Autism Spectrum Disorders (ASD): Causes, Symptoms and Treatment

Autism is a relatively recent diagnosis. Even at the end of the last century, doctors, faced with manifestations of autism, erroneously diagnosed schizophrenia. Incorrectly prescribed treatment led to irreversible consequences. To date, experts are conducting a large number of studies of this disease, but its nature is not completely clear.

The picture of autism is more manifested in childhood than in adults, and leads to a violation of the integration of the child into society, isolating him from the outside world.

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  What is autism

  Psychologists understand developmental disorders as autism, during which the disorder plays the main role. emotional sphere and communication skills. This is a developmental disorder in which there is a maximum deficit of emotions and the sphere of communication. A child or adult with autism does not feel the need to receive a response from the outside world. His gestures, speech and emotions are not filled with meaning in the usual social terms for those around him.

  Symptoms and treatment of autism in patients of any age depend on the form of the disease. There is no consensus in understanding the nature of the disease: some scientists believe that autism is an inherited pathology, while others believe the acquired nature of the disease is the main cause of autism.

  The literal translation of the word "autism" is within oneself.

  Causes of the syndrome

  Scientists from various fields cannot come to a common opinion regarding the causes of the disease. Children suffering from this disorder, as a rule, are well developed physically and do not have any outwardly distinguishable abnormalities.

  According to one version, the disease occurs due tobrain development disorders.

  Mothers of autistic children also do not have any serious disorders, their pregnancy is uneventful. It is believed that the following factors play a role in the development of pathology:

  • cerebral palsy (CP);
  • infection of the mother with the rubella virus during pregnancy;
  • lipid metabolism disorders, etc.

  Many infectious diseases can negatively affect the development of the brain and be a kind of "trigger" factors that trigger the course of the disease. Until recently, the leading theory of the etiology of autism was genetic. It was believed that there is a gene, the site of which encodes this disorder. However, it is now generally accepted that autism is a polyetiological disease with unclear reasons and mechanism of occurrence.

  

  Symptoms

  In children, autism is characterized by a specific clinical picture. Autism early childhood- a condition that occurs in the first three years of life.

  The first symptoms of autism can occur in the first 2-3 years of a baby's life. Depending on the severity of the disease, the intensity of symptoms varies.

  Autism is a difficult disease to diagnose, so only a qualified psychiatrist has the right to make this diagnosis. However, there are certain symptoms allowing parents to assume that their child has autism.

  For this syndrome There are four main signs that manifest themselves with varying intensity in different children:

  Symptom	Description
  Violation of social interaction
  Emotional component	Emotions, gestures and facial expressions of the baby do not correspond to the current situation: the child does not smile or laugh when someone tries to play with him, amuse him, etc. At the same time, laughter can occur without any external stimulus. The face of an autistic person is like a mask, on which some kind of grimaces appear from time to time. Also, an autistic person is not capable of understanding the emotions of those around him. Healthy children, looking at a person, can understand his mood: joyful, upset, etc.
  Isolation from people	The kid does not participate in games with peers, striving to immerse himself in his own world, unattainable for anyone. Older children are prone to loneliness and do not pay attention to others, perceiving them as inanimate objects.
  Lack of understanding of roles	Autistic children experience problems in games where it is necessary to take on this or that role (Cossack robbers, mother daughters, etc.). Such children may not perceive toys as objects that personify something, have any function. For example, when picking up a toy car, an autistic person spins a separate wheel for hours, and does not roll the car on the floor, as healthy children do.
  Autistic child responds inadequately to contact with parents	Some time ago, it was generally accepted that autistic people do not understand how their parents differ from strangers. This assumption has been refuted: being in the company of their own parents, children are less obsessed with performing one or another action. Children younger age show anxiety when alone, although the autistic person makes no attempt to find or return their parents
  Communication breakdown	Manifested by a delay in the appearance of speech or its complete absence . In the case of a severe form of the course of the disease, the child is not able to speak. To communicate and indicate his own needs, he uses monosyllabic words: eat, sleep, etc. The speech of autistic people is often incoherent, not directed towards other people. An autistic person often repeats the same meaningless phrase. Often, when talking about themselves, autistic people use the pronouns “he”, “she”, that is, they do it in the third person. Answering the question, the children repeat the question or part of it. If you call an autistic child by name, there is a good chance that he will not respond. Also, such children have difficulty giving the sentence the correct intonation, talking too loudly or, on the contrary, too quietly. When communicating, they do not make eye contact.
  Lack of interest in the environment	In childhood, autistic people are not interested in the world around them, they do not ask their parents questions about its structure.
  stereotypical behavior
  looping	For a long time, the child, without being distracted by external stimuli, performs the same type of actions: sorts toys by color, builds a tower of cubes, etc.
  Rituality of actions	Characterized by the fact that autistic children feel comfortable only if they are in their usual environment. The slightest change in the usual flow of things (a slight rearrangement in their room, a change in their diet, etc.) frightens them, forcing them to withdraw into themselves, or provoke aggressive behavior. Autistic behavior is characterized by the fulfillment of certain obsessions(clapping hands, snapping fingers, etc.) in an unusual environment
  Fear and aggression	In an unusual situation for a child, he is able to fall into attacks of aggression or "go into himself", not reacting to what is happening.
  Early symptoms autism	Signs of autism appear quite early. In the first months of their lives, autistic children are inactive, show an inadequate response to external stimuli, and have poor facial expressions.

