease that is one of the forms of mental disorder, in which children detect significant violations in the development, expressed in distorted perception of reality and denial of social interaction. How to identify autism, what is it expressing, what criteria may indicate the beginning of the disease? Answers to these and many other questions can be found by reading the next article.
The beginning of the manifestation of the disease and classification
Such a disease in children is found in two or four cases per hundred thousand people. If there is also a hidden atypical autism for this, when the main disease is accompanied by mental retardation, then this number will immediately increase to twenty. At the same time, autism in boys manifests itself four times more often than girls.
Autistic disorder can manifest itself from any person absolutely at any age, but the clinical signs of the disease will be much varied in children, adolescents and in adults.
It is customary to distinguish: Early children's autism (RDA), which can be revealed from kids under the age of three, children's autism, manifested from three to eleven years, and adolescent autism, usually detected in people after eleven years.
There are several types of such a disease. They have different symptoms and some specific features characteristic of a particular type of disease. According to the data of the International Classification of Diseases, there are: Kanner syndrome or classic autism, Asperger Syndrome, Rett Syndrome and Atypical Autism.
The manifestation of the first signs of child autism can be seen already at a one-year-old child. Although more pronounced symptoms of the disease appear, as a rule, in two and a half - three years. During this period, the closure of the child, care, and the limited interests of his interests is most noticeable.
If such a child in the family is not the first, then mom sees the initial signs of illness in infancy, as you can make a comparison between this baby and his elder brother or sister. Otherwise, to understand that something is wrong with the child, it is quite difficult. Usually, this is manifested at the moment when the kid authist goes to kindergarten, that is, much later.
It happens that the diagnosis of autism is placed after five years. For such children, it is characteristic:
the presence of a higher intelligence coefficient compared with those patients who have been diagnosed earlier;
- preservation of communication skills;
- the presence of less pronounced cognitive disorders;
- distorted perception of the surrounding world;
- Behavior in which is an isolated from society.
- Almost always between the first signs of the manifestation of autism and the direct diagnosis, there is a certain period of time. After all, later, when the child appears the need for communication not only with relatives and loved ones, there are other traits of character who have not given values at all at all. In other words, the disease does not occur suddenly, just at the initial stage it is quite difficult to recognize it.
Main features for the diagnosis of autism
Although the symptoms of the disease varies significantly depending on the form of autism, the age of the child and other factors, there are the main signs of the disease inherent to all the autists. It should be understood that the presence of one of the symptoms is not enough to form such a diagnosis. In such cases, the so-called triad is used for diagnostics - the three most obvious features for which the presence of this disease can be determined. Consider each of the main signs in more detail.
This characteristic is the main for children with autism. The autists face an external environment, closing in their invented world. They do not like to communicate and avoid various communications.
Mom's per capita should already have the fact that the baby does not ask his hands at all, it is not allowed, it reacts little to new toys, does not slam down in his hands, rarely smiles, does not look into the eyes when communicating with him. Sick children, as a rule, do not respond to their own name, react poorly to sounds and light. When trying to establish communication with them, they are frightened, or fall into aggression. The absence of visual contact is characteristic of heavier forms of autism and manifests this sign not all patients. Often such children can look at one point for a long time, as if through the person.
Mortification, the child is increasingly going to himself, almost never refers to help, contacts little with other family members. Many of the diseases do not tolerate hugs and touches.
Speech and her perception
Violations of verbal communication always occur during autism. In some, they can be pronounced, others are weak. It can be observed as a speech delay and a complete absence of speech function.
With early childhood autism, this is manifested more clearly. Young children can even be completely absent. In some cases, on the contrary: the child begins to speak, and after some time it closes in itself and ships. It happens that such children are initially ahead of their peers in speech development, and then, about a year and a half there is a regressive recession, and they cease to speak at all. However, while often talking to themselves, and sometimes in a dream.
Also, the kids often missing and bustling, various gestures and facial expansion are rarely used. Adult, the child begins to speak tonazingly, confuses pronouns. Speaking about yourself, they usually use appeal in the third face: "He wants to eat," Andrei wants to eat "and so on.
Being among other people, such children are usually silent, are not inclined to communicate and may not be answered. However, remaining alone with them, they often comment on their actions, they say with themselves and even read poems.
Speech of such children is characterized by monotony, lack of intonation. It predominates quotes, various teams, strange words, rhymes.
Speech delay is a frequent cause of parental appeal to a speech therapist or a defectologist. A specialist can determine what caused a violation of speech function. With autism, this is associated with the reluctance of communications, communicating with anyone, the denial of interactions with the outside world. Speech delay in such cases indicates serious violations in the social sphere.
Limit of interest
The children of autists most often show interest in any one toy and it remains for long years. The games of such children are monotonous, or they do not play in principle. Often it can be seen as a child watching the movement of the sun bunny or reconsidates the same cartoon several times. They can be so absorbed in one occupation, which create an impression of complete abundance from the outside world, and attempts to tear them from this end with the attacks of hysteria.
Children suffering from autism most often do not play with their toys, but are inclined to largely build them in a certain order and constantly sort: in shape, size or color.
The interests of the autists are reduced to constant recalculation and sorting of objects, as well as building them in a certain order. Sometimes they are fond of collecting, design. Any of interests that are found from autists is distinguished by the lack of social relationships. The autists lead a closed, atypical for their peers, lifestyle, and do not allow anyone in their games, even the same sick children, like themselves.
Often, they are not attracted by the game itself, but certain algorithms, they are taking place in them. For such children, it is typical to periodically turn on and turn off the crane, looking at the running water and perform other similar actions.
Children, patients with autism often can be recognized by specific gait and movements. They often at walk greatly swing their hands and become on socks. Many prefer to move the scout. For children, autists are characterized by awkwardness, clumsy in movements. And when running, they are often uncontrolled by their hands and make too big steps.
Often, such patients can watch walking along a strictly defined route, swaying from side to side while walking, as well as marching with an insert step.
Stereotypes, stima or constantly repeated actions are characteristic of almost all children suffering from this disease. They appear, as a rule, in speech and behavior. Most commonly encountered are motor stereotypes that look like: compressing, squeezing the fingers in a fist, twitching shoulders, repeating head turns, swaying from side to side, running in a circle and so on. Sometimes you can watch how the child constantly shakes the door, shifts sand or cereals, clums the switch monotonously, tear or the paper. All this also applies to stereotypes with autism.
Speech stereotypes are called Echolalia. At the same time, children can constantly repeat the same sounds, syllables, words and even separate phrases. Usually, it is phrases heard from parents or extracted from a favorite cartoon. It is also characteristic that children say phrases absolutely unconsciously and not putting any point in them.
