Brief explanations of what ASD is in general, L. Wing’s triad of disorders, weak central coordination (weak central coherence), theory of mind, programming and control functions (executive functions), etc.
What are autism spectrum disorders (ASD)?
The term autism spectrum disorder describes a range of developmental conditions that includes [classical] autism, high-functioning autism, and Asperger's syndrome. Regardless of the specific diagnosis, autism spectrum disorders are characterized by difficulties with social interaction, social communication, and mental flexibility. This is called the triad of disorders (Lorna Wing, 1996). The following description of the "triad of disorders" is adapted from Jordan (1997):
Social interaction - disturbance, delay or atypicality social development, especially the development of interpersonal relationships. Difficulty forming, maintaining, and understanding complex social relationships.
For example: may not participate in social interaction except to satisfy immediate needs; can play next to other children, but not share impressions; may strive for friendship but have difficulty understanding the desires and feelings of others; may have little or no empathy.
Speech and communication - impaired and unusual speech and communication, verbal and non-verbal. Unusual pragmatic and semantic aspects of speech, including speech use, meaning, and language grammar.
For example: may not develop speech; can use language only to describe needs; may speak freely but have difficulty understanding the full meaning behind an utterance; may be extremely literal in interpreting speech; may not recognize the intonation of others' speech; may speak in a monotone; may have difficulty with each type of turn-taking in conversation; may not identify gestures and body language as part of communication.
Thoughts and behavior - rigidity of thinking and behavior and poor social imagination. Ritualistic behavior, dependence on routines, extreme delay or lack of “role play.”
For example: may react negatively to any changes in routine or environment; can follow a set of ritual patterns; may have difficulty forming mental images of what something will look like; imaginative games may be missing; may have difficulty distinguishing between reality and fiction; may react negatively if rules are not followed.
In addition to the triad of disorders, people with autism spectrum disorder (ASD) also often have other difficulties related to: high anxiety; resistance to change; transferring skills from one environment to another; vulnerability; sensory information processing; poverty of diet and/or food; coordination; sleep; putting yourself in order; organization and planning.
What is the difference between [classic] autism, high-functioning autism and Asperger's syndrome?
A diagnosis of high-functioning autism is made when the triad of impairments is present, but there are no cognitive delays. A diagnosis of Asperger's syndrome is made when the triad of impairments is present, but there is no cognitive or language delay.
People with high-functioning autism and Asperger's syndrome therefore have an average or above average IQ. However, such individuals may still experience extreme deficits in the areas of social relationships, flexibility of thought and behavior, and speech and communication.
In addition to the triad of impairments, people with Asperger's syndrome have associated difficulties that include: using language that is too precise or stereotyped; limited nonverbal communication skills (facial expressions, gestures); social insensitivity; special interests that do not correspond to the interest of the listener.
My child sometimes covers his ears/squints his eyes and dislikes certain smells.
Many children with ASD have sensory problems. Some children are hypersensitive (oversensitive) and will try to block stimulation. Others are hyposensitive (low sensitivity) and will require stimulation. Children may often fluctuate between these two options.
Common signs include: walking on the tips of your fingers, pinching your ears, spinning, rocking, protest reactions to smells and tastes, aversion to skin touching certain materials, finger sniffing, intolerance to touch, avoidance of balancing activities, dislike of darkness or bright lights, attraction to light, moving fingers or objects in front of the eyes, love of vibration, insufficient or excessive reaction to heat/cold/pain, love of pressure, tight clothing, chewing and licking objects.
What is central coordination?
Central concordance is a current psychological theory first described by Uta Frith. It is the process by which all incoming stimuli are organized and interpreted in a coherent manner. Central coherence allows us to extract meaning and make connections between sets of perceived information.
Children with ASD often perceive stimuli as isolated parts. Details prevail over the overall meaning. Stimuli are not necessarily processed as related. Children can perceive things without interpretation or understanding.
Weakness of central coordination can cause many difficulties, for example: difficulty transferring skills learned in one environment to another; difficulty putting something together into a whole and making connections; difficulty understanding events; familiar surroundings may not be recognized when approaching from an unusual direction; insistence on monotony; Difficulty identifying relevant and irrelevant sensory information.
What is a model of mind?