  The cause of this syndrome is not fully understood. In each case, the manifestations of the disease, despite the general patterns, proceed purely individually. If there are suspicions about the behavior of the child, parents should immediately contact specialists studying this issue.

  

  Development of intelligence in autistic children

  In the development of the child's intellect, so-called autistic traits arise. Autistic children have minor or mild mental retardation. With the development of severe mental retardation, children lose their ability to learn. In the event that there is mild form autism, intellectual development may be either slightly impaired or not impaired at all.

  A feature of the course of autism is the selectivity of intelligence. These children often show success in various fields: mathematics, physics, chemistry, creative subjects. This phenomenon is called the savant syndrome, or savantism. With savantism, the autistic person is extremely gifted in a certain area: he has a photographic memory or is able to multiply multi-digit numbers in his head, but in a number of other disciplines he lags noticeably behind.

  There is speculation that a number of celebrities have had autistic traits to some extent, including Albert Einstein, Woody Allen, Andy Warhol, Leonardo da Vinci, and many others.

  Asperger's Syndrome

  • the absence of intellectual disabilities or, conversely, high level intellect;
  • speech skills without anomalies;
  • the child has difficulty determining the intonation of sentences and the volume of their reproduction;
  • fixation on the performance of any action;
  • a slight violation of coordination of movements, manifested in the form of clumsy walking, running, taking unusual postures that are inappropriate in this situation, etc .;
  • self-centeredness.
  
  

  Children with this diagnosis live without actual restrictions: they study in ordinary and even prestigious educational institutions, create families, etc. It should be understood that their normal integration into society occurs only thanks to a competent approach to the peculiarities of their character, care and love from their parents.

  Rett syndrome

  This is a severe neurological disease that causes severe mental retardation. The disease is genetic. The gene encoding the occurrence of disorders is localized on the X chromosome, which means the occurrence of pathology only in girls. Due to the fact that the genotype of boys contains only one X chromosome, they are not able to live until their own birth and die in the mother's womb. The disease is quite rare - its frequency is 1: 10,000 among newborns. The clinical picture of Rett syndrome includes:

  • a severe degree of autism, contributing to the complete isolation of the child from the world around him;
  • the baby develops normally only during the first year and a half, after which there are violations of the development of the brain, cranium smaller than normal;
  • the impossibility of mastering purposeful movements of the limbs and acquiring any skills;
  • speech is difficult or disappears (mutism);
  • there is a violation of normal motor activity.

  When diagnosing this disease, the prognosis is unfavorable, since the methods of treatment and rehabilitation are ineffective.

  How does an autistic child perceive the world?

  The clinical picture of autism is characterized by certain signs, one of which is considered to be the inability of an autistic child to imaginative thinking. Such children are not able to perceive a person as a complex, holistic formation, including all his features and individual characteristics.

  An autistic child practically does not distinguish between inanimate and animate objects. External stimuli - bright lights, loud music, touch - can make such children feel severe discomfort until they develop aggressive behavior. At the same time, the child closes in on himself, trying to completely isolate himself from everything that surrounds him.

