Good Essay About Childhood Autism Spectrum Disorders
The paper discusses the childhood autism spectrum disorders and its sign and symptoms and treatment.Recent years have seen a marked increase in autism range of children around the world. For many years, psychiatrists linked infantile autism with schizophrenia. There was even a terminological "confusion", as the term "autism" therapists represent pathognomonic symptom of schizophrenia in which the patient loses touch with reality and gradually loses the need to communicate with strangers at first, and then with close relatives. Kanner used the term "infantile autism" as the name of the disorder, as children, he observed, were also impaired ability to establish regular contacts with people. Although more with 80s childhood autism wasconsidered a separate disorder, and has been proven absence of its connection with schizophrenia are still some psychiatrists say, the Soviet school, consider the problem of childhood autism through the prism of schizophrenia.
Childhood Autism Spectrum Disorders
Modern ideas about autism are also changing and today, most experts in the field of psychiatry, neurology and cognitive neuroscience believe that autism spectrum disorders are caused by genetic mutations involving several genes that determine a violation of neuronal development (Christensen, et al., 2013). The main neuropsychological consequences of such mutations are disorders of perception, cognitive processes, executive function and social behavior. Pathophysiological aspect of autism, based on the famous theory (theory of body and theory of mind), implies the absence of an autistic child's ability to understand other people's actions on the body level (touching, stroking, hugging, divining gestures) referred to as the lack of "body model" ( theory of body). It iswith the lack of ability to understand the mental state of self and others (theory of mind). Such representations are quite correlated with neuropsychological features of the brain in autism.
In the English-language, publications describe dysfunction of various parts of the brain in autism revealed by modern neuroimaging. There is information about the specifics of the frontal structures of the cerebellum (especially relevant to social interaction), the deep structures of the temporal lobes (especially almonds), secondary and tertiary field’s parietal region. It is known in particular that autism disrupted the prefrontal cortex involved in the implementation of executive functions (planning, cognitive flexibility when deciding on the focus of the objective et al.). There is also speculation that the ASD violated integrative functions of somatosensory parietal cortex, forming asomatognosia, i.e. notions of his own body. As we know, these ideas are closely related to the little child with affective experiences in the process of body contact with the mother. Lack of unity of perception (perception of coherent multimodal sensory information) leads to the impossibility of forming integral representations (representations) in the imagination of autistic children (Baghdadli, et al., 2012). This, apparently, is related to their increased interest in the details and the individual properties of objects ("games" with shadow, shuffling his fingers in front of his eyes in the light, the love of a small rectangular object), as well as the inability to "read" social cues from faces of other people because this process requires an integrative perception. Such unusual behavior patterns in autism, as the ability to unconsciously copy ("mirror"), speech and actions of others, are probably related to the function of mirror neurons that are activated when a person observes the actions of others or imitates such actions. Neuroscientists attach great importance to the function of mirror neurons in learning behavior, and especially the mother tongue, through the processes of simulation.
Signs and Symptoms
Autism is a brain pathology in which there are certain difficulties in communication. In this disease the individual parts of the brain do not work in unison as they should have. In most cases, symptoms may be seen at the age of three. Even if the disease is caused by hereditary factors, it does not mean that the baby will behave in the same way as the ill relative. The symptoms of childhood autism enough multifaceted. Most researchers of the disease divided all children into four groups. Each group of symptoms of the disease is described by how hard manifested autism.
The first group includes children with the most profound degree of the disease. Usually these children is not possible to even enter the eye contact - they never look purposefully, do not go to other people, even gestures and do not respond when they are accessed. In most cases, the children of the first group using speech. Only in exceptional cases, a child can say a word or phrase that was used he knew a man in a similar situation. Children in this group may be for hours looking out the window, it is not moving or swaying slightly. However, although the child and seems indifferent to the world around them, they can still get out of balance, especially if something has changed in the environment (for example, has been removed favorite advertising sign on the street). In this case, the child may express discomfort with the help of crying, screaming, or self-injury.
In the second group of symptoms expressed to a lesser extent. Children in this group may already adequately conduct themselves in a familiar environment, that is, if you follow their usual routine. But getting beyond this situation a child experiences fear and self-injurious behavior. Typically, children with autism in general almost always causes fear, which are not typical for a child of that age. For example, a child may not afraid of unfamiliar dogs or darkness, but afraid if necessary, get your hands dirty, or go to the toilet. Self-injury in children suffering from autism, in situations that are critical for the child, there are almost always. Its manifestations can be extremely dangerous for the children themselves, and expressed, for example, peeling burrs blood. This child in this group developed a degree far from normal, but it is nevertheless, when necessary, can express its needs mentioning. Talk with the child resembles a conversation with a foreigner who has just recently learned the language - the child talks about himself in the third person pronouns are confusing, uses only fixed phrases that they heard were in a similar situation to or subtracted from the books.
