6 year old autistic

Age 6 may represent key turning point in autism | Spectrum

School start: Autistic children may benefit from extra support at age 6, when trait improvements often stall out.

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Autism trait severity decreases from age 3 to 6 in most autistic children, but that progress then stalls for nearly three-quarters of them, according to a new long-term study.

The findings suggest that age 6 — when elementary school usually begins — is a key turning point for autistic children, when families, clinics, schools and communities can provide extra support.

“We can think about making sure these turning points turn out positively instead of negatively for kids,” says lead investigator Stelios Georgiades, associate professor of psychiatry and behavioral neurosciences at McMaster University in Hamilton, Canada.

The results jibe with a 2020 study showing that autism traits are not stable in young children with autism. But they run counter to the long-standing idea that these traits don’t typically ease with time.

“Most children with autism do show some improvement, in contrast with a lot of the literature,” says David Amaral, professor of medical psychiatry at the University of California, Davis, who led the 2020 study but was not involved in the new work. “Change in the severity of symptoms over time is more likely than ever thought before.”

Turning point:

Georgiades and his colleagues analyzed data from 187 children with autism enrolled in the Pathways in ASD study, a long-term project tracking the development of autistic children. They measured autism trait severity when the children were diagnosed — at 41 months of age, on average — and again at about ages 4, 6 and 10.

The children fell into two groups based on how their traits changed over that period.

About 73 percent of the children showed a slight decrease in trait severity up to age 6, and no further change past that point. The remaining 27 percent showed a more marked decline at first and continued to decrease after that, albeit at a slower rate.

The children in the continuously improving group started out with slightly less severe traits than children in the other group and performed marginally better on tests of cognition, language and daily-living skills.

“They didn’t start off all that different from children in the other group, but the discrepancies between the groups increased over time,” Georgiades says. “What that tells me is that at diagnosis, we may have a window of opportunity to ensure that all children develop in a positive way, and that family, clinical and community services should help make sure that improvement doesn’t stop or plateau or regress.”

The study is the first to reveal this specific turning point, Georgiades and his colleagues say. The work was published in March in the Journal of Autism and Developmental Disorders.

“I think their idea of turning points is really important — as someone who tries to do trajectory analysis myself, I look forward to trying to figure out how to find them with our own studies,” says Cathy Lord, professor of psychiatry at the University of California, Los Angeles.

Uncertain causes:

The reasons for the turning point remain uncertain, other experts note.

“We know that the social environment of school can be a challenge for many young children with autism,” says Tony Charman, professor of clinical child psychology at King’s College London in the United Kingdom. “But from the work presented, which has no school-based data about the cohort, it is hard to draw any definitive conclusions about whether school entry itself — and if so, what factors — are contributing to the change in trajectory.”

Brain development might also help to account for the turning point. It differs between autistic children whose traits wane over time and those whose traits do not, according to a 2020 brain imaging study by Amaral and his colleagues.

About 85 percent of the children in the new study are boys, so it’s unclear whether the turning point also applies to autistic girls, Amaral says. But his team’s previous work suggests that the severity of girls’ traits decreases more over time than that of boys’ traits.

“There is the question of whether or not this decrease in the severity of symptoms we see in girls is real, or whether they are better able to mask or hide their symptoms,” says Einat Waizbard-Bartov‬, a graduate student in Amaral’s lab who was not involved in the new work. “There are many different types of mental-health costs from such camouflaging or compensation, such as anxiety, depression and burnout, so that is something we want to be mindful of.”

Georgiades and his colleagues have launched a new initiative, the Pediatric Autism Research Cohort project, to analyze how clinical services and other forms of support might alter the developmental trajectories of autistic children, he says. “We also plan to regularly share our research data with families, who can share it with clinical teams and school teams and community teams to have conversations of how to adapt and refine care going forward.”

Autism Special Needs Checklist: Big Kids (ages 6-12) (for Parents)

When your child is ready for school, expect exciting new opportunities and challenges. The right education plan can help your child reach his or her full potential. But school is not just about learning. Just like his or her peers, your child is navigating friendships and social situations.

Follow this 8-step checklist to help your child succeed during the elementary school years.