  How to behave as parents of healthy children

  Parents who have no idea about autism should be aware that such children can be found among their children's peers. If any of them reacted inadequately to touch, loud music or a flash of bright light, one might suspect autism or something else mental disorder.It is necessary to calmly assess the situation, in no case to condemn their parents:

  • It is best to cheer them up, try to offer help. Perhaps in this moment they need it.
  • You should not scold the child or condemn his parents, believing that this is a manifestation of spoilage.
  • It is necessary to react to everything calmly, without drawing the attention of others to this incident.
  • If you suspect the presence of mental disorders, you should unobtrusively hide all dangerous piercing and cutting objects.

  Diagnostics

  At a cursory glance, it is quite difficult to determine the manifestations of autism in newborns. The earlier the disease is diagnosed, the higher the success in the rehabilitation of such children and their integration into society.

  Most often, the strange behavior of children is noticed by their own parents, especially if they already have children.

  Specialists from the field of psychology, pedagogy and psychiatry have been working for several decades on various methods for the early diagnosis of autism in newborns.

  Diagnostic method	Description
  Test Methods
  Specialized Questionnaires	When young children are suspected of having an autism spectrum disorder, in addition to taking a history from their parents, the following tests are used: Autism Diagnostic Observation Scale (ADOS); test for the diagnosis of autism (ADI-R); Childhood Autism Rating Scale (CARS); behavioral test for the diagnosis of autism (ABC); autism scores checklist (ATEC); Autism in Young Children Questionnaire (CHAT)
  Assessment of speech abilities	An experienced speech therapist evaluates the child's communication skills, determines the presence or absence of signs of autism
  Cognitive tests	If autism is suspected, the child and their parents are encouraged to take an IQ test or a similar study of intellectual development
  Assessment of adaptive capacity	The psychologist sets the child certain tasks, the solution of which is associated with the ability to interact with the outside world, adapt to a particular situation encountered in everyday life. An autist is offered to describe a particular sequence of actions (dressing, eating, etc.)
  Sensory-motor system assessment	Dysfunction of the sensory sphere (sphere of sensations) often accompanies autism. A specialist diagnoses fine and gross motor skills, vision, smell and hearing of the baby
  Instrumental Methods
  Ultrasound examination (ultrasound) of the brain	It is carried out in order to exclude damage to brain structures
  Computed (CT) and magnetic resonance (MRI) tomography	The methods are based on obtaining a layered image of the structures under study. Appointed to exclude the presence of an organic component in the etiology of the disease The dotted line and marker indicate a neoplasm in the brain that can cause a clinical picture similar to autism.
  Electroencephalography (EEG)	Sometimes autism is accompanied by epileptic seizures. In order to determine the epileptic focus in the brain, this study

  Treatment

  
  

  To date, there is no cure for the disease. Despite this, it is possible to rehabilitate such children with the help of regular classes and the creation of a favorable psycho-emotional environment.

  Pedagogical methods require huge efforts both from parents and their children, and from specialists. A well-designed care plan can include a child in a normal social life.

  General patterns of raising an autistic child:

  1. 1. It is important to understand that autism is not a death sentence. Therefore, it is necessary to vaccinate the baby minimum set social skills, having previously established friendly contact with him.
  2. 2. Reduce to a minimum negative phenomena in behavior: “withdrawal into oneself”, aggression, fears, etc.
  3. 3. Learn to understand and embody social roles.
  4. 4. Teach communication with peers.

  Treatment method	Description
  Behavioral Therapy	It is carried out with the aim of observing and analyzing the behavior of an autistic person in a given situation. After the habitual actions of children are studied, the specialist selects a certain set of motivating factors. For some, this stimulus is a favorite food, for others - a musical composition. Rewards reinforce socially acceptable behavior when needed. With many years of therapy, a kind of contact arises between parents and their child, the acquired skills are consolidated, and the manifestations of autistic behavior subside somewhat.
  speech therapy	It is prescribed if the baby has difficulties with the function of speech formation - essential function, which determines the communicative ability of a person
  Instilling the skills of self-service and integration into society	Since autistic children for the most part do not have the ability to play, eat independently, maintain personal hygiene, the psychologist conducts special exercises designed to help the child adhere to a certain order of performing any actions
  Medical treatment	It is permissible in the case when the patient's aggressive behavior becomes a threat both to himself and to those around him. The attending physician strictly individually determines the type of drug and its dosage in accordance with the indications and contraindications for the use of any drugs, the age and gender of the baby, the presence or absence of chronic systemic diseases expected therapeutic effect

Autism is understood as a congenital developmental disorder in which a person has a violation of social interaction, socialization; violation of the development of language and communication skills; stereotypical (repetitive) behavior and resistance to change, which is expressed in limited interests and the desire for uniformity.