You can also highlight stima in clothes, food, walks. Children are prone to the formation of certain rituals: walk along a certain route, the same way, do not step on cracks on the asphalt, put on the same clothes, absorb one and the same food. They are prone to performing a certain rhythm, swinging on a chair under a certain tact, turning off pages in the book and back without much interest.
Why there are stereotypes with autism there is no unambiguous answer. Some believe that constantly repeated actions stimulate the nervous system, others, on the contrary, suggest that in this way the child calms down. The presence of steits with such a disease allows a person to exorcate from the outside world.
Disorder of intelligence
A frequent symptom for autism, manifested in seventy five percent of patients, is an intellectual ability disorder. It can begin with a delay in intellectual development and eventually lead to mental retardation. This condition is usually a different degree of backlog in the development of the brain. Such a child is hard to concentrate its attention, focus on something. Often there is a quick loss of interests, the inability to apply generally accepted generalizations and associations.
In some cases, with autistic disorders, a child has an interest in certain classes, and therefore only separate intellectual abilities are formed.
Easy and average degree of mental retardation during autism is noted in the greater half of patients. In a third of patients, the coefficient of intellectuality rarely exceeds seventy. But you should know that it usually does not progress such a state, and it rarely comes to full dementia. Children with high IQ often have non-standard thinking, which highlights them among other children and is often the cause of their limited social interaction. It should also be noted that the lower the level of the child's mental abilities, the hardest to adapt them in the social sphere.
Nevertheless, such children are more inclined to self-study. Many of them themselves learn to read, master simple mathematical abilities. Some sustain musical skills, mathematical and mechanical skills for a long time.
Usually mental disorders have a periodic character: there are periods of improvement and deterioration, the emergence of which can provoke various factors: stressful states, anxiety, interference with the closed world of an autista.
Unmotional disorders with autism include sudden outbreaks of aggression, autoagression, unmotivated anger or fear. Most often, such states arise suddenly and do not have any obvious causes. Such children are susceptible to hyperactivity, or vice versa are closed, injured and confused. Such children prone to self-injury. Often, their aggressive behavior is directed to itself and manifest themselves with biting, pulp, scratching and other types of self-ruling. Such children have practically no pain, or a reaction to the pain of atypical.
Clinical manifestations of autism forms
Each form of autism also has its own specific signs and symptoms. Consider more the most common of them.
Kanner syndrome or infantile form of autism
This category includes children's, infantile autism and other autistic disorders manifested in children from one year to three years.
They are characterized by the following signs:
lack of interest in relationships with other people, starting from early age;
- stereotype in games;
- Fear of any changes in everyday life and in the surrounding space;
- Delay in development;
- shortage of speech function for communications with others;
- The appearance of speech stereotypes;
- Ignoring pain and other external stimuli.
- Asperger Syndrome
Asperger syndrome or high-functional autism is largely similar to Kanner syndrome. However, with this form of the disease, there are no violations in speech development and highly developed cognitive abilities.
With this form of soft autism in children, mental processes are well developed, there is a distorted perception of the surrounding reality and itself, there is a difficulty in the concentration of attention. Other psychological and physiological symptoms of this disease look like this:
stereotype of behavior and limited interests;
- impulsive behavior;
- attachment to the usual environment;
- violations in communicative skills;
- View of the view, or the aspiration of it in one point.
- Atypical form
For an atypical form of autism, a manifestation of later age is characterized. It also arises in adults, especially in the presence of mental backwardness and other diseases related to development. The signs of such a form of illness include:
emergence and development after three years;
- Serious deviations in social interaction between the patient and the people around him;
- Limited and stereotypical behavior arising with certain frequency.
- Manifestations of autism in newborns
Breasts and newborn children have significantly expressed external signs that indicate the presence of a disease: the absence of a smile, bright emotions, activity inherent in other children of their age, facial expressions and many gestures. The baby's glance is often fixed in the same point or any specific item.
Such children practically do not ask for hands and do not copy the emotions of adults. In the infants of the autists there is practically no crying, he does not create problems to parents, is able to occupy themselves on their own, without showing any interest in the world around. The kid is not gulit, does not mean, does not respond to his own name. For such children, some delay in development is characterized: it is late to sit and walk, there is a backwardness in growth and weight.
Such children often refuse to breastfeeding and do not accept the touches of the father or mother.
Symptoms in children of younger and school age
Patients of younger and school age are distinguished by the lack of emotions and closedness. Approximately a half or two years old, such children may have a completely absent speech function, there is a reluctance to go to visual contact. Often, speech disorders at this time are due to the reluctance to communicate in society. When patients still start talking, they face certain difficulties. They often talk about themselves in the third face, confuse pronouns, repeat the same words, sounds and phrases. Often, such children arise vocalization, as one of the species of stereotypes.
Often, autists prevail hyperactivity, but their movements are monotonous and are repetitive. Also, such children practically do not cry, even when they hurt high. They avoid the society of peers, in kindergartens or school, as a rule, are sitting alone. Sometimes they have attacks of aggression or autoagression.
The child may not pay attention to the whole subject in general, but it is attracted by some of its elements. For example, it can cycle on the wheels or the steering wheel of the car, constantly rotating them in his hands. Toys are not interested in the autista as such, but they love to sort them and lay out in a certain order.
Such children are very selective in food or clothing. They have many different fears: the fear of darkness, various noise. When progressing the disease deteriorates and possible fears. They are afraid to leave the house, and in particularly severe cases in general to leave their room and remain alone. They are afraid of any change in the situation, and being not in their place, they often roll hysteries.
School-age autists can visit ordinary or specialized schools. Such children have a passion for any one of the items. Most often it is drawing, music or mathematics. The adolescents of autists prevailing consuming attention, they also experience considerable reading difficulties.
In some autists, there is a savance syndrome characterized by incredible abilities in any particular disciplines. They may differ talents in the musical sphere or visual art, as well as possess phenomenal memory.
Children with a low intelligence coefficient most often closed in themselves and go to their invented world. Such children often have violations in the speech development and social sphere. The baby tries to resort to speech only in very exceptional cases. They never complain and try not to ask for anything, trying to avoid any communication in every way.
At this age, children often appear serious deviations in food behavior, up to full failure of food, which often leads to diseases of the gastrointestinal tract. Eating is reduced to certain rituals, the food is selected of a certain color or form. Taste food criteria are not taken into account.
With timely diagnosis of disease and qualified treatment, the children of autists can live quite a normal life, attend general education schools, master professional skills. The best success is achieved by autists, speech and intellectual violations that have minimized.