Step 1: Look for Support at School

Many kids with autism spectrum disorder are diagnosed by age 3 and receive early intervention services. When they turn 3, they're eligible for additional services at their local school district with the help of an individualized education program (IEP).

The IEP may include therapy for speech/language, behavior, or sensory concerns. In school, kids might get extra support through a classroom aide or during a "lunch bunch" or social skills group.

Parents meet with an IEP team to determine a child's needs. While you can't insist on certain services, you can appeal the IEP if you feel that the plan doesn't meet your child's needs. The IEP is reviewed and updated each year, but you can ask for updates before that to make sure your child is meeting goals.

Not all kids with autism need an IEP. Those who do not qualify for an IEP can get educational assistance through a 504 education plan, which provides for accommodations in a regular classroom that improve a child's learning experience.

Step 2: Get Tech Savvy

Technology can help kids with autism improve verbal skills, social skills, and behavior. Through the use of educational apps and computer games and programs, kids can increase their focus, get rewarded for good behavior, learn new skills, and have fun doing it. Some devices (called "assistive devices") can even vocalize kids' thoughts if they have trouble speaking.

Ask your child's doctor or speech or behavioral therapist for suggestions on what kinds of apps or other media can help your child. Many games help to reinforce the skills that kids are already learning in the classroom or during therapy sessions.

Step 3: Plan Playdates and Social Time

It's important for kids with autism to socialize with their peers, even if sometimes it can be challenging for them. Playdates and other activities are some much-needed chances to practice social skills and make new friends. Those who are struggling can sign up for a social skills group, which helps with things like introducing yourself, talking to others, reading social cues, and more.

When helping your child choose a playmate, look for someone who shares the same interests. Pre-plan the activities (like going to a park, playground, or another activity you know your child will enjoy), and avoid places with too much noise and stimulation if you think it will overwhelm your child. Let your child know what to expect ahead of time. Consider using a visual schedule with pictures or create social stories to help "tell ahead" what will happen during a playdate.

Step 4: Get Kids Moving

Physical activity is also great for kids with autism — it can help improve their fitness, coordination, strength, and body awareness. Regular physical activity can help prevent childhood obesity. Exercise may also help decrease repetitive, self-stimulating behaviors and improve attention.

Many sports programs, such as Special Olympics, Little League Challenger Division, TOPSoccer and at the YMCA, can help your child to be physically active while also meeting new friends who have similar challenges. Karate, therapeutic horseback riding programs, and aquatic therapy are also great ways to keep kids active.

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Step 5: Address Emotional Needs

At times your child may feel left out, left behind, or bullied. Kids with autism sometimes have trouble relating to others, and this can make them feel angry or sad.

Get help from a professional counselor if your child shows signs of depression, which include sadness, moodiness, or keeping to himself or herself. Signs of bullying include:

not wanting to go to school
decreased appetite
trouble sleeping
unexplained crying

If your child is being teased or bullied, speak with school administrators as soon as possible. At home, talk with your child about the experience and use role-play to discuss how to handle bullies and report problems to teachers, guidance counselors, or other trusted adults.

Step 6: Prepare for Puberty

As puberty approaches, your child will be dealing with new emotions that are a normal part of growing up. Talk with your doctor about what to expect as your child matures and how to handle it. Reassure your child that the changes that come with puberty are normal.

Teach your child the difference between public and private places when it comes to private behaviors like getting dressed or touching private parts. When girls get their periods they will need to learn how to change pads, while boys might need reassurance that wet dreams are normal.

Talk to your child about appropriate versus inappropriate touching, explaining that he or she should immediately tell you if someone crosses the line.

Step 7: Find Support

Dealing with the day-to-day challenges of parenting a child with autism can be overwhelming. Having a strong support network can help you power through even the most challenging days.

To connect with other parents who understand your situation, find a local support group or get involved with a local chapter of a national autism awareness group. If a local group isn't available, look for online support.

Step 8: Secure Your Child's Future

If you haven't written a will or set up a legal and financial framework for your child's future, it's not too late. Talk with an attorney who specializes in special needs law and a financial advisor to find the best way to manage your assets and prepare financially for your child's adulthood.

