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. You can calm your child down only by giving him a 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 the diagnostic results and clinical picture, a diagnosis of autism spectrum disorder was made.
Autism spectrum disorders (ASD) are complex mental development disorders that are characterized by social maladjustment and inability to social interaction, communication and stereotypical behavior (multiple repetitions of monotonous actions).
Back in the middle of the last century, autism was a fairly 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.
Throughout the world, to this day, scientists studying the causes of autism have not come to a consensus. Many assumptions have been made. Among the possible factors for the appearance of this disorder in children, some hypotheses are mentioned:
Hypothesis about genetic predisposition
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 influence external factors: infections, chemical influences on the mother’s body during pregnancy, birth injuries, congenital metabolic disorders, the effects 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 the age of 3, they cannot 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 by 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.
Violations eating behavior : 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 ignoring real threats to life: a child can climb very high, play with sharp objects, or 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 with their hands), as well as stereotypical manipulations with objects (sorting through small parts, lining them up 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 most of the listed signs in an extreme degree of manifestation, or 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 different signs, 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 the outside world, stereotypic 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 in its mildest 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, developed logical thinking, and no impairments 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. Complex psycho correctional work, which includes all sections and types of rehabilitation assistance, which will be described below, is, along with drug therapy, an effective means of relieving the negative symptoms of ASD, and also contributes to the normal inclusion of the child in society. Types of ASD correction:
1) Psychological correction- the most common and famous type; quite characteristic wide range methods, of which the TEACCH and ABA therapy programs are the most widespread and recognized 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 training; 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 up.
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 medicinal assistance to kid. 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 medications 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, examination - electroencephalography, etc. As well as correction techniques, such as ABA therapy.
Ministry of Education of the Sakhalin RegionState Budgetary Institution "Center for Psychological and Pedagogical Assistance to Family and Children"
Psychological characteristics of children
Taste sensitivity.
Intolerance to many foods. The desire to eat inedible things. Sucking inedible objects, tissues. Inspecting the environment by licking.
Olfactory sensitivity.
Hypersensitivity to odors. Inspecting the surroundings using sniffing.
Proprioceptive sensitivity.
Tendency to autostimulation by tensing the body, limbs, hitting oneself on the ears, pinching them when yawning, hitting the head against the side of the stroller, the headboard of the bed. Attraction to play with an adult, such as spinning, spinning, tossing, inappropriate grimaces.
Intellectual development
The impression of unusual expressiveness and meaningfulness of gaze in the first months of life. The impression of “stupidity”, lack of understanding of simple instructions. Poor concentration, quick satiety. “Field” behavior with chaotic migration, inability to concentrate, lack of response to treatment. Overselectivity of attention. Over-concentration on a specific object. Helplessness in basic everyday life. Delay in the formation of self-service skills, difficulties in learning skills, lack of inclination to imitate the actions of others. Lack of interest in the functional significance of the object. A large stock of knowledge in certain areas for age. Love of listening to reading, attraction to poetry. The predominance of interest in shape, color, size over the image as a whole. Interest in the sign: the text of the book, letter, number, other symbols. Conventions in the game. The predominance of interest in the depicted object over the real one. Superordinate interests (to certain areas of knowledge, nature, etc.).
Unusual auditory memory (memorizing poems and other texts). Unusual visual memory (memorizing routes, the location of signs on a sheet of paper, a gramophone record, early orientation in geographical maps).
Features of time relationships: equal relevance of impressions of the past and present. The difference between “smartness” and intellectual activity in spontaneous and assigned activities.
Features of gaming activities
Play activity significantly determines the mental development of a child throughout his childhood, especially in preschool age, when plot-based role-playing play comes to the fore. Children with autism traits on none age stage They do not play story games with their peers, do not take on social roles, and do not reproduce in games situations that reflect real life relationships: professional, family, etc. They have no interest or inclination to reproduce this kind of relationship.
The lack of social orientation generated by autism in these children is manifested in a lack of interest not only in role-playing games, but also in watching films and television shows that reflect interpersonal relationships.
Development of role-playing games autistic child differs in a number of features. Firstly, such a game usually does not arise without special organization. Requires training and creation special conditions for games. However, even after special training, for a very long time only limited play actions are present - here is a child running around the apartment with a bubble; when he sees the bear, he quickly puts “drops” into his nose, voicing this action: “Bury his nose,” and runs on; throws dolls into a basin of water with the words “Pool - swim”, after which he begins to pour water into a bottle.