Signs of autism in adolescence
The majority of adolescent autists have significantly changed behavior. They acquire new skills, but communicating with peers causes certain difficulties. Particularly hard for such children is puberty. Autists in adolescence are most susceptible to depressive states, the development of various fears, phobias and panic states. Also, they often use epileptic seizures.
Autism in adults
Adult men and women suffering from autism, most often live and work independently. This directly depends on their intellectual abilities and on social activity. About thirty three percent of such people achieve partial independence.
The same adults whose intellect is reduced, or communication is reduced to a minimum require sufficient attention to themselves. They cannot be without any guardianship, which significantly complicates their life and the life of their relatives.
People with an average level of intelligence or having IQ above average often achieve significant success in the professional sphere and may well live a full life: marry, to start a family. However, this is done not to many, since they have significant difficulties in relationships with the opposite sex.
Signs of the fetus during pregnancy
Recognize the presence of autism in the fetus can still be during pregnancy. This can be seen in the second trimester during a ultrasound study. Scientists have proven that the intensive growth of the bodies of the fetus and the brain at the beginning of the second trimester make it possible to assume that the child will be born with autism.
The cause of such intensive growth may be the presence of serious infectious diseases in women: measles, chickenpox, rubella. Especially if the future mother suffered them in the second trimester, when the child's brain is formed.
The difference of autism from dementia
Often, autism is confused with other similar diseases, for example, with dementia. Indeed, the symptoms of such diseases is quite similar. However, children suffering from dementia differ from children of autists:
- abstract thinking;
- Large vocabulary.
- Such symptoms are not characteristic of autism, but in such a disease, patients may experience mental retardation.
Myth about postactivity
There is an opinion that autism in a child is developing after vaccination of young children. However, such a theory has absolutely no evidence. A lot of scientific research was conducted, and none of them revealed the links between vaccination and the occurrence of the disease.
It may happen that the time when the child was vaccinated, simply coincided with the moment when parents noticed the first signs of autism. But not more. The error in this issue led to a sharp decrease in the level of vaccination of the population, and as a result of the outbreaks of infectious diseases, in particular, measles.
Testing a child at home
To identify the presence of autism of the child at home can be using various tests. At the same time, it should be aware that only test results are not enough to make a diagnosis, but this will be an excess reason to appeal to a specialist. There are many tests intended for children of a certain age:
Testing a child in general development indicators, intended for children to age until sixteen months;
- M-CHAT test or modified screening test for autism, for children from sixteen to thirty months;
- CARS autism rating scale is used to test children from two to four years;
- Screening test for autism ASSQ is offered to pass children aged six to sixteen years.
- M-Chat Test or Modified Screening Test for Autism
Does the child get a pleasure from swinging on her knees or hands?
- Does the child have an interest in other children?
- Do you like the child to use objects as steps and climb on them up?
- Do you like to play hide and seek?
- Does the child imitate the action during the game (pretends to talk on the phone or tells the doll)?
- Does the child use the index finger if necessary in anything?
- Does he use the index finger, emphasizing his interest in any action, subject or person?
- Are the toys are used by a child for purpose (riding a machine, dressing dolls, construction of fortresses from cubes)?
- How did the child emphasized attention on the subjects of interest to its items, bringing them and showing parents?
- Is the child who is able to hold the visual contact with adults more than one or two seconds?
- Did the baby ever showed signs of increased sensitivity to acoustic stimuli (asked to turn off the vacuum cleaner, closed the ears with loud music)?
- Does the child arise a response to a smile?
- Does the child repeats the movement, intonation and facial express for adults?
- Does the child respond when his name is named?
- When specifying any object or toy in the room, will the child look at her?
- Does the child know how to walk?
- If you look at any subject, will the child repeat your actions?
- Have you noticed the child to commit unusual actions with your fingers near the face?
- Does the baby try to draw attention to himself and to their actions?
- Does the child think that he has problems with hearing?
- Does the child understand what people around him are talking about?
- Did you notice the baby to shine aimlessly or do anything automatically, producing the impression of a complete absence?
- Having encountered unfamiliar people, or faced with incomprehensible phenomena, does the child look in the face of parents to watch their reaction?
- Decoding test
For each question of the test, the answer is "yes" or "no", and after compare the results obtained with the decoding list:
- No (critical item).
- No (critical item).
- No (critical item).
- No (critical item).
- No (critical item).
- No (critical item).
- No (critical item).
- No (critical item).
- No (critical item).
- No (critical item).
- No (critical item).
- If answers coincided with three regular items or two critical, then such a child must be advised by a specialist.
- No (critical item).
- No (critical item).
Autism is a disease, mainly childhood, which is characterized by a number of specific symptoms and signs. The description of them is often varied depending on the form of a mental disorder, the age of the child and many other factors.
It is necessary to know what kind of signs says about the occurrence of this disease, so as not to confuse it with other diseases. And when several of them occur, you need to seek advice from a specialist as soon as possible.
Furmanova Elena Alexandrovna
Pediatrician doctor, infectious, allergist immunologist Common experience: .
7 years Education: .
2010, SibGMU, Pediatric, Pediatrics We will be grateful if you use the buttons: .
- this is not a single disease, but a large complex of violations of the development of a nervous system of various origins, denoted as
Autism Autistic spectrum disorders (RAS) . According to modern data, the frequency of occurrence is 5: 1000 (Source: Charles Nyokictien "Children's behavioral neurology", 2018). Boys meet 4 times more often than girls. The apparent increase in the incidence of races (according to the old data prevalence was 4: 10,000) is associated with improved diagnosis and expansion of its criteria. The very concept of the spectrum appeared relatively recently, in 2013, when a new DSM-5 edition was adopted, before that, only certain types of autism were considered. According to the international classification of illness 10 reviews (ICD-10), children's autistic (F84.0), atypical autism (F84.1), Rett syndrome (F84.2), Asperger syndrome (F84.5) and several other other forms. However, in many countries of the ICD-11 (in our country, it will act since 2022) "the disorder of the autistic spectrum" appears as the main nosological unit, and its forms are allocated, based on the available intelligent and language deficits, for example: "RAS with Disruption of intellectual development and with a soft or absent violation of the functional language "," races without disrupting intellectual development and with a violation of the functional language "and others. CAPs may vary by severity and by pathogenetic mechanisms, which strongly affects the clinical picture, the forecast and social adaptation.
