Autism – the violation of mental development which is followed by deficiency of social interactions, difficulty of mutual contact at communication with other people, the repeating actions and restriction of interests. The reasons of development of a disease are up to the end not found out, most of scientists assumes communication with congenital dysfunction of a brain. Autism is usually diagnosed aged up to 3 years, the first signs can be noticeable already in infancy. The absolute recovery is considered impossible, however sometimes the diagnosis is removed with age. The purpose of treatment is social adaptation and development of skills of self-service.
Autism – a disease of which violations of movements and the speech, and also the stereotype of interests and behavior which are followed by violation of social interactions of the patient with people around are characteristic. Data on prevalence of autism significantly differ that is caused by various approaches to diagnostics and classification of a disease. According to various data, autism without frustration of an autistic range 0,1-0,6% of children, from autism taking into account frustration of an autistic range – 1,1-2% of children suffer. At girls autism comes to light four times less than at boys. In the last 25 years this diagnosis began to be exposed much more often, however, so far unclear with what it is connected – with change of diagnostic criteria or with real increase in prevalence of a disease.
In literature the term "autism" can doubly be treated – as actually autism (children's autism, classical autistic frustration, Kanner's syndrome) and as all frustration of an autistic range, including Asperger's syndrome, atypical autism etc. Degree of expressiveness of individual manifestations of autism can significantly differ – from the full inability to social contacts which is followed by heavy intellectual backwardness to some strangenesses at communication with people, a pedantry of the speech and narrowness of interests. Treatment of autism long, complex, is performed with participation of experts in the field of psychiatry, psychologists, psychotherapists, neurologists, speech pathologists and logopedists.
Reasons of development of autism
Now the causes of autism are finally not found out, however is established that a biological basis of a disease is violation of development of certain structures of a brain. Hereditary character of autism is confirmed though the genes responsible for development of a disease while it is only necessary to define. At children with autism a large number of complications is noted during pregnancy and in labor (pre-natal viral infections, a toksemiya, uterine bleedings, premature birth). It is supposed that complications during pregnancy cannot cause autism, but can increase probability of its development in the presence of other contributing factors.
Heredity. Among close and distant relatives of the children suffering from autism 3-7% of patients with autism come to light that repeatedly exceeds prevalence of a disease on average on population. The probability of development of autism in both monoovular twins makes 60-90%. At relatives of patients the separate violations characteristic of autism are often observed: tendency to persuasive behavior, the low need for social contacts, difficulties at understanding of the speech, speech frustration (including an ekholaliya). In such families epilepsy and intellectual backwardness which are not obligatory signs of autism comes to light more often, but are quite often diagnosed at this disease. Everything listed is confirmation of hereditary character of autism.
In the late nineties the last century scientists managed to reveal a gene of predisposition to autism. Existence of this gene not necessarily leads to emergence of autism (according to most of geneticists, the disease develops as a result of interaction of several genes). However definition of this gene allowed to confirm the hereditary nature of autism objectively. It is serious progress in area of studying of an etiology and pathogenesis of this disease as shortly before this opening as the possible reasons of autism some scientists considered a lack of care and attention from parents (now this version is rejected, as untrue).
Structural violations of a brain. According to researches, at patients with autism structural changes of frontal departments of a cerebral cortex, hippocampus, a median temporal share and cerebellum often come to light. The main function of a cerebellum is ensuring successful physical activity, however, this department of a brain also exerts impact on the speech, attention, thinking, emotions and abilities to training. At many autists some departments of a cerebellum are reduced. It is supposed that by this circumstance problems of patients with autism when switching attention can be caused.
The median temporal shares, hippocampus and almond-shaped body which are also often suffering at autism exert impact on memory, ability to training and emotional self-control, including – emergence of feeling of pleasure at commission of significant social actions. Researchers note that at animals with damage of the listed shares of a brain the changes of behavior similar to autism are observed (decrease in need for social contacts, deterioration in adaptation at hit in new conditions, difficulties at danger recognition). Besides, delay of maturing of frontal lobes often is found in patients with autism.
Functional violations of a brain. Approximately at 50% of patients for EEG the changes characteristic of violations of memory, the selective and directed attention, verbal thinking and purposeful use of the speech come to light. Degree of prevalence and expressiveness of changes differs, at the same time children with high-functional autism have violations on EEG, as a rule, less expressed in comparison with the patients suffering from low-functional forms of a disease.
