Children’s Autism

What is Child Autism?

Childhood autism itself includes autistic disorder, infantile autism, infantile psychosis, and Kanner syndrome.

The first descriptions of this disorder were made by Henry Maudsley (1867). In 1943, Leo Kanner, in his work Autistic Disorders of Affective Communication, gave a clear description of this syndrome, calling it “infantile autism.”

Prevalence

The prevalence of childhood autism is 4-5 cases per 10,000 children. First-born boys prevail (3-5 times more often than girls). But in girls, autism has a more severe course, and, as a rule, cases of cognitive impairment have already been encountered in these families.

Causes of Child Autism

The causes of childhood autism are not fully known.

There are a number of clinically and experimentally confirmed hypotheses about the etiopathogenesis of the disorder:

1. the weakness of instincts and affective sphere;
2. informational blockade associated with perceptual disorders;
3. violation of the processing of auditory impressions, leading to a blockade of contacts;
4. violation of the activating effect of the reticular formation of the brain stem;
5. dysfunction of the frontal-limbic complex, leading to impaired motivation and behavior planning;
6. distortions of serotonin metabolism and the functioning of the brain’s serotonergic systems;
7. violations of the paired functioning of the hemispheres of the brain.

Along with this, there are psychological and psychoanalytic causes of the disorder. Genetic factors play a significant role, as this disease is more common in families with autism than in the general population. Autism is to some extent associated with organic brain disorder (often in the history of complications in the period of prenatal development and childbirth), correlation with epilepsy in 2% of cases (according to some data, in the general pediatric epilepsy population is 3.5%) . In some patients, diffuse neurological abnormalities – “mild signs”. There are no specific EEG abnormalities, but a different EEG pathology was found in 10-83% of autistic children.

Symptoms of Child Autism

In his original description, Kanner highlighted the main features that are used to date.

• The onset of the disorder at the age of 2.5-3 years, sometimes after a period of normal development in early childhood. Usually these are beautiful children with a seemingly drawn pencil with a pensive, sleepy, detached face – “the face of a prince”.
• Autistic loneliness – the inability to establish a warm emotional relationship with people. Such children do not respond with a smile to the affection and love of their parents. They do not like being taken in their arms or embraced. They react to parents no more than to other people. Equally behave with people and inanimate objects. Practically do not reveal anxiety during separation from loved ones and in unfamiliar surroundings. Typical is the absence of eye contact.
• Speech disorder. Speech often develops with a delay or does not occur at all. Sometimes it develops normally up to 2 years of age, and then partially disappears. Autistic children make little use of the category of “meanings” in memory and thinking. Some children make noise (clicks, sounds, wheezing, meaningless syllables) in a stereotypical manner with no desire to communicate. Speech is usually built on the type of immediate or delayed echolalia or in the form of stereotypical phrases out of context, with the incorrect use of pronouns. Even by the age of 5-6, most children call themselves in the second or third person or by name, without using the “I”.
• “Obsessive desire for monotony.” Stereotypical and ritual behavior, insisting on keeping everything unchanged and resisting change. They prefer to eat the same food, wear the same clothes, play repetitive games. The activities and play of autistic children are characterized by rigidity, repeatability and monotony.
• Freakish behavior and mannerisms are also typical (for example, a child is constantly spinning or swaying, picking his fingers or clapping his hands).
• Deviations in the game. Games are often stereotypical, non-functional and non-social. Mostly atypical manipulation of toys, lack of imagination and symbolic features. There is a predilection for games with unstructured material – sand, water.
• Atypical sensory reactions. Autistic children respond to sensory stimuli either extremely or too weakly (sounds, pain). They selectively ignore the speech addressed to them, showing an interest in non-speech, more often mechanical sounds. The pain threshold is often lowered, or there is an atypical response to pain.

In childhood autism, there may be other signs. Sudden outbursts of anger, or irritation, or fear, not caused by any obvious reasons. Sometimes these children are either hyperactive or confused. Behavior with self-harm in the form of beats, biting, scratching, pulling out hair. Sometimes there are sleep disorders, enuresis, encopresis, nutritional problems. In 25% of cases, there may be convulsive seizures at pre-pubertal or pubertal age.