If you have already written a will, review it from time to time to make sure that the custodial plan you made when your child was younger is still the best option.

Reviewed by: Anne M. Meduri, MD

Date reviewed: November 2017

"Children of the rain". What you need to know about autism

11 April 2019 12:01

Behind the poetic expression "children of the rain" lies the daily feat of people who are faced with a diagnosis of autism. Children who will never be able to perceive themselves as part of the world around them, and parents for whom every day is a series of battles and victories. First, fighting with yourself, accepting and realizing that their child will never be cured, and then fighting the disease for every gesture, every smile, every look and word of the child - small, but such important victories.

Scientists have not been able to reliably establish the causes of the disease. It is known about the genetic predisposition: signs of autism are more often manifested in people whose family already has an autistic person. Pregnancy in mothers of such children proceeds normally, and the children themselves are often very attractive in appearance - autism, as a rule, does not affect the physical development of the child. However, the development of autism is still in some cases associated with the manifestation of other diseases:

cerebral palsy;
maternal rubella infection during pregnancy;
tuberous sclerosis;
impaired fat metabolism (the risk of having a baby with autism is greater in obese women).

All of these conditions can have a bad effect on the brain and, as a result, provoke symptoms of autism. However, what autism is, and what are the causes of its manifestation, is still not completely clear.

Early diagnosis plays an important role in the further development of an autistic child. Autism in children is manifested by certain signs. Early childhood autism is a condition that can manifest itself in children at a very early age - both at 1 year old and at 2 years old. What is autism in a child, and whether this disease occurs, is determined by a specialist. But you can independently figure out what kind of illness a child has and suspect him, based on information about the signs of such a condition.

Early signs of autism in a child

This syndrome is characterized by 4 main signs. In children with this disease, they can be determined to varying degrees.

Signs of autism in children are as follows:

impaired social interaction;
broken communication;
stereotyped behaviour;
early symptoms of childhood autism in children under 3 years of age.

The first signs of autistic children can be expressed as early as the age of 2 years. Symptoms may be mild when eye-to-eye contact is impaired, or more severe when it is completely absent. As a rule, autism manifests itself very early - even before the age of 1, parents can recognize it. In the first months, such children are less mobile, react inadequately to stimuli from the outside, they have poor facial expressions.

The child cannot perceive a holistic image of a person who is trying to communicate with him. Even in the photo and video, you can recognize that such a baby's facial expressions do not correspond to the current situation. He does not smile when someone tries to amuse him, but he can laugh when the reason for this is not clear to anyone close to him. The face of such a baby is mask-like, grimaces periodically appear on it.

Baby uses gestures only to indicate needs. As a rule, even in children under one year old, interest is sharply shown if they see an interesting object - the baby laughs, points with a finger, and demonstrates joyful behavior. The first signs in children under 1 year old can be suspected if the child does not behave like this. Symptoms of autism in children under one year old are manifested by the fact that they use a certain gesture, wanting to get something, but do not seek to capture the attention of their parents by including them in their game.

An autistic person cannot understand other people's emotions. How this symptom manifests itself in a child can be traced already at an early age. If ordinary children have a brain designed in such a way that they can easily determine when they look at other people, they are upset, cheerful or scared, then an autistic person is not capable of this.

The child is not interested in peers. Already at the age of 2, ordinary children strive for company - to play, to get acquainted with their peers. Signs of autism in children of 2 years old are expressed by the fact that such a baby does not participate in games, but plunges into his own world. Those who want to know how to recognize a child 2 years old and older should simply look at the company of children: an autist is always alone and does not pay attention to others or perceives them as inanimate objects.

It is difficult for a child to play with imagination and social roles. Children 3 years old and even younger play, fantasizing and inventing role-playing games. In autistics, symptoms at 3 years old may be expressed by the fact that they do not understand what a social role in the game is, and do not perceive toys as integral objects. For example, signs of autism in a child of 3 years old can be expressed by the fact that the baby spins the wheel of a car for hours or repeats other actions.