By age 3 or 4, typically developing children begin to learn that other people have thoughts and feelings that are different from their own. Knowing this allows children to interpret the world through understanding people's actions. We understand other people's actions by being able to think about their beliefs, desires, intentions, and emotions.
Psychological research shows that some children with ASD do not develop ToM until adolescence, others do not fully develop ToM, and some may not develop ToM at all.
Poor development of ToM leads to difficulties in each area of the triad of impairments (social interaction, social communication, and mental flexibility).
For example: inability to predict the behavior of others; inability to understand others' plans for the future; inability to understand or predict the desires and/or intentions of others; difficulty reflecting on one's own behavior and the behavior of others; not responding when speaking; following your own sequence of operations.
What are programming and control functions?
Programming and control functions provide the ability to plan complex cognitive tasks. The frontal lobes of the brain are responsible for programming and control functions. They include activities such as: planning to achieve a goal; adhering to a strategy to achieve this goal; lack of distraction by other close but incorrect responses. Important in in this case are the ability to think about the sequence of events and their routine, flexibility of thinking and action, and general idea about causes and effects.
Children with ASD often have deficits in programming and control functions. Common problems relate to: self-organization and organization of supplies; planning; determining the sequence of movements (for example, for dressing, washing, cleaning, cooking); consistent thinking; impulsiveness.
What Causes Autism Spectrum Disorders?
The exact causes of autism spectrum disorders are not yet known, but research indicates the importance of genetic factors (Gillberg, K. and Coleman, M., 1992). It is unlikely that a single autism gene will be discovered, and it is estimated that at least a dozen genes may be involved. Other factors may relate to pregnancy/birth; be biological, neurochemical/brain chemistry, neurological (brain related).
Can ASD be cured?
ASD - pervasive developmental disorder; this means that it affects all aspects of a child's development. Autism spectrum disorder is now a lifelong condition.
What advantages do people with ASD have?
Thinking about ASD in a positive light can have a number of benefits for the individual. Again, they will change and can be refracted through the personality of each person.
People with Asperger's syndrome often have higher intelligence levels than the general population. People with ASD often have an enhanced memory for factual information and details; are concrete and logical thinkers; obviously honest; excellent visual learners; perfectionists; possess outstanding tenacity and determination, and a small number have special "savant" abilities.
The text is compiled according to
A child with autism spectrum disorder is characterized by the following developmental and behavioral features:
- difficulties in communication, which manifest themselves in the need to maintain the constancy of the surrounding world and stereotyping (meaningless, monotonous repetition) of phrases, words, movements, and one’s own behavior. Attempts to destroy these stereotypical living conditions of a child cause anxiety, aggression, or self-injury;
- the child does not engage in normal communication for his age. Visual attention is often selective or fragmentary (partial). Characterized by intolerance to eye contact - “running gaze”. The eyes see correctly, but the child does not pay attention to this, looks “through people”, “walks past people” and treats them as inanimate carriers of individual properties that interest him; does not notice anyone around, does not respond to questions, does not ask or ask for anything, avoids looking into the eyes of another person, often even the mother;
- violations of concentration (concentration) of attention and its rapid exhaustion are detected. There are sharp fluctuations in active attention, when the child is almost completely disconnected from the situation;
- All types of perception are accompanied by a feeling of unpleasantness. From early childhood, such a child has sensory and emotional hypersensitivity. This sensitivity initially leads to a state of agitation. In the future, it becomes difficult to attract the child’s attention; he does not respond to requests. Fears distort and deform the objectivity of perception of the world around us. Hence the desire to maintain the unchanged environment;
- intellectual disability is not obligatory in early childhood autism. Some children with early childhood autism have a high intellectual level. Such children can often have good intellectual capabilities and even be partially gifted in various areas. However, for them intellectual activity in general, disturbances in focus and difficulty concentrating are typical;
- well developed mechanical memory. They quickly memorize large poems and stories, but poorly understand their content and do not know how to use the memorized knowledge in practice;
- The content of the games is monotonous, the behavior in them is monotonous. Children can play the same game for years, draw the same pictures, perform the same stereotypical actions (turning the light or water on and off, etc.). Attempts by adults to interrupt these actions are often unsuccessful. The preschooler cannot play with peers; he plays “nearby”, but not together. But, at the same time, he shows a need for joint play when playing with children, formally follows the rules, has difficulty taking into account feedback (both emotional and plot), which irritates his peers, and this, in turn, increases the child’s insecurity. There is a characteristic preference for manipulating non-play objects, including household items that do not have play functions (stockings, laces, keys, reels, sticks, pieces of paper, etc.). Favorite ones are such monotonous manipulations as pouring sand and pouring water. The child is absorbed in the game, i.e. it is difficult to distract him from monotonous game actions. Monotonous games can last for hours, without the slightest sign fatigue;