Initially, Kanner believed that mental abilities in children with autism are normal. However, about 40% of children with autism have an IQ below 55 (severe mental retardation); 30% – from 50 to 70 (easy retardation) and about 30% have indicators above 70. Some children show abilities in a particular field of activity – “fragments of functions”, despite the decline in other intellectual functions.

Diagnosis of Child Autism

Criteria:

1. the inability to establish full-fledged relationships with people from the beginning of life;
2. extreme isolation from the outside world with disregard of environmental stimuli until they become painful;
3. lack of communicative use of speech;
4. the absence or insufficiency of eye contact;
5. fear of changes in the environment (“the phenomenon of identity” by Kanner);
6. direct and retired echolalia (“gramophone parrot speech” by Kanner);
7. overhauling the development of “I”;
8. stereotypical games with non-player items;
9. clinical manifestation of symptoms no later than 2-3 years.

When using these criteria it is important:

1. do not expand the content;
2. to build diagnostics at the syndromological level, and not on the basis of a formal fixation of the presence of certain symptoms;
3. take into account the presence or absence of procedural dynamics of detected symptoms;
4. take into account that the inability to establish contact with other people creates conditions for social deprivation, leading to symptoms of secondary developmental delays and compensatory entities.

Differential diagnostics

Incomplete syndromes are more common. They need to be distinguished from childhood psychotic disorders, Asperger’s autistic psychopathy. Pediatric schizophrenia is rarely found under the age of 7 years. It is accompanied by hallucinations or delusions, convulsive seizures are extremely rare, mental retardation is not typical.

Hearing disorders should be excluded. Autistic children rarely babble, while deaf children have relatively normal babbling for up to 1 year. Audiogram and evoked potentials indicate significant hearing loss in deaf children.

A speech development disorder differs from autism in that the child responds adequately to people and is capable of non-verbal communication.

Mental retardation should be differentiated from childhood autism, since about 40-70% of autistic children suffer from moderate or severe mental retardation. The main distinguishing features: 1) mentally retarded children usually refer to adults and other children in accordance with their age; 2) they use speech, which they possess in varying degrees to communicate with others; 3) they have a relatively even delay profile without the “fragments” of enhanced functions; 4) A child with childhood autism is more affected than other abilities.

Disintegrative (regressive) psychosis (lipoidosis, leukodystrophy, or Geller disease) usually begins at the age of 3 to 5 years. The disease begins after a period of normal development and progresses over several months with the development of intellectual disorders, all spheres of behavior with stereotypes and mannerisms. The prognosis is unfavorable.

Treating Child Autism

It includes three directions:

1. Treatment of behavioral disorders.
2. Medical-psychological-pedagogical correction.
3. Family therapy.

Diversity, versatility and complexity of treatment and rehabilitation measures with the unity of biological and psychological methods are needed. Medical-pedagogical and psychological assistance is most productive at the main stages of personality formation (up to 5-7 years).

Drug treatment

The pathogenetic effect of drugs is maximal at the age of 7-8 years, after which the drugs have a symptomatic effect.

Currently, the most recommended amitriptyline as the main psychotropic agent in children of preschool age (15-50 mg / day), long-term courses for 4-5 months. Some researchers assign the role of the etiopathogenetic agent to vitamin B6 (in doses up to 50 mg / day). Atypical antipsychotics risperidone (rispolept) can be used in doses of 0.5-2 mg / day for 1-2 years. When they are taken, behavioral disturbances are reduced, hyperactivity, stereotypes, fussiness and isolation are reduced, and learning is accelerated.

Fenfluramine, a drug with antiserotonergic properties, affects behavioral disorders and autism.

Tranquilizers do not affect pathogenetic links. They affect neurotic symptoms. Benzodiazepines are more appropriate.

Traditional neuroleptics have an ambiguous effect on the clinical picture. Medications without a pronounced sedative effect (haloperidol 0.5–1 mg / day; Triftazin 1–3 mg / day) are preferred, small doses of neuleptila are sometimes effective. In general, a significant and sustained improvement in neuroleptics does not provide. Replacement therapy (nootropil, piracetam, aminalon, pantogam, baclofen, phenibut) is used by repeated courses for a number of years.

Prospects for drug therapy depend on the timing of onset, regularity of admission, individual justification and involvement in the general system of treatment and rehabilitation work.