Currently, the number of requests from parents regarding the “special” development of the child has increased. Sometimes these are already diagnosed children, but very often parents do not know the real problem or do not want to accept the fact that the child has autism spectrum disorder. They prefer to visit a psychologist or speech therapist, but not a psychiatrist. The thought of a child’s developmental abnormalities is frightening, sometimes causing a feeling of helplessness, and sometimes denial of the existing problem.
TV shows and movies shape some of our perceptions of people with autism. For example, we all remember “Rain Man” and the autistic hero from the movie “Cube,” both gifted in mathematics. The autistic boy from the movie Jupiter Ascending could decipher complex codes. The self-absorption of such people, their detachment from their surroundings arouses interest and even admiration.
But specialists working with them see something completely different: helplessness, dependence on loved ones, social inability and inappropriate behavior. Knowledge of the psychological picture of the disorder allows you to see the real state of affairs.
ASD is often diagnosed at age 3 years. It is during this period that the speech disorders, limited social communication and isolation.
Despite the fact that the symptoms of this disease are very diverse and depend on age, there are nevertheless certain behavioral traits that are common to all children with autism spectrum disorders:
- violation social contacts and interactions;
- limited interests and characteristics of the game;
- tendency to engage in repetitive behavior stereotypies);
- verbal communication disorders;
- intellectual disorders;
- impaired sense of self-preservation;
- gait and movement patterns, poor coordination of movements,
- increased sensitivity to sound stimuli.
Violation of social contacts and interactions
I is the main characteristic of the behavior of children with ASD and occurs in 100 percent. They live in their own world, are uncommunicative, and actively avoid their peers. The first thing that may seem strange to a mother is that the child practically does not ask to be held. Infants characterized by inertia and inactivity. They do not react as animatedly as other children to a new toy. They have a weak reaction to light and sound, and they may also rarely smile. The revitalization complex, inherent in all young children, is absent or poorly developed in children with ASD. Babies do not respond to their name, do not respond to sounds and other stimuli, which often imitates deafness. As a rule, at this age parents turn to an audiologist for the first time. The child reacts differently to an attempt to make contact. Attacks of aggression may occur and fears may develop. One of the most well-known symptoms of autism is lack of eye contact. However, it does not manifest itself in all children, but occurs in more severe forms. Sometimes a child can look as if through a person. Children with ASD have impaired emotional functioning. As the child grows, he can go deeper into his own world. The first thing that attracts attention is the inability to address family members. The child rarely asks for help and practically does not use the words “give” or “take.” He does not make physical contact - when asked to give up this or that object, he does not give it in his hands, but throws it. Thus, he limits his interaction with people around him. Most children also cannot tolerate hugs or other physical contact.
Limited interests and game features
. If the child shows interest, then, as a rule, it is in one toy or in one category (cars, construction toys, etc.), in one television program, cartoon. At the same time, children’s absorption in a monotonous activity can be alarming; they do not lose interest in it, sometimes giving the impression of detachment. When trying to tear them away from classes, they express dissatisfaction.
Games that require fantasy and imagination rarely attract such children. If a girl has a doll, she will not change her clothes, sit her down at the table and introduce her to others. Her play will be limited to monotonous actions, for example, combing this doll's hair. She can perform this action dozens of times a day. Even if a child does several actions with his toy, it is always in the same sequence. Children with ASD has difficulty understanding the rules of the game; when playing, they tend to concentrate not on the toy, but on its individual parts; it is difficult for them to replace some objects with others or use fictitious images in the game, since poorly developed abstract thinking and imagination are one of the symptoms of this disease.
Tendency to engage in repetitive actions (stereotypies) observed in almost all children with ASD. In this case, stereotypies are observed both in behavior and in speech. Most often these are motor stereotypies:
- pouring sand, mosaics, cereals;
- door swinging;
- stereotypical account;
- turning lights on and off;
- rocking;
- tension and relaxation of the limbs.
Stereotypes observed in speech are called echolalia. This can be manipulations with sounds, words, phrases. In this case, children repeat words heard from their parents, on TV or from other sources without realizing their meaning. For example, when asked “Shall we play?”, the child repeats “We will play, we will play, we will play.” These repetitions are unconscious and sometimes stop only after interrupting the child with a similar phrase. For example, to the question “Where are we going?”, Mom answers “Where are we going?” and then the child stops. Stereotypes in food, clothing, and walking routes are often observed. They take on the character of rituals. For example, a child always follows the same path, prefers the same food and clothes. Parents very often experience difficulties when buying new clothes and shoes, as the child refuses to try them on. new clothes, shoes or even going into a store.
Verbal communication disorders
to one degree or another, occurs in all forms of autism. Speech may develop delayed or not develop at all.
Sometimes even the phenomenon of mutism may be observed (complete lack of speech
). Many parents note that after the child begins to speak normally, he becomes silent for a certain time (a year or more). Sometimes, even at the initial stages, a child is ahead of his peers in his speech development. Then regression is observed - the child stops talking to others, but at the same time speaks fully to himself or in his sleep. In early childhood, humming and babbling may be absent. Children also use pronouns and addresses incorrectly. Most often they refer to themselves in the second or third person. For example, instead of “I’m thirsty,” the child says “he’s thirsty” or “you’re thirsty.” He also refers to himself in the third person, for example, “Vova needs a car.” Often children may use snippets of conversation heard from adults or on television, especially advertisements. In society, a child may not use speech at all and not answer questions. However, alone with himself, he can comment on his actions and declare poetry.
Also, the speech of children with ASD is often characterized by a peculiar intonation with a predominance of high tones at the end of sentences. Vocal tics and phonetic disorders are often observed.
Intellectual disorders
observed more thanin 70% of cases. This may be mental retardation or uneven mental development. A child with ASD exhibits difficulty concentrating and being goal-oriented. He also notes quick loss interest, attention disorder. Commonly accepted associations and generalizations are rarely available. An autistic child usually performs well on tests of manipulation and visual skills. However, tests that require symbolic and abstract thinking, as well as logic, perform poorly. Sometimes children show interest in certain disciplines and the formation of certain aspects of intelligence. The lower a child’s level of intelligence, the more difficult his social adaptation. Despite the decline in intellectual functions, many children learn basic school skills on their own. Some of them independently learn to read and acquire mathematical skills. Many people can retain musical, mechanical and mathematical abilities for a long time.
Intellectual disorders are characterized by irregularity, namely, periodic improvements and deteriorations. So, against the backdrop of the situationalstress
, diseases may experience episodes of regression.