Characteristic features of children with autism (races)
Violation of emotional contact in communicating with other people. This feature of autists is associated with several mechanisms, namely:
- "Social agnosia" is a disorder of perception of facial expressions, intonation of people. Despite the fact that children with races there are no primary problems with visual perception, they turn to others more, as with objects, without having the ability to experience empathy. The studies have established that when identifying human persons in the brain of the autista, zones are activated responsible for the perception of inanimate objects, unlike healthy people.
- Violation of "Central Binding". Due to the violations of the perception of the autists, they "catch a variety of small details well, but cannot" collect "a holistic picture. That is why they are all perceived literally, they are not able to perceive the context, the relevance of behavior in one situation or another, do not understand the figurative meaning and the language of gestures.
- Disorder of own facial expression, speech and expression intonation. Even if a person with autism was able to perceive the emotions of another person (as a rule, basic emotions they can feel - anger, fear, joy), the establishment of adequate contact is complicated by the fact that the response from the autistist is complicated. This is due to the dysfunction of prime departments of the cerebral cortex and frontal-limbic ties. Due to the data of violations, facial disptions arises (violation of the arbitrary management of facial expositions) and the generation of emotions. Mimic and bodily expressions of emotions in such children are poor, fuzzles and are inadequate in nature. Speech mechanistic (if it is).
- The absence of the so-called "Mental Model" (Theory of Mind). Autocoves do not have difficulty understanding the immediately observed physical events, but are not able to submit and understand what feels and wants to make another person or interpret their own actions and intentions. The fact is that these are the phenomena of a higher representative order, they are abstract compared to physical objects. The mental model is related not only to the awareness of thoughts, but also awareness of the body, and it, in turn, is based on the body scheme (which comes from the early sensory experience of the child). Since the scheme and awareness of the body in people with races are also violated, then physical contact with other people (touches, stroking, hugs) is similarly difficult. The autists most often do not have a physical contact need, because they do not understand the communicative meaning of these actions. In addition, physical contact may be unpleasant and painful due to the disruption of the sensory processing of tactile and proprioceptive (muscle, tendon) signals.
- Semantic and pragmatic violation of speech or her absence. More than half of the autists do not say, or they say very bad. Many children with races have signs of development dysfasi (Alalia - in Russian interpretation), but autism and dysfasia are in no case synonyms. Simply put, there is autism with dysfazia, but often dysfasia without autism is found, and it is very important to distinguish them in practice. In recent studies, it was proved that the age in which the child begins to develop speech, affects the severity of autism manifestations and for the forecast for when a child has a fluent conversational speech (Rühl d, Bölte S, Poustka F "Sprachentwicklung und Intelligenzniveau beim autismus . Der Nervenartzt »72: 535-40 (2001); Szatmari P, Bryson SE, Streiner DL EA" Two-Year Outcome of Preschool Children With Autism or Asperger's Syndrome. Am J Psychiat "(2000) 157: 1980 -87). Recalling semantic and pragmatic disorders during autism:
- The difficulties of a coherent presentation of thoughts (integrity, "central binding", which was mentioned above);
- Discrepancy between the use of speech by the social context of the situation;
- Restriction in understanding speech revolutions, sarcasm, irony and jokes, figurative meaning. Too literal understanding of speech.
- It does not serve to interact and is egocentric.
- The intonation is incorrect, which makes the speech mechanism. From the speech of the autista, the impression is as about "pseudovosla", pedantic.
- Echolalia is very often present in children, including delayed when a child can mechanistically reproduce entire proposals and dialogues, for example, from cartoons. Also, for children-autists are characterized by replacing the pronouns "I" - "You" or mention of yourself in the third person. They practically do not use index gestures.
- At the same time, the verbal memory of a person with races can be very good, and articulation is a clear. By itself, this item is not a violation, but all these moments refer to the overall syndrome of semantico-pragmatic violation of speech, describing it entirely.
- Additional symptoms, often accompanying the disorder of the autistic spectrum. The following symptoms are very often identified with autism, but it is incorrect, they are not specific and may occur during other violations.
- Cognitive rigidity, violation of mobility of mental processes, switching. It is easy to see that the autists tend to "stick" on certain objects, often not interesting to normal for normal children. This feature is associated with dysfunction of the prefortional departments of the cerebral cortex and cerebellum. Children with races often discover the rejection of any changes in their lives and the surrounding environment. If something has been broken in the usual way, they are frightened up to the state of panic.
- Stereotypical behavior. Autical children can play for hours with the same toy, look at the same thing. They can move monotonously (for example, run in a circle, swing, open and close furniture doors), to repeat the same words and expressions, perform influences on your own body. On the one hand, such behavior contains sensory self-conforming associated with the disruption of sensory processing (see paragraph below). On the other hand, such repeating actions and rituals help the autistist to structure reality in order to perceive it, make cognitive processing.
- Sensory peculiarity, namely, hypo-or hypersensitivity to sensory effects. Very often, in the study of the processing processes of incentives of various modalities, the so-called disturbance of sensory integration is diagnosed with autists. For diagnostics, both special samples can be used and the method of caused potentials (by different modalities). Such children can fall into hysterics at the sound of a blender or vacuum cleaner, there are inedible items, to show food selectivity, to be afraid of a swing or vice versa, for hours to swing on them. To correct the hearing hypocent or hypersensitivity, as well as in violation of acoustic pulses in the cerebral bark in our center, the Tomatis method is successfully used, the effectiveness of which is proved by a variety of studies. In addition to the non-formation of processing acoustic incentives in children, the difficulties of integrating propriceceptive, vestibular and tactile incentives are often found.
- Violation of Praxis (disptions) - disorder of arbitrary movements. It is directly related to the disorder of sensory processing, violation of the body scheme, as well as violations of control functions. With autism, various types of Praxis are disturbed, including kinesthetic, dynamic, constructive, mimic. According to some specialists engaged in RAC studies, with high-function autism (especially with Asperger syndrome), the disction is a mandatory feature. In practice, the violation of arbitrary movements is manifested by awkwardness, difficulties of coordination, indecisive in movements, inability to make simple motor actions in their age (throw and catch the ball, to drive on a bike, to conceive a thread in needle).
- Violation of proxheme (degree of proximity in social interaction). The autists do not have a sense of distance, so they can, for example, sniff people, to approach excessively closely than that the social context allows. Such behavior is also found with other disorders, for example, in children with ADHD. Another extreme is a complete avoidance of contact, including tactile. This is exactly specific to children with races.
- Symbolic game, the game "Ponaroshka", with an imaginary object in autistic children is either no, or is very poorly developed, which becomes obvious to age 18 months. The basis for the symbolic game serve as visual representations that suffer from autism. Therefore, the imagination is developing dysfunctionally.