Children belonging to the third group, at first glance does not seem aloof or closed. They often talk a lot, and in most cases have a considerable vocabulary, but their speech is not addressed to the other party. Any attempt to communicate the child seemed to be trying to throw the object of his interest. During the first conversation is often not even possible to note, however when observing the baby talk with other people can see that he is talking all this only. In the area of interest may include a variety of topics - road signs, the history of his native land, cars, knights, etc. Field of interest studied them in the slightest detail. Typically, children with autism have virtually absolute mechanical memory that allows the child to talk read or heard almost by heart, while constantly increasing the pace of conversation and choking on the words. For all its seeming overdevelopment, the child belongs to this group, very trusting, vulnerable, suffering from a variety of fears and do not understand humor.
The fourth group of autistic children are peculiar only mild symptoms. The baby of the group can communicate with other people, but completely lost for any resistance on the part of these people. Like other groups, it is a slow and awkward in his movements, has scant gestures and facial expressions.
Autism is a developmental disorder of the nervous system, which are peculiar to various manifestations, marks the first time in infancy or childhood, and sustainable for the disorder, usually without remission.In its infancy it is worth paying attention to symptoms such as distortion response to discomfort, excessive startle response, and violent crying in response to weak sound stimuli and minor changes in the environment, but the poor response to strong stimuli; also there is a weakening response to feeding posture, a slight expression of pleasure after feeding. Children distorted reaction “complex revitalization ", characterized by effective willingness to communicate with adults. The components of the response in the absence of manifest revival adult and refer to inanimate objects, such as hanging over the bed toy.The symptoms usually persist in adults, albeit often in a softened form.One symptom of autism is not enough to determine the required the presence of a characteristic triad:
lack of social interaction;
Impaired mutual communication;
Parochialism and repetitive repertoire of behavior.
Other aspects, such as selectivity in the food, too, are often found in autism, but the diagnosis of significant.
In most cases, social problems in children with autism spectrum disorders can be detected in early childhood or even infancy. The first signs of the social difficulties of the child, as a rule, include the lack of social interaction skills, such as establishing eye contact, reaction to his name, joint attention and imitation skills (Christensen, et al., 2013).
These symptoms can be quite stable, especially in children with severe cognitive difficulties. Often these children for a long time remain socially indifferent or closed. At the same time, infants and pre-school children who have received a diagnosis of "Asperger's Syndrome" or "common developmental disorder, not otherwise specified", may have social problems that initially went unnoticed because their manifestations are very similar to the undesirable behavior in children normotipichnyh experiencing a "crisis three years of age "(refusal of cooperation, tantrums). Children with ASD from children normotipichnyh two-three years of age are extremely social rigidities, persistent desire for permanence, as well as heavy outbursts and tantrums associated with changes in routine procedures, transitions, or any other situations in which the child cannot control what is happening or achieve the desired. Such models are inflexible behavior common to many autistic children with different levels of functionality. Infants with autism pay less attention to social stimuli, rarely smiling and looking at other people, at least respond to his own name (Croen, et al., 2011).
According to two studies, baseline language skills, including vocabulary and spelling, we highly functional autistic children 8-15 years were not worse than that of the control group, and in adults with autism - even better. At the same time, both age groups showed a decrease in autism results in complex tasks that require the use of figurative language, evaluates the ability to understand speech and draw conclusions. Since the first impression of a person often constitutes the base for his linguistic skills, studies suggest that people in dealing with autism tend to overestimate the degree of their understanding (Baghdadli, et al., 2012).
In respect of these children with autism most severe forms of regularity exist: 50% IQ <50 70% <70 and almost 100% IQ <100. Despite the fact, that Asperger syndrome and other autistic spectrum disorders frequently detected in all children with normal intelligence (including above average), these lighter autistic disorder also often accompanied by a generalized lack of learning disabilities. There are about a quarter of autistic individuals with widespread lack of learning disabilities and about 5% of autistic individuals with a normal IQ. Seizures often manifest in adolescence. Often apparent hyperactivity manifested in tasks imposed by adults (e.g., school classes), the child may well focus on self-selected tasks (for example, building blocks in a row, watching the same cartoon repeatedly). However, in other cases of autism poor concentration observed in all classes (Christensen, et al., 2013). Parents of autistic children suffer from high levels of stress.Brothers and sisters with autism rarely come into conflict with them, and are often the object of admiration for them, but in adulthood, they often marked malaise and deterioration of relations with sibling –autistic (Croen, et al., 2011).