Impaired sense of self-preservation
, which manifests itself as auto-aggression, occurs in one third of children with ASD. Aggression is one of the forms of response to various not entirely favorable life relationships. But since in autism there is no social contact, negative energy is projected onto oneself: hitting oneself, biting oneself are typical. Very often they lack a “sense of edge.” This is observed even in early childhood, when the baby hangs over the side of the stroller and climbs over the playpen. Older children may jump onto the road or jump from a height. Many of them do not consolidate negative experiences after falls, burns, or cuts. So, ordinary child Having fallen or cut yourself once, he will avoid this in the future. The nature of this behavior has been little studied. Many experts suggest that this behavior is due to a decrease in the threshold of pain sensitivity. In addition to self-aggression, aggressive behavior directed at someone can be observed. The reason for this behavior may be a defensive reaction. Very often it is observed if an adult tries to disrupt the child’s usual way of life.
Features of gait and movements. Children with ASD often have a specific gait. Most often, they imitate a butterfly, walking on tiptoes and balancing with their hands. Some people skip and jump. Features of movements autistic child there is a certain awkwardness, angularity. The running of such children may seem ridiculous, because during it they swing their arms and spread their legs wide.
Increased sensitivity to sound stimuli observed in most children with ASD. Any unusual sounds or loud noises cause anxiety and crying in the child.
Schoolchildren can attend as specialized educational establishments and general education schools. If the child does not have any disorders in intellectual sphere and he copes with his studies, then selectivity of his favorite subjects is observed. However, even with borderline or average intelligence, children have attention deficits. They have difficulty concentrating on tasks, but at the same time they are extremely focused on their studies. Reading difficulties are common (dyslexia). At the same time, in one tenth of cases, children with ASD demonstrate unusual intellectual abilities. These could be talents in music, art, or a unique memory.
A child psychiatrist should be contacted at the first suspicion of elements of autism in a child. Before testing the child, the specialist observes his behavior. Often the diagnosis of autism is not difficult (there are stereotypies, echolalia, there is no contact with the environment ). At the same time, making a diagnosis requires careful collection of the child’s medical history. The doctor is attracted to details about how the child grew and developed in the first months of life, when the mother’s first concerns appeared and what they are connected with.
A child with ASD should be under the supervision of a child psychiatrist and, if necessary, receive medication treatment. At the same time, classes with a defectologist, speech therapist, and psychologist will be useful.The task of a specialist at the initial stage of training is to establish emotional contact with the child and provide the child with new, positively colored sensory impressions. At the same time, it is preferable to start classes with a child with just such psychological work, and proceed directly to training only after the general psychological background of his development has improved.
in a certain place, at a certain time,
a place so that there are a minimum of objects in the child’s visual field (the table is facing the wall),
the teacher’s position is “next to” and not “opposite”,
formation and observance of rituals,
The lesson consists of blocks that are understandable to the child; he remembers in blocks, i.e. small volume, there should be a pause,
strengthening visual cues,
avoid overload with sensory stimuli,
there must always be a certain sequence,
alternating tasks that the child likes with educational ones,
accustom to assessment,
using a conditional “timer” (so that the child understands how many tasks need to be completed): cards, circles;
all actions are commented on and given meaning.
When organizing classes, it is important to arrange the space sensory in such a way as to prepare for reading, writing, and use the method of encouragement (an action that is pleasant for the child). At the initial stage, instead of grades, you can use pictures and stickers. When mastering abstract concepts, concrete reinforcement is needed. Keep in mind that Children with ASD learn not from their mistakes, but on a correctly performed action, he needs help in completing the task, not punishment.
The main task of our center’s specialists is to provide psychological support to parents, inform, attract correctional work, assistance in organizing the spatio-temporal environment in which the child lives and develops, as well as the creation of special conditions for classes.
Gradual introduction to new types of activities.
Working with your own anxiety (I. Mlodik “The Miracle in a Child’s Palm”).
Clear schemes, rituals.
Visual material, photographs.
Activation in middle classes.
Presentation of adequate requirements.
Expanding positive social experiences.
It is important for parents of a child with ASD to learn not to compare their child with other children. It is necessary to adequately assess the real level of his development, his characteristics and focus on the dynamics of the child’s achievements, and not on age norms.
Familiarization with working methods such as MAKATON,PECS, ABA therapy.
For those who are faced with this problem, it will be very useful to read the book by E.A. Yanushko "Games with an autistic child» is a generalization of experience working with autistic children, supported by knowledge of the unsatisfactory state of the organization of assistance to such children in our country. The main goal of the author ishelp with specific tips and recommendations for everyone who works with autistic children. Another, but less important goal isto help specialists who are faced with a case of early childhood autism for the first time. Another goal of the book isinformational: here are sources of information on this issue (literature, Internet resources), as well as institutions and organizations known to us where it is possible to obtain advice and assistance from specialists.
The article was prepared by educational psychologist E.S. Ermakova.
The autism spectrum is a group of disorders that are characterized by congenital impairments in social interactions. Unfortunately, such pathologies are often diagnosed in children. In this case, it is extremely important to determine the presence of a problem in time, because the sooner the child receives the necessary help, the greater the possibility of successful correction.
Autism spectrum: what is it?
The diagnosis of “autism” is on everyone’s lips these days. But not everyone understands what this term means and what to expect from an autistic child. Autism spectrum disorders are characterized by deficits in social interaction, difficulties in contact with other people, inappropriate reactions during communication, limited interest and a tendency towards stereotypy (repetitive actions, patterns).
According to statistics, about 2% of children suffer from such disorders. At the same time, girls are diagnosed with autism 4 times less often. Over the past two decades, cases of such disorders have increased significantly, although it is not yet clear whether the pathology is actually becoming more common or whether the increase is due to changes in diagnostic criteria (a few years ago, patients with autism were often given other diagnoses, such as schizophrenia).
Causes of development of autism spectrum disorders
Unfortunately, the development of the autism spectrum, the reasons for its appearance and a host of other facts remain unclear today. Scientists have been able to identify several risk factors, although there is still no complete picture of the mechanism of development of the pathology.
Early signs of autism
Is it possible to diagnose autism at an early age? Autism spectrum disorder does not often manifest itself in childhood. However, parents should pay attention to some warning signs:
It should be said right away that these signs are not absolute characteristics of autism. It often happens that children develop normally until they are 2-3 years old, but then regression occurs and they lose previously acquired skills. If you have any suspicions, it is better to consult a specialist - only a doctor can make a correct diagnosis.
Symptoms: what should parents pay attention to?
The autism spectrum can manifest in different ways in children. Today, there are several criteria that you must pay attention to:
Children with autism do not necessarily have all the symptoms listed above - each child has their own set of disorders, with varying degrees of severity.
Classification of autistic disorders (Nikolskaya classification)
Autism spectrum disorders are incredibly diverse. Moreover, research into the disease is still actively ongoing, which is why there are many classification schemes. Nikolskaya’s classification is popular among teachers and other specialists; it is this that is taken into account when drawing up correction schemes. The autism spectrum can be divided into four groups:
Asperger's syndrome
Asperger's syndrome is a form of high-functioning autism. This disorder differs from the classic form. For example, a child has a minimal delay in speech development. Such children easily make contact and can carry on a conversation, although it is more like a monologue. The patient can talk for hours about things that interest him, and it is quite difficult to stop him. Children are not against playing with their peers, but, as a rule, they do it in an unconventional way. By the way, there is also physical clumsiness. Often children with Asperger's syndrome have extraordinary intelligence and good memory, especially when it comes to things that interest them.