- already in the first two years of life, speech disorders are quite pronounced and specific. Particularly characteristic is weakness or lack of reaction to the speech of an adult (does not respond to calls, does not fix his gaze on the speaking adult). Phrasal speech appears from 1 year to 3 years, but is mainly of a commentary nature. Involuntary repetition of sounds, words and phrases, and mutism are common. Lack of the pronoun "I". They talk about themselves in the second and third person;
- motor skills are characterized by pretentious movements (a special bouncing gait, running on tiptoe, bizarre grimaces and poses). The movements lack childlike plasticity, are clumsy, angular, slow, poorly coordinated, and give the impression of being “wooden” and puppet-like. Slowness is combined with impulsiveness (externally unmotivated movements that are unexpected for others: suddenly flinches, breaks out and runs, aimlessly grabs and throws objects, suddenly bites someone or hits for no reason), a tendency to grimace, unexpected and peculiar gestures.
If your child has these characteristics, he can attend preschool educational institutions(hereinafter - preschool educational institution) of a compensating type or an inclusive group of preschool educational institution, a group at PPMS centers, short-term stay groups.
It is difficult for an autistic child to establish contact with peers without the help of an adult, so accompanying him with a tutor (specialist) can become the main, if not the most necessary component that will lead to success in the socialization process.
Dear parents! It is necessary to remember that it is difficult for your child to adapt to a new situation, to a preschool institution; it is easier for him in a familiar, predictable environment, so he will behave better in class than during recess. The pace and productivity of activities is very uneven, so the child needs to individualize the curriculum.
The selection of effective drug therapy and timely treatment play an important role. It is possible to use play therapy techniques, behavioral therapy, and forms of therapeutic intervention such as hippotherapy. It is often necessary to include drug therapy, which can be prescribed and carried out exclusively by a psychiatrist. It is advisable to strictly adhere to the daily routine, presented in the form of symbols and pictograms, and to an ordered subject-spatial educational environment.
The prognosis for the development and adaptation of such a child depends not so much on objective factors as on his resource capabilities; it completely depends on the form and severity of the disease and is determined by a psychiatrist. Under favorable circumstances and optimal conditions, a child can successfully complete secondary school.
- Your child must be taken on excursions to public places, such as a store, pharmacy, zoo, hairdresser. Excursions evoke emotional and sensory experiences, which is important for your child.
- Thanks to the support of the emotional mode, time marking becomes possible. The regularity of the alternation of events of the day, their predictability, joint experience with the child of the past and planning for the future together create a time grid, thanks to which each strong impression for the child does not fill all of his living space and time, but finds some limited area in it. Then you can more easily survive what happened in the past and wait for what will happen in the future.
- Talking through the details of the day, their natural alternation makes it possible to more successfully regulate the child’s behavior than attempts to suddenly organize it - when the mother, for example, has time and energy.
Many autistic children love to listen to music, they perceive and understand it well, but they cannot perform simple dance movements, since such children experience enormous difficulties at all levels of the organization of motor action: disturbances in tone, rhythm, coordination of movements, and their distribution in space.
Therefore, your child may benefit from special individual program physical and musical development, combining work techniques in a free, playful and clearly structured form.
Playing sports is useful, as the child gets the opportunity to complicate his understanding of the meaning of what is happening, learn to understand what losing and winning are, to experience them adequately, and learns to interact with other children.
The child’s speech often suffers, especially its communicative function. At the initial stages of training, work on speech development should be aimed at creating the prerequisites for speech development - interest in the environment, objective activities, auditory attention and perception.
- If your child, without the help of an adult, does not know the gestures of attracting attention, request, denial, affirmation, joy, then it is necessary to conduct special classes on the formation of sign language, on the formation of his “I”.
- Very important for a child are activities to familiarize himself with the nursery. fiction. What is necessary is a slow, careful, emotionally rich development of the artistic images of people contained in these books, fairy tales, stories, the logic of their lives, and the relationships between people. This helps to improve understanding of oneself and others; it is important for the socialization of the child and his emotional stabilization.