Autism symptoms arise due to changes in the various systems of the brain that occur during its development. Despite extensive research, until a full understanding of this process is still far away. In the description of the mechanism of the disorder can be divided into two areas: the pathophysiology of brain structures and processes associated with autism and neurophysiological structures due to behavioral reactions. Changing the behavior could be due to many pathophysiological factors (Baghdadli, et al., 2012).
For the treatment needed coordination and successful cooperation of parents, teachers, psychologists and psychiatrists. Should adhere to the therapeutic regimen, a clear order of the day. Of course, the children must take medication and sedatives, but is particularly important therapy constant communication, which helps to develop the child's independence, autonomy and skills of social adaptation. Autism can not be cured until the end, but improvements can be achieved, so never not suspend classes for a child: no weekends, no holidays or summer. In the case of autism spectrum disorders, about half of parents notice unusual behavior of the child reaches 18 months and 24 months to pay attention to deviations for 80% of the parents.Since the delay of treatment may affect long-term outcome, the child should immediately show the presence of a specialist any of the following:
If at any age is a loss of any part of the language or social skills.
American Academy of Pediatrics recommends screening all children with autism spectrum disorders advisory visits at 18 and 24 months, using appropriate screening tests.In contrast, the British selection committee does not recommend such screening in the general population, since the accuracy of testing methods are not received due acknowledgment, besides there is not sufficient evidence of the effectiveness of the proposed measures of therapeutic intervention.
There are several diagnostic tools and two of them are in autism research: it is a revised version of the "Questionnaire for the diagnosis of autism" (ADI-R), which is a semi-structured interview with parent's plan. In addition it is the scale of observation to diagnose autism (ADOS), suggesting observation of and interaction with the child them. " grading scale of infantile autism (CARS) is widely used in the clinical setting, allowing to establish the severity of the disorder as a result of observation of the child (Lichtenstein, et al., 2010).
Initial consultation usually spends a pediatrician, recording the history of the child and performing a physical exam (Barnard-Brak, et al., 2011). Then, if necessary, involve expert help for autism spectrum disorders. He diagnoses and assessing the state of cognitive and communicative abilities, family circumstances of the child and other factors as through observations, and using standard tools, taking into account the possible presence of associated disorders.Often, to assess the behavior and cognitive abilities are invited to child neuropsychologist it can help in the diagnosis and recommend educational methods of correction.
In connection with the improvement of mental health care, spreading the testimony in the appointment of psychotropic drugs, the emergence of new dosage forms, especially drug pleomorphism, the influence of the age factor on the results of treatment of the issues related to drug therapy and rehabilitation. Habilitation efforts aimed at arresting the positive symptoms of the disease, reduction of cognitive impairment, mitigate the severity of autism, social interaction, stimulation of functional systems, and the creation of preconditions for learning opportunities. In each case, before prescribing medication require a detailed diagnosis and thorough analysis of the relationship between the desired effect and undesirable side effects (Fan, et al., 2010). The choice of drug is carried out taking into account the peculiarities of the structure of psychopathological disorders, the presence or absence of comorbid psychiatric, neurological and somatic disorders.
Asperger's syndrome (F84.5) occurs in 30-70 children with the ten 000-evolutionary constitutional autism usually occurs when integrating into society (kindergarten, school). Patients aredeviations bilateral social communication, nonverbal behavior (gestures, facial expressions, mannerisms, eye contact); patients incapable of emotional empathy. Expressed disturbances of attention and motor skills, the lack of effective communication in society make them an object of ridicule, forced to change schools, even with good intellectual abilities of the child. In patients with Asperger's syndrome marked early speech development, rich vocabulary, the use of unusual turns of speech, peculiar intonation, good logical and abstract thinking, as well as stereotypical monomaniac esky interest in specific areas of expertise (Geschwind, 2011).
Clinical manifestations of evolutionary Procedure Kanner’s syndrome (F84.0) define an asynchronous disintegrative dizontogeneza with incomplete maturation of higher mental functions. Kanner's syndrome isat birth and is characterized by the following offenses: is the lack of social interaction, communication, presence of stereotyped regressive behaviors. Receptive and expressive speech develops delayed, no gestures, saved echolalia, phrases, cliches, egocentric speech (Barnard-Brak, et al., 2011). Kanner's syndromes patients are not able to dialogue, retelling, do not use personal pronouns (Chlebowski, et al., 2010).