Child does not respond to emotions and communication from parents. Previously, it was believed that such children are not emotionally attached to their parents at all. But now scientists have proven that when a mother leaves, such a child at 4 years old and even earlier shows anxiety. If family members are around, he looks less obsessed. However, in autism, signs in children of 4 years old are expressed by a lack of reaction to the fact that parents are absent. The autist shows anxiety, but he does not try to return his parents.

In children under 5 years of age and later, there is a delay in speech or its complete absence (mutism). The speech is incoherent, the child repeats the same phrases, devoid of meaning, speaks of himself in the third person. He does not respond to other people's speech either. When the “age of questions” comes, parents will not hear them from the baby, and if they do, then these questions will be monotonous and without practical significance.

Stereotyped behavior includes obsession with one activity, repetition of daily rituals, development of fears and obsessions. At the same time, if the sequence of the ritual is violated, the child becomes hysterical or may show aggression or self-aggression.

Can autism be cured and is it curable at all? Unfortunately, there is no cure. How you can help your child depends on each individual case. Drug treatment is prescribed only in case of destructive behavior of a small patient. But, despite the fact that the disease is not curable, it is possible to correct the situation. The best "treatment" in this case is regular practice every day and the creation of the most favorable environment for the autistic. Classes are held in stages:

To form the skills that are needed for training. If the child does not make contact, gradually establish it, not forgetting who it is - autistics. Gradually it is necessary to develop at least the rudiments of speech.
Eliminate forms of behavior that are non-constructive: aggression, self-aggression, fears, withdrawing into oneself, etc.
Learn to observe, imitate.
Teaching social games and roles.
Learn to make emotional contact.

The most common treatment for autism is practiced according to the principles of behaviorism (behavioral psychology). One of the subtypes of such therapy is ABA therapy. The basis of this treatment is to observe what the reactions and behavior of the baby look like. After all the features are studied, incentives are selected for a particular autist. Speech therapy practice is obligatory: if the kid regularly works with a speech therapist, his intonation and pronunciation are getting better. At home, parents help the child develop self-service and socialization skills. Since autists have no motivation to play, they get used to the daily routine, everyday affairs, cards are created where the order of performing this or that action is written or drawn.

Why is early diagnosis important? There are conditions that mimic autism that can be confused with its symptoms. But other methods are used to correct them.

ZPRR with autistic features

The symptoms of this disease are associated with a delay in psychoverbal development. They are in many ways similar to the signs of autism. Starting from a very early age, the baby does not develop in terms of speech in the way that existing norms suggest. In the first months of life, he does not babble, then he does not learn to speak simple words. At 2-3 years old, his vocabulary is very poor. Such children are often poorly developed physically, sometimes hyperactive. The final diagnosis is made by the doctor. It is important to visit a psychiatrist, speech therapist with the child.

Attention deficit hyperactivity disorder

This condition is also often mistaken for autism. With a lack of attention, children are restless, it is difficult for them to study at school. There are problems with concentration, such children are very mobile. Even in adulthood, echoes of this state remain, because it is difficult for such people to remember information and make decisions. You should try to diagnose this condition as early as possible, practice treatment with psychostimulants and sedative drugs, and visit a psychologist.

Hearing loss

These are various hearing impairments, both congenital and acquired. Hearing-impaired children also have speech delays. Therefore, such children do not respond well to the name, fulfill requests and may seem naughty. At the same time, parents may suspect autism in children. But a professional psychiatrist will definitely send the baby for an examination of auditory function.

Hearing aid helps solve problems.

Schizophrenia

Autism was previously considered one of the manifestations of schizophrenia in children. However, it is now clear that these are two completely different diseases. Schizophrenia in children begins later - at 5-7 years. The symptoms of this disease appear gradually. Such children have obsessive fears, talk to themselves, later delusions and hallucinations appear. This condition is treated with medication.

It is important to understand that autism is not a death sentence. Indeed, with proper care, the earliest correction of autism and support from specialists and parents, such a baby can fully live, learn and find happiness, becoming an adult.

Autism: what can parents do to help their child?