- Stimulation of speech activity against the background of emotional upsurge. Interaction with the child against the background of increasing his tone can significantly facilitate the appearance of involuntary pronunciation of syllables, words, and sentences. The child is more likely to pick up on individual interjections and exclamations, but emotionally uttered by an adult. For example, when blowing soap bubbles - gurgle (glug-glug-glug), cues (more, clap, fly, catch-catch); when playing with water - drip-drip, splash; when the baby is rocking on a swing - swing-rocking, on a rocking horse - no-oh, yoke-go, gallop, image of the clatter of hooves, etc.
The words or fragments thereof reproduced by the child must be strengthened by repetition, adding little by little new words (but-oh, horse, gallop faster, etc.).
- When the baby is in a state of emotional upsurge, you should say lines for him that make sense to the situation, even if he is silent. For example, if he really wants something and it’s clear what it is, and he pulls the handle in the right direction, you need to say for him: “Give it to me,” “Open”; if he runs to his mother, inspired, with some object or toy in his hands: “Mom, look”; if you are about to jump from the table: “Catch me,” etc.
- It is known that an assistant to an adult trying to establish interaction with a child can be, first of all, the rhythmic organization of influences.
- To increase the child’s emotional tone, it is recommended to use pleasant sensory impressions, positive, strong experiences. To do this, of course, you need to know well the specific preferences of your child, his special interests, as well as what may cause his displeasure and fear.
- It is also necessary to carry out work on the development of productive activities (drawing, modeling, appliqué, design). We need to start with cultivating interest in these types of activities, interest in its process and as a result. You must sculpt, draw, build from cubes, perform appliqué in front of your child, then together, and then, following a model, play with buildings and crafts with him.
- We advise you to rationally use those objects and toys that arouse interest and a special emotional response in your child. It is necessary to carry out various games and exercises to get acquainted with visual materials (paints, plasticine, crayons, pencils).
- It is necessary to start learning to play with the simplest actions with toys. You should play with your child (rock, roll the doll in a stroller, feed, put to bed, etc.). When performing these actions with your child, you must pay attention to their sequence. Play can open access to a child’s heart and make him want to explore the world around him.
- Remember emotionally intense rhythmic games and movements often reduce movement disorders(violent jumping, swinging, etc.). But before introducing new stimuli into the play situation, it is necessary to find out what is unpleasant for the child - light or bright colors, etc., and protect him from their influences; it is necessary to revise familiar things and toys and remove those that cause negative emotional reaction or fears.
- Play various outdoor games with your child. In these games, the child can express himself (by screaming, laughing). In such games, a child learns about himself through an object and with the help of an object in motion and in time.
- The child must be taught self-care. the main role here belongs to you. A child often has difficulty learning the sequence of performing self-care skills, so it is necessary to support the child’s desire for independence in every possible way, teach him to eat carefully, dress, undress, use the toilet, and teach him to carry out individual tasks for caring for animals and plants.
- It is impossible to expect quick results from a child. They absorb information for a long time. Sometimes the result of the work can appear in a few months, or maybe in a year or two. Remember that a child is easily fed up with even pleasant impressions, often really cannot wait for what is promised, and is helpless in a situation of choice. This shouldn't scare you.
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 speech disorders, limited social communication and isolation are most clearly manifested.
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:
- disruption of 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;
- peculiarities of gait and movements, 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, seat her 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, they tend to concentrate when playing not on a 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 the child in his speech development ahead of his peers. 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 requiring symbolic and abstract thinking, as well as the inclusion of logic, are performed 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 autism lacks social contact, negative energy projected onto oneself: striking oneself, biting oneself are characteristic. 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 auto-aggression, there may be aggressive behavior directed at someone. 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. A peculiarity of the movements of an autistic child is a certain awkwardness and 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 a child does not have any disorders in the intellectual sphere, and he copes with learning, 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 drug 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, information, involvement in correctional work, assistance in organizing the spatio-temporal environment in which the child lives and develops, as well as creating 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.
