Atypical autism – the psychoneurological frustration caused by structural violations of a brain and which is characterized dizontogenezy. It is shown by limitation of social interactions, decrease in informative activity, speech and motive stereotypies. At patients perception of reality, thinking concrete is broken, often there is an intellectual underdevelopment. Clinical examination is conducted by the psychiatrist and the neurologist, EEG and psychological testing is in addition appointed. The help to patients includes drug treatment, special intensive training and rehabilitation.
Atypical autism is most widespread among patients with a deep oligofreniya, and also among patients with heavy specific violations of development of the speech providing understanding of grammatical structures, intonations, gesticulations. Frustration received the name because of features of a clinical picture, is atypical or age of a debut (after 3 years), or the complex of symptoms – a disease can be shown in the first 3 years of life, but from three obligatory clinical criteria of RDA (a stereotypy, speech and communicative violations) only two are defined or one. The epidemiology of an atypical form of autism makes 0,02%. Among patients males prevail.
Reasons of atypical autism
Physiological basis of a disease are structural changes of various departments in a brain. They can be provoked by different factors – endogenous (internal) or exogenous (external), genetic. The reasons of development of atypical autism are subdivided into three big groups:
- Hereditary otyagoshchennost. More than at a half of patients close relatives with the same diagnosis come to light. At the end of the 20th century researchers found the gene responsible for autism. Its existence does not guarantee development of a disease, but increases risk at influence of other factors.
- Prenatal and natal complications. The probability of autism increases at the complicated period of pregnancy and childbirth. Most of sick children were subject to a pre-natal hypoxia, infections, a toksemiya, are given birth before term.
- Somatic and mental diseases. Heavy psychotic options of autism are debuted at the malignant course of children's schizophrenia and a number of genetic diseases. Symptomatic they are shown at a fenilketonuriya, TsMVI, epilepsy.
Pathophysiological basis of a disease – damage of a brain. The provocative mechanism at a debut of autism is influence of the damaging factor at the certain age coinciding with the critical period of development of systems of an organism, in particular TsNS. Ontogenesis of nervous system represents the sequence of the crises providing high-quality changes of mental and physiological processes. Hypersensibility to influence of adverse factors is peculiar to these periods. Emergence of severe forms of atypical autism is the share of age of 16-18 months and coincides with important structural ontogenetichesky processes in a brain, peak of natural death of neurons in visual bark.
According to MKB-10 distinguish two kinds of pathology. The first – the atypical autism which is combined with an oligofreniya. Includes all types of intellectual backwardness with autistic lines, character of a current – maloprogrediyentny. This form meets at Martin-Bella's syndrome. The second version – atypical autism without intellectual insufficiency. It is also called atypical children's psychosis, atypical psychotic frustration at children. This option of a disease comes to light at Rhett's syndrome, a Down syndrome and children's malignant schizophrenia. Allocate three general stages of atypical psychosis:
- Autistic. Its duration makes of 4 weeks before half a year. Key manifestations – detachment, fading of emotional reactions, passivity increase. Natural development stops, autism goes deep.
- Regressive. It is developed in an interval of half a year about one year. It is characterized by strengthening of symptomatology of autism, a reduction of the speech and skills of hygiene. Patients begin to eat inedible, a considerable part of their physical activity is made by stereotypies.
- Catatonic. Is the most long, lasts from one and a half to two years. Autism depth decreases, catatonic frustration – motive excitement with stereotypies appear. Patients are turned, jump, shake a trunk, run circles.
After end of a catatonic stage there is a gradual exit from psychosis. At remission steady hyperkinetic frustration with impulsiveness, nevrozopodobny symptoms in the form of primitive persuasive actions are observed. Manifestations of autism are reduced, there is a weak informative activity, reactions on people around, understanding of the turned speech, skills of neatness are restored. Stable is an otgorozhennost from reality, emotional coldness in the relations, stereotypic forms of activity.
Symptoms of atypical autism
One of key displays of pathology – violation of ability to come into social contacts. This symptom happens expressed or weak. In the stable period patients do not refuse communication, but cannot begin and keep up the conversation. At severe forms of autism the aspiration to remain alone, to be fenced off from the world around is brightly expressed. Patients do not want to interact with people by means of the speech, gestures or views. Attempts of coercion to contact cause impulsive emotional and motive reactions – shout, crying, self-damages, aggression. Specific violation of the speech includes inability to formulate and introduce own ideas, in hard cases the understanding of the turned phrases and words is complicated. Ability to abstraction is lost – patients do not understand a figurative sense of expressions, sarcasm, humour.
Affective coldness is characterized by difficulties in expression of emotions, feelings and experiences. Patients seem indifferent and indifferent to the events, incapable to rejoice, long. They cannot empathize, show love or hatred. At children the emotional relations with mother are often shown as the pathological attachment based on fear of unfamiliar situations, objects and people, but not on love and the need for maternal care. Excessive irritability of patients is explained by hypersensibility to external factors.
The Rigidnost of the psychomotor sphere is presented by stereotypies and lack of flexibility of thinking. Physical activity includes various options of the repeating not purposeful actions: patients knock objects about firm surfaces (toys about a floor, a spoon about a table), are shaken in a sitting position or standing, go around or on room perimeter. Because of the expressed decrease in adaptive abilities at any changes in a surrounding situation or a day regimen there is sensation of fear, panic. Patients seek to live in an environment of habitual things, day by day to perform identical rituals. One more symptom – touch frustration. Autists have a perception and processing of the sensual information arriving from the visual, acoustic, tactile, olfactory and flavoring analyzer, happens differently. It breaks process of knowledge of reality, and is sometimes shown by unusual abilities, for example, eydetichesky memory, a sinesteziya.
Patients with children's malignant schizophrenia have regressive and catatonic attacks, depth of an autistic component progresses to heavy degree. At patients with Rhett's syndrome autism accrues gradually, from a lung to expressed, then the regress stage begins, in the outcome the negativism, motor excitement and impulsiveness, the stereotypic movements and actions is formed. Catatonia attacks with regress on 12-14 month of life are typical for a syndrome of a fragile X-chromosome. In the period of psychosis autism depth heavy, in remission – easy and moderate. At the termination of a psychotic state the catatonia and stuporozny states, ekholaliya, a selective mutizm is observed. At a trisomiya on 21 chromosomes frustration is shown in 24-36 months, has character of regressive and catatonic psychosis with consecutive change of all three stages. Psychosis comes to the end 4-7 months later after the beginning, weight of autism is weakened.
Quality of life of patients remains unsatisfactory. Practically all patients appear out of the public relations, have no social support for creation of the future, are considerably limited in opportunities of self-determination, education, employment. The main reason for development of complications – social deficiency. The children suffering from atypical forms of autism experience difficulties in training, need the individualized intensive psychology and pedagogical maintenance. Adults do not establish a family, do not realize themselves in a profession. If autism is combined with the expressed frustration of the receptive speech or a heavy oligofreniya, permanent care is necessary for patients.
The diagnosis "atypical autism" is confirmed by the psychiatrist. Except it in the course of inspection of the patient the pediatrician, the neurologist, the clinical psychologist take part. For diagnostics a number of criteria is used: anomaly of development in type of a dizontogenez, a demonstration without binding to early age, symptoms of high-quality violations of social interaction and/or a stereotypy, lack of necessary criteria of children's autism. Inspection of patients includes the following methods:
- Clinical conversation. Informative kliniko-anamnestichesky data are provided by parents, and when finding the patient in medical institution – personnel. The conversation with the patient is possible in rare instances, after several meetings with the doctor (after accustoming). In the speech repetitions of phrases, ekholaliya, terse answers, stories about themselves in the third party are noted ("Mischa went to sleep", "he does not want to eat").
- Observation. The analysis of direct emotional and behavioural reactions is the main way of obtaining diagnostic information. At the first meeting patients often do not come into contact, seek to avoid contact with the doctor (cry, show aggression). Later more various displays of a disease are found: stereotypies, coldness of emotions, lack of interest in social interaction.
- Research of informative functions. At diagnostics it is important to differentiate autism of psychotic type from autism with an oligofreniya. The research of the cognitive sphere is complicated by violation of interpersonal interactions, speech development. The psychologist uses nonverbal techniques – collecting a pyramid, drawing up separate pictures and subject stories, cubes the Braid, the test of progressive matrixes Ravenna.
- EEG. According to an electroencephalography the probability of the diagnosis is confirmed. At steady psychosis strengthening a theta rhythm, at a regressive stage – an alpha rhythm reduction is defined, at catatonic and regressive psychosis the theta rhythm is not found, amplifies a beta rhythm. During remission the alpha rhythm is restored, decreases or completely the theta activity disappears.
Treatment of atypical autism
Concerning patients with autism it is more correct to speak not about the isolated therapy, and about the complex medico-psychology and pedagogical support directed to improvement of quality of life, freedom and independence in daily affairs, restoration of subjectivity in society. The uniform scheme of the help is not developed because there is no method or system, equally effective for all patients. Approach is always individual, is implemented in three directions:
- The intensive structured education. The training and behavioural methods are focused on development of skills of the self-help, communication, useful work. Their formation increases functioning level, reduces expressiveness of symptoms, corrects not adaptive forms of activity. Are widely applied technology of the applied analysis of behavior, occupation with the logopedist, work therapy.
- Medicamentous therapy. The expressed autistic symptoms are stopped by means of medicines. To many patients psychotropic or anticonvulsive drugs are appointed. Antidepressants, psychostimulators, antikonvulsant are rather safe. At the expressed psychomotor excitement it is used neuroleptics, however they are capable to provoke atypical reaction or side effects. For this reason their application is proved only in cases of uncontrollable behavior with aggression, drawing self-damages.
- Social rehabilitation. At restoration of social activity of patients inclusive approach to education and implementation of professional duties practices. Rehabilitation events are held in a complex, group of experts – psychiatrists, medical psychologists and special teachers, logopedists, speech pathologists, instructors of LFK, music-masters and creativity. Integrative groups in educational institutions and at the large enterprises are created.
Forecast and prevention
The positive result of overcoming cognitive violations, restoration of skills of self-service and communication, improvement of motility and adaptation in the conditions of a family is possible at early detection of a disease and urgent carrying out the correctional work including special training, pharmacotherapy and involvement of patients in social institutes. At active therapy symptoms do not progress, the mental state approaches norm (if is not present heavy mental retardation). Preventive measures are not developed now.