Often mothers come to the doctor with complaints about the delayed speech development in the child. But for some children, when looking closely at a specialist, in addition to this, he sees features of the child’s behavior that are different from the norm and alarming.
Consider a clinical example:
Boy S. Age 2 years 9 months. According to mom, the child’s vocabulary is no more than 20 separate words consisting of two or three syllables. Phrase no. Mom says that the child is often hysterical, restless, difficult to sleep. The mother does not make any other complaints. On examination, the doctor notices that the child does not look into his eyes, is always in motion, reacts with a cry if he is not given something or denied it. You can soothe a child only by giving him a mobile phone or tablet. Shows interest not in children’s toys, but more in brilliant pieces of furniture and interior. Starting to play something, quickly loses interest and switches to another. Asking the mother, it turns out that the child is very selective in eating. Not accustomed to the pot, defecation only in diapers in a standing position. He falls asleep badly and wakes up during sleep. The child underwent electroencephalography and consultations with a clinical psychologist and speech therapist. According to the results of the diagnosis and the clinical picture, a diagnosis was made – Autistic Spectrum Disorder.
Autism Spectrum Disorders (ASD) are complex disorders of mental development, which are characterized by social maladjustment and inability to social interaction, communication and stereotyped behavior (multiple repetitions of the same actions).
Back in the middle of the last century, autism was a rather rare disease. But over time, more and more children suffering from this disorder began to appear. Statistics show that the frequency of occurrence of ASD in children over the past 30-40 years in countries where such statistics are conducted has risen from 4-5 people per 10 thousand children to 50-116 cases per 10 thousand children. At the same time, boys are more susceptible to this disease than girls (a ratio of about 4: 1).
Causes causing ASD.
All over the world, until today, scientists studying the causes of autism have not come to a common opinion. Set many assumptions. Among the possible factors for the appearance in children of this disorder are some hypotheses:
– hypothesis of genetic predisposition
– a hypothesis based on impaired development of the nervous system (autism is considered as a disease caused by impaired brain development in the early stages of a child’s growth).
– hypotheses about the influence of external factors: infections, chemical effects on the mother’s body during pregnancy, birth trauma, congenital metabolic disorders, the effect of certain drugs, industrial toxins.
But whether these factors really can lead to autism in children has not yet been clarified.
Features of mental development of children with ASD.
In order to understand and recognize the presence of autism in a child, parents must carefully monitor the child’s behavior, notice unusual signs that are not characteristic of the age norm. Most often, these signs can be identified in children under the age of 3 years.
Children’s autism is considered as a developmental disorder that affects all spheres of a child’s psyche: intellectual, emotional, sensitivity, motor sphere, attention, thinking, memory, speech.
Violations of speech development: at an early age, the absence or weakness of chatter and babble can be noted. After a year, it becomes noticeable that the child does not use speech to communicate with adults, does not respond to the name, does not follow speech instructions. By the 2nd year children have a very small vocabulary. By the 3rd year do not build phrases or sentences. At the same time, children often stereotypically repeat words (often incomprehensible to others) in the form of an echo. Some children have a lack of speech development. For others, it continues to evolve, but there are still some violations of communication. Children do not use pronouns, appeals, speak about themselves in the third person. In some cases, there is a regression of previously acquired speech skills.
Difficulties in communication and lack of emotional contact with others: Such children shun tactile contact, there is almost no visual contact, there are inadequate mimic reactions and difficulties in using gestures. Children most often do not smile, do not reach for their parents and resist attempts to take them in their arms. Children with autism lack the ability to express their emotions, as well as recognize them from other people. There is a lack of empathy for other people. A child with an adult does not focus on one activity. Children with autism do not make contact with other children or avoid it, it is difficult for them to cooperate with other children, most often they tend to retire (difficulties in adapting to the environment).
Violation of research behavior: children are not attracted by the novelty of the situation, are not interested in the environment, are not interested in toys. Therefore, children with autism often use toys unusually, for example, a child may not roll the whole machine, and turn one of its wheels for hours like monotonous. Or not understanding the purpose of the toy to use it for other purposes.
Eating disorders: a child with autism can be extremely selective in the products offered, food can cause disgust in a child, danger, often children begin to sniff 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 may be any external irritant that causes an inadequate reaction in the child. For example, a sudden noise can cause a child to run away in a randomly chosen direction. Also, the reason is ignoring the real threats to life: the child can climb very high, play with sharp objects, cross the road without looking.
Violation of motor development: as soon as the child begins to walk, he noted awkwardness. Also, some children with autism are characterized by walking on their toes, a violation of hand and foot coordination is very noticeable. It is very difficult to teach such children to everyday actions, it is rather difficult to imitate them. Instead, they develop stereotypical movements (perform repetitive actions for a long time, run around in circles, swinging, flapping “like wings” and circular movements with hands), as well as stereotypical manipulations with objects (sorting out small parts, aligning them in a row). Children with autism are learning how to master self-care skills. Expressed motor awkwardness.
Disturbances of perception: difficulties in orientation in space, fragmentary perception of the environment, distortion of the holistic picture of the objective world.
Difficulties in concentration: children hardly concentrate attention on one thing, there is a high impulsivity and restlessness.
Poor memory: often both parents and specialists notice that children with autism remember well what is significant for them (this may cause them pleasure or fear). Such children remember their fear for a long time, even if it happened a long time ago.
Features of thinking: experts note difficulties in arbitrary learning. Also, children with autism do not focus on understanding the causal relationships in what is happening, there are difficulties in transferring the acquired skills into a new situation, the concreteness of 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 the instructions of an adult, to carry out joint activities with him, to leave the learning situation). Often accompanied by resistance, screams, aggressive flashes. A huge problem is the fears of such children. Usually they are incomprehensible to others, because often children can not explain them. The child may be intimidated by harsh sounds, certain 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 (hysterical or physical attack) and auto-aggressive flashes (damage to oneself).
