Level one autism spectrum disorder

Autism Spectrum Disorders (ASD) are complex disorders of mental development that are characterized by social maladaptation and inability to social interaction, communication and behavioral stereotypy (multiple repetitions of monotonous actions).

Back in the middle of the last century, autism was a fairly rare disease. But over time, more and more children suffering from this disorder began to appear. Statistics show that the incidence of ASD in children over the past 30-40 years in countries where such statistics are carried out has risen from 4-5 people per 10,000 children to 50-116 cases per 10,000 children. At the same time, boys are more susceptible to this disease than girls (approximately 4:1 ratio). nine0003

Causes of RAS.

All over the world, until today, scientists studying the causes of autism have not come to a consensus. Many assumptions are put forward. Among the possible factors for the appearance of this disorder in children are some hypotheses:

- genetic predisposition hypothesis

- a hypothesis based on disorders of the development of the nervous system (autism is considered as a disease caused by disorders of brain development in the early stages of a child's growth). nine0003

- hypotheses about the influence of external factors: infections, chemical effects on the mother's body during pregnancy, birth trauma, congenital metabolic disorders, the influence of certain drugs, industrial toxins.

But whether these factors really can lead to the appearance of autism in children has not yet been clarified.

Features of the mental development of children with ASD.

To understand and recognize the presence of autism in a child, parents need to carefully monitor the behavior of the child, notice unusual signs that are not characteristic of the age norm. Most often, these signs can be detected in children under the age of 3 years. nine0003

Childhood autism is considered as a developmental disorder that affects all areas of the child's psyche: intellectual, emotional, sensitivity, motor sphere, attention, thinking, memory, speech.

Disorders of speech development : absent or weak cooing and babbling may be noted at an early age. After a year, it becomes noticeable that the child does not use speech to communicate with adults, does not respond to a name, and does not follow verbal instructions. By the age of 2, children have a very small vocabulary. By the age of 3 they 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, speech continues to develop, but there are still communication impairments. Children do not use pronouns, address, speak about themselves in the third person. In some cases, there is a regression of previously acquired speech skills. nine0003

Difficulties in communication and lack of emotional contact with others: Such children shy away from tactile contact, eye contact is almost completely absent, there are inadequate facial reactions and difficulties in using gestures. Children most often do not smile, do not reach out to their parents and resist attempts by adults to take them in their arms. Children with autism lack the ability to express their emotions, as well as to recognize them in the people around them. There is a lack of empathy for other people. The child, along with the adult, does not focus on one activity. Children with autism do not make contact with other children or avoid it, they find it difficult to cooperate with other children, most often they tend to retire (difficulties in adapting to the environment). nine0003

H violation of exploratory 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 most often use toys in an unusual way, for example, a child may not roll the whole car, but turn one of its wheels monotonously for hours. 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 the child to be disgusted, dangerous, often children begin to sniff food. But along with this, children may try to eat an inedible thing. nine0003

Violation of self-preservation behavior: due to a large number of fears, the child often finds himself in a situation that is dangerous for himself. The cause can be any external stimulus that causes an inadequate reaction in the child. For example, a sudden noise may cause a child to run in a random direction. Also, the reason is ignoring real threats to life: a child can climb very high, play with sharp objects, cross the road without looking. nine0003

Disturbance of motor development: as soon as the child begins to walk, he is noted for clumsiness. Also, some children with autism are inherent in walking on their toes, a very noticeable violation of the coordination of hands and feet. It is very difficult for such children to teach everyday actions, it is rather difficult for them to imitate. Instead, they develop stereotypical movements (performing the same actions for a long time, running in circles, swinging, flapping “like wings” and circular movements with their arms), as well as stereotypical manipulations with objects (tweaking small details, lining them up). Children with autism have significant difficulty in learning self-care skills. Pronounced motor awkwardness. nine0003

Perception disorders: difficulties in orientation in space, fragmentation in the perception of the environment, distortion of a holistic picture of the objective world.

Difficulty in concentrating: children have difficulty concentrating on one thing, there is high impulsivity and restlessness.

Poor memory: Often, both parents and professionals notice that children with autism are good at remembering things that are meaningful to them (this may cause them pleasure or fear). Such children remember their fear for a long time, even if it happened a very long time ago. nine0003

Features of thinking: experts note difficulties in arbitrary learning. Also, children with autism do not focus on understanding the cause-and-effect relationships in what is happening, there are difficulties in transferring the acquired skills to 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 adult's instructions, to perform joint activities with him, avoiding the learning situation). Often accompanied by resistance, screams, aggressive outbursts. A huge problem is the fears of such children. Usually they are incomprehensible to others, because often children cannot explain them. The child may be frightened by sharp sounds, some specific actions. Another behavioral disorder is aggression. Any disorder, violation of a stereotype, interference of the outside world in a child's life can provoke aggressive (hysteria or physical attack) and auto-aggressive outbursts (damage to oneself). nine0003

Each case of the disease is very individual: autism can have most of the listed signs in an extreme degree of manifestation, and it can manifest itself only in some barely noticeable features.

Diagnosis of Autism Spectrum Disorders

To diagnose autism, specialists 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: nine0003

- violation of social adaptation

- violations in the communication sphere

- stereotypical behavior

The main diagnostic steps include:

- examination of the child by a psychiatrist, neurologist, psychologist

- observation of the child and filling out the "Autism Rating Scale", which can be used to determine the severity of the disorder

- conversation with parents nine0003

- filling in questionnaires by parents - "Questionnaire for the diagnosis of autism"

Species PAC

There are several existing classifications of ASD, and the separation often occurs on completely different grounds, which, of course, can bring some inconvenience to a person who is initially little familiar with medicine or psychology; therefore, the most basic and frequently encountered types of ASD will be highlighted below: - Kanner's syndrome (Early childhood autism) - characterized by a "triad" of the main violations: difficulty in establishing contacts with the outside world, stereotypical behavior, as well as a delay or violation of the communicative 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) nine0003

It manifests itself in children in 4 forms, depending on the degree of fencing off from the outside world:

Complete detachment from what is happening. This group is characterized by the absence of speech and the inability to organize the child (to establish eye contact, to achieve the implementation of instructions and assignments). When trying to interact with the child, he shows the greatest discomfort and impaired activity.