- Early diagnosis of autism
The feeling that with the child "something is wrong," can occur with the parents when the child is still very small (up to the year). The weakness of the eye contact and excessive fixation in itself are the first signs of autism. Until 18 months, it is impossible to determine whether the baby will develop a symbolic game. Very important diagnostic criteria in determining autism upon reaching 18 months - an indicable gesture and joint attention when a child himself shows something interesting and looks in the same direction as an adult. It is also important to take into account how the child's speech develops.
Developed countries use special questionnaires for parents, such as Chat and Adi-R. Chat can be used from 18 months, and its filling will take about 10 minutes. In 90% of cases, the diagnosis will be confirmed, but there is also an error probability, so the results of the questionnaire should be considered only as preliminary data.
In 0-1 years it is necessary to estimate:
- Is there a retaliatory smile
- Does the child seek a tactile contact
- Does the child respond to his name
- Does social gestures use (for example, "yet")
- In 1-2 years:
Do you have some words
- Does the child understand
- Does gestures understand
- Indicating gesture, joint attention (by 18 months)
- Is there any interest in other children
- Is unusual reactions to sensory stimuli (closing the ears of sounds, strange habits in food, sniffing objects, etc.)
- Motor stereotypes (repetitive actions, for example, building cubes in a row)
- In 2-3 years:
Does a simple phrase say from 2 words
- There are echolalia
- Symbolic game
- Availability of stereotype
- At 3 years:
Is the child's speech to communicate
- Does other children play
- Can they regret someone (empathy manifestations)
- Evaluation of facial expressions and gestures, expressions of emotions
- Reaction to setting changes
- Signs of autism at 4 years and older:
The child understands speech too literally
- Confuses personal pronouns
- Not able to support friendships
- Stubbornness (rigidity)
- Does not play plot games (to school, doctor, to the store).
- For single manifestations it is not necessary for the diagnosis as a whole. An integral clinical picture is important. For diagnostics, family-run video are now widely used to understand what age the child knows and how to develop.
A reliably diagnosis can be put by a psychiatrist since 2 years. It is necessary to carry out differential diagnosis with other similar disorders: Alalia (Dysfazia), children's schizophrenia, children's depression, ADHD, obsessive-compulsive disorder, turret syndrome.
After diagnosis, it is necessary to advise for parents and therapy for a child. In our center, consultations and classes are held for families with children with the peculiarities of behavior on autistic type (regardless of whether an official diagnosis is made or not). The primary reception is in the form of a conservium from 2 specialists (neuropsychologist and a corpped defectologist). The consultation defines the structure of the violation, which types of deficits are, and which links of the nervous system are preserved. Compiled
Correction Program which may include: Classes with a speech therapist, including the Forbrain apparatus (speech correction);
- Classes with a defectologist-oligophrenopedagog (correction of cognitive deficit, mental delays);
- Classes with a neuropsychologist (correction of disction, violations of perception, spatial representations, control functions);
- Tomatis therapy (improving the understanding of speech, conducting a hearing impulse in the bark of the brain, a decrease in hyper-or hypositiveness, an improvement in the vestibular function);
- SoundSory (Improve Motoric and Speech).
- Text author: Clinical psychologist, Neuropsychologist Alexandrova O.A.
The content of the article
Autism in children is a disorder at which mental disorders arise. The kids with such a pathological condition are experiencing difficulties in contact with others, have limited interests and tend to perform repeating actions. The reasons for the development of this state are still at the study stage. The main goal of treatment is to increase the skills of self-service and the formation of social contacts.
General information about disorder
Over the past 25 years, the frequency of identification of pathology has increased significantly. However, the reasons for this growth are still unknown. It is assumed that an increase in the percentage of sick children is not associated with the spread of the disorder, but with the change of diagnostic criteria.
Statistics on the prevalence of such a violation will be much varied. This is due to the fact that various countries apply various approaches to the diagnosis of pathology and its classification. According to summarized data, about 0.1-0.6% percent of kids suffers from autism. At the same time, the disease, taking into account the disorders of the autistic spectrum, affects 1.1-2% of children.
Violation is manifested at an early age. It is noteworthy that the frequency of detection of pathology depends on the floor. Girls suffer from autism three to five times less often than boys. Some scientists believe that this is due to different pathology genetics. Others adhere to the opinion that the reason lies in the best development of communicative abilities in girls, due to which the light forms of autism can remain invisible.
A source: Gender differences in children's autism. Klinkov V.N., Soyko V.V. Tauride magazine Psychiatry, 2015. With. 9-13 .
Symptoms in children of different ages
With a careful attitude to the child, to identify the first signs of autism in the highest possible age. To do this, you need to pay attention to how it is in contact with others, expresses his feelings and mood. Deviations in neuropsychic development make themselves known as early as possible, they can even be noticed in infants A source: .
- Autism: Cause Factors, Early Diagnosis and Therapies. Shreya Bhat, U Rajendra ACHARYA, Hojjatadeli, G Muralidharbairy, Amir Adeli. Revneurosci, 2014. In children under the year
- The alertness should cause the reluctance to go to the hands, passivity when mom or dad appears and during communication with them. Already a few months, the baby must recognize the parents, distinguish their intonation. The mental development of children with autism occurs otherwise, they are indifferent to adults, do not perceive their mood, do not make differences between parents and other people. Aged 1-3 years
- When healthy children begin to talk, a sign of autism is the lack of speech. In this case, the vocabulary may correspond to the norm. However, the baby says the words of the Nefopad, applies his own Wordformes, speaks with unsuitable intonation. One of the main characteristics of the speech of such children is Echolalia, which manifests itself in the repetition of the same phrases. In preschool children
- The key symptom of autism is complexity in communications with others. The autists do not understand the rules of the Games, do not perceive the emotions of the peers. They are not available non-verbal signals, it is not clear the condition of others. The autists have discomfort, avoid surroundings, do not look into the eyes, react poorly to their name. As a result, there are some and invent their own games that are deprived of the plot base and look like meaninglessness of the same type. In early school age
- Maximum pronounced problems with learning. The functional activity of the bark of large hemispheres is broken. Therefore, mentally often arises mental retardation. However, in rare cases, such children arises a fundamentally opposite feature - their intellectual abilities significantly exceed the average. However, even with a developed speech and excellent memory, they have difficulties with abstract thinking, summarizing information, emotional reactions. The desire for loneliness and isolation is only enhanced. At the same time, aggression may occur, the attacks of anger. Most often, it is aimed at itself - bites, blows, damage. In teenagers The disease causes maximum discomfort, as pathology is manifested much more on the background of hormonal rearrangements. Difficulties with training are exacerbated by the inability to fully exist in the team. The child is already fully aware of his peculiarity and is very suffering because of this. In rare cases, puberty has a beneficial effect on the psyche of the autista: it becomes more stressful, it starts to communicate better .