Modern diagnostics
It is very important to diagnose the autism spectrum early. The sooner the presence of disorders in a child is determined, the sooner correction can begin. Early intervention in a child's development increases the chance of successful socialization. If a child has the symptoms described above, you should contact a child psychiatrist or neuropsychiatrist. As a rule, children are observed in different situations: based on the symptoms present, a specialist can conclude that the child has autism spectrum disorder. Necessary consultations with other doctors, for example, an otolaryngologist, to check the patient's hearing. An electroencephalogram allows you to determine the presence of epileptic foci, which are often paired with autism. In some cases, genetic tests are prescribed, as well as magnetic resonance imaging (allows us to study the structure of the brain, determine the presence of tumors and changes).
Drug treatment for autism
Autism cannot be corrected with medication. Drug therapy indicated only if other disorders are present. For example, in some cases, your doctor may prescribe serotonin reuptake inhibitors. Such drugs are used as antidepressants, but in the case of an autistic child they can relieve increased anxiety, improve behavior, and increase learning ability. Nootropic drugs help normalize blood circulation in the brain and improve concentration. If epilepsy is present, anticonvulsant drugs are used. Psychotropic drugs are used when the patient has strong, uncontrollable attacks of aggression. Again, all of the above drugs are very powerful and the likelihood of developing adverse reactions if the dose is exceeded it is very high. Therefore, under no circumstances should they be used without permission.
Correctional work with children with autism spectrum disorders
What to do if a child is diagnosed with autism? A correctional program for children on the autism spectrum is developed individually. The child needs help from a group of specialists, in particular, classes with a psychologist, speech therapist and special educator, sessions with a psychiatrist, exercises with a physiotherapist (in case of severe clumsiness and lack of awareness of one’s own body). The correction occurs gradually, lesson by lesson. Children are taught to feel shapes and sizes, find matches, feel relationships, participate, and then initiate a story game. Children with autistic disorders are offered classes in social skills groups, where children learn to play together, follow social norms and help develop certain patterns of behavior in society. The main task of a speech therapist is to develop speech and phonemic hearing, increase vocabulary, and learn to compose short and then long sentences. Specialists also try to teach the child to distinguish between the tones of speech and emotions of another person. An adapted autism spectrum program is also needed in kindergartens and schools. Unfortunately, not all educational institutions (especially government ones) can provide qualified specialists to work with autistic people.
Pedagogy and learning
The main goal of correction is to teach the child social interaction, develop the ability for voluntary spontaneous behavior, and show initiative. Today, an inclusive education system is popular, which assumes that a child with autism spectrum disorders will study surrounded by normotypical children. Of course, this “implementation” occurs gradually. In order to introduce a child into a team, we need experienced teachers, and sometimes a tutor (a person with special education and skills who accompanies the child at school, corrects his behavior and monitors relationships in the team). It is likely that children with such disabilities will need training in specialized specialized schools. However, there are students with autism spectrum disorders in educational institutions. It all depends on the child’s condition, the severity of symptoms, and his ability to learn. Today, autism is considered an incurable disease. The forecast is not favorable for everyone. Children with autism spectrum disorders, but with an average level of intelligence and ability (develops up to 6 years) with proper training and corrections may well become independent in the future. Unfortunately, this does not always happen.
Autism spectrum disorders (ASD). Features of the development of a child with ASD
Autism is a special variant of atypical development in which communication impairment is dominant in the entire development and behavior of the child.
The clinical picture with this development is formed gradually by 2.5-3 years and remains pronounced until 5-6 years, representing a complex combination of primary disorders caused by the disease and secondary difficulties arising as a result of incorrect, pathological adaptation of both the child and the child to them. adults. Its main symptom, from the point of view of most researchers, is a special pathological state of the psyche, in which the child has a lack of need for communication, a preference for his own inner world any contact with other people, isolation from reality. A child with autism is immersed in the world of his own experiences. He is passive, withdrawn and avoids communication with children, does not look others in the eyes, and withdraws from physical contact. He doesn’t seem to notice other people, he seems to shield them, he doesn’t accept the pedagogical influence. Emotions are poorly differentiated, blurred, and elementary. Mental development varies from deep pathology to a relative, but insufficiently harmonious norm. Such children are characterized by monotonous, stereotypical, often unfocused physical activity, the so-called "field" behavior. Motor restlessness in the form of monotonous motor actions: rocking, tapping, jumping, etc. alternates with periods of inhibition, freezing in one position. Specific disorders of speech development may be observed (mutism, echolalia, verbal cliches, stereotypical monologues, absence of the first person in speech).
In addition to these specific diagnostic signs, children with autism often exhibit a number of other non-specific problems, such as fears (phobias), sleep and eating disorders, angry outbursts and aggressiveness. Self-harm (eg, wrist biting) is common, especially if there is concomitant severe mental retardation. Most children with autism lack spontaneity, initiative, and creativity in leisure activities, and have difficulty using general concepts when making decisions (even when completing tasks is well within their abilities). The specific manifestations of the defect characteristic of autism change as the child grows, but throughout adulthood this defect persists, manifesting itself in many ways with a similar type of problems in socialization, communication and interests. To make a diagnosis, developmental anomalies must be noted in the first 3 years of life, but the syndrome itself can be diagnosed in all age groups.
The term “autism” was introduced in 1912 by the Swiss psychiatrist E. Bleuler to designate a special type of affective (sensitive) sphere and thinking, which are regulated by a person’s internal emotional needs and have little dependence on the surrounding reality. Autism was first described by Leo Kanner in 1943, but due to the hyperisolation of children, this disorder has not yet been fully studied. Independently of L. Kanner, the Austrian pediatrician Hans Asperger described a condition that he called autistic psychopathy. In Russia, the first description of childhood autism was presented by S.S. Mnukhin in 1947, who put forward the concept of the organic origin of ASD.
Reason autistic disorders CNS insufficiency is usually noted, which can be caused by a wide range of reasons: congenital abnormal constitution, congenital metabolic disorders, organic damage to the central nervous system as a result of pathology of pregnancy and childbirth, early onset schizophrenic process, etc. The average incidence of autism is 5:10,000 with a clear predominance (1:4) of males. RDA can be combined with any other form of atypical development.