Obligatory signs of children's autism (typical autistic frustration, Kanner's syndrome) are shortage of social interactions, problems at creation of productive mutual contact with people around, stereotype of behavior and interests. All listed signs appear aged up to 2-3 years, at the same time the separate symptoms testifying to possible autism sometimes are found at infantile age.
Violation of social interactions is the brightest sign distinguishing autism from other violations of development. The children suffering from autism cannot fully interact with other people. They do not feel a condition of people around, do not distinguish nonverbal signals, do not understand implication of social contacts. This sign can come to light already at babies. Such children poorly react to adults, do not look in the face, fix a look on inanimate objects more willingly, but not on surrounding people. They do not smile, badly react to own name, do not last towards to the adult in attempt to take them on hands.
Growing up, patients do not imitate behavior of people around, do not react to emotions of other people, do not participate in the games calculated on interaction and do not show interest in new people. They strongly become attached to relatives, but do not show the attachment as ordinary kids – do not rejoice, do not run towards, do not try to show to adults of a toy or to somehow share events from the life. Isolation of autists is caused not by their aspiration to loneliness, and with their difficulties because of impossibility to build normal relationship with people around.
Patients begin to speak later, it is less and less often murmur, begin to pronounce separate words later and to use the phrase speech. They often confuse pronouns, call themselves "you", "it" or "it". In the subsequent high-functional autists "gather" a sufficient lexicon and do not concede to healthy children when passing tests for knowledge of words and spelling, however experience difficulties in attempts to use images, to draw conclusions concerning written or read etc. At children with low-functional forms of autism the speech is significantly grown poor.
Unusual gesticulation and difficulties in attempt to use gestures in the course of contacts with other people is characteristic of children with autism. In infancy they seldom show a hand on objects or, trying to specify regarding, look not at it, and at the hand. Having become more senior, they pronounce words less often during gesticulation (healthy children are inclined to gesticulate and speak at the same time, for example, to give a hand and "let" speak). In the subsequent it is difficult for them to play difficult games, to organically combine gestures and the speech, to pass from simpler forms of communication to more difficult.
One more bright sign of autism is the limited or repeating behavior. Stereotypies – the trunks repeating rocking, swings by the head and so forth are observed. The patient with autism very important that everything always occurred in the same way: objects were placed in the necessary order, actions were made in a certain sequence. The child suffering from autism can begin to shout and protest if mother usually puts on to it at first the right sock, and then left, and today arrived on the contrary if the saltcellar costs not in the center of a table, and is shifted to the right if instead of a habitual cup delivered to it similar, but with other pattern. At the same time, unlike healthy children, he does not show desire to actively improve the state of affairs which is not arranging it (to stretch to the right sock, to rearrange a saltcellar, to ask other cup), and in the ways available to it signals about abnormality of the events.
The attention of the autist is focused on details, on the repeating scenarios. Children with autism often choose not toys, but not game objects for games, their games are deprived of a subject basis. They do not build locks, do not roll the machine on the apartment, and display objects in a certain sequence, aimlessly, from the point of view of the foreign observer, move them from place to place and back. The child suffering from autism can be extremely strongly tied to a certain toy or not game subject, can watch daily at the same time the same telecast, without showing interest in other programs and to worry extremely intensively if it was not succeeded to look at this program for any reason.
Along with other forms of behavior, refer an autoaggression (the blows, stings and other damages put to themselves) to the repeating behavior. Statistically, about a third of autists during life show an autoaggression and as much – aggression in relation to people around. Aggression is, as a rule, caused by anger attacks because of violation of habitual vital rituals and stereotypes or because of impossibility to inform of the desires people around.
The opinion on obligatory genius of autists and presence at them of any unusual abilities is not confirmed by practice. Separate unusual abilities (for example, ability to storing of details) or talent for one narrow sphere at deficiency in other areas are observed at only 0,5-10% of patients. I.Q. at children with high-functional autism can be an average or is slightly higher than an average. At low-functional autism decrease in intelligence quite often comes to light up to intellectual backwardness. At all types of autism generalized insufficient learning ability is often observed.
Among others not obligatory, to enough often found symptoms of autism It should be noted attacks (come to light at 5-25% of children, more often for the first time arise at pubertatny age), a syndrome of a hyperactivity and insufficiency of attention, various paradoxical reactions to external incentives: touches, sounds, lighting changes. The need for touch self-stimulation (the repeating movements) is often observed. More than at a half of autists deviations in food behavior (refusal of meal or refusal of certain products, preference of certain products, etc.) and sleep disorders (difficulties come to light at falling asleep, night and early awakenings).