Neurological disorders in children with autism. Zavadenko N.N., Probernikov N.L., Simashkova N.V., Zavadenko A.N., Orlova K.A. Russian Bulletin of Perinatology and Pediatrics, 2015. With. 14-21
- Causes of autism in children So far, scientists have not come to a single theory that could clearly explain why autism develops. There are several hypotheses, which, as the main risk factors, isolated genetic deviations, structural and functional impaired brain, biochemical processes. )Genetic deviations (heredity A source: .
- Autism Risk Factors: Genes, Environment, and Gene-Environment Interactions. PaulineChaste, Marionleboyer. DialoguesclinneurOrosci, 2012. . Scientists have discovered the predisposition gene to Autism, which confirmed its hereditary nature. The presence of a gene does not necessarily lead to a disorder, but significantly increases the risk of its development. The presence in the family history of autism even among distant relatives increases the risk of developing pathology. Even if the native has no diagnosis, but simply there are separate characteristic violations: speech disorders, difficulty understanding of speech and with social communication, epilepsy, mental retardation
- A source: Genetics of autism (review of foreign literature). Bobylova M.Yu., Printedry N.L. Russian Journal of Children's Neurology, 2013. 31-45
- Structural brain disorders . In children with autism, during the studies, changes in the structure of the cerebellum, the median temporal share, hippocampus, frontal departments of the cerebral cortex are found. For example, the cerebellum is responsible for successful motor activity, but at the same time affects thinking, attention, training ability, emotional reactions. In turn, hippocampus, median temporal shares affect memory, emotional self-regulation. In kids with pathology, there is a decrease, the disproportion of some departments, and the frontal lobes ripen much slower than in healthy people.
Functional brain disorders . In 50% of kids with such a disease, the EEG detects changes, which indicate faults in memory, attention, verbal thinking, speech activity. Biochemical processes . As a result of research, scientists have found that such patients have a brain metabolism metabolism, which is responsible for the transfer of pulses between nervous cells. Patients have an increase in serotonin, aspartate and glutamate in the blood. It does not absorb gluten, casein and some other proteins. There is quite common The view that vaccination significantly increases the risk of autism of the child .
it's just a delusion
- which has no scientific evidence under him. It appeared after at the end of the 90s, a corresponding study was published in the LanCet medical journal. After 10 years there have been evidence that the data was falsified and did not correspond to reality. A source:
- Does vaccination autistic cause? Golubev D.B. Epidemiology and Vaccinofilaxia, 2009. With. 63-34. Varieties of autism
- Doctors use several species distributions in practice. Most often, experts apply Nikolskaya classification, which allows you to allocate four forms of autism in children, depending on the severity of the manifestations of symptoms. Accordingly, further therapeutic actions and forecast depend on the established type of disease. First form
- . The most severe type of violation with the most pronounced manifestations. It is characterized by almost complete lack of need to contact with others, as well as a person's inability to independently take care of itself. Such children are always detached and constantly use simple repeating movements. The main goal of therapy is to establish contact, involve in cooperation, develop self-service skills. Second form
. In the usual environment, the autists are open and show abilities for simple household skills. Violations of speech are manifested in the stamped repetition of the same phrases. The main pathology is to reject reality. They do not want to learn or change, and the protest is expressed by aggression or negativism. Treatment is aimed at developing contacts with close, developing different behavior scenarios to adapt to the environment.
Third form . The child is committed to learning and new achievements, but at the same time it is afraid to risk, does not know how to find compromises. Against the background of good general encyclopedic knowledge, weak understanding of the real world and the inability to conduct a dialogue. The key treatment goal is to teach communication, form the skills of behavior in society. .
. The easiest, best suggests correction. A timid and very wounded person can adequately behave in society, but it does not know how to concentrate, work according to the instructions, adhere to the regulations. Therapy is aimed at developing congenital abilities, social skills.
Diagnostics: how to determine autism in a child
- The methods of early diagnosis of autism in children are reduced to the observation of the kid in the conditions familiar to it. Detection of deviations is hampered in the event that the parents have the first child and they do not understand what behavior speaks of deviations, and what is the option of norm
- A source:
- Early children's autism: problems and clinical observation. Emelyanova E.Yu., Ivanova T.I., Krachmaleva O.E., Sharamkova M.A. Omsk Psychiatric Magazine, 2019
- You need to contact a specialist if the baby does not look into the eyes, does not react to adults, manifests atypical gaming actions. In one year, the baby must already be broken, showing a handle to the items, make grabbing movements. In one and a half - talk individual words, two - build phrases from two words.
- The absence of such skills should alert and indicate the need to pass a survey. Initially, you can seek advice to the pediatrician, which, if there is an indication, will send to a psychiatrist or neurologist.
- At the stage of primary diagnostics, parents need to fill in special questionnaires. Most often use:
questionnaire for diagnostics (ADI-R);
behavioral questionnaire for diagnostics (ABC);
Test for young children (Chat); Checklist indicators (ATEC); .
Observation Scale for Diagnostics (ADOS);
Children's autism rating scale (CARS).
The presence of violations is indicated by the so-called triad symptoms: difficulties with social interaction, weak communication and the presence of stereotype in behavior. On the basis of the received data, the specialist identifies characteristic features and determines the need for further instrumental examination, which consists of: For differentiation of pathology and exclusion of speech disorders, auditory development, as well as pathologies of view, consultations are prescribed from a speech therapist, a sirologist, an ophthalmologist. :
- It is extremely important when the first suspicion of the development of pathology appears to contact a specialist. Doctors will hold a comprehensive examination, will be diagnosed and prescribed adequate treatment, which will minimize symptoms and will help the child adapt in society A source:
- Diagnosis of child autism: mistakes and difficulties. Makarov I.V., Avthenyuk A.S. Social and clinical psychiatry, 2018. p. 74-81 Methods for the treatment of autism in children
- It would be wrong to assert that autism can be cured in children or in adults. Full cure is impossible to complete this disorder. However, complex therapy makes it possible to significantly reduce symptoms, improve communicative skills, correct the behavior and at times to improve the quality of life. Complex therapy of autism in children provides for the use of different methods of correction in such directions
- Medical therapy A source:
- Children's autism: diagnosis, therapy, rehabilitation. Machrican.n. INTERNATIONAL SCIENTFIC REVIEW, 2016 Psychological help
. Directed on social adaptation, work with communicative difficulties, recognizing the emotions and mood of others. Allows the child to feel comfortable in society.