Secondly, the plot-role-playing game develops very gradually, and in its development it must go through several successive stages. Playing with other children, as usually happens normally, is initially inaccessible to an autistic child. At the initial stage of special education, an adult plays with the child. And only after long and painstaking work can you involve the child in the games of other children. At the same time, the situation of organized interaction should be as comfortable as possible for the child: a familiar environment, familiar children.
In addition to role-playing games in preschool age, other types of games are also important for children with autistic symptoms.
1. Each type of game has its own main task:
a child’s stereotypical play is the basis for interaction with him; it also makes it possible to switch if the child’s behavior gets out of control;
sensory games provide new sensory information, the experience of pleasant emotions and create the opportunity to establish contact with the child;
therapeutic games allow you to relieve internal tension, throw out negative emotions, identify hidden fears and, in general, are the child’s first step towards controlling his own behavior;
psychodrama is a way of dealing with fears and getting rid of them;
Joint drawing provides wonderful opportunities for an autistic child to be active and to develop his or her ideas about the environment.
In the future, different types of games are used alternately in different classes. At the same time, the choice of game often depends not only on the goals set by the teacher, but also on how the lesson proceeds and on the child’s reactions. This requires flexibility in using different games.
3. All games are interconnected and freely “flow” into one another. Games develop in close interconnection. Thus, during sensory play, therapeutic play can arise. In this case, a calm game develops into a violent outburst of emotions. In the same way, she can return to her previous calm course. In therapeutic play, the child’s old, hidden fears are revealed, which can immediately result in the enactment of psychodrama. On the other hand, in order to prevent the child from becoming overexcited during therapeutic play or psychodrama, at the right moment we have the opportunity to switch him to reproducing the actions of his stereotypical game or offer his favorite sensory game. In addition, it is possible to develop the same game plot in different types of games.
4. All types of games are characterized by general patterns:
repeatability;
the way “from the child”: it is unacceptable to force a game on a child, it is useless and even harmful;
the game will achieve its goal only if the child himself wants to play it;
Each game requires development within itself - the introduction of new plot elements and characters, the use of various techniques and methods.
Any voluntary activity in accordance with a set goal poorly regulates the behavior of children. It is difficult for them to distract themselves from immediate impressions, from the positive and negative “valence” of objects, i.e. on what makes them attractive to the child or makes them unpleasant. In addition, autistic attitudes and fears of a child with RDA are the second reason that prevents the formation of educational activities in all its integral components.
Depending on the severity of the disorder, a child with RDA can be educated either in an individual education program or in a mass school program. At school there is still isolation from the community; these children do not know how to communicate and have no friends. They are characterized by mood swings and the presence of new fears already associated with school. School activities cause great difficulties; teachers note passivity and inattention in lessons. At home, children perform tasks only under the supervision of their parents, satiety quickly sets in, and interest in the subject is lost. At school age, these children are characterized by an increased desire for “creativity.” They write poems, stories, compose stories in which they are the heroes. A selective attachment appears to those adults who listen to them and do not interfere with their fantasies. Often these are random, unfamiliar people. But there is still no need for active life together with adults, for productive communication with them. Studying at school does not develop into a leading educational activity. In any case, special correctional work is required to shape the educational behavior of an autistic child, to develop a kind of “learning stereotype.”
List of used literature
Karvasarskaya E. Conscious autism, or I lack freedom / E. Karvasarskaya. – M.: Publishing house: Genesis, 2010.
Epifantseva T. B. Handbook for a teacher-defectologist / T. B. Epifantseva - Rostov n/D: Phoenix, 2007
Nikolskaya O.S. Autistic child. Ways of help / O.S. Nikolskaya, E.R. Baenskaya, M.M. Liebling. – M.: Publisher: Terevinf, 2005.
