Autism is a mental disorder from the group of general developmental disorders with characteristic qualitative abnormalities in social communication and interaction, a limited, stereotyped, repetitive set of interests and activities. It is not one function or a small number of functions that suffer in autism, but the psyche as a whole.
The term "autism spectrum disorder" (ASD) has emerged due to the clinical diversity of distortion manifestations. It unites all variants of autistic disorders and denotes a group of patients in need of specialized care. Patients with ASD have the same problems as children with autism, they require the same regimens of observation, treatment, rehabilitation, social adaptation and social functioning.
The relevance of developing assistance for people with autism spectrum disorder (ASD) is determined by several factors:
- high and gradually increasing frequency of occurrence (approximately 1% of the population);
- the complexity and diversity of the clinical picture;
- difficulties in diagnostics and differential diagnostics;
- insufficient effectiveness of the treatment and correction process.
The earlier you start working with the patient, the more you can count on the inclusion of compensatory processes and a positive result. Also, many signs of ASD develop over a fairly long period (up to several years) and, therefore, earlier intervention may contribute to the milder course of many symptoms of this developmental disorder.
At the same time, early diagnostics of ASD is associated with significant difficulties.
At an early age, symptoms of autism, like many other developmental disorders, manifest themselves in immature forms that are difficult to be detected.
Some of the symptoms, especially stereotyped forms of behavior, are found in children at an early age, normal conditions, and in a fairly wide range in terms of severity and time of manifestation, which makes it difficult to diagnose ASD.
Many early-onset symptoms of autism are found in other developmental disorders.
The psychopathology of autism in early childhood is not well understood.
Taking into account the above circumstances, establishing the diagnosis of ASD becomes sufficiently reliable only at the age of 3-4 years. At the same time, psychological and pedagogical correctional classes can and should be started at an earlier age. Early intervention at school age provides an increase in a satisfactory social adaptation by more than 10% and, despite a certain inevitable percentage of diagnostic errors, provides a positive economic effect (R. Macold, P. Macold, 2004; R. Macold, P. Macold, 2009; Bishop et al., 2008).
The diagnosis of ASD is based on the current international classification of diseases in the Republic of Belarus, revision 10 of ICD-10 (heading F84).
However, both the ICD-10 and DSM-IV were developed on the basis of studies of older children and adults and are not sufficiently focused on an early age. At the same time, a large number of various tests, questionnaires have been developed. These materials are addressed to parents, other people (nannies, home educators, etc.) who know the child with autism well and/or professionals. These diagnostic tools differ in the target group (children with autism, communication disorders, various developmental disorders), age characteristics of the subjects, the spectrum of the investigated functions (social interaction, communication, speech, play, symbolization, etc.), in insensitivity, sensitivity, positive and negative predictive power and other characteristics of the tests. The correct choice of diagnostic tools is very important. The most reliable is the diagnosis of ASD established on the basis of information obtained from various sources and in different ways. Along with this, the leading role is given to clinical diagnostics, including dynamic observation, careful collection and analysis of anamnestic data. Unfortunately, functional and radiological methods, laboratory studies do not currently have markers for autistic disorders and are mainly of an auxiliary nature.
The influence of epidemiological factors on the incidence of ASD.
Factors that do not influence:
- which child is in the order of birth;
- father’s age (the older the father, the higher the likelihood of having a child with autism).
Factors that may influence:
- mother’s age.
- psychogenic (violation of emotional contact with the mother);
- cumulative risk (it is believed that there is an accumulation of genetic mutations);
- information shock (it is believed that escape from reality occurs with an increase in an information flow);
- biological (the main direction for further research).
The contribution of etiological factors.
- heredity – 20-65%;
- exogeny – 25-80%;
- concordance for monozygotic twins – 90-93%;
- concordance for dizygotic twins – 0-10%;
Conclusion: inheritance is not monogenic, exogenous factors play a certain role.
The risk of bearing 2nd children in a family with autism is 4-10%.
If there are 2 older children in a family with autism, then the probability of having a third child with autism is up to 50%.
About 17-20 genes are associated with autism.
Basic symptoms (found in every patient)
- Violation of social functioning.
- Impaired development of communication skills.
- Unusual ability to play symbolic games.
- Limited interests and stereotyped behavior.
- Onset before age 3 years.
- Unusual motor stereotypes.
- Cognitive impairment.
- Emotional response disorders.
- Neurological disorders.
- Behavioral disorders.
How is social functioning disrupted?
Social functioning is always disrupted. Its degree varies, from oddities in social interaction (in the case of Asperger's syndrome) to almost complete detachment and lack of response to external social stimuli. Social deficiency is most clearly manifested in communication with strangers and peers; many children with autism show a differentiated preference for familiar people and demonstrate a pronounced dependence on loved ones.
Social disorders include:
- insufficient use of eye contact;
- lack of longing in the absence of parents and joy when they appear;
- difficulties both in recognizing the emotions of others and in expressing one’s emotional state (through body movement, facial expressions).
Communication skills disorders.
Communication deficits is much deeper than a simple impairment in speaking skills:
- a child does not point to objects, does not show them;
- a child does not try to attract the attention of parents with a glance;
- the speech may not develop at all;
- there is no babbling before the start of speech;
- a child can be chatty but cannot keep up a conversation;
- a child does not grasp humor and irony in conversation.
What kind of behavioral oddities are characteristic of autism?
- lack of play with ordinary toys;
- inadequate repetition of one action;
- the need of an obsessive nature to preserve the constancy of the objective world around them;
- observation of flowing water, moving and rotating objects;
- communication topics are limited around very specific areas – however, speech is well-developed.
How common are cognitive impairments?
Intelligence in autistic children is most often impaired.
- 40-60% have severe and moderate mental retardation
- 20-30% have mild mental retardation
- 17% have borderline mental retardation
- 3% have average indicators and indicators above average
The basis of the taxonomy of modern approaches to correction can be represented as follows:
I Traditional (main) approaches:
2. psychological and pedagogical.
II Alternative (auxiliary) approaches:
alternative options for medical and biological influences;
alternative options for psychological and pedagogical influences.
The lifelong nature of the pathology in ASD, the absence of not only guarantees for successful correctional work but also of a relatively firm prognosis create serious psychological problems. Parents often perceive the diagnosis of autism as a judgement. This diagnosis often displaces the child's real problems, pushes the parent not to use modern opportunities to help the child, but to seek an unattainable “complete cure” by alternative methods.
At the current level of knowledge, drug treatment is not a causal (affecting the cause) method of treating autistic syndromes.
In each case, the use of medical methods requires a clear analysis of the detailed diagnostics problem and careful consideration of the balance between the desired effect and unwanted side effects.
Since medications do not yet act on the cause of the disorder, they are prescribed in accordance with the target symptoms or syndromes (eg, fear, depression, violent behavior, self-harm).
There is accurate data on the mechanisms of drug effect. But this information is not always used yet. An important task for medical professionals dealing with autistic disorders (mainly psychiatrists-narcologists) is to disseminate this knowledge among pediatricians, allied professionals and parents. A persistent bias against drug treatment does not improve the condition of patients with autism.
Rehabilitation of patients with ASD is a long-term process of interaction between medical workers, teachers and social services.
The right of a patient with ASD to be himself, to be different from others is a characteristic of his personality, and it must be recognized by society.