It should be noted that autism is considered a developmental disorder and not a disease. The difference is that the disease occurs initially healthy person, and after a while, thanks to the treatment, the person recovers. Developmental Disorder - congenital feature, a kind of special way along which the development of a person takes place, which differs from the typical course of development of most people.

Autism is usually detected within the first three years of a child's life. Unfortunately, in our country a small amount of pediatricians have the necessary competencies to detect autism at an early age. And parents try not to turn to neurologists and psychiatrists once again. Therefore, cases are not uncommon when autism is detected in children at the age of 4, and at 5, or even at 6 years old. it a big problem, since the efficiency of correction of violations, adaptation and socialization of children is higher, the earlier these violations are detected.

Against the background of basic disorders of social interaction, communication, the presence of limited interests and stereotyped actions, autism has many of the most different manifestations, depending on the level of intellectual development of the child, the degree of deficits in speech and communication, and other features of his development. Each child is unique, and their developmental features can manifest themselves in different ways. Therefore, today people usually talk not about autism as such, but about “autism spectrum disorders” (ASD).

Autism Spectrum Disorders are predominantly a "male" developmental disorder. The ratio of boys and girls with ASD is 4:1, respectively.

So far, the most likely causes of autism in children are considered genetic factors and factors associated with environment, ecology, leading to the formation of pathological chemical and biological mechanisms of the brain.

As it happens, a number of enduring myths have developed around autism and other autism spectrum disorders. These myths have been refuted more than once by experts, but they continue to exist in the minds of citizens who are not very aware of the essence of the problem and periodically “emerge” in social networks.

Let's take a look at three of the most common myths.

Myth 1: autism is the result of improper treatment of parents (primarily mothers) with a child. The author of this myth is Bruno Bettelheim (Bettelheim, Bruno) - American psychoanalyst, psychiatrist of Austrian origin. He believed that the detached, "cold" attitude of the mother towards her child leads to the fact that the child is protected, closed from the outside world, refuses to communicate and interact with him. This myth was refuted by subsequent objective scientific research. It turned out that the attitude of parents to the child, the ways of upbringing and communication are in no way the cause of autism, since it is a congenital developmental disorder of a biological nature. Also, studies have shown that children with autism spectrum disorders are born in approximately equal proportions in families of kind, caring parents, and families of “disengaged” parents who care little about their offspring; and in families leading an asocial lifestyle, including families of alcoholics, drug addicts, etc., and in families of quite respectable citizens, including scientists, entrepreneurs, officials, etc.; both rich families and poor ones. In other words, life circumstances and family conditions are not the cause of autism spectrum disorders.

Myth 2: children with autism, with autism spectrum disorders are gifted children, they have some kind of superpowers. It is not known who is the author of this myth, but ideas about the presence of unusual abilities in children with ASD stubbornly wander through the media and social networks. Unfortunately, according to American scientists, about 50%, and according to domestic doctors, about 70% of people with ASD have serious intellectual disabilities, they are diagnosed with mental retardation varying degrees expressiveness. So there is no need to talk about the "superpowers" of these people. Among the remaining 30% (50%) of people with ASD, there are indeed gifted children and adults, but their percentage does not exceed the percentage of gifted children and adults among ordinary, neurotypical people.

Myth 3: Autism occurs only in children, it does not occur in adults. This myth appeared in connection with the peculiarities of the functioning of the healthcare system in our country. The fact is that, until recently, for every child diagnosed with autism spectrum disorders and who has reached the age of 18, doctors automatically changed this diagnosis to a diagnosis of schizophrenia. Thus, it turned out that we do not have adults with ASD. This practice has been abolished only recently, so there are still very few adults diagnosed with autism spectrum disorders in our country. It is clear that since autism is a congenital developmental disorder, it does not disappear anywhere, but continues throughout a person's life. With the help of special treatment and behavior correction programs, it is possible to significantly reduce, and sometimes completely eliminate, some individual manifestations of autistic disorders, but it is hardly possible to “cure” autism as such at the current level of medical development.