Nikolskaya O.S. Children and adolescents with autism. Psychological support /O.S. Nikolskaya, E.R. Baenskaya, M.M. Liebling, I.A. Kostin, M.Yu. Vedenina, A.V. Arshatsky, O. S. Arshatskaya - M.: Publisher: Terevinf, 2005
Mamaichuk I.I. Help from a psychologist for children with autism. – St. Petersburg: Speech, 2007
Fundamentals of special psychology / ed. Kuznetsova L.V., Moscow, Academy, 2005
Manifestations of autism can be noticeable in infants (however, experts have not yet come to a consensus that these manifestations can be reliably characterized as ASD) and become more pronounced after a year. Symptoms of autism become obvious around the age of two or three. At this age, as a rule, it is possible to diagnose the presence of autism quite confidently. As the child gets older, most often the symptoms of autism begin to disappear or become less severe, but in most cases they remain noticeable to some extent.
Let's take a closer look at what you should pay attention to.
This is mainly a triad of violations, that is, in three areas:
Communication. How a person communicates with children and adults (social interaction disorders)
Communications. How a person speaks, uses gestures or facial expressions (communication disorders)
Behavior. How a person behaves (originality, limited and stereotypical interests and activities)
The symptoms listed below are for reference only. Of course, not all of them can be observed in a child with autism at the same time; in addition, some symptoms also occur in children without autism. But if some of these symptoms are observed in your child, this is a reason to consult a doctor.
Social interaction disorders
Disorders of social interaction are the most important symptoms autism. Often Small child with autism behaves as if he is tuned in to his own wavelength, he may not show interest in the games of other children and even stubbornly refuse to participate in common games, it can be difficult to interest him in something that an adult offers him, he does not repeat actions, movements and sounds for adults.
- The child may not notice whether parents are at home or at work, whether they have gone somewhere or returned home
- May become upset when an adult tries to join in his games
- Can sit alone in the crib and scream loudly, monotonously, instead of calling mom
- May not show interest in other children's games
- May not show interest in playing hide and seek and other games that involve interacting with other people
- It is often difficult to attract his attention to toys or books
- Doesn't smile back when you smile
- Doesn't respond to his name
- May clearly and desperately resist hugs, kisses and not allow himself to be picked up by either his parents or other people
Communication violations
Communication disorders are also a leading symptom of autism. Many children with autism begin to speak much later than others and may not use gestures.
Instead, they use other people's hands, lead adults to objects they want to interact with, or point at them with their mother's hand.
Other children may begin to speak early and remember many words, but do not use them to communicate.
For example, they repeat favorite quotes from cartoons and books or words and phrases heard from others over and over again. Often children with autism understand speech addressed to them less well. Often they also begin to follow instructions later than other children; it may seem that they do not hear the words addressed to them.
So, the most striking symptoms in the field of communication that are worth paying attention to:
- Avoid eye-to-eye contact
- Automatically repeat words not addressed to others (echolalia)
- Use an adult's "guided hand"
Behavioral disorders
The third group of symptoms required for a diagnosis of ASD is originality, limitedness and stereotyping of behavior, games and interests. Many children with autism play with toys in unusual ways (such as lining them up or throwing them around), may engage in frequent repetitive actions, become interested in unusual objects, or move in strange ways, such as flapping their arms, rocking in place, or running in circles. The manifestation of symptoms in this group is very diverse.
- Looking at objects (fan blades, air conditioners). The observer has the feeling that the child is “stuck with his gaze” and cannot tear himself away
- May have no interest in toys and may admire ordinary objects, such as a heater
- May not play with toys in the usual way, but is extremely interested in some part of the toy (for example, likes to spin a wheel on a car)
- The child may often spin around his own axis
- Frequently waves his arms repeatedly
- Arranging toys in a row; the creation of a series is valuable in itself, no plot can be traced
- Can spin objects, bringing them very close to the face
- May persistently try to eat inedible objects: clothes, sheets, mattress, curtains
- May fiddle, shake, or snap fingers in front of his eyes frequently or for long periods of time
- Rock often and for a long time, sitting still and doing nothing else
- Flick the switch endlessly, turning the lights on and off
Motor disorders
Motor skills are not the leading diagnostic criteria when diagnosing autism. But many parents and specialists note various variants of uneven motor skills in children with ASD. Some children may simultaneously demonstrate excellent body control in one area and be very awkward in another.
- Impaired judgment of distance to an object can also lead to motor clumsiness
- Walking on tiptoes
- Poor motor coordination – learning to walk up and down stairs can be very difficult for a child with autism
- Often the child cannot grasp and hold small objects with his hands
- Cannot ride a bicycle or pedal car
- Amazing ability to maintain balance and at the same time noticeable clumsiness
- Increased drooling may occur due to problems regulating the tone of the mouth and jaw muscles
Peculiarities of perception - heightened sensitivity
Children with autism can be very sensitive and have difficulty tolerating certain sensations: noise, music, flashing lights, the touch of clothing, smells, etc., that others find quite comfortable in intensity.
