Frustration of an autistic range
The Frustration of an Autistic Range (FAR) – group of the mental diseases which are characterized by distortion of development with deficiency of communicative abilities, behavioural and motive stereotypies. The debut occurs at infantile and early children's age. Symptoms – impossibility to begin and support interpersonal interaction, limited interests, the repeating monotonous actions. Diagnostics is carried out by method of observation and a conversation. Medical actions include behavioural therapy, special training, medicamentous correction of behavioural and catatonic frustration.
Frustration of an autistic range
In the International classification of diseases of the 10th revision (MKB-10) of frustration of an autistic range are not allocated with separate category, but are included in the heading F84 "General Disorders of Development". RACES unite children's autism, atypical autism, Asperger's syndrome, other disorders of ontogenesis, the general disorder of development not specified. Separate diagnostic unit "Frustration of an autistic range" is entered into the new version of the qualifier (MKB-11). RACES demonstrate in the childhood - up to 5 years, remain in a podrostnichestvo and adult age. Prevalence among children makes 0,6-1%. According to epidemiological statistics of the last decades, the frequency of frustration around the world gradually increases.
Reasons of RACES
The factors capable to provoke frustration of an autistic range are subdivided on genetic and environmental. Depending on the family anamnesis, development of autistic frustration is defined on 64%-91% by heredity. The mechanism of transfer of diseases from parents to children is not found out, but is established that the risk of development of pathology is highest at monoovular twins, is slightly lower at raznoyaytsevy and even less at brothers and sisters. The majority of the genes associated from RACES define functioning of nervous system and activity of the proteins influencing reproduction of genetic information. Carry to other factors increasing probability of autistic pathologies:
- Floor. Boys are more subject to frustration. An epidemiological ratio between children of different floors – 1:4.
- Exchange and chromosomal diseases. The origin of RACES is connected with genesis of a syndrome of a fragile X-chromosome, Rhett's syndrome, a Down syndrome, a fenilketonuriya, tuberozny sclerosis. Presumably, there are similar defeats of structures of TsNS defining a komorbidnost of diseases.
- Premature birth. A part in development of autistic violations is played by influence of adverse factors during the crisis periods of formation of TsNS. Therefore premature babies are in group of the increased risk.
- Age of parents. The probability of RACES grows together with increase in age of parents at the time of conception. Most often children whose fathers are more senior than 50 years have a disease, and mothers are more senior than 35-40 years. Also high risk exists at the kids born by minor mothers.
By consideration of pathogenetic mechanisms of frustration of an autistic range are divided into endogenous and exogenous (atypical). Kanner's syndrome and procedural autism of schizophrenic type concerns to the first group. Feature of these diseases – the asynchronous type of an arrest of development which is shown violation of hierarchy of mental, speech, motor functions and an emotional maturity. Distortion of natural process of replacement of primitive forms of the organization by difficult is observed. Other mechanism of development is observed at atypical autism within intellectual backwardness and gross speech violations. Features of a dizontogenez are close to the heavy intellectual underdevelopment specific to chromosomal and exchange pathologies, there are no signs of an asinkhroniya.
Researches of pathogenesis of autistic diseases are conducted with positions of neuromorphology, neurophysiology and biochemistry of a brain. Ontogenesis of TsNS includes several critical periods in which there are structural and functional high-quality changes providing formation of more difficult functions. The peak of transformations falls on an infancy and the early childhood: since the birth about one year, from 1 to 3 years, with 3 and to 6 years. The number of neurons in each area increases, the quantity increases autoantitet to a factor of growth of nerves, EEG-activity parameters definitely change, lysis of neurons of visual bark amplifies. Development of RACES happens at influence adverse endo-and exogenous factors during the critical periods. Presumably, there is one of three mechanisms of pathogenesis: loss of significant neural populations, stop of neuroontogenesis or inactivation of spare cages of young areas of a brain.
Include eight nosological units in MKB-10 of RACES: five of them admit as autistic all experts, concerning others three, the most rare, discussions are conducted. Classifications are the cornerstone of feature of etiopatogenetichesky mechanisms and a clinical picture. The following types of frustration are allocated:
- Children's autism. Begins aged up to 3 years, but it can be diagnosed later. The classical triad is distinguished from symptoms: violation of social interactions, stereotypies, regress of the speech.