For a general type of violation mental development children with autism have significant individual differences. Among typical cases of childhood autism, one can distinguish children with four main behavioral patterns, differing in their systemic characteristics. Within the framework of each of them, a characteristic unity is formed of the means of active contact with the environment and surrounding people available to the child, on the one hand, and forms of autistic protection and autostimulation, on the other. What differentiates these models is the depth and nature of the autism; activity, selectivity and purposefulness of the child in contacts with the world, the possibility of its arbitrary organization, the specifics of “behavior problems”, the availability of social contacts, the level and forms of development of mental functions (the degree of disturbance and distortion of their development).
First group. Children do not develop active selectivity in contacts with the environment and people, which is manifested in their field behavior. They practically do not react to treatment and do not use either speech or nonverbal means of communication; their autism outwardly manifests itself as detachment from what is happening.
These children have almost no points of active contact with the environment and may not react clearly even to pain and cold. They don’t seem to see or hear and, nevertheless, using mostly peripheral vision, rarely hurt themselves and fit well into the spatial environment, fearlessly climb, deftly jump, and balance. Without listening, and without paying obvious attention to anything, their behavior can show an unexpected understanding of what is happening; loved ones often say that it is difficult to hide or hide anything from such a child.
Field behavior in this case is fundamentally different from the field behavior of an “organic” child. Unlike hyperactive and impulsive children, such a child does not respond to everything, does not reach, grab, or manipulate objects, but slides by. The inability to actively and purposefully act with objects is manifested in a characteristic violation of the formation of hand-eye coordination. These children can be fleetingly interested, but it is extremely difficult to attract them to a minimally developed interaction. When actively trying to concentrate the child voluntarily, he may resist, but as soon as the coercion stops, he calms down. Negativism in these cases is not actively expressed; children do not defend themselves, but simply leave, eluding unpleasant interference.
With such pronounced impairments in the organization of purposeful action, children have great difficulty mastering self-service skills, as well as communication skills. They are mute, although it is known that many of them can from time to time repeat after others a word or phrase that attracted them, and sometimes unexpectedly reflect what is happening in a word. These words, however, are without special assistance are not secured for active use, and remain a passive echo of what is seen or heard. In the obvious absence of active own speech, their understanding of addressed speech remains in question. Thus, children can show obvious confusion, misunderstanding of instructions directly addressed to them and, at the same time, occasionally demonstrate adequate perception of much more complex speech information not directly directed to them and perceived from the conversations of others.
When mastering communication skills using cards with pictures, words, and in some cases written speech using a computer keyboard (such cases have been repeatedly recorded), these children can show an understanding of what is happening much more complete than what is expected by others. They can also show abilities in solving sensorimotor problems, in actions with boards with inserts, with boxes of forms, their intelligence is also manifested in actions with household appliances, telephones, and home computers.
Having practically no points of active contact with the world, these children may not react clearly to a violation of constancy in the environment.
Discharges of stereotypical movements, as well as episodes of self-injury, appear in them only for a short time and in especially tense moments of disturbance of peace, in particular under pressure from adults, when the child is not able to immediately escape from them.
Nevertheless, despite the practical absence of active personal actions, we can still identify a characteristic type of autostimulation in these children. They use mainly passive methods of absorbing external impressions that soothe, support and nourish a state of comfort. Children receive them by moving aimlessly in space - climbing, spinning, jumping, climbing; They can sit motionless on the windowsill, absent-mindedly contemplating the flickering of lights, the movement of branches, clouds, the flow of cars; they experience special satisfaction on a swing, at the window of a moving vehicle. By passively using the developing capabilities, they receive the same type of impressions associated with the perception of movement in space, motor and vestibular sensations, which also gives their behavior a touch of stereotypy and monotony.
At the same time, even about these deeply autistic children it cannot be said that they do not distinguish a person from their surroundings and do not have a need for communication and attachment to loved ones. They separate friends and strangers, this is evident from the changing spatial distance and the possibility of fleeting tactile contact; they approach loved ones in order to be circled and tossed. It is with loved ones that these children show the maximum selectivity available to them: they can take a hand, lead them to the desired object and put an adult’s hand on it. Thus, just like ordinary children, these deeply autistic children, together with an adult, are capable of more active organization of behavior and more active methods of toning.
There are successful methods for establishing and developing emotional contact even with such deeply autistic children. The objectives of subsequent work are to gradually involve them in more and more extensive interaction with adults and in contacts with peers, to develop communication and social skills, and to maximize the realization of the opportunities for the emotional, intellectual and social development of the child that open up in this process.
Second group includes children at the next most severe stage of autistic dysontogenesis. Children have only the simplest forms of active contact with people, use stereotypical forms of behavior, including speech, and strive to scrupulously maintain constancy and order in the environment. Their autistic attitudes are already expressed in active negativism, and autostimulation in both primitive and sophisticated stereotypical actions - active selective reproduction the same familiar and pleasant impressions, often sensory and obtained through self-irritation.
Unlike the passive child of the first group, who is characterized by a lack of active selectivity, the behavior of these children is not field-oriented. They develop familiar forms of life, but they are strictly limited and the child strives to defend their immutability: here the desire to maintain constancy in the environment, in the usual order of life is maximally expressed - selectivity in food, clothing, walking routes. These children are suspicious of everything new, are afraid of surprises, can show pronounced sensory discomfort, disgust, easily and rigidly record discomfort and fear and, accordingly, can accumulate persistent fears. Uncertainty, an unexpected disruption in the order of what is happening, maladapt the child and can easily provoke a behavioral breakdown, which can manifest itself in active negativism, generalized aggression and self-aggression.
In familiar, predictable conditions, they can be calm, content and more open to communication. Within this framework, they more easily master social skills and use them independently in familiar situations. In developing a motor skill, such a child can show skill, even skill: often beautiful calligraphic handwriting, skill in drawing ornaments, in children's crafts, etc. The developed everyday skills are strong, but they are too tightly connected with the life situations in which they have developed, and special work is needed to transfer them to new conditions. Speech is typical in cliches; the child’s demands are expressed in words and phrases in the infinitive, in the second or third person, formed on the basis of echolalia (repetition of the words of an adult - “cover”, “want to drink” or suitable quotes from songs, cartoons). Speech develops within the framework of a stereotype, tied to certain situation, to understand it may require specific knowledge of how this or that stamp was formed.
It is in these children that motor and speech stereotypic actions (special, non-functional movements, repetition of words, phrases, actions - like tearing paper, flipping through a book) attract the most attention. They are subjectively significant for the child and can intensify in situations of anxiety: the threat of the appearance of an object of fear or a violation of the usual order. These can be primitive stereotypical actions, when the child extracts the sensory impressions he needs primarily through self-irritation or through stereotypical manipulations with objects, or they can be quite complex, such as the repetition of certain affectively charged words, phrases, stereotypical drawings, singing, ordinal counting, or even much more complex as a mathematical operation - it is important that this is a persistent reproduction of the same effect in a stereotypical form. These stereotypical actions of the child are important to him as autostimulation for stabilizing internal states and protecting him from traumatic impressions from the outside. With successful correctional work, the needs of autostimulation may lose their significance and stereotypical actions, accordingly, are reduced.