Each case of the disease is very individual: autism can have most of the listed symptoms in an extreme degree of manifestation, and can only manifest itself with some barely noticeable features.
Diagnosing 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 distinguished are:
– violation of social adaptation
– disturbances in the communicative sphere
The main diagnostic stages include:
– examination by a psychiatrist, neurologist, psychologist
– monitoring the child and completing the “Autism Rating Scale”, which can be used to determine the severity of the disorder
– conversation with parents
– parents filling out questionnaires – “Questionnaire for the diagnosis of autism”
There are several existing classifications of ASD, and the separation often takes place on completely different grounds, which, of course, can bring some inconvenience to a person who is not very familiar with medicine or psychology; therefore, the most basic and commonly occurring types of ASD will be highlighted below: – Kanner syndrome (Early childhood autism) – characterized by a “triad” of basic impairment: difficulty in contacting the outside world, stereotyped behavior, and delayed or impaired communication functions of speech development . It is also necessary to note the condition of the early onset of these symptoms (up to about 2.5 years)
Manifested 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 a child (to establish eye contact, to achieve the implementation of instructions and instructions). When trying to interact with the child, he demonstrates the greatest discomfort and disruption of activity.
Active rejection. It is characterized by a 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 a child. The child shows selective behavior (in communication with people, in food, in clothing)
Preoccupation with autistic interests. It is characterized by the formation of supervaluable addictions (for years, a child can speak on the same topic, draw the same plot). The glance of such children is directed at the face of a person, but they look “through” this person. In such children, stereotypical reproduction of individual impressions causes pleasure.
The extreme difficulty of organizing communication and interaction. Autism in the most mild form. Children are characterized by increased vulnerability, contact with the world ceases with the slightest sensation of obstacles. Eye contact can be made with such children.
– Asperger syndrome. Formed from birth. Children have an early onset of speech development, a rich vocabulary, developed logical thinking, and there are no mental disorders. But at the same time, the communicative aspect of speech suffers: such children do not know how to establish contact with other people, do not listen to them, can talk with themselves, do not observe distance in communication, 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 old proceeds normally, but then the newly acquired speech, motor, and subject-role skills begin to disintegrate. Stereotypical, monotonous movements of hands, their rubbing, wringing, while not being targeted, are characteristic of this state. The rarest of the diseases presented is almost always found only in girls.
– Children’s psychosis. The first manifestations of symptoms up to 3 years. Characterized by violations of social behavior, communication disorders. There are stereotypes in behavior (children monotonously run in a circle, sway standing and sitting, touch fingers, shake hands). Such children have eating disorders: they can swallow food without chewing. Their speech is unclear sometimes can be an incoherent set of words. There are periods when children freeze in place like dolls.
– Atypical autism. It differs from autism by age 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 psycho-corrective and social rehabilitation assistance, with the formation of social interaction and adaptation skills. Comprehensive psychocorrectional work, which includes all sections and types of rehabilitation assistance, which will be described below, is, along with drug therapy, an effective means of stopping the negative symptoms of ASD, and also contributes to the normal inclusion of the child in the society. Types of PAC correction:
1) Psychological correction – the most common and well-known type; It is characterized by a fairly wide range of methods, of which TEACCH and ABA-therapy programs are the most widely used and recognized in the world.
The first program is based on the following principles:
– The characteristics of each individual child are interpreted on the basis of his observations, and not of theoretical ideas;
– Adaptation is enhanced both by learning new skills and by adapting existing ones to the environment.
– creating an individual training program for each child; use of structured learning; holistic approach to intervention.
The second program is largely based on learning, depending on the consequences that arise after the behavior. The consequences can be in the form of punishment or encouragement. In this model, it is necessary to identify the main methods, such as the procedure for creating a contour and reinforcement of behavior similar to the target; method of learning chains of behavior; teaching methodology distinguishing incentives.
2) Neuropsychological correction – this type includes a set of exercises consisting of stretch marks, respiratory, oculomotor, facial and other exercises for the development of the communicative and cognitive spheres, and the exercises themselves vary considerably in time and quantity.
3) Working with the family and the child’s environment is primarily a type of correction aimed at alleviating emotional tension and anxiety among family members, as often parents of children with ASD also need help, including psychotherapeutic support and training programs programs are aimed mainly at developing feelings of understanding 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 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 pronounced as the child grows with ASD.
5) Speech therapy correction – given the fact that the violation of 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. Characterized by a focus on the formation of vocabulary, the development of auditory attention, as well as phonetic and speech hearing.
6) Medical correction of ASD. For some forms of autism, medication is needed for a child. For example, to improve concentration and perseverance, the doctor may prescribe vitamins and nootropic drugs that improve thinking processes and stimulate speech development. And with high impulsivity, aggression, negativity, and pronounced signs of “withdrawing into oneself”, psychotropic drugs can help. In some cases, Autism is combined with epileptic seizures. In such cases, drugs are needed to prevent attacks. Many mothers are afraid of drugs. But medications are prescribed for a specific period, not forever. Adverse effects from drugs 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 which therapy is needed. And the doctor should be able to clearly explain to parents all questions regarding medications.
The Children’s Diagnostic Center in Domodedovo has all the facilities for the diagnosis of Autistic Spectrum Disorders. Such as: examination by a children’s neurologist, clinical psychologist, speech therapist, examination – electroencephalography and video EEG monitoring. As well as methods of correction, such as ABA-therapy.