Autism Spectrum Disorders (ASD) is a group of mental illnesses characterized by a distortion of the developmental process with a deficit of communication abilities, behavioral and motor stereotypies. The onset occurs in infancy and early childhood. Symptoms: inability to initiate and maintain interpersonal interactions, limited interests, repetitive monotonous actions. Diagnosis is carried out by observation and conversation. Treatment options include behavioral therapy, special training, and drug correction of behavioral and catatonic disorders.
ICD-10
F84 General disorders of psychological development
General information
In the International Classification of Diseases, 10th revision (ICD-10), autism spectrum disorders are not identified as a separate category, but are included in the heading F84 “General developmental disorders.” ASD includes childhood autism, atypical autism, Asperger's syndrome, other ontogenetic disorders, general disorder development unspecified. IN new version classifier (ICD-11), a separate diagnostic unit “Autism Spectrum Disorder” was introduced. ASD manifests itself in childhood - up to 5 years, and persists into adolescence and adulthood. The prevalence in children is 0.6-1%. According to epidemiological statistics of recent decades, the frequency of disorders throughout the world is gradually increasing.
Causes of ASD
Factors that can provoke autism spectrum disorders are divided into genetic and environmental. Depending on family history, the development of autistic disorders is 64%-91% determined by heredity. The mechanism of transmission of diseases from parents to children is not clear, but it has been established that the risk of developing pathology is highest in identical twins, slightly lower in fraternal twins, and even lower in siblings. Most genes associated with ASD determine the functioning of nervous system and the activity of proteins that influence the reproduction of genetic information. Other factors that increase the likelihood of autistic pathologies include:
- Floor. Boys are more susceptible to disorders. The epidemiological ratio between children of different sexes is 1:4.
- Metabolic and chromosomal diseases. The origin of ASD is associated with the genesis of fragile X syndrome, Rett syndrome, Down syndrome, phenylketonuria, tuberous sclerosis. Presumably, there are similar lesions of the central nervous system structures that determine the comorbidity of diseases.
- Prematurity. The influence of unfavorable factors during crisis periods in the formation of the central nervous system plays a certain role in the development of autistic disorders. Therefore, premature babies are at increased risk.
- Age of parents. The likelihood of ASD increases as the parents' age at conception increases. Most often, the disease affects children whose fathers are over 50 years old and whose mothers are over 35-40 years old. There is also a high risk for babies born to teenage mothers.
Pathogenesis
When considering the pathogenetic mechanisms, autism spectrum disorders are divided into endogenous and exogenous (atypical). The first group includes Kanner syndrome and procedural autism of the schizophrenic type. The peculiarity of these diseases is an asynchronous type of developmental delay, manifested by a violation of the hierarchy of mental, speech, motor functions and emotional maturity. There is distortion natural process displacement of primitive forms of organization by complex ones. Another development mechanism is observed when atypical autism within the framework of mental retardation and gross speech disorders. The features of dysontogenesis are close to severe mental retardation, specific for chromosomal and metabolic pathologies; there are no signs of asynchrony.
Research is underway into the pathogenesis of autistic diseases from the perspective of neuromorphology, neurophysiology and brain biochemistry. The ontogeny of the central nervous system includes several critical periods during which structural and functional qualitative changes occur, ensuring the formation of more complex functions. The peak of transformations occurs in infancy and early childhood: from birth to one year, from 1 to 3 years, from 3 to 6 years. The number of neurons in each area increases, the number of autoantibodies to nerve growth factor increases, the parameters of EEG activity change in a certain way, and the lysis of neurons in the visual cortex increases. The development of ASD occurs under the influence of unfavorable endo- and exogenous factors during critical periods. Presumably, there are one of three mechanisms of pathogenesis: loss of significant neuronal populations, arrest of neuroontogenesis, or inactivation of reserve cells of young brain regions.
Classification
In ICD-10, ASD includes eight nosological units: five of them are recognized as autistic by all specialists, while discussions are underway about the other three, the most rare ones. The classification is based on the features of etiopathogenetic mechanisms and clinical picture. The following types of disorders are identified:
- Childhood autism. Begins before age 3 but may be diagnosed later. Among the symptoms, the classic triad stands out: impaired social interactions, stereotypies, speech regression.
- An atypical form of autism. It differs from the previous form of the disorder by a later onset and/or absence of the entire triad of symptoms. Characteristic of persons with deep mental retardation, severe violation receptive speech.