The formation of the mental functions of such a child is distorted to the greatest extent. What suffers, first of all, is the possibility of their development and use to solve real life problems, while stereotypical actions of autostimulation may reveal capabilities that are not realized in practice: unique memory, ear for music, motor dexterity, early discharge colors and shapes, aptitude for mathematical calculations, linguistic abilities.
The problem of these children is the extreme fragmentation of ideas about the environment, the limited picture of the world by the existing narrow life stereotype. Within the usual framework of ordered education, some of these children can master the program of not only auxiliary, but also mass schools. The problem is that this knowledge is acquired mechanically without special work and fits into a set of stereotypical formulations reproduced by the child in response to a question asked in the usual form. It must be understood that this mechanically acquired knowledge cannot be used by the child in real life without special work.
A child in this group may be very attached to to a loved one, but this is not quite an emotional attachment. Those close to him are extremely significant for him, but they are significant, first of all, as the basis for maintaining the stability and constancy in his environment that is so necessary for him. The child can tightly control the mother, demand her constant presence, and protest when trying to break the stereotype of the established contact. The development of emotional contact with loved ones, the achievement of freer and more flexible relationships with the environment and significant normalization of psycho-speech development are possible on the basis of corrective work on differentiation and saturation of the child’s life stereotype, meaningful active contacts with the environment.
Children of the first and second groups clinical classification belong to the most typical, classic forms of childhood autism, described by L. Kanner.
Third group. Children have developed, but extremely inert forms of contact with the outside world and people - quite complex, but rigid programs of behavior (including speech), poorly adapted to changing circumstances and stereotypical hobbies, often associated with unpleasant acute impressions. This creates extreme difficulties in interacting with people and circumstances; the autism of such children manifests itself as preoccupation with their own stereotypical interests and an inability to build dialogical interaction.
These children strive for achievement, success, and their behavior can formally be called goal-oriented. The problem is that in order to act actively, they need a complete guarantee of success; the experience of risk and uncertainty completely disorganizes them. If normally a child’s self-esteem is formed in indicative research activities, in the real experience of successes and failures, then for this child only stable confirmation of his success is important. He is little capable of research, flexible dialogue with circumstances and accepts only those tasks that he knows and is guaranteed to cope with.
The stereotyping of these children is expressed to a greater extent in the desire to maintain not so much the constancy and order of the environment (although this is also important for them), but rather the immutability of their own program of action, the need to change the program of action along the way (and this is what dialogue with circumstances requires) can provoke such child has an affective breakdown. Relatives, due to the desire of such a child to insist on his own at all costs, often evaluate him as a potential leader. This is a mistaken impression, since the inability to conduct a dialogue, negotiate, find compromises and build cooperation not only disrupts the child’s interaction with adults, but also throws him out of the children’s team.
Despite the enormous difficulties of building a dialogue with circumstances, children are capable of an extended monologue. Their speech is grammatically correct, detailed, with a good vocabulary can be assessed as too correct and adult - “phonographic”. Given the possibility of complex monologues on abstract intellectual topics, these children find it difficult to maintain a simple conversation.
The mental development of such children often makes a brilliant impression, which is confirmed by the results of standardized examinations. Moreover, unlike other children with ASD, their success is more manifested in the verbal rather than the non-verbal area. They can show an early interest in abstract knowledge and accumulate encyclopedic information on astronomy, botany, electrical engineering, genealogy, and often give the impression of “walking encyclopedias.” Despite brilliant knowledge in certain areas related to their stereotypical interests, children have a limited and fragmented understanding of the real world around them. They derive pleasure from arranging information in rows and systematizing it, but these interests and mental actions are also stereotypical, have little connection with reality and are a kind of autostimulation for them.
Despite significant achievements in intellectual and speech development, these children are much less successful in motor development - they are clumsy, extremely awkward, and their self-service skills suffer. In the field of social development, they demonstrate extreme naivety and straightforwardness, the development of social skills, understanding and consideration of the subtext and context of what is happening is disrupted. While the need for communication and the desire to have friends are preserved, they do not understand the other person well.
Characteristic is the sharpening of such a child’s interest in dangerous, unpleasant, asocial impressions. Stereotypical fantasies, conversations, drawings on “scary” themes are also a special form of autostimulation. In these fantasies, the child gains relative control over the risky impression that frightened him and enjoys it, reproducing it again and again.
At an early age, such a child may be assessed as over-gifted; later, problems are discovered in building flexible interaction, difficulties in voluntary concentration, and preoccupation with one’s own highly valuable stereotypical interests. Despite all these difficulties, the social adaptation of such children, at least outwardly, is much more successful than in the cases of the two previous groups. These children, as a rule, study under the public school program in a classroom setting or individually, and can consistently receive excellent grades, but they also urgently need constant special support, allowing them to gain experience in dialogical relationships, expand their range of interests and understanding of the environment and others, develop social behavior skills.
Children in this group can be clinically classified as children with Asperger syndrome.
Fourth group. For these children, voluntary organization is very difficult, but in principle accessible. In contact with other people, they quickly get tired, can become exhausted and overexcited, and have pronounced problems organizing attention, concentrating on verbal instructions, and fully understanding them. Characterized by a general delay in psycho-speech and social development. Difficulties in interacting with people and changing circumstances are manifested in the fact that, while mastering interaction skills and social rules of behavior, children stereotypically follow them and are at a loss when faced with an unprepared demand for their change. In relationships with people they show delayed emotional development, social immaturity, and naivety.
Despite all the difficulties, their autism is the least profound, and no longer acts as a defensive attitude, but as underlying communication difficulties - vulnerability, inhibition in contacts and problems organizing dialogue and voluntary interaction. These children are also anxious, they are characterized by a slight occurrence of sensory discomfort, they are ready to get scared when the usual course of events is disrupted, and become confused when there is a failure and an obstacle arises. Their difference is that they, more than others, seek the help of loved ones, are extremely dependent on them, and need constant support and encouragement. In an effort to gain the approval and protection of loved ones, children become too dependent on them: they behave too correctly, they are afraid to deviate from the developed and recorded forms of approved behavior. This manifests their inflexibility and stereotyping, typical of any autistic child.
The limitations of such a child are manifested in the fact that he strives to build his relationships with the world primarily indirectly, through an adult. With its help, he controls contacts with the environment and tries to gain stability in an unstable situation. Without mastered and established rules of behavior, these children organize themselves very poorly, are easily overexcited and become impulsive. It is clear that under these conditions the child is especially sensitive to a breakdown in contact and a negative assessment from an adult.
Such children do not develop sophisticated means of autostimulation; they have access to normal ways maintaining activity - they need constant support, approval and encouragement from loved ones. And, if children of the second group are physically dependent on them, then this child needs constant emotional support. Having lost contact with his emotional donor, translator and organizer of the meanings of what is happening around him, such a child stops in development and can regress to the level characteristic of children of the second group.