Classification of autism
There are several classifications of autism, however in clinical practice Nikolskaya's classification made taking into account weight of displays of a disease, the main psychopathological syndrome and the remote forecast is most widely used. Despite the lack of an etiopatogenetichesky component and high degree of generality, teachers and other experts consider this classification of one of the most successful as it gives the chance to make the differentiated plans of psychological correction and to define the treatment purposes taking into account real opportunities of the child suffering from autism.
First group. The deepest violations. The field behavior, a mutizm, lack of need for interactions with people around, lack of active negativism, an autostimulyation with use of the simple repeating movements and inability to self-service is characteristic. The leading patopsikhologichesky syndrome is detachment. As a main objective of treatment contact establishment, involvement of the child in interactions with adults and peers, and also development of skills of self-service is considered.
Second group. Rigid restrictions in the choice of forms of behavior, the expressed aspiration to an invariance are characteristic. Any changes can provoke the failure which is expressed in negativism, aggression or an autoaggression. In the habitual environment the child is rather open, capable to development and reproduction of household skills. The speech is stamped, constructed on the basis of ekholaliya. The leading psychopathological syndrome is rejection of reality. As a main objective of treatment development of emotional contacts with close people and expansion of opportunities of adaptation by Wednesday by development of a large number of various stereotypes of behavior is considered.
Third group. More difficult behavior at absorption is observed by own stereotypic interests and weak ability to dialogue. The child strives for success, but, unlike healthy children, is not ready to try, to risk and go on compromises. Often the developed encyclopedic knowledge in abstract area in combination with fragmentary ideas of the real world comes to light. Interest in dangerous asocial impressions is characteristic. The leading psychopathological syndrome is replacement. As a main objective of treatment training in dialogue, expansion of a circle of representations and formation of skills of social behavior is considered.
Fourth group. Children are capable to the true any behavior, but quickly get tired, suffer from difficulties in attempt to concentrate attention, to carry out instructions etc. Unlike the children of the previous group making an impression of young intellectuals can look shy, timid and scattered, however at adequate correction show the best results in comparison with other groups. The leading psychopathological syndrome is vulnerability. As a main objective of treatment spontaneity training, improvement of social skills and development of individual abilities is considered.
Diagnostics of autism
Parents should see a doctor and to exclude autism if the child does not respond on own name, does not smile and does not look in the face, does not notice instructions of adults, shows atypical game behavior (does not know what to do with toys, plays with not game objects) and cannot report to adults about the desires. At the age of 1 year the child has to babble, murmur, show a hand on objects and try to catch them, at the age of 1,5 years – to pronounce separate words, at the age of 2 years – to use phrases from two words. If these skills are absent, it is necessary to undergo inspection at the expert.
The diagnosis autism is exposed on the basis of observations of behavior of the child and identification of a characteristic triad which enter a lack of social interactions, a lack of communication and stereotypic behavior. For an exception of disorders of speech development appoint consultation of the logopedist, for an exception of a hearing disorder and sight – survey of the audiologist and ophthalmologist. Autism can be combined or not be combined mentally retarded, at the same time at identical I.Q. the forecast and schemes of correction for children oligophrenic persons and children autists will significantly differ therefore in the course of diagnostics it is important to differentiate two of these frustration, having attentively studied features of behavior of the patient.
Treatment and the forecast at autism
Main objective of treatment is increase in level of independence of the patient in the course of self-service, formation and maintenance of social contacts. Long behavioural therapy, game therapy, work therapy and logopedic therapy is used. Correctional work is carried out against the background of reception of psychotropic drugs. The program of training is chosen taking into account the child's opportunities. Low-functional autists (the first and second group in Nikolskaya's classification) are trained at home. Children with Asperger's syndrome and high-functional autists (the third and fourth group) attend auxiliary or mass school.
Now autism is considered an incurable disease. However after competent long correction at some children (3-25% of total number of patients) there occurs remission, and the diagnosis autism over time remove. The insufficient number of researches does not allow to build authentic long-term forecasts concerning a current of autism at mature age. Experts note that with age at many patients symptoms of a disease become less expressed. At the same time, there are messages on age deterioration in communicative skills and skills of self-service. Favorable predictive signs are intelligence quotient higher than 50 and development of the speech aged up to 6 years, however full or almost full independence manages to reach to only 20 percent of children from this group.