The first 2-3 years are especially difficult for a couple who have had their first child. Young mothers and fathers are still learning to be parents, and it is quite difficult to understand that the development of their child is different from others. It's even harder to accept that your baby may have a mental disorder. Childhood autism, or as it is now also called, autism spectrum disorders (ASD), today occurs in every 88th child. How to recognize the disease and what should parents pay attention to? These and other questions related to autism were answered by the Head of the Department of Psychiatry and Narcology, Doctor of Medical Sciences, Associate Professor Grechany Severin Vyacheslavovich.

What is autism? Is this disease born or is it an acquired condition in the environment in which the child grows up?

Childhood autism is a congenital disease. The fact of its occurrence cannot be the result of such external causes as, for example, the social or cultural level of the family. The decisive role is played by the biological factor that determines the birth of such a child. Of course, there are external circumstances that, ceteris paribus, provoke the appearance of symptoms of this disorder - a severe viral infection, in some cases even a sharp change in the family situation, for example, a sudden separation from the mother, hospitalization of the child in the hospital and more. Often an autistic child is the firstborn in the family, and parents do not yet know how the child should develop. Subsequently, they recall that they often thought about why their child did not develop like other children, but still they did not suspect serious deviations. Therefore, this day - April 2 - just calls for adults to take a closer look at the child in general and notice any anomalies in his development as early as possible. And whether this is autism or some other disease - this should be decided by the doctor.

How can parents tell if their child has the condition?

Unfortunately, often parents do not immediately pay attention to the atypical, age-specific behavior of their child. This circumstance gave rise to some myths that autism can occur with the wrong parenting approach or after some medical interventions, including preventive vaccinations. This cannot be believed, since childhood autism also goes through a latent phase in its development, when its symptoms are almost imperceptible, but this does not mean that it was not there from birth. However, you need to know the so-called "red flags of autism", with the manifestation of which it is worth contacting a specialist. These include:

child does not use pointing gesture,
does not make eye contact, does not smile in response to a smile,
does not respond to his name or to requests addressed to him,
does not hear speech, does not understand why adults turn to him,
does not say a 2-word phrase by age 2,
does not use toys for its intended purpose.

Often the child does not develop a plot game. For example, a car for a boy is not an image of a car that he saw on the street, but only wheels that can be turned. With the help of a toy, a child cannot reproduce the plot seen in life. In the same way, for a girl, a doll is not an image of a little man whom she can put to sleep or feed, but an indifferent object with moving parts. It is also worth paying attention to how the child communicates, whether he can follow the simple instructions of an adult, and concentrate his attention. If parents notice these features, then you need to see a doctor.

Is it possible to cure autism or only bring adaptation to life to a certain level? Which doctor to contact in this case?

Any specialist can suspect autism. Suppose the district pediatrician assumes that the child has autism and advises parents to contact a psychiatrist. However, it is important to understand that the final diagnosis may differ from the initial one, and there are other mental disorders besides childhood autism at an early age.

Is child autism treated at the Pediatric University Clinic?

We don’t have a separate department yet, besides, working with an autistic child is a long-term, often many-year work of a large team of different specialists, including not only doctors, but also correctional teachers, clinical psychologists and their varieties, rehabilitation specialists etc. However, we consult such children and their mothers at the stage of early diagnosis, when parents, for various reasons, are not yet ready to go to official psychiatric institutions. Thus, difficult and doubtful diagnostic cases are solved, the very first recommendations are given. For example, I receive at the Multidisciplinary Center, Vera Vladimirovna Pozdnyak takes at the Consultative and Diagnostic Center. We provide primary care to these children. We give advice on how to treat a possible disease in a child, how to behave with such children and what options for drug therapy exist. Most moms walk away grateful as they get answers to questions that have haunted them for a long time.

As far as treatment is concerned, we do not provide it. In addition, parents, faced with the problem of autism, must understand that it is impossible to completely cure it, and they will have to accept that throughout their life the child will be special, unlike all others. There has never been such a case that the same classic autism ended in complete adaptation in society, even if the child at some stage was able to master the profession. Although it is believed that with age the diagnosis of "autism" cannot be reconsidered for a child, but most of the actual "autistic" traits disappear on their own over time. And already at the age of 6-7, other problems related to behavior, underdevelopment of abstract concepts, misunderstanding of the context of communication, i.e. purely intellectual difficulties, come to the fore. In the future, parents will need to adapt the child to life with what is, including special requirements for the learning process. At home, you should also follow a special system of rules developed individually for a particular child.