- Rett syndrome. A genetic disease diagnosed in girls. Complete or partial loss of speech, ataxia, deep mental retardation, stereotypical circular movements hands. Interest in communication is relatively preserved, therefore this disorder not considered by all researchers to be classified as ASD.
- Disintegrative childhood disorder. Develops after 2 years of normal ontogenesis. Behavior similar to childhood autism and childhood schizophrenia. There are at least two regressions out of four: social skills, language, motor skills, bowel and bladder control. The question of classifying this pathology as ASD remains open.
- Hyperkinetic disorder with oligophrenia. The diagnosis is confirmed in cases of deep mental retardation with an IQ of up to 35 points, hyperactivity, decreased attention, and stereotypical behavior. The inclusion of this disorder in the ASD group is subject to debate.
- Asperger's disease. Speech and cognitive functions are better developed than in childhood autism. Distinctive characteristics– eccentricity, clumsiness, monotonous behavior patterns, concrete thinking, difficulties understanding irony and humor.
- Other common developmental disorders. Diseases characterized by stereotypies, qualitative deviations in social interactions, recurring interests. They cannot be unambiguously attributed to any of the diseases listed above due to the blurring or confusion of symptoms.
- Ontogenesis disorder, unspecified. It manifests itself in a wide range of cognitive and behavioral abnormalities, and impairment of social activity. Does not meet criteria for other ASDs.
Symptoms of ASD
Patients with autism spectrum disorders experience communication difficulties. They are not able to initiate and continue a dialogue, get close to people, sympathize, empathize, share emotions, or involve others in their ideas. In severe cases, the response to attempts by others to establish contact is completely absent. Features of thinking determine problems in understanding the sensory and role implications of relationships. Children do not make friends, refuse to play, or participate without being involved in play interactions or using their imagination. The function of communication is relatively preserved in Asperger's syndrome, but the concreteness of the patients' thinking and misunderstanding of facial expressions and intonations complicate the establishment of friendly relationships, and in adults, love-romantic relationships.
Another characteristic symptom most ASD - deviations in non-verbal communicative behavior. Patients avoid visual contact, do not use body language and speech intonation, and have problems understanding and using nonverbal means of communication. With special training, they can learn a small number of functional gestures, but their variety is much less than that of other people, and the spontaneity of use is lacking. Severe forms of the disorder are accompanied by a complete absence of eye contact, gestures, and facial expressions.
Patients' interests are limited and rigid. There is often a pathological attachment to objects - to toys or items from a collection, to personal utensils, furniture, clothing. Often there is a pathological reaction to incoming sensory signals - light, sound, touch, temperature change. The paradox of the answer lies in the fact that unpleasant influences, for example, pain, can be perceived calmly, but neutral ones - whispering, noise, twilight lighting - cause unpleasant sensations.
Stereotypes manifest themselves in simple actions, speech and complex behavior. Children run in circles, knock toys on hard surfaces, and line them up in a strict order. Adults perform rituals, are pathologically pedantic regarding the arrangement of things in the room, and feel the need for immutability and constancy (the arrangement of things, daily routine, walking route, strict menu). Verbal stereotypies are represented by verbal and phrasal echolalia - meaningless repeated repetition of words, last syllables, and endings of phrases.
Many patients have intellectual and speech disorders. Movement disorders are often detected - a shaky or angular gait, tiptoeing, and incoordination. With severe symptoms, self-harm of a stereotypical nature is present. Adults and teenagers are prone to depression and anxiety. At various forms disorders, catatan-like behavior is possible. In its most severe form, catatonia manifests itself as a complete lack of movement and speech, prolonged preservation of postures and waxy flexibility (catalepsy).
Complications
Patients need special developmental measures and rehabilitation. Without them, the quality of life deteriorates significantly: patients do not master the school curriculum (regular or correctional), do not interact with other people, and do not know how to use simple system gestures or other communication aids, such as PEX cards ( PECS). As a result, both adults and children need constant care and support and cannot even cope with everyday self-care rituals on their own. Untreated neurological symptoms, including cactatonic seizures, poorly coordinated gait, self-injurious stereotypic movements, lead to various kinds injuries. According to statistics, 20-40% of patients suffer physical damage, most of whom have an IQ score below 50.