Disturbances in communication and social interaction in children with ASD cause a lot of trouble for themselves, their parents, educators and school teachers. Communication disorders are manifested in the fact that the formation of speech is delayed in children, many of them cannot speak and understand poorly or almost completely do not understand the speech addressed to them. How can a child ask for something if he cannot say? Agree, any of us, if we need something, and others around us can’t understand what exactly we want, will be angry at these “surrounding people”, “roll up” scandals to them, shout at them. So does a child with ASD, if adults do not understand what he wants. The child throws a tantrum, adults try to guess what he needs, by trial and error they try to find what the son or daughter needs, and, in the end, they find it. The kid stops the tantrum, the adults calm down, but the child has learned a lesson: if you need something, you need to throw a tantrum. Now the rest of the parents will be reduced.

Experts know this feature of children with ASD and often begin corrective work precisely with teaching the child the skill of asking. When it is possible to teach a child to ask (since he does not speak, he is taught to use gestures or pictures to ask), the number of tantrums is reduced significantly, and further corrective work runs more smoothly.

Violation of social interaction is often associated in children with ASD with a low level of imagination, which also creates difficulties for them in adapting to life among other people. For example, a child with ASD, as a rule, does not know how to deceive (imagination is not sufficiently developed for this), and he also takes all the words of others at face value and understands them literally. But will others like it if someone constantly tells them the truth?

Here's a simple example: a teacher leans over to help a child color a drawing. “Your breath stinks,” the boy says loudly. The teacher, of course, brushed her teeth in the morning and even rinsed her mouth, but children with ASD often have increased sensitivity to smells, so the boy caught something that other children and adults would not notice, and honestly announced it. It is clear that such behavior did not add to the teacher's love for him.

A literal understanding of speech can also lead to problems. Sometimes, quite funny.

Another example from life: mother in social network tells how she and her five-year-old son with ASD went to see a psychiatrist. An elderly male doctor asked the child various questions, and among other things he asked: “What do you think, which is more - fingers on the hand or hair on the head?”. Mom writes: “I sit and think what he will answer, looking at the doctor’s bald head?”. Of course, the child answered the truth, because there were much more fingers on the doctor's hand than there were hairs on his head.

Another source of problems is the desire of children with ASD for constancy, monotony, a categorical dislike for changes: for changes in the daily routine, for changes in the routes of movement to school, home, to the store, to transitions from one activity to another, in general, to any changes, especially unexpected ones.

Experts recommend that you always inform your child in advance about all upcoming changes. You can use visual schedules - pictures that sequentially depict the classes that the child has to do; social stories describing upcoming activities, etc.

Such features of development have a strong influence on the early development of the child and on the whole life of a person in the future. There are no medical tests that can diagnose autism. Only by observing the behavior of the child and his communication with others, visiting a neurologist and a psychiatrist, you can make a diagnosis of autism.

Children with autism do not want to make friends. Such children give preference to loneliness, and not to games with peers. Autistic people develop speech slowly, often use gestures instead of words, and do not respond to smiles. This disease is quite common (5-20 cases per 10,000 children).

What advice would you give to parents and loved ones of children with autism?

If signs of an autistic type of development become noticeable for parents, then it is imperative to contact a child psychiatrist to make sure how these features of the child's development are justified. Diagnosis "early childhood autism"can only be delivered by a specialist - a child psychoneurologist - after a thorough examination of the baby. If this diagnosis is made to the child, then parents need to decide on a program for the further education and development of the baby. To do this, it is important to consult a special psychologist or correctional teacher who has experience working with such children, can provide a detailed description of the state of the child's mental development, and also determine the forms and directions of correctional classes for the child.

Parents need to be patient, firmly believe in success and not lose hope. Today in many cities there are special courses and schools for parents whose children have autism.

The basis for successfully overcoming autism is the implementation at home and in the conditions of special centers of an individual rehabilitation program for a sick child. Naturally, the main task here lies on the shoulders of the parents. Therefore, the first step should be to accept that their child has autism. After all, he is not a mentally ill person, he just has a "different way of seeing the world", it is more difficult for him to express his feelings. This is where she needs to be helped, supported, taught.

With the correct and constant implementation of the rehabilitation program, children with autism show excellent results and can largely recover and adapt to normal life. Often they have a gift or talent in some area of ​​art or knowledge.

Parents of special children face such developmental problems as: hypersensitivity to sounds and touch, delayed speech development, imbalance.

intellectual development these children are quite diverse. Among them may be children with normal, accelerated, sharply delayed and uneven mental development. There is also both partial or general giftedness, and mental retardation.