How can parents help their child cope with autism? Can you give any recommendations for them?

From our point of view, the most important recommendation is to understand the child's capabilities from the very beginning, not to do too much and not to set too high goals. The biggest conflict arises precisely when parents are faced with a contradiction between the real abilities of the child and their own ambitions for him. And everything negative that can happen later - protests, disobedience, experiencing disappointment and despair - all this comes precisely from this conflict.

The main principle for parents is to gain a sense of confidence as a caregiver and get rid of excessive feelings of guilt. You need to know that an autistic child is very sensitive to the internal state of his parents, easily reacts to their anxiety, confusion. With regard to mental development, one should be prepared for the fact that it will take a long time to achieve success, even small ones. It does not happen that a child falls asleep with one person and wakes up with another person.

Another common mistake is the opinion that the most important thing for a child is to learn to talk. This is not true. If speech does not appear on its own, then there are objective reasons for this. As soon as the prerequisites for pronouncing words are formed, the child will begin to speak independently without our help. Therefore, you should not artificially try to accelerate the development of such a child.

Is it possible to say that modern communication devices, computers, gadgets, mobile phones can develop autism in a child? And do they somehow affect children who have already been diagnosed with this disease? (Can modern technology help to socialize or, on the contrary, contribute to the fact that the child withdraws more and more into himself?)

In autism, this is neither good nor bad. There can be no universal recommendation here, everything is individual. It is important for a mother to understand whether her child is now ready to master society or whether she still needs to wait, subsequently carefully “grafting” him to life. Here the advice of a defectologist, a psychiatrist will help. True, very often the mothers of such children are guided only by their own opinion, without accepting someone else's help. This happens if their relatives betrayed them, the father left, the grandparents did not accept the child, and the mother is left alone with the problem.

Why is autism thought to be more common in boys? And why is it more characteristic of them?

Indeed, this is a fundamental fact. And childhood autism is not the only example. A lot of mental disorders occur more often in boys. Why this is so is hard to say. There are many hypotheses for this, but an exhaustive explanation has not yet been received.

Perhaps there is some relationship between the mother's condition during pregnancy and the child's subsequently diagnosed autistic disorder? Is it possible to somehow predict the birth of a child with autism? What are the medical reasons?

Mothers often ask me: “Tell me, please, where, at what stage did I make a mistake? What did I do wrong? Unfortunately, despite the fact that we live in the 21st century, there are no prerequisites to predict the birth of such a child. With the exception of the examination of the amniotic fluid for gross genetic anomalies. If this is observed, then we can say with a high degree of probability that a clinical picture of autism should be expected here. In all other cases, it is difficult to predict anything. There is no data for this.

Is it true that autism is more common in children today than it was 10, 20, 30 years ago?

It is believed that the number of children with autism has not increased, diagnosis has improved. This happened due to the spread of information about autism and its manifestations. As a result, parents began to pay more attention to what they had not noticed before. And, as a result, the number of visits to doctors for the purpose of making a diagnosis has increased. What used to cause confusion and misunderstanding in parents, now prompts a search for answers in specialized literature, the Internet. As a result, the symptoms of autism began to be detected more often and at an earlier age. And here there is another extreme - the emerging trend towards overdiagnosis of this disorder. A special term has even appeared - autism spectrum disorders, the role of which is seen in drawing more attention of parents to any symptoms of deviant development, closely or remotely resembling childhood autism, in order to promptly apply for practical assistance.

Can an autistic child go to a regular school, or is it better to send him to a special school?

There are inclusive types of education that allow such children to study in a public school. A group of 3-4 such children is recruited, and most of the time they study with a separate teacher. Periodically, the teacher selectively leads, as far as possible, such children to classes with healthy children. But the need for such classes must be considered individually. All possible consequences should be taken into account. For example, in practice, children with autism are not very physically healthy, they are characterized by weak immunity - this increases their risk of getting respiratory and other infectious diseases, which usually occur in a more severe form in children with autism.

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