- Atypical form of autism. Differs from the previous form of frustration in later debut and/or lack of all triad of symptoms. It is characteristic of persons with a deep oligofreniya, heavy violation of the receptive speech.
- Rhett's syndrome. The genetic disease diagnosed for girls. Full or partial loss of the speech, an ataxy, deep mental retardation, stereotypic roundabouts is defined by hands. Interest in communication is rather kept therefore this frustration not by all researchers is ranked to RACES.
- Dezintegrativny children's frustration. Develops after 2 years of normal ontogenesis. The behavior is similar to children's autism and children's schizophrenia. Not less than two regressions from four are observed: social skill, language, movement skills, control of intestines and bladder. The question of reference of this pathology to category RACES remains open.
- Hyperkinetic frustration with an oligofreniya. The diagnosis is confirmed at deep mental retardation with IQ indicator to 35 points, a hyperactivity, decrease in attention, stereotypic behavior. Inclusion of this disease in the RACES group is exposed to discussions.
- Asperger's disease. Speech and informative functions are developed better, than at children's autism. Distinctive characteristics – eccentricity, awkwardness, monotonous behavior models, concrete thinking, difficulties of understanding of irony and humour.
- Other general ontogenetichesky frustration. Diseases, characterized by stereotypies, qualitative deviations in social interactions, the repeating interests. Cannot be unambiguously carried to any of the listed above diseases because of a stertost or combination of symptoms.
- Disorder of ontogenesis not specified. It is shown by a wide range of informative and behavioural deviations, violation of social activity. Does not correspond to criteria of other RACES.
Symptoms of RACES
Patients with frustration of an autistic range experience difficulties of communication. They are not capable to initiate and continue dialogue, to approach people, to sympathize, empathize, share emotions, to involve people around in the ideas. In hard cases the response to attempts of people around to come into contact completely is absent. Features of thinking define problems in understanding of sensual and role implication of relationship. Children do not make friends, refuse games or participate, without being involved in game interactions, without using imagination. Concerning a sokhrann function of communication at Asperger's syndrome, but concreteness of thinking of patients, misunderstanding of a mimicry and intonations complicates establishment of the friendly relations, and at adults – love and romantic.
Other characteristic symptom of the majority of RACES – deviations of nonverbal communicative behavior. Patients avoid visual contact, do not use language of a body and speech intonation, have problems with understanding and use of nonverbal means of communication. In the course of special training they can learn a small amount of functional gestures, but their variety much less, than at other people, and spontaneity of use is absent. Severe forms of frustration are followed by total absence of visual contacts, gestures, mimic expressions.
Interests of patients are limited also rigidna. Quite often there is a pathological attachment to objects – to toys or copies of a collection, to personal ware, furniture, clothes. Often there is a pathological reaction to the arriving sensual signals – light, a sound, a touch, change of temperature. The paradoxicality of the answer is that unpleasant influences, for example, painful, can quietly be perceived, and neutral – whisper, noise, twilight lighting – cause unpleasant feelings.
Stereotypies are shown in simple actions, the speech and difficult acts. Children run round, knock toys about firm surfaces, build them in a strict order. Adults perform rituals, are pathologically pedantic concerning an arrangement of things in the room, feel the need for an invariance and constancy (an arrangement of things, a day regimen, a route of walks, the strict menu). Verbal stereotypies are presented by verbal and phrase ekholaliya – senseless repeated repetition of words, final syllables, the terminations of phrases.
Many patients have intellectual frustration and speech violations. Often violations in the motive sphere – shaky or angular gait, walking on tiptoe, a diskoordination are found. At heavy symptomatology there are samoprovrezhdeniye of stereotypic character. Adults, teenagers are inclined to a depression, alarm. At various forms of frustration perhaps katatanopodobny behavior. In the heaviest option the catatonia is shown as total absence of movements and the speech, long safety of poses and wax flexibility (katalepsiya).
The special developing events and rehabilitation are necessary for patients. Without them quality of life significantly worsens: patients do not seize the school program (usual or correctional), do not interact with other people, are not able to use simple system of gestures or others auxiliary the technician of communication, for example, of the PEKS (PECS) cards. As a result both adults, and children need permanent care and support, independently do not cope even with daily rituals of self-service. The uncured neurologic symptomatology including the kaktatonichesky attacks, badly coordinate gait self-damaging the stereotypic movements leads to different injuries. Statistically, physical damage are sustained by 20-40% of patients, the majority of whom have an indicator IQ lower than 50.