Catatonic attacks occur in the first three years of life against the backdrop of dissociated dizontogeneza or normal development. Catatonic disorders occupy a leading place in psychosis are hyperkinetic character. Patients excited, running around in a circle or a straight line, bounce, swing, climb upstairs with the agility of a monkey and make stereotyped movements (athetosis, shaking tassels, claps). Speech slurred, with echolalia, perseveration. Autism severity on a scale of CARS 37 points (the lower bound severe autism) (Fan, et al., 2010). Duration of attacks is 2-3 years.
The ICD-10 classification of some types of atypical autism (F84.1). If the disease begins to develop after the age of 3 years, the clinical picture is typical childhood psychosis (ADP) is different from childhood psychosis. Regressive-catatonic attacks occur against the backdrop of autism dizontogeneza 2-3-year life. They begin with the deepening of autistic detachment with rapid regression of speech, play skills, neatness, and eating disorders (eating inedible). Catatonic disorder, predominantly in the form of motor stereotypes arises after the negative symptoms, against fatigue. In the hands marked movement ancient archaic level: washing, folding, rubbing his type, banging on the chin, waving his arms like wings (Chlebowski, et al., 2010). Duration of attacks in atypical childhood psychosis is 4.5-5 years (Geschwind, 2011).
In the treatment of Asperger syndrome is preferred course of treatment nootropics (Fenibut, Pantogam 250-500 mg / day); neuropeptides and their analogues (Cere - 1,0 № 10, Cortexin - 5-10 mg 2,0 № 10, Tserebramin - 10 mg / day, 1 month, Semaks 0.1% - 1kaplya nose 1 month), and cerebrovascular Drugs (Cavinton, stugeron).
In patients with the syndrome of Kanner used complex treatment. Neuroleptics, aimed at the development of cognitive functions (Triazine - 5-10mg / day, Etaperazin - 4-8 mg / day, Azaleptin - 6.2525 mg / day), combined with the use of foreign exchange nootropics (Fendi but, Pantogam) - 250-500 mg / day (Chlebowski, et al., 2010).
Patient’s psychotic forms of autism (childhood psychosis, atypical childhood psychosis, atypical psychosis is also assigned to the complex treatment with the basic use of neuroleptics. When excited appoint typical neuroleptics with sedative effect: Chlorpromazine (25-75 mg / day), Tisercinum (6,25-25 mg / day), Teraligen (5-25 mg / day), Sonapaks (20-40 mg / day) ; Chlorprothixene (15-45mg / day); Haloperidol (0.5-3 mg / day), and others. In order to overcome cognitive deficits using typical neuroleptics (Triftazin 5-10mg / day, Etaperazin 4-8 mg / day), atypical antipsychotics (Azaleptin 6,25-25 mg / day, Rispolept 0.5-1 mg / day).
Treatment of Rett syndrome and atypical autism includes the use of neuropeptides and their analogues (Cortexin, Tserebramin, Semaks); amino acids (glycine, Biotredin), cerebrovascular funds (Cavinton, Cinnarizine, stugeron), anticonvulsants; sodium valproate. An indispensable tool for the correction of metabolic processes, especially in remote disturbed flow stages of Rett syndrome is Elkar (drug related group B vitamins) (Barnard-Brak, et al., 2011).
Integrated use of the drug and non-drug therapies combined with neuropsychological and psychological and extraordinary education, social work with the patient and family is one of the fundamental principles of supervision of autistic disorders in children.
Inpatient care is carried out in the Department of Child Psychiatry, where the open beds for rooming-in mother and child, and daytime polustatsionarah (Fan, et al., 2010). The basic principle of treatment is biosocial comprehensive approach that includes medication, psychotherapy, speech pathology program assistance NTSPZ RAMS rehabilitative training - TEACCH; behavioral therapy - ABAand others (Barnard-Brak, et al., 2011). Outpatient care follows the stationary or is independent and includes in addition to medication to an extended pedagogical correction centers for psychological, medical and social support, speech therapy, correctional kindergartens, schools, HDPE. Positive effect on the communication skills of a child with autism music lessons (Geschwind, 2011). Communicating with animals (horses, dogs, dolphins), children with ASD learn to establish relationships with people. Getting adequate education is one of the basic and inalienable conditions of successful socialization of children with ASD.
Autism in children remains an urgent problem of psychiatry at the moment. Autistic disorder in children due to the dissociation of the development of higher mental functions with asynchronous and influence positive trends ontogeny exacerbations of the disease is amenable to correction with an effective drug therapy and rehabilitation. Much attention isto the treatment of ASD nootropic drugs row, means of correction of metabolic processes, including the widely used Pantogam, Elkar in combination with antipsychotics drugs and other pharmacological groups. More cost-effective outpatient forms of assistance based on a multimodal approach leads the habilitation of patients.
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