Nevertheless, with all the dependence on another person, among all autistic children, only children of the fourth group try to enter into a dialogue with circumstances (active and verbal), although they have enormous difficulties in organizing it. The mental development of such children proceeds with a more uniform lag. Characterized by awkwardness of large and fine motor skills, lack of coordination of movements, difficulties in mastering self-care skills; delay in the development of speech, its vagueness, lack of articulation, poverty of active vocabulary, late appearing, ungrammatical phrase; slowness, unevenness in intellectual activity, insufficiency and fragmentation of ideas about the environment, limited play and fantasy. Unlike children in the third group, achievements here are more manifested in the non-verbal area, perhaps in design, drawing, and music classes.
In comparison with the “brilliant”, clearly verbally intellectually gifted children of the third group, they initially make an unfavorable impression: they seem absent-minded, confused, and intellectually limited. Pedagogical examination often reveals in them a state borderline between mental retardation and mental retardation. When assessing these results, it is necessary, however, to take into account that children of the fourth group use ready-made stereotypes to a lesser extent - they try to speak and act spontaneously, and enter into verbal and effective dialogue with the environment. It is in these developmentally progressive attempts to communicate, imitate, and learn that they show their awkwardness.
Their difficulties are great, they are exhausted in voluntary interaction, and in a situation of exhaustion they may also experience motor stereotypies. The desire to answer correctly prevents them from learning to think independently and take initiative. These children are also naive, awkward, inflexible in social skills, fragmented in their picture of the world, and find it difficult to understand the subtext and context of what is happening. However, with an adequate correctional approach, they are the ones who provide the greatest dynamics of development and have the best prognosis for mental development and social adaptation. In these children we also encounter partial giftedness, which has prospects for fruitful implementation.
Thus, the depth of autistic dysontogenesis is assessed in accordance with the degree of impairment of the child’s ability to organize active and flexible interaction with the world. Identification of key difficulties in the development of active contact with the world allows us to build for each child the direction and sequence of steps of correctional work, leading him to greater activity and stability in relationships.
Early childhood autism(RDA) - unfortunately, in modern medicine there is still no clear definition of this diagnosis. This definition does not include any specific disorder or pathology of brain development, but a general set of behavioral symptoms and manifestations, the main of which are a decrease or absence of communicative functions, changes in the emotional background, social dysadaptation, limited interests, a set of stereotypical actions, and selectivity. And as a result, it often turns out that the concepts of “autism”, “early childhood autism” and “autism spectrum disorder” are used as synonyms, which is fundamentally incorrect.
Let us immediately make a reservation that autism, as a diagnosis, can only be given to a child at middle school age. Until this point, the child can only be diagnosed with early childhood autism, which, as a rule, manifests itself before the age of 3 years.
It is extremely important to draw a dividing line between the concepts of “autism spectrum disorder” and “early childhood autism”. This is important because the lack of clear differentiation between ASD and RDA leads to the fact that many children fail to provide effective assistance. Since the route of treatment and correction of the child depends on the correct diagnosis.
Early childhood autism (ECA).
This diagnosis refers to a deviation in mental development, which is manifested by a whole range of disorders associated with difficulties in building relationships with the outside world.
Over the past few years, the number of children with RDA has increased significantly. According to public data, the incidence of RDA is approximately 2-4 cases per 10,000. Conclusions about the causes of this disease are still quite contradictory. The origin of RDA is associated with complex biological factors such as genetic defects (2 to 3% of autistic people have a history of hereditary factor) or perinatal organic damage to the child’s central nervous system. Pregnant women in the early stages are primarily at risk; their bodies can be negatively affected by various factors, such as: some food components, alcohol, nicotine and drugs, medications, intrauterine infections, stress, pollution external environment, and also, according to some data, the electromagnetic field of megacities.
To make an accurate diagnosis and, as a result, select the correct correction programs, consultations with several doctors are required - first of all, a psychiatrist and a neurologist. An equally important role in diagnosis is assigned to a clinical psychologist (neuropsychologist, pathopsychologist) - a qualified specialist in the field of medical (clinical) psychology. This is a specialist whose competence includes the study of the higher mental functions of the child and his emotional sphere. A clinical psychologist has a wide range of diagnostic tools with which he can identify areas of memory, attention, thinking and communication that require correction. IN diagnostic examination A speech pathologist and speech pathologist must take part to model a complex of further correctional work. Since starting speech in a child with autistic traits is a very important task. After all, speech is the basis of communication and connection between a child and the outside world.
What's next?
Only an accurate diagnosis allows you to choose correct methods correction of speech and behavioral disorders. In both cases they will be fundamentally different. And understanding this is extremely important.
Early childhood autism is extremely difficult to compensate for, and, as a rule, children with such a disorder are taught social adaptation, such as: self-service skills, verbal (maximum) skills, and most likely non-verbal interaction with the outside world. This may be the development of kinesthetic skills (the ability to perceive one’s body, direction of movements, space), giving the child a non-verbal understanding of exactly what messages the world around him is sending him.
Often, the only way for autistic children to communicate and express themselves is through special PECS picture cards, with which they can communicate their desires and intentions. A fairly effective alternative to communication using PEX cards may be communication through writing. Such children, as a rule, understand letters very well and are quite capable of learning to write (typing). In our practice, we have had amazing results using this form of training. In many cases, the method of communication through writing can be translated (transformed) into verbal, produced speech.
In many cases of correction of behavioral disorders in early childhood autism, the use of ABA (applied behavior analysis) behavioral therapy works effectively.
Of course, drug therapy is necessary. In cases where it is chosen correctly, it gives rapid positive dynamics.
One of the most effective methods today is transcranial magnetic stimulation (TMS). This innovative methodology, widely used in rehabilitation in the West, allows you to use short-term magnetic pulses to activate nerve cells in the affected areas of the brain and “make them work.” This method is painless, non-invasive and has virtually no contraindications. With the help of TMS, it became possible to influence a child’s perception of the world around him in just 10-12 sessions.
Regarding autism spectrum disorder, here compensatory possibilities significantly wider. Compared to early childhood autism, ASD is much easier to correct, and the prognosis for significant positive changes is more favorable. On the one hand, working with ASD involves the use of many techniques that were described above. At the same time, one of the most big mistakes is the thoughtless copying of these methods (again in the absence of a correctly diagnosed diagnosis: ASD or RDA). In particular, we are talking about transferring a child with autistic traits to PECS cards. The reality, unfortunately, is that in 80% of cases such a child does not return to verbal communication in the future. Thus, it is advisable to start using PECS cards only from the age when all options have been tried and there is an understanding that it is impossible to teach a child verbal communication using other methods.