Hypersensitivity can manifest itself in all types of sensations, but sometimes concerns only certain stimuli. For this reason, children with autism may have a very difficult time in new situations or environments. The more varied stimuli there are, the more likely it is that the child will not cope with such a load and will lose control of himself.
- May show aversion to anything new or rare, such as candles on a birthday cake or balloons
- The child may be intolerant to touching the skin (resist being undressed or washed)
- May not tolerate touching the scalp and hair that is inevitable when cutting and washing hair
- May not tolerate music
- May appear deaf at times and not startle or turn around at loud noises, but at other times respond to normal or mild auditory stimuli
- May not tolerate common household odors, especially household chemicals
- May refuse to change clothes or put on any clothing except a few specific items
- May refuse seat belts in a child car seat
Self harm
In some cases, the desire for unusual sensations or reduced sensitivity to pain can lead to the child injuring himself and causing harm. This behavior is not very common, but the harm can be serious.
- May tear out his own hair in clumps
- May hit head hard on hard surfaces (floor, walls)
- Scratch and tear off skin and wound surfaces (crusts)
- May bite himself
Impaired sense of danger
Sometimes the sense of danger is impaired in autism. In this case, the child may behave as if he does not have the instinct of self-preservation, he does not recognize situations that require caution, he may strive for danger and violate safety rules in the same situation over and over again, despite previous negative experience. This behavior is also not very common; many children with autism, on the contrary, are fearful and anxious. If the child’s sense of danger is reduced, then he needs to be monitored very carefully: such behavior can lead to serious injuries.
Disorders gastrointestinal tract
Many children with autism experience frequent gastrointestinal disorders. The child agrees to eat an extremely limited range of foods and/or has increased sensitivity to the taste of food. Other symptoms: The child often has diarrhea. There is undigested food in the stool. The child often suffers from constipation
Sleep disorders
Many children with autism experience sleep disturbances. Children may not distinguish between day and night, remain equally active at any time of the day, they may be difficult to put to sleep, and they may wake up frequently during the night. Sleep periods can be very short: one to two hours. Pain sensitivity in children with autism may be reduced and even absent, or, on the contrary, it may be excessively high. Children with autism also experience seizures. The likelihood of developing epilepsy as a concomitant disease increases with age.
Intelligence
A significant proportion of people with autism have normal intelligence; often people with autism have amazing abilities in the field visual perception, memory, ear for music, mathematics and other sciences. Some people with autism find themselves in art due to their unusual view of the world. Contrary to popular myth, people with autism do not strive to live in their own world; on the contrary, many are very interested in communicating with others, are able to form deep emotional connections with people important to them, but do not have sufficient skills to communicate in the way that they do. peers.
Each person with autism is unique in their manifestations, and sometimes at first glance it is difficult to understand what unites people with autism spectrum disorders. Some (about 20–25%) never begin to speak and communicate using alternative methods of communication (gestures, exchanging cards or written text). As adults, they may require a lot of support and care and may not be able to live independently. Other people with autism develop speech and other social interaction skills and are able to attend school and enter higher education. educational establishments and work.
They need support in order to live, fully realize their capabilities, and cope with social challenges that are difficult for them. They need recognition and acceptance of their differences just like you and I, but many people with autism simply cannot live with dignity without this support.
Treatment
Early education, an individual approach to treatment, intensive therapy, and the participation of all family members in education lead to noticeable improvements in the development of most children with autism.
Help for children with autism
Treating autism is a process that requires individual approach to each child depending on the severity of his symptoms, as well as the presence of any disorders associated with autism and other disorders. Some children with autism need very intensive help to acquire basic social skills and to learn to speak. Many children, however, can independently learn complex skills and need more support, taking into account their peculiarities of perception and thinking, at school and at home, rather than in intensive therapy. The most effective method of correcting autistic disorders is considered behavioral therapy - a process of systematic and consistent training using prompts and encouragement of desired behavior. Development programs for children with autism based on behavioral therapy, especially if diagnosed early and assistance started early, help the child become more independent, capable of socially acceptable and age-appropriate behavior, and significantly improve the prognosis of his development and socialization.