To prevent emotional and behavioral disorders, it is very important that adults treat the baby carefully, with great patience and respect. At the same time, in no case should a child be suppressed or intimidated, it is necessary to simultaneously stimulate and organize his activity, to form an arbitrary regulation of behavior.

Of particular importance in the upbringing of an autistic child is the organization of his purposeful behavior and a clear daily routine, the formation of stereotypical behavior in certain situations.

Since autism spectrum disorders are multiple, then the correction of the child's development should take place in a complex manner. We are talking about the fact that the focus should be on the motor, emotional and cognitive spheres. For achievement best result it is advisable to get expert advice (it is especially important to work out certain skills), be able to activate the child, perform exercises to redistribute muscle tension, master different ways relieve stress, promote the harmonization of tonic regulation as a whole, since it is precisely this that is the basis of a full-fledged mental development.

The main guideline for the development of a child with autism should be a varied, emotionally rich communication with his parents. Parents should talk to him more than to healthy child. It is necessary to constantly stimulate the child's interest in the outside world. Interested performance by you regime moments and affectionate attitude towards the child, the designation of emotional states with various sound combinations will contribute to the emotional "infection" of the baby. And this, in turn, will gradually cause in him a need for contact and a gradual change by the child of his own emotional (often aggressive) state.

Constantly draw the attention of the child to your actions. Bathing, dressing, examining, etc. child, do not be silent and do not ignore the child, but, on the contrary, constantly gently push him to imitate. At the same time, remember that the child is only able to imitate what, in a general form, he himself can already do. It's good when mom sings, and it can be not only songs; you can sing the name of the child, your comments, your requests, stories, praise, and the like. And you need to talk with such a child in a calm and quiet voice.

Keep in mind that next to indifference, affective blockade (isolation) in relation to you, a symbiotic form of contact is also possible, when the child refuses to remain without you at least for a while, despite the fact that he is never gentle with you.

At all stages of establishing contact, choose a safe distance for communication and unobtrusively demonstrate your readiness for contact, each time necessarily starting from the mental level at which the child is located.

During tactile contact with the child, you need to tell him about your feelings, including even manifestations of anger at his resistance. When doing this, keep in mind that an autistic child can understand your feelings and speech. However, the emotional characteristics of the baby is an obstacle to the process of perceiving maternal affection. It is important to continue to eliminate children's resistance with such stimuli that are emotionally oversensitive and uncomfortable for him (a long kiss, a whisper in the ear, etc.).

Use (as possible) a method of mobilizing the child to play without any requirements and instructions only for the purpose of establishing an emotionally favorable, trusting contact, even though the child may not pay attention to you.

Constantly stimulate emotional reactions child for warmth, coolness, wind, beautiful leaves, bright sun, melting snow, streams, birdsong, green grass, flowers; to polluted places in the environment (contaminated, bad smell, dirty water) and clean and cozy glades and the like. At the same time, repeatedly teach and encourage the child to use appropriate gestures and body movements, vocalizations, words; approve of his behavior.

Learn to “read” his elementary attempts to make contact with you and with a smile (in an affectionate voice, gentle look, hugs, repeated repetition of her name, etc.), encourage the child to continue this contact.

Often, mothers come to the doctor with complaints of delayed speech development in a child. But in some children, with a close look, the specialist, in addition to this, sees the features of the child's behavior that differ from the norm and are alarming.

Consider a clinical example:

Boy S. Age 2 years 9 months. According to the mother, the child's vocabulary is no more than 20 separate words, consisting of two or three syllables. There are no phrases. Mom says that the child often has tantrums, is restless, it is difficult to fall asleep. The child's mother has no other complaints. On examination, the doctor notices that the child does not look into the eyes, is constantly in motion, reacts with a cry if something is not given or forbidden to him. You can calm the child only by giving him mobile phone or tablet. Shows interest not in children's toys, but more in shiny pieces of furniture and interior. Starting to play something, quickly loses interest and switches to something else. Asking the mother, it turns out that the child is very selective in food. Not accustomed to the potty, defecation only in a diaper in a standing position. Difficulty falling asleep and waking up during sleep. The child underwent Electroencephalography and consultations with a clinical psychologist and a speech therapist. According to the diagnostic results and clinical picture diagnosed with Autism Spectrum Disorder.

Autism Spectrum Disorders (ASDs) are complex mental developmental disorders characterized by social maladaptation 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 quite 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).

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 possible factors The appearance of this disorder in children is called some hypotheses:

Hypothesis of genetic predisposition

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).

