Autism symptoms in children ultrasound scanner. The program “Autism: Comprehensive Diagnostics. Autism programs

MUNICIPAL BUDGETARY INSTITUTION, IMPLEMENTING PSYCHOLOGICAL AND PEDAGOGICAL AND SOCIO-PEDAGOGICAL ASSISTANCE "CENTER FOR DIAGNOSTICS AND CONSULTING

for educational psychologists

"Autism:diagnostics, correction».

Anapa resort town

MBU "Diagnostic and Consulting Center"

Mr. - to. Anapa, st. Parkovaya, d. 29.

ppmscentr @ yandex. ru

The urgency of the problem.

Distorted development is a type of dysontogenesis, in which complex combinations of general psychological underdevelopment, delayed, damaged and accelerated development of individual mental functions are observed, which leads to a number of qualitatively new pathological formations. One of the clinical variants of this dysontogenesis is early childhood autism (EDA) (1998). The word autism comes from the Latin word autos - itself and means detachment from reality, isolation from the world.

Children with autism need constant psychological and pedagogical support. As domestic and foreign experience shows, when carrying out early diagnostic work and the timely beginning of correction, it is possible to achieve positive results. Most children manage to prepare for learning and develop their potential giftedness in various fields of knowledge.

Objectives of the program:

-methods for diagnosing early childhood autism.

Overcoming negativism when communicating and establishing contact with an autistic child;
-development of cognitive skills;
- mitigation of sensory and emotional discomfort characteristic of autistic children;
-increasing the child's activity in the process of communicating with adults and children;
- overcoming difficulties in organizing purposeful behavior.

Objectives of the program:

Orientation of an autistic child in the outside world;

Teaching him simple contact skills;
- teaching the child more complex forms of behavior;
-development of self-awareness and personality of an autistic child;
-development of attention;
-development of memory, thinking.

Main stages psychological correction:

First stage- establishing contact with an autistic child. For the successful implementation of this stage, a gentle sensory atmosphere of the session is recommended. This is achieved with the help of calm, quiet music in a specially equipped classroom. Great importance is attached to the free soft emotionality of classes. The psychologist should communicate with the child in a low voice, in some cases, especially if the child is agitated, even in a whisper. It is necessary to avoid a direct look at the child, sudden movements. You should not ask your child direct questions. Establishing contact with an autistic child takes quite a long time and is the pivotal moment of the entire psychocorrectional process. The psychologist is faced with the specific task of overcoming fear in the autistic child, and this is achieved by encouraging even minimal activity.

Second phase- strengthening the psychological activity of children. Solving this problem requires the psychologist to be able to feel the child's mood, understand the specifics of his behavior and use this in the correction process.

On the third stage psychocorrection, an important task is to organize the purposeful behavior of an autistic child. And also the development of basic psychological processes.

Effectiveness of the program.

The implementation of a correctional program for children with RAD provides the basis for effective adaptation of the child to the world. Thanks to these activities, the child is attuned to active contact with the world around him. Thus, the child will feel safe and emotionally comfortable, which means that behavior correction will take place.

ü functional level of the child;

ü health problems in the family;

ü family situation, social data and previous experience related to the diagnosis and provision of medical and psychological-pedagogical assistance.

Diagnosis of early childhood autism includes three stages.

The first step is screening.

Developmental deviations are revealed without their exact qualification.

Screening is a quick collection of information about the social and communicative development of a child in order to identify a specific risk group from the general population of children, assess their need for further in-depth diagnostics and provide the necessary corrective assistance. Since screening is not used for diagnosis, it can be done by educators, pediatricians and parents themselves.

Key indicators of early childhood autism

Indicators of early childhood autism:

Lack of single words at the age of 16 months;

Missing a two-word phrase in 2 years;

Lack of non-verbal communication (in particular, pointing gesture) at 12 months;

Loss of speech or social ability.

Preschool Autism Indicators:

Lack of speech or delay in its development;

Special eye contact: infrequent and very short or long and motionless, rarely direct to the eyes, in most cases peripheral;

Difficulty imitating actions;

Performing monotonous actions with toys, lack of creative play;

Lack of social reaction to the emotions of other people, lack of behavior change depending on the social context;

Unusual response to sensory stimuli;

Any concern about the social or speech development of the child, especially if there are unusual interests, stereotypical behavior.

Indicators of autism at school age:

Lack of interest in other people, contacts with peers;

Great interest in inanimate objects;

Lack of need for comfort in situations of psychological necessity;

Difficulty waiting in social situations;

Failure to maintain dialogue;

Passionate about one topic;

Strong reaction to changes in the usual daily schedule;

Any concern about the social or speech development of the child, especially if there are unusual interests, stereotypical behavior.

The following standardized screening instruments have long been developed and widely used in the world:

CHAT - Scale for Early Recognition of Autism, STAT - Autism Screening Test,

ADI-R - Parent Diagnostic Interview.

For example, SNAT is a short screening tool designed for the initial assessment of the development of a child between the ages of 18 and 36 months.

The first part of the test includes nine questions for parents, which record whether the child demonstrates certain types of behavior: social and functional play, social interest in other children, joint attention, and some motor skills (pointing gesture, unusual movements).

The second part of the test contains observation questions for five short types of interactions between the researcher and the child, which allow the analyst to compare the actual behavior of the child with the data obtained from the parents.

A positive screening result should be accompanied by an in-depth differentiated examination.

Second phase- the actual differential diagnosis, that is, an in-depth medical, psychological and pedagogical examination of the child in order to determine the type of developmental disorder and the corresponding educational route. It is carried out by a multidisciplinary team of specialists: psychiatrist, neurologist, psychologist, teacher-defectologist, etc. This stage includes medical examination, parent interviews, psychological testing, pedagogical observation. The differential diagnosis is made by a psychiatrist.

Abroad, ADOS Diagnostic Scale is used as the main tool for differential diagnosis of autism

And finally third stage- developmental diagnostics: identifying the individual characteristics of a child, characterizing his communicative abilities, cognitive activity, emotional and volitional sphere, working capacity, etc. The identified features should be taken into account when organizing and conducting individual correctional and developmental work with him. The development of a child with early childhood autism is diagnosed by a teacher-defectologist. For this purpose, the standardized test PEP-R is used abroad - the Profile of the Development and Behavior of a Child. PEP-R has two scales: development and behavior. In particular, the developmental scale assesses the level of a child's functioning in relation to his peers in seven areas (imitation, perception, fine motor skills, gross motor skills, hand-eye coordination, cognition; communication and expressive speech).

DIAGNOSTICS OF AUTISM

DIAGNOSTIC PRINCIPLES

1. Autism is a spectral disorder.

2. Symptoms of autism change with age and the level of intellectual development of the child.

3. Empirical approach (ICD-10, DSS-IV).

4. Thorough study of the history of the child's development.

5. Taking into account individual differences in the severity of symptoms and overlapping symptoms of other possible disorders.

6. The importance of