Specialists involved in the development of speech, academic skills, psychologists, neuropsychologists and many other specialists can participate in helping children with autism, provided they have sufficient training and experience in the field of autism.
Autism in a child affects the entire family. Many parents of children with autism describe difficult experiences arising from their child's disorder, and may experience extreme stress due to challenging behavior or the need to constantly supervise their child. When planning assistance to the family, the condition of the adults who are with the child and the perception of the situation by his brothers and sisters must be taken into account. Often they may also need support and advice from specialists in order to maintain good relationships with each other, relax and enjoy life.
Article for the “bio/mol/text” competition: They see the world differently, do not like to interact with society, have “oddities” in behavior and speech disorders. Parents and educators often mistake them for gifted children with their own characteristics, but doctors have long ago determined their diagnosis - “ autism spectrum disorder" In this article, you will learn about what autism spectrum disorder is and what is known about the causes of its development.
The general sponsor of the competition is the Diaem company: the largest supplier of equipment, reagents and Supplies for biological research and production.
The audience award was sponsored by the Medical Genetics Center.
"Book" sponsor of the competition - "Alpina Non-Fiction"
If you know someone with autism,
then you know someone with autism.
Stephen Shore,
Professor at Adelphi University (USA),
has a diagnosis of autism
For the average person, when the term “autism spectrum disorder” (ASD) is mentioned, the image of the main character of the film “Rain Man” will most likely pop up in his head, and that’s probably all. In the post-Soviet space, the topic of ASD is not sufficiently covered, and diagnosis in most cases is far from perfect. The number of children with autism spectrum disorders increases every year around the world. Doctors talk about various reasons: an improved diagnostic system, suspicion of the influence of early vaccination, the harmful effects of the notorious GMOs, and even the older age of future fathers. So what is ASD and what have scientists already learned about the reasons for its development?
Autism spectrum disorder (ASD) is a nervous system disorder that is characterized by deficits in social interactions and communication with the presence of stereotypies(repetitive behavior) and, according to 2014 United States data, it affects one in 59 children. In Russia, the prevalence is one case per 100 children, but far fewer people receive an official diagnosis. ASD is diagnosed across all racial, ethnic, and socioeconomic groups and is five times more common in boys than girls. On this moment The causes of the disease are unknown, but it is thought to arise from a complex interaction between genetic, epigenetic and environmental factors (Figure 1).
Until May 2013, autism spectrum disorder was listed as an official diagnosis in the U.S. Diagnostic and Statistical Manual of Mental Disorders ( Diagnostic and statistical manual of mental disorders, DSM) included: autistic disorder, pervasive developmental disorder not otherwise specified (PPD-NOS), Asperger's syndrome, childhood disintegrative disorder and Rett syndrome. Today, in the latest, fifth edition of the DSM, there is only one diagnosis - "autism spectrum disorder" with three levels of severity, but many therapists, clinicians, parents and organizations continue to use terms such as BDD-NOS and Asperger's syndrome.
Symptoms
Autism spectrum disorder is often characterized by problems in patients' social, communication and intellectual abilities. Depending on age and intelligence, children with autism have noticeable varying degrees communication deficit. These deficits manifest themselves in speech delays, monotonous speech, echolalia(uncontrolled automatic repetition of words heard in someone else's speech), and also vary from poor understanding to complete absence oral speech. Nonverbal communication is also impaired and may include difficulty making eye contact and difficulty understanding facial expressions and gestures. Another important characteristic of people with ASD is a deficit in socio-emotional reciprocity (Figure 2).
Simply put, children with autism spectrum disorder are uninterested in interacting with people, have difficulty understanding people, like to adhere to various rituals, are prone to repetitive body movements, and may have language problems and delays in intellectual development. Various symptoms lead to significant impairment in many areas of adaptive functioning. At the same time, children with ASD often have many strengths: perseverance, attention to detail, good visual and mechanical memory, a tendency to monotonous work, which can be useful in some professions.
Medical history
German scientist Hans Asperger described a "milder" form of autism in 1944, which until today was known as Asperger's syndrome. He described cases of boys who were very smart but had problems with social interactions. He noted that the children had difficulties with eye contact, stereotyped words and movements, and resistance to change, but they did not have speech and language deficits. Unlike Kanner, Asperger also noted problems with coordination in these children, but at the same time more abilities for abstract thinking. Unfortunately, Asperger's research was not discovered until three decades later, when people began to question the diagnostic criteria used at the time. It was not until the 1980s that Asperger's work was translated into English, published and gained fame.