Influence hypotheses external factors: infections, chemical exposure on the mother's body during pregnancy, birth trauma, congenital disorders metabolism, 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 age norm. Most often, these signs can be detected in children under the age of 3 years.

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.

Speech Development Disorders: at an early age, the absence or weak cooing and babbling can be noted. 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.

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).

H violation of exploratory behavior: children are not attracted by the novelty of the situation, they are not interested in the environment, they 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.

Violations eating behavior : a child with autism can be extremely selective in the products offered, food can cause a child to be disgusted, dangerous, often children begin to sniff food. But along with this, children may try to eat an inedible thing.

Violation of self-preservation behavior: by virtue of a large number 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.

Motor Development Disorder: as soon as the child begins to walk, he is noted for awkwardness. 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.

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

Difficulties in concentrating: children hardly focus on one thing, there is a high impulsiveness and restlessness.

Bad memory: Often, both parents and professionals notice that children with autism remember well what is 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.

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 new situation, 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 perform joint activities with him, leaving 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 scared harsh 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).

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:

Violation social adaptation

Communication disorders

Stereotypical behavior

The main diagnostic steps include:

Examination of a child by a psychiatrist, neurologist, psychologist

Observing the child and completing the Autism Rating Scale, which can be used to determine the severity of the disorder

Conversation with parents

Filling out questionnaires by parents - "Questionnaire for the diagnosis of autism"

Types of RAS

There are several current classifications ASD, and the separation often occurs on completely different grounds, which, naturally, 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 major disorders: difficulty in establishing contacts with the outside world, stereotypical behavior, as well as a delay or impairment in the communicative functions of speech development . It is also necessary to note the condition early appearance of these symptoms (up to about 2.5 years)

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. 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)

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 in the most mild form. Children are characterized by increased vulnerability, contact with the world stops at the slightest sensation of obstacles. These children can make eye contact.

Asperger Syndrome. Formed from birth. Children are observed early start speech development, rich vocabulary, developed logical thinking, 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 given state are stereotypical, monotonous movements of the hands, their rubbing, wringing, while not bearing a purposeful character. The rarest of the presented diseases, occurring almost always only in girls.

Child psychosis. The first manifestation of symptoms before 3 years of age. Characterized by violations 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 set of words. There are times when children freeze in place, like dolls.

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. Complex psycho-correctional work, which includes all sections and types of rehabilitation assistance, which will be described below, is, along with drug therapy, effective means relief of negative symptoms of ASD, and also contributes to the normal inclusion of the child in society. Types of RAS correction:

1) Psychological correction - the most common and known species; characteristic enough a wide range 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 features 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;

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.

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).

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.

6) Medical correction of RAS. Some forms of autism require medicinal help to kid. 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 events from medicines 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.

In Children's diagnostic center Domodedovo has all the facilities for diagnosing Autism Spectrum Disorders. Such as: examination by a pediatric neurologist, clinical psychologist, speech therapist, examination - electroencephalography and. As well as correction techniques, such as ABA therapy.

GBU "Center for Psychological and Pedagogical Assistance to Families and Children"

Psychological characteristics of children

Intolerance to many foods. Aspiration is inedible. Sucking inedible objects, tissues. Examination of the surroundings with the help of licking.

Hypersensitivity to odors. Examination of the environment with the help of sniffing.

A tendency to autostimulation by tension of the body, limbs, hitting oneself on the ears, pinching them when yawning, hitting the head against the side of the stroller, headboard. Inclination to play with an adult such as spinning, whirling, tossing, inadequate grimaces.

The impression of an unusual expressiveness of the meaningfulness of the look in the first months of life. The impression of "stupidity", misunderstanding of simple instructions. Poor concentration of attention, its rapid satiety. "Field" behavior with chaotic migration, inability to concentrate, lack of response to appeal. Overselective attention. Over-focus on a particular object. Helplessness in elementary life. Delay in the formation of self-service skills, difficulties in learning skills, lack of inclination to imitate other people's actions. Lack of interest in the functional meaning of the subject. A large stock of knowledge for the age in certain areas. Love of listening to reading, attraction to verse. The predominance of interest in form, color, size over the image as a whole. Interest in the sign: the text of the book, letter, number, other designations. Conventions in Game. The predominance of interest in the depicted subject over the real. Valuable interests (in certain areas of knowledge, nature, etc.).