One of the most important moments in correctional work there is an interdisciplinary approach. Working with such children requires the joint interaction of several specialists at once. And here it is very important to understand that a disjointed, non-holistic approach risks the fact that each doctor individually begins to work on the problem from the perspective of only his own specialization, which greatly reduces the result and can lead to its absence altogether. The ideal solution is to use comprehensive program for the correction of speech and behavioral disorders “Neurohabilitation”, which is supervised by a specialist with several qualifications (neuropsychologist, pathopsychologist, clinical psychologist, defectologist). From the first consultation to the final result, the program director fully controls the interaction of drug therapy and corrective measures carried out by all specialists.
In conclusion, it is important to say that the biggest mistake in correctional work can be wasted time. At the first manifestation of the above symptoms, it makes sense to seek advice from an experienced neurologist as soon as possible. And if the diagnosis of RDA or ASD is confirmed, correction should begin immediately. You will need a lot of time and resources, but the results are worth it.
Often mothers come to the doctor with complaints about delayed speech development in their child. But in some children, with a close look, a specialist, in addition to this, sees features of the child’s behavior that differ from the norm and are alarming.
Let's look at a clinical example:
Boy S. Age 2 years 9 months. According to the mother, the child’s vocabulary is no more than 20 individual words consisting of two or three syllables. There are no phrases. The mother says that the child often has hysterics, is restless, and has difficulty falling asleep. The child's mother has no other complaints. During the examination, the doctor notices that the child does not look into the eyes, is constantly in motion, reacts by screaming if he is not given something or is forbidden. The only way to calm a child down is by giving him mobile phone or tablet. Shows interest not in children's toys, but more in shiny pieces of furniture and interior design. Starting to play something, he quickly loses interest and switches to something else. Questioning the mother, it turns out that the child is very selective in food. Not potty trained, defecates only in a diaper while standing. Has difficulty falling asleep and waking up during sleep. The child underwent electroencephalography and consultations with a clinical psychologist and speech therapist. Based on diagnostic results and clinical picture Diagnosed with autism spectrum disorder.
Autism spectrum disorders (ASD) are complex disorders mental development, which are characterized by social maladaptation and inability to social interaction, communication and stereotypical behavior (multiple repetitions of monotonous actions).
Back in the middle of the last century, autism was quite rare disease. But over time, more and more children began to appear suffering from this disorder. Statistics show that the incidence of ASD in children over the past 30-40 years in countries where such statistics are carried out has risen from 4-5 people per 10 thousand children to 50-116 cases per 10 thousand children. However, boys are more susceptible to this disease than girls (ratio approximately 4:1).
Causes of ASD.
All over the world, to this day, scientists studying the causes of autism have not come to a consensus. Many assumptions have been made. Among possible factors Some hypotheses for the appearance of this disorder in children include:
Genetic predisposition hypothesis
A hypothesis based on disorders of the development of the nervous system (autism is considered as a disease caused by disorders of brain development in the early stages of a child’s growth).
Hypotheses about the influence of external factors: infections, chemical effects on the mother’s body during pregnancy, birth injuries, congenital metabolic disorders, the influence of certain medications, industrial toxins.
But whether these factors can really lead to the appearance of autism in children has not yet been clarified.
Features of mental development of children with ASD.
To understand and recognize the presence of autism in a child, parents need to carefully monitor the child’s behavior and notice unusual signs that are not typical for the age norm. Most often, these signs can be identified in children under 3 years of age.
Childhood autism is considered as a developmental disorder that affects all areas of the child’s psyche: intellectual, emotional, sensitivity, motor sphere, attention, thinking, memory, speech.
Speech development disorders: At an early age, absent or weak humming and babbling may be noted. After a year, it becomes noticeable that the child does not use speech to communicate with adults, does not respond to names, and does not follow verbal instructions. By the age of 2, children have a very small vocabulary. By 3 years of age they are not able to form phrases or sentences. At the same time, children often stereotypically repeat words (often incomprehensible to others) in the form of an echo. Some children experience a lack of speech development. For others, speech continues to develop, but there are still communication impairments. Children do not use pronouns, addresses, or talk about themselves in the third person. In some cases, regression of previously acquired speech skills is noted.
Difficulties in communication and lack of emotional contact with others: Such children avoid tactile contact, visual contact is almost completely absent, there are inadequate facial reactions and difficulties in using gestures. Children most often do not smile, do not reach out to their parents, and resist attempts to be picked up by adults. Children with autism lack the ability to express their emotions, as well as recognize them in others. There is a lack of empathy for other people. The child and the adult do not focus on one activity. Children with autism do not make contact with other children or avoid it, they find it difficult to cooperate with other children, and most often they tend to withdraw (difficulties in adapting to the environment).
N violation of research behavior: children are not attracted to the novelty of the situation, are not interested in the environment, and are not interested in toys. Therefore, children with autism most often use toys in an unusual way; for example, a child may not roll the entire car, but spend hours monotonously spinning one of its wheels. Or not understanding the purpose of the toy to use it for other purposes.
Eating disorders: a child with autism can be extremely selective in the foods offered; food can cause disgust and danger in the child; often children begin to sniff the food. But at the same time, children may try to eat an inedible thing.
Violation of self-preservation behavior: Due to a large number of fears, the child often finds himself in a situation that is dangerous for himself. The cause can be any external stimulus that causes an inadequate reaction in the child. For example, a sudden noise may cause a child to run in a random direction. Another reason is ignorance real threats life: a child can climb very high, play with sharp objects, run across the road without looking.
Motor development disorder: As soon as the child begins to walk, awkwardness is noted. Also, some children with autism are characterized by walking on their toes, and there is a very noticeable lack of coordination of arms and legs. It is very difficult for such children to teach everyday actions; imitation is quite difficult for them. Instead, they develop stereotypical movements (performing monotonous actions for a long time, running in circles, swinging, flapping “like wings” and circular movements hands), as well as stereotypical manipulations with objects (sorting through small parts, arranging them in a row). Children with autism have significant difficulty mastering self-care skills. Motor clumsiness is pronounced.
Perception disorders: difficulties in orientation in space, fragmentation in the perception of the environment, distortion of the holistic picture of the objective world.
Difficulty concentrating: Children have difficulty focusing attention on one thing; there is high impulsiveness and restlessness.
Bad memory: Often, parents and specialists notice that children with autism are good at remembering what is meaningful to them (this can cause them pleasure or fear). Such children remember their fright for a long time, even if it happened a long time ago.
Features of thinking: Experts note difficulties in voluntary learning. Also, children with autism do not focus on understanding the cause-and-effect relationships in what is happening, there are difficulties in transferring acquired skills to a new situation, and concrete thinking. It is difficult for a child to understand the sequence of events and the logic of another person.