In 1967, psychiatrist Bruno Bettelheim wrote that autism has no organic basis, but is the result of being raised by mothers who consciously or unconsciously did not want their children, which in turn led to reticence in their relationships with them. He argued that the main cause of the disease was negative parental attitudes towards infants in the critical early stages of their development. psychological development.
Bernard Rimland, a psychologist and father of a child with autism, disagreed with Bettelheim. He couldn't accept the idea that his son's autism was either his parenting or his wife's. In 1964 Bernard Rimland published the work "Infantile autism: the syndrome and its consequences for the neural theory of behavior", which indicated the direction for further research at that time.
Autism became better known in the 1970s, but at that time many parents still confused autism with mental retardation and psychosis. Scientists have begun to clarify the etiology of the disease: a 1977 study of twins showed that autism is largely due to genetics and biological differences in brain development. In 1980, the diagnosis of infantile autism was first included in the Diagnostic and Statistical Manual of Mental Disorders (DSM); the disease is also officially separated from childhood schizophrenia. In 1987, the DSM replaced "infantile autism" with the broader definition of "autistic disorder" and included it in the third revision. At the same time, psychologist and Ph.D. Ivar Lovaas published the first study that showed how intensive behavioral therapy could help children with autism, giving parents new hope (Figure 3). In 1994, Asperger's syndrome was added to the DSM, expanding autism spectrum diagnoses to include milder cases.
In 1998, a study was published showing that the measles, mumps, and rubella (MMR) vaccine causes autism. The results of this study were disproved, but it attracted enough attention to cause confusion to this day (Figure 4). Not today no scientific evidence supporting the link between vaccination and ASD. It's sad, but just recently, in August 2018, a report came out saying that more than 50% of people in some European countries People still believe that vaccines cause autism.
Finally, in 2013, the DSM-5 combines all subcategories of the condition into one diagnosis of "autism spectrum disorder" and Asperger's syndrome is no longer considered a separate condition.
Causes of ASD
The exact cause of autism spectrum disorder (ASD) is currently unknown. It can arise as a result of genetic predisposition, environmental or unknown factors, that is, ASD is not etiologically homogeneous. There are likely many subtypes of ASD, each with a different origin.
Genetics
It is assumed that the development of ASD is largely due to the influence of genetic factors. Adding support for genetics as a cause is research showing that ASD is more common in boys than girls, most likely caused by genetic differences related to the Y chromosome. The theory is also supported by studies of twins with ASD, which determined concordance rates ( concordance- the presence of a certain trait in both twins) for monozygotic (60–90%) and dizygotic (0–10%) twins. High concordance in pairs of monozygotic twins and significantly lower concordance in pairs of dizygotic twins indicate a significant role of genetic factors. In a 2011 study, nearly 20% of infants with an older biological sibling with ASD also had ASD, and if there were more than one older sibling, the likelihood of being diagnosed with ASD was even higher.
The researchers estimate that there are 65 genes that are considered strongly associated with autism, and 200 genes that are less strongly associated with the diagnosis. Genome-wide association search ( genome-wide association studies, GWAS) confirms the contribution of shared allelic variance to ASD, including single nucleotide polymorphisms ( single nucleotide polymorphism, SNP) and gene copy number variations ( copy number variation, CNV) . When examining the parents of patients, a large contribution was found de novo CNV in RAS ( de novo mutations or variations- these are mutations that none of the family members had and appeared for the first time in the patient). According to 2014 data gene mutations de novo and CNVs influence the occurrence of the disease in approximately 30% of cases. A 2011 analysis of data from 1,000 families linked two chromosomal regions, 7q11.23 and 16p11.2, to autism, but in 2015 Sanders and colleagues, in a study of 10,220 people from 2,591 families, showed that CNVs in four more regions with the same may be true candidates for variations associated with autism. In September 2018, an article was published reporting that Japanese people with autism and schizophrenia have overlapping CNVs. Recent studies of ASD cohorts report relatively high mutation rates de novo in noncoding regions of the genome, as well as small mutations in the exome, that is, the coding regions of the genome that include both known and previously undetected candidate genes associated with ASD (Fig. 5).