Training and education
. Pedagogical techniques that take into account the features of pathology allow you to expand the vocabulary, form the right speech. Individual classes in the usual atmosphere eliminate the baby from stress, increase efficiency.
Acquisition of self-service skills
. There is a complex of effective techniques and techniques that adjust the behavior and teach a child to be in society, adapt to the world and independence.
. Medicinal preparations allow you to adjust the behavior and some manifestations of pathology. They do not treat the disease, but improve the quality of life, helping to cope with behavioral problems: hyperactivity, anxiety, aggression, sleep disorders, hysteries. Essential drugs should exclusively do a doctor after a child survey. After reaching remission, medication is gradually canceled.
- . Disorder is accompanied by failures in the work of exchange processes. The body does not digest proteins, gluten and casein. Throughout life is shown a diet that eliminates these substances - silent, gluten-free food.
- If a child has concomitant diseases during the examination, treatment is complemented by other medicines, methods and approaches.
- Experts give a favorable forecast with such a diagnosis. Disorder is not dangerous for life, although it affects its quality. The future of the child directly depends not only on the form and the severity of the disease, but also from its timely detection, as well as from the correct therapy.
- It is important to remember that autism is not a sentence. If you create a special child to create comfortable conditions, he will be able to get a proper profession and will lead a normal lifestyle without any discomfort or problems. There are many examples when people with autism not only learn to control their condition, but also achieve success on a professional field. There is information that such pathology was even a scientist Charles Darwin, the director Stanley Kubrika and the former US President Thomas Jefferson.
- It is important to remember that psychological rehabilitation, competent and regular treatment becomes of particular importance. Only so you can adapt the child to society, teach him to communicate with others and provide your own needs.
- Autism Risk Factors: Genes, Environment, and Gene-Environment Interactions. Pauline Chaste, Marion Leboyer. Dialogues Clin Neurosci, 2012.
- Autism: Cause Factors, Early Diagnosis and Therapies. Shreya Bhat, U Rajendra ACHARYA, Hojjatadeli, G Muralidharbairy, Amir Adeli. Revneurosci, 2014.
- Does vaccination autistic cause? Golubev D.B. Epidemiology and Vaccinofilaxia, 2009. With. 63-34
Neurological disorders in children with autism. Zavadenko N.N., Probernikov N.L., Simashkova N.V., Zavadenko A.N., Orlova K.A. Russian Bulletin of Perinatology and Pediatrics, 2015. With. 14-21
Development of scientific ideas about autism. Nelyubina D.O. Education and problems of the development of society, 2019. p. 54-58
Diagnosis of child autism: mistakes and difficulties. Makarov I.V., Avthenyuk A.S. Social and clinical psychiatry, 2018. p. 74-81
Genetics of autism (review of foreign literature). Bobylova M.Yu., Printedry N.L. Russian Journal of Children's Neurology, 2013. 31-45
Children's autism: diagnosis, therapy, rehabilitation. Machrican.n. INTERNATIONAL SCIENTFIC REVIEW, 2016
A new theory about the causes of autism. Dimitrushkina L.I. Herald of Science and Education, 2019 Gender differences in children's autism. Klinkov V.N., Soyko V.V. Tauride magazine Psychiatry, 2015. With. 9-13
Early children's autism: problems and clinical observation. Emelyanova E.Yu., Ivanova T.I., Krachmaleva O.E., Sharamkova M.A. Omsk Psychiatric Magazine, 2019
General Autism is a disease for which disturbances of movements and speech, as well as the stereotype of interests and behavior, accompanied by a violation of the patient's social interactions with others. Data on the prevalence of autism will significantly differ, due to various approaches to the diagnosis and classification of the disease. According to various data, autistic excursions of the autistic spectrum suffers from 0.1-0.6% of children, autism, taking into account the disorders of the autistic spectrum - 1.1-2% of children. In girls, autism is revealed four times less frequently than that of boys. In the past 25 years, this diagnosis began to exhibit much more often, however, it is not clear what it is connected with a change in diagnostic criteria or with a real increase in the prevalence of the disease.
In the literature, the term "autism" can be interpreted in two ways - as self-autistic (children's autism, classical autistic disorder, Kanner syndrome) and as all the disorders of the autistic spectrum, including Asperger's syndrome, atypical autism, etc. The degree of severity of individual manifestations of autism can vary - From the complete inability to social contacts accompanied by severe mental retardation to some oddities when communicating with people, the pedanticity of speech and narrow interest. The treatment of autism is long, comprehensive, is carried out with the participation of specialists in the field of psychiatry, psychologists, psychotherapists, neurologists, defectologists and speech therapists.
Causes of the development of autism Currently, the causes of autism are not finalized, but it has been established that the biological basis of the disease is a violation of the development of certain brain structures. The hereditary nature of autism was confirmed, although genes responsible for the development of the disease, so far only have to be defined. Children with autism marked a large number of complications during pregnancy and in childbirth (intrauterine viral infections, toxmia, uterine bleeding, premature genera). It is assumed that complications during pregnancy cannot cause autism, but may increase the likelihood of its development in the presence of other predisposing factors.
Symptoms of autism
Among the close and distant relatives of children suffering from autism are revealed by 3-7% of patients with autism, which repeatedly exceeds the prevalence of the disease in an average of the population. The probability of the development of autism in both single-time twins is 60-90%. Relatives of patients often observed separate violations characteristic of autism: a tendency to obsessive behavior, a low need for social contacts, difficulties in understanding speech, speech disorders (including Echolalia). In such families, epilepsy and mental retardation are often detected, which are not mandatory signs of autism, but are often diagnosed with the disease. All of the above is a confirmation of the hereditary nature of autism.
In the late 90s of the last century, scientists managed to identify the predisposition gene to autism. The presence of this gene does not necessarily lead to autism (according to the majority of genetics, the disease develops as a result of the interaction of several genes). However, the definition of this gene made it possible to objectively confirm the inheritance nature of autism. This is a serious progress in the study of etiology and pathogenesis of this disease, since shortly before the discovery as possible autism as possible, some scientists considered a lack of care and attention from parents (this version is currently rejected, as not corresponding to reality).
Structural disorders of the brain.
According to studies, in patients with autistic, structural changes in the frontal departments of the cerebral cortex, hippocampus, the median temporal lobe and the cerebellum are often detected. The main function of the cerebellum is to ensure successful motor activity, however, this brain department also affects speech, attention, thinking, emotions and learning ability. Many autists have some cerebellum departments reduced. It is assumed that this circumstance may be caused by the problems of patients with autistic when switching attention.