Unusual auditory memory (remembering poetry, other texts). Unusual visual memory (remembering routes, the location of signs on a sheet, a gramophone record, early orientation in geographical maps).

Features of temporal relationships: the same relevance of impressions of the past and present. The difference between "wit" and intellectual activity in spontaneous and given activity.

Gaming activity significantly determines mental development child throughout his childhood, especially before school age when the role-playing game comes to the fore. Children with autistic traits at any age stage do not play story games with their peers, 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 and inclination to reproduce this kind of relationship. .

Insufficient social orientation, generated by autism, in these children is manifested in the lack of interest not only in role-playing games, but also in watching movies and TV shows that reflect interpersonal relationships.

The development of the role-playing game of an autistic child is distinguished by a number of features. First, such a game usually does not arise without a special organization. Training and creation of special conditions for games is required. However, even after special training, only folded play actions are present for a very long time - 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: “Drip the nose”, and runs on; throws dolls into a basin of water with the words “Pool - swim”, after which it begins to pour water into a bottle.

Secondly, the role-playing game develops very gradually, and in its development must go through several successive stages. Playing with other children, as normally happens, is initially out of reach for the autistic child. On the initial stage special education with a child is played by an adult. And only after a long and painstaking work, you can connect the child to 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 at preschool age, other types of games are also important for children with autistic symptoms.

1. Each type of game has its main task:

• 
  the child's stereotypical game is the basis of interaction with him; it also provides an opportunity to switch if the child's behavior gets out of control;
• 
  sensory games provide new sensory information, experience pleasant emotions and create an opportunity to establish contact with the child;
• 
  therapeutic games allow you to remove internal stress, throw out negative emotions, reveal hidden fears and, in general, are the first step of the child to control his own behavior;
• 
  psychodrama - a way to deal with fears and get rid of them;
• 
  joint drawing provides wonderful opportunities for the autistic child to be active, to develop his ideas about the environment.

In the future, in different classes, you use types of games alternately. At the same time, the choice of a game often depends not only on the goals set by the teacher, but also on how the lesson proceeds, on the reactions of the child. This requires flexibility in the use of different games.

3. All games are interconnected and freely "flow" one into another. Games develop in close relationship. So, in the course of a sensory game, a therapeutic game can arise. In this case, a calm game develops into a violent splashing of emotions. In the same way, it can return to its former calm course. In the therapeutic game, old, hidden fears of the child are revealed, which can immediately result in playing out a psychodrama. On the other hand, in order to prevent the child from becoming overexcited during a therapeutic game or psychodrama, at the right time we have the opportunity to switch him to reproducing the actions of his stereotypical game or to offer a favorite sensory play. In addition, it is possible to develop the same game plot in different types games.

4. All types of games are characterized by common patterns:

• 
  repeatability;
• 
  the path “from the child”: it is unacceptable to impose 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 various tricks and methods.

Any arbitrary activity in accordance with the set goal poorly regulates the behavior of children. It is difficult for them to distract themselves from direct impressions, from the positive and negative "valency" 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 learning activities in all its integral components.

Depending on the severity of the disorder, a child with RDA can be trained both in an individual education program and in a mass school program. The school still remains isolated from the team, these children do not know how to communicate, they do not have friends. They are characterized by mood swings, the presence of new fears already associated with the school. School activities cause great difficulties, teachers note passivity and inattention in the classroom. 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, the heroes of which they are. There is a selective attachment to those adults who listen to them and do not interfere with fantasy. Often these are random, unfamiliar people. But there is still no need for an active life together with adults, for productive communication with them. Studying at school does not add up to leading learning activities. In any case, special corrective work is required to form the learning behavior of an autistic child, to develop a kind of "learning stereotype".

List of used literature

1. 
   Karvasarskaya E. Conscious autism, or I lack freedom / E. Karvasarskaya. - M.: Publisher: Genesis, 2010
2. 
   Epifantseva T. B. Handbook of a teacher-defectologist / T. B. Epifantseva - Rostov n / D: Phoenix, 2007
3. 
   Nikolskaya O.S. Autistic child. Ways of help / O.S. Nikolskaya, E.R. Baenskaya, M.M. Liebling. - M.: Publisher: Terevinf, 2005
4. 
   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
5. 
   Mamaichuk I.I. Psychologist support for children with autism. - St. Petersburg: Speech, 2007
6. 
   Fundamentals of special psychology / ed. Kuznetsova L.V., Moscow, Academy, 2005