Behavioral problems: negativism (refusal to listen to an adult’s instructions, perform joint activities with him, leaving a learning situation). Often accompanied by resistance, screaming, and aggressive outbursts. A huge problem is the fears of such children. They are usually incomprehensible to others because children often cannot explain them. The child may be frightened sharp sounds, some specific actions. Another behavioral disorder is aggression. Any disorder, violation of a stereotype, interference of the outside world in a child’s life can provoke aggressive (hysteria or physical attack) and auto-aggressive outbursts (damage to oneself).
Each case of the disease is very individual: autism may have the majority listed signs to the extreme degree of manifestation, and may manifest itself only in some barely noticeable features.
Diagnosis of autism spectrum disorders
To diagnose autism, experts use the criteria of 2 international classifications: ICD-10 and DSM-5.
But the main three criteria (“triad” of violations) that can be identified are:
Violation of social adaptation
Communication disorders
Stereotypical behavior
The main diagnostic stages include:
Examination of the child by a psychiatrist, neurologist, psychologist
Observing the child and completing the Autism Rating Scale, which can be used to determine the severity of the disorder
Conversation with parents
Filling out questionnaires by parents - “Questionnaire for diagnosing autism”
Types of ASD
There are several current classifications of ASD, and the division often occurs according to completely different criteria, which, naturally, can bring some inconvenience to a person who initially has little knowledge of medicine or psychology; therefore, the most basic and frequently encountered types of ASD in practice will be highlighted below: - Kanner syndrome (Early childhood autism) - characterized by a “triad” of main disorders: difficulty establishing contacts with outside world, stereotypical behavior, as well as delay or impairment of communicative functions of speech development. It is also necessary to note the condition for the early appearance of these symptoms (up to about 2.5 years)
It manifests itself in children in 4 forms, depending on the degree of isolation from the outside world:
Complete detachment from what is happening. This group is characterized by a lack of speech and the inability to organize the child (make eye contact, ensure that instructions and assignments are followed). When trying to interact with the child, he demonstrates the greatest discomfort and disruption of activity.
Active rejection. Characterized by more active contact with the environment than the first group. There is no such detachment, but there is a rejection of a part of the world that is unacceptable to the child. The child exhibits selective behavior (in communicating with people, in food, in clothing)
Preoccupation with autistic interests. It is characterized by the formation of overvalued preferences (for years a child can talk on the same topic, draw the same plot). The gaze of such children is directed at the person’s face, but they look “through” this person. Such children enjoy the stereotypical reproduction of individual impressions.
Extreme difficulty in organizing communication and interaction. Autism at its most mild form. Children are characterized by increased vulnerability; contact with the world ceases at the slightest sensation of obstacles. You can make eye contact with these children
Asperger's syndrome. Formed from birth. Children have an early onset of speech development, a rich vocabulary, well-developed logical thinking, no violations are noted in mental development. But at the same time, the communicative side of speech suffers: such children do not know how to establish contact with other people, do not listen to them, can talk to themselves, do not keep a distance in communication, and do not know how to empathize with other people.
Rett syndrome. Its peculiarity lies in the fact that the development of a child up to 1-1.5 years proceeds normally, but then the newly acquired speech, motor and subject-role skills begin to disintegrate. This condition is characterized by stereotypical, monotonous movements of the hands, rubbing and wringing of the hands, which are not of a purposeful nature. The rarest of the diseases presented, almost always occurring only in girls.
Childhood psychosis. The first manifestations of symptoms are before 3 years of age. Characterized by disturbances in social behavior and communication disorders. There are stereotypies in behavior (children run monotonously in circles, sway while standing and sitting, move their fingers, shake their hands). Such children have eating disorders: they can swallow food without chewing. Their unclear speech can sometimes be an incoherent set of words. There are times when children freeze in place, like dolls.
Atypical autism. It differs from autism in age-related manifestations and the absence of one criterion from the “triad” of basic disorders.
Correction of patients with ASD
One of the most important sections of habilitation for children with ASD is undoubtedly the provision of psychocorrectional and social rehabilitation assistance, with the formation of social interaction and adaptation skills. Comprehensive psychocorrectional work, which includes all sections and types of rehabilitation assistance, which will be described below, is, along with drug therapy, an effective means of relief negative symptoms ASD, and also contributes to the child’s normal inclusion in society. Types of ASD correction:
1) Psychological correction is the most common and well-known type; characterized by a fairly wide range of techniques, of which the TEACCH and ABA therapy programs have received the most widespread and recognition in the world.
The first program is based on the following principles:
The characteristics of each individual child are interpreted based on observations of him, and not from theoretical concepts;
Adaptation is increased both by learning new skills and by adapting existing ones to the environment;
Creation individual program education for every child; use of structured learning; holistic approach to intervention.
The second program relies heavily on learning that depends on the consequences that arise after the behavior. Consequences can be in the form of punishment or reward. In this model, it is necessary to highlight the main methods, such as the procedure for creating a contour and reinforcing behavior similar to the target; method of teaching chains of behavior; method of teaching stimulus discrimination.
2) Neuropsychological correction - this type includes a set of classes consisting of stretching, breathing, oculomotor, facial and other exercises for the development of the communicative and cognitive sphere, and the classes themselves differ markedly in time and quantity.
3) Working with the child’s family and environment - first of all, this type of correction is aimed at mitigating emotional tension and anxiety among family members, since often parents of children with ASD also need help, including psychotherapeutic support and training programs (such programs are aimed mainly at developing a sense of understanding of the problem, the reality of its solution and the meaningfulness of behavior in the current family situation).
4) Psychosocial therapy - in fact, work with the child himself on the formation of cognitive, emotional and motivational-volitional resources of the individual for the possibility of further social adaptation, the need for which becomes more and more apparent as the child with ASD grows older.
5) Speech therapy correction - given the fact that impaired speech development is one of the cardinal manifestations of ASD, this type of work with the child will be an integral part of the correction program. It is characterized by a focus on the formation of vocabulary, the development of auditory attention, as well as phonetic and speech hearing.
6) Drug correction of ASD. Some forms of autism require medication for the child. For example, to improve concentration and perseverance, a doctor may prescribe vitamins and nootropic medications that improve thinking processes and stimulate speech development. And with high impulsiveness, aggression, negativism, and pronounced signs of “withdrawal,” psychotropic drugs can help. In some cases, Autism is combined with epileptic seizures. In such cases, drugs to prevent attacks are needed. Many mothers are afraid of medications. But medications are prescribed for a certain period, and not forever. Adverse events from medicines are rare. And the result of the effect in most cases is worth the courage of the parents. In each case, it is necessary to individually decide what kind of therapy is needed. And the doctor must be able to clearly explain to parents all questions regarding medications.
In the Children's diagnostic center Domodedovo has all the facilities for diagnosing autism spectrum disorders. Such as: examination by a pediatric neurologist, clinical psychologist, speech therapist, conducting examinations - electroencephalography, etc. As well as correction techniques, such as ABA therapy.