The median temporal shares, hippocampus and the almond-shaped body, also often suffering from autism, have an impact on memory, learning ability and emotional self-regulation, including the emergence of a feeling of pleasure when performing significant social activities. Researchers note that animals with damage to the listed brain fractions there are changes in behavior similar to autism (reducing the need for social contacts, deterioration of adaptation when entering new conditions, difficulties in hazard recognition). In addition, the patients with autism often detects the slowdown in the ripening of frontal fractions.
Functional disorders of the brain.
Approximately 50% of patients with EEG have changed changes characteristic of memory violations, election and directional attention, verbal thinking and targeted use of speech. The degree of prevalence and severity of changes varies, with children with high-functional autism in EEG, as a rule, less pronounced compared to patients suffering from low-functional forms of the disease.
Mandatory signs of children's autism (typical autistic disorder, Kanner syndrome) are the lack of social interactions, problems in building a productive mutual contact with the surrounding, stereotype of behavior and interests. All listed features appear under the age of 2-3 years, while individual symptoms indicating possible autism are sometimes detected in infancy.
Violation of social interactions is the most striking sign that distinguishes autism from other developmental disorders. Children suffering from autism cannot fully interact with other people. They do not feel the state of others, do not recognize non-verbal signals, do not understand the subtext of social contacts. This feature can be detected already in babies. Such children are weakly reacting to adults, do not look into the eyes, you willingly fix the look at inanimate objects, and not on the people around you. They do not smile, react poorly to their own name, do not take advantage of the adult while trying to take them in hand.
Greater, patients do not imitate the behavior of others, do not react to the emotions of other people, do not participate in the interaction games, and do not show interest in new people. They are strongly tied to loved ones, but do not show their attachment as ordinary kids - do not rejoice, they do not run towards people, do not try to show adult toys or somehow share events from their lives. The withdrawal of autists is due not to their desire for loneliness, but with their difficulties because of the impossibility of building a normal relationship with others.
Patients later begin to speak, less and less too much, later begin to pronounce separate words and use a phrase speech. They often confuse pronouns, call themselves "you", "he" or "she". Subsequently, high-functional autists are "gaining" sufficient vocabulary and are not inferior to healthy children when testing tests on knowing words and spelling, however, it is difficult to try to use images, draw conclusions about written or read, etc. in children with low-fucked autism forms Speech is substantially depleted.
For children with autism, unusual gesticulation is characterized and difficulty trying to use gestures in the process of contacts with other people. In infancy, they rarely show hand to objects or, trying to point to the subject, they do not look at him, but on their own hand. Becoming older, they are less likely to say words during gestage (healthy children tend to gesticulate and speak at the same time, for example, stretching the hand and say "give"). Subsequently, it is difficult for them to play complex games, organically combine gestures and speech, move from simpler forms of communication to more complex. Another bright sign of autism is limited or repeating behavior. Stereotypes are observed - repeated rocking of the body, swinging heads, etc. Patients with autism very important so that everything always happens in the same way: the items were placed in the right order, the actions were performed in a certain sequence. The child, who suffers with autism, can start shouting and protest if his mother usually puts on his right toe first, and then left, and today he did on the contrary, if Solonka is not in the center of the table, but it is shifted to the right, but instead of the usual cup they put a similar one, but With another pattern. At the same time, unlike healthy children, he does not show desire to actively correct the not satisfying the position of things (reach to the right sock, rearrange the solonka, ask for another cup), and the methods available to it will signal the wrongness of what is happening.
Autist's attention is focused on details, on repetitive scenarios. Children with autism often choose not toys for games, but non-chamber items, their games are devoid of a plot base. They do not build locks, do not roll cars around the apartment, but lay out items in a certain sequence, aimlessly, from the point of view of an outside observer, move them from place to place and back. A child suffering from autism can be extremely strongly tied to a certain toy or non-chamber object, can at the same time at the same time look at the same TV show, without showing interest in other programs, and extremely intensively worry, if this program is intensively The reason could not see. Along with other forms of behavior, the repeating behavior includes autoagression (strikes, bites and other damage applied to itself). According to statistics, about a third of the autists during the lifetime exhibit autoagression and the same amount - aggression towards others. Aggression is usually due to the attacks of anger because of the violation of the usual life rituals and stereotypes or because of the inability to convey their desires to others.
The opinion on the mandatory genius of autists and the presence of some unusual abilities are not confirmed by the practice. Separate unusual abilities (for example, the ability to memorize parts) or talentedness in one narrow sphere during deficitivity in other areas (Savanism) are observed in only 0.5-10% of patients. The level of intelligence in children with high-function autism can be average or slightly above average. With low-functional autism, a decrease in the intelligence is often detected to mental retardation. With all types of autism, generalized insufficient learning is often observed. Among others, it is not obligatory, to fairly frequently found symptoms of autism worth noting the seizures (revealed in 5-25% of children, it is more often for the first time in a publity), hyperactivity syndrome and attention synthesis, various paradoxical reactions to external stimuli: touch, sounds, lighting changes . Often there is a need for sensory self-immovation (repetitive movements). More than half of the autists detect deviations in food behavior (refusal of food or refusal of certain products, preference for certain products, etc.) and sleep disorders (difficulty when falling asleep, night and early awakening).
Classification of autism There are several classifications of autism, however, in clinical practice, the most widely used classification of Nicolskaya, compiled, taking into account the severity of the manifestations of the disease, the main psychopathological syndrome and the remote forecast. Despite the absence of an etiopathogenetic component and a high degree of generalization, teachers and other specialists consider this classification of one of the most successful, since it makes it possible to draw up differentiated psychological correction plans and determine the objectives of the treatment with the real possibilities of a child suffering from autism.
Diagnosis of autism
The deepest disorders. Characteristically field behavior, mutism, lack of need in interactions with others, lack of active negativism, autostimulation using simple repetitive movements and inability to self-service. The leading pathopsychological syndrome is the extension. As the main objective of treatment, the establishment of contact, the involvement of the child in interaction with adults and peers, as well as the development of self-service skills.
The second group.
Characterized tough restrictions in the selection of forms of behavior, a pronounced desire for immutability. Any changes can provoke a breakdown, expressed in negativism, aggression or autoagression. In the usual environment, the child is open enough, capable of developing and reproducing household skills. Speech stamped, built on the basis of echolalia. The leading psychopathological syndrome is the reality reality. As the main objective of treatment, the development of emotional contacts with loved ones and expanding the possibilities of adaptation to the medium by developing a large number of different behavioral stereotypes is considered.