The diagnosis is exposed by the psychiatrist on the basis of data of clinical inspection. Usually happens to make enough observation of behavior and emotional reactions of the child, to estimate his ability to keep in touch, interview parents, having revealed complaints and the family anamnesis. For obtaining more exact and full information special techniques, for example, the questionnaire of social communication, the screening test for autism at children (M-ChAT), an observation algorithm for diagnostics of autism (ADOS) are used.
Consultation and survey by the neurologist, the psychological testing aimed at measurement of intelligence, level of development of social, cognitive and language skills is in addition appointed. Differential diagnostics includes distinction of RACES with a selective mutizm, speech frustration and social disorders of communication, oligofreniy without autistic symptomatology, SDVG, the stereotypic repeating movements and schizophrenia. For diagnosis of frustration of an autistic range a number of criteria has to be revealed:
- Deficiencies of communication, social interaction. Inferiority of these spheres is steady, is shown at direct contact. The lack of emotional reciprocity, an obednennost of nonverbal means of communication, difficulties of establishment, maintenance and understanding of relationship is defined.
- Stereotypies. In structure of behavior, activity, interests limitation and repeatability of elements is found. Identification of at least two symptoms from the following is necessary: motor/speech stereotypies; behavior rigidnost, commitment of stability; limited abnormal interests; the perverted reactions to entrance touch information.
- Early debut. Symptoms have to be present at the early period of development. But the clinical picture is not shown, when there is no relevant requirements of the environment.
- Deterioration in adaptation. Frustration worsens daily functioning. Adaptation in the family, school, professional relations is reduced.
- The symptomatology is excellent from mental retardation. Communicative violations cannot be explained with exclusively intellectual insufficiency. However, intellectual backwardness is often combined with autistic violations.
Treatment of RACES
Therapy of frustration of an autistic range always of a multidistsiplinarn, includes psychology and pedagogical escort of the child/adult and family members, medicamentous knocking over of sharp symptomatology, the all-strengthening and rehabilitation actions. The main objective of treatment – to create the skills necessary for comfortable communication, independent functioning in life and a habitual microsocial environment – in a family, an educational class. As RACES are various on clinical manifestations, the plan of therapeutic actions is formed individually. It can consist of several components:
- Behavioural therapy. Use of intensive behavioural methods which are based on encouragement of any forms of communication and constructive interaction is widespread. One of techniques – the applied analysis of behavior (ABA therapy). It is based on stage-by-stage development of difficult skills: the speech, a creative game, ability to come into visual contact are displayed on the small actions more available to the patient. Complexity of operations increases the teacher gradually.
- Correction of the speech, language. Logopedic classes are given as in a classical form with development of sounds, syllables, words and offers, and in the special program which purpose – to master any available means of communication. Patients are trained in a sign language, a technique of exchange of images, use of the technical communicative devices generating the speech on the basis of the symbols chosen by patients on the screen.
- Physical therapy. Massage therapists, physiotherapists, make the instructor of LFK and realize the plan of medical actions helping patients to compensate deficiencies of the motive sphere. Occupations and sessions are directed to replacement of stereotypies with purposeful actions, elimination of an ataxy and apraxias. Courses of massage, remedial gymnastics, physical therapy low-frequency currents are appointed.
- Medicamentous therapy. At the expressed behavioural symptoms – rituals, self-damage, aggression – atypical antipsychotic medicines are applied. For control of affective frustration antidepressants, in particular, of SIOZS, and also stabilizers of mood (valproata), light sedatives are shown.
Forecast and prevention
Predictively the RACES form which are not followed by intellectual backwardness and heavy speech violations are optimum. Patients of these groups at intensive medico-psychology and pedagogical support overcome the majority of symptoms of a disease, rather successfully adapt in society, master a profession and are engaged in work. In this plan the greatest percent of a positive outcome decides at patients on Asperger's syndrome. Prevention of autistic frustration is not developed because the leading etiologichesky role is played by a genetic factor, and the exogenous reasons of a predpolozhitelna. Children from risk groups are recommended to undergo screening of arrests of development in 9 and 18 months, in 2 and 2,5 years.