Neurobiological factors
Genetic abnormalities can lead to abnormal mechanisms of brain development, which in turn leads to structural and functional, as well as cognitive and neurobiological disorders. Neurobiological differences associated with an ASD diagnosis include structural and functional brain pathologies, including:
Researchers in 2018 found that boys with ASD have smaller fractal dimension (a measure of the structural complexity of an object) in the right side of the cerebellum than healthy children.
Some studies focus on the hypothesis that disrupted interactions between brain regions are the main cause of ASD, while other researchers are studying molecular causes, such as disruptions in certain types of neurons (such as mirror neurons) or disturbances in neurotransmission (signal transmission between brain regions). neurons).
Other reasons
More and more researchers are writing about environmental causes that may contribute to autism. Research has identified a number of potentially hazardous substances that may be associated with the development of ASD: lead, polychlorinated biphenyls (PCBs), insecticides, automobile exhaust, hydrocarbons and flame retardants, but so far none of these substances has been proven to trigger the occurrence of ASD. RAS.
Interest in the role is also growing immune system in the etiology of the disease. In June 2018, it was reported that 11.25% of children with ASD have food allergies, which is significantly higher than the 4.25% of children with allergies without a diagnosis, adding to the growing body of evidence pointing to immunological dysfunction as a possible factor. risk for ASD.
There have also been recent studies that have linked deficiencies in the diet of pregnant mothers and the presence of elevated levels of pesticides in the blood with the diagnosis of ASD in their children.
Diagnostics
A child with developmental delays should be examined by a doctor to find the cause of the developmental delay. If a child exhibits any symptoms of autism spectrum disorder, he will most likely be referred to specialists for consultation, for example, a child psychiatrist, child psychologist, or pediatric neurologist.
Proper diagnosis requires consideration of the patient's complete history, physical examination, neurological examination, and direct assessment of the child's social, language, and cognitive development. Sufficient time should be allowed for standardized interviews with parents regarding current problems and behavioral history, as well as structured observation of social and communicative behavior and play.
According to a new 2018 study, a new blood test can detect about 17% of children with ASD. Scientists have identified a group of blood metabolites that could help detect some children with autism spectrum disorder. As part of the Metabolome project childhood autism(CAMP), the largest ASD metabolomics study, these results are a key step toward developing a biomarker test for ASD.
In August 2018, researchers reported differences in bacterial gene expression in the oral region that may distinguish children with ASD from their healthy peers. The study suggests that GI microbiome abnormalities previously identified in children with ASD may extend to the mouth and throat.
Researchers from the University of Missouri School of Medicine and the Center for Autism and Neurological Disorders. M.W. Thompson in June 2018 identified a link between neurotransmitter imbalances and patterns of connections between brain regions that play a role in social communication and language. The study described two tests that could lead to more accurate treatment.
Treatment
Treatments used in the 1960s and 1970s consisted of LSD, electric shocks, and severe control of the patient's behavior, which often included pain and punishment. It wasn't until the 1980s and 1990s that doctors began introducing more modern treatments for children with autism, such as behavioral therapy with an emphasis on positive reinforcement and supervised learning.
Today, treatment may include both psychotherapy and drug treatment. Many people with autism have additional symptoms, such as sleep disturbances, seizures, and gastrointestinal problems. Treatment of these symptoms may improve patients' attention, learning, and related behavior. Some medications used for other conditions help with certain symptoms: antipsychotics ( risperidone And aripiprazole), antidepressants, stimulants, anticonvulsants. Currently, risperidone and aripiprazole are the only medications approved by the FDA for symptoms associated with autism spectrum disorder, given the irritability often seen with this diagnosis. Children and adolescents with autism spectrum disorder appear to be more susceptible to side effects when using medications, so the use of small doses is recommended.
Non-drug treatments currently include applied behavior analysis, cognitive behavioral therapy, social skills training, sensory integration therapy, occupational therapy, and speech therapy.
Children with autism spectrum disorders may also have strengths. Their unique views on the world give other people the opportunity to see the world from a different perspective, and children with ASD can grow into talented and successful people who will make wonderful discoveries to improve our world. New research in the field of diagnosis and treatment of “rain children” gives these unusual children hope for more successful social adaptation and even recovery.
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