Active rejection. It is characterized by more active contact with the environment than the first group. There is no such detachment, but there is rejection of a part of the world that is unacceptable to the child. The child shows selective behavior (in communication with people, in food, in clothes) nine0003

Preoccupation with autistic interests. It is characterized by the formation of overvalued addictions (for years a child can talk on the same topic, draw the same plot). The gaze of such children is directed at the face of a person, but they look "through" this person. Such children enjoy the stereotyped reproduction of individual impressions.

Extreme difficulty in organizing communication and interaction. Autism at its mildest. Children are characterized by increased vulnerability, contact with the world stops at the slightest sensation of obstacles. These children can make eye contact. nine0003

- Asperger's Syndrome. Formed from birth. Children have an early onset of speech development, a rich vocabulary, developed logical thinking, and there are no disorders in mental development. But at the same time, the communicative side of speech suffers: such children do not know how to establish contact with other people, do not listen to them, can talk to themselves, do not keep a distance in communication, and do not know how to empathize with other people.

- Rett syndrome. Its peculiarity lies in the fact that the development of a child up to 1-1. 5 years proceeds normally, but then the newly acquired speech, motor and subject-role skills begin to disintegrate. Characteristic for this condition are stereotypical, monotonous movements of the hands, rubbing, wringing, while not carrying a purposeful character. The rarest of the presented diseases, occurring almost always only in girls. nine0003

- Childhood psychosis. The first manifestation of symptoms before 3 years of age. It is characterized by violations of social behavior, communication disorders. There are stereotypes in behavior (children run in a monotonous circle, sway while standing and sitting, fingering their fingers, shaking their hands). These children have eating disorders: they can swallow food without chewing. Their unclear speech can sometimes be an incoherent collection of words. There are times when children freeze in place, like dolls. nine0003

- Atypical autism. It differs from autism in terms of age manifestation and the absence of one criterion from the “triad” of major disorders.

Correction of patients with ASD

One of the most important sections of habilitation for children with ASD is undoubtedly the provision of psycho-correctional and social rehabilitation assistance, with the formation of social interaction and adaptation skills. Comprehensive psycho-correctional work, which includes all sections and types of rehabilitation assistance, which will be described below, is, along with drug therapy, an effective means of stopping the negative symptoms of ASD, and also contributes to the normal inclusion of the child in society. Types of RAS correction: nine0003

1) Psychological correction - the most common and well-known type; It is characterized by a fairly wide range of methods, of which the TEACCH and ABA-therapy programs are 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 observations of him, and not from theoretical ideas;

- increasing adaptation is carried out both by learning new skills and by adapting existing ones to the environment; nine0003

- Creation of an individual training program for each child; use of structured learning; holistic approach to intervention.

The second program is largely based on learning, which depends on the consequences that have arisen after the behavior. Consequences can be in the form of punishment or reward. In this model, it is necessary to highlight the main methods, such as the procedure for creating a contour and reinforcing behavior similar to the target; method of teaching chains of behavior; method of teaching discrimination of stimuli. nine0003

2) Neuropsychological correction - this type includes a set of exercises consisting of stretching, breathing, oculomotor, facial and other exercises for the development of the communicative and cognitive sphere, and the exercises themselves differ markedly in time and quantity.

3) Work with the child's family and environment - first of all, this type of correction is aimed at alleviating emotional tension and anxiety among family members, since parents of children with ASD often also need help, including psychotherapeutic support and training programs (such programs are mainly aimed at developing feelings of understanding of the problem, the reality of its solution and the meaningfulness of behavior in the current family situation). nine0003

4) Psychosocial therapy - in fact, work with the child himself to form the 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 with ASD grows older.

5) Logopedic correction - given the fact that speech development disorder is one of the cardinal manifestations of ASD, this type of work with a child will be an integral part of the correction program. It is characterized by a focus on the formation of vocabulary, the development of auditory attention, as well as phonetic and speech hearing. nine0003

6) Medical correction of RAS. In some forms of autism, medication is needed for the child. For example, to improve concentration and perseverance, a doctor may prescribe vitamins and nootropic drugs that improve thinking processes and stimulate speech development. And with high impulsivity, aggression, negativism, pronounced signs of "withdrawal into oneself", psychotropic drugs can help. In some cases, autism is combined with epileptic seizures. In such cases, anti-seizure medications are needed. Many mothers are afraid of drugs. But drugs are prescribed for a certain period, and not forever. Adverse drug reactions are rare. And the result of the effect in most cases is worth the courage of the parents. In each case, it is necessary to individually decide what kind of therapy is needed. And the doctor should be able to clearly explain to parents all questions regarding medications. nine0003

The Children's Diagnostic Center in Domodedovo has all the facilities for diagnosing Autism Spectrum Disorders. Such as: examination by a child neurologist, clinical psychologist, speech therapist, examination - electroencephalography and video EEG monitoring. As well as correction techniques, such as ABA therapy.

Alpatsky D.A. (chief physician, neurologist of DDC), Litvinova E.V. (psychologist DDC)

Applied Behavior Analysis (ABA)

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