Diagnostics
The diagnosis is made by a psychiatrist based on clinical examination data. Usually it is enough to observe the child’s behavior and emotional reactions, assess his ability to maintain contact, interview parents, identifying complaints and family history. To obtain more accurate and complete information Special techniques are used, for example, the Social Communication Questionnaire, the Childhood Autism Screening Test (M-CHAT), and the Autism Diagnostic Observation Algorithm (ADOS).
Additionally, a consultation and examination by a neurologist and psychological testing are prescribed, aimed at measuring intelligence, the level of development of social, cognitive and language skills. Differential diagnosis includes distinguishing ASD from selective mutism, speech disorders and social communication disorders, mental retardation without autistic symptoms, ADHD, stereotypic repetitive movements and schizophrenia. To make a diagnosis of autism spectrum disorder, a number of criteria must be identified:
- Deficits in communication and social interaction. The inferiority of these areas is stable and manifests itself in direct contact. The lack of emotional reciprocity, the impoverishment of non-verbal means of communication, the difficulties of establishing, maintaining and understanding relationships are determined.
- Stereotypes. In the structure of behavior, activity, and interests, limited and repetitive elements are revealed. It is necessary to identify at least two of the following symptoms: motor/speech stereotypies; rigidity of behavior, commitment to stability; limited anomalous interests; perverse responses to sensory input.
- Early debut. Symptoms must be present in early period development. But clinical picture does not appear when there are no corresponding environmental requirements.
- Deterioration of adaptation. The disorder impairs daily functioning. Reduced adaptation in family, school, and professional relationships.
- The symptoms are different from oligophrenia. Communication impairments cannot be explained solely by intellectual impairment. However, mental retardation is often combined with autistic disorders.
Treatment of ASD
Therapy for autism spectrum disorders is always multidisciplinary, including psychological and pedagogical support for the child/adult and family members, drug relief of acute symptoms, restorative and rehabilitation measures. The main goal of treatment is to develop the skills necessary for comfortable communication, independent functioning in everyday life and in the usual microsocial environment - in the family, classroom. Since ASD varies in clinical manifestations, the plan of therapeutic measures is drawn up individually. It may consist of several components:
- Behavioral therapy. The use of intensive behavioral methods, which are based on encouraging all forms of communication and constructive interaction, is common. One of the techniques is applied behavior analysis (). It is based on the gradual development of complex skills: speech, creative game, the ability to establish visual contact is broken down into small actions that are more accessible to the patient. The complexity of the operations is gradually increased by the teacher.
- Correction of speech and language. Speech therapy classes are conducted both in the classical form with the development of sounds, syllables, words and sentences, and in special program, the goal of which is to master any available means of communication. Patients are taught sign language, image exchange techniques, and the use of technical communication devices that generate speech based on symbols selected by patients on the screen.
- Physiotherapy. Massage therapists, physiotherapists, and exercise therapy instructors draw up and implement a treatment plan that helps patients compensate for motor deficits. Classes and sessions are aimed at replacing stereotypies with purposeful actions, eliminating ataxia and apraxia. Massage courses are prescribed, therapeutic exercises, physiotherapy with low-frequency currents.
- Drug therapy. For severe behavioral symptoms - rituals, self-harm, aggression - atypical antipsychotic drugs. To control mood disorders, antidepressants are indicated, in particular SSRIs, as well as mood stabilizers (valproate), and mild sedatives.
Prognosis and prevention
Prognostically, the most favorable forms of ASD are those not accompanied by mental retardation and severe speech disorders. Patients of these groups, with intensive medical, psychological and pedagogical support, overcome most of the symptoms of the disease, adapt relatively successfully to society, master a profession and engage in labor activity. In this regard, the highest percentage of positive outcomes is determined in patients with Asperger's syndrome. Prevention of autistic disorders has not been developed, because the leading etiological role is played by a genetic factor, and exogenous causes are speculative. Children at risk are recommended to be screened for developmental delays at 9 and 18 months, and at 2 and 2.5 years.
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 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 functional significance subject. 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
Gaming activity significantly determines mental development child throughout his childhood, especially in preschool age, when the plot-role-playing game comes to the fore. Children with autism traits do not play story games with their peers at any age, 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 to watching movies and television shows that reflect interpersonal relationships.
The development of role-playing play in an autistic child is distinguished by a number of features. Firstly, such a game usually does not arise without special organization. Training and the creation of special conditions for games are required. 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, splash 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 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 on the formation of the learning behavior of an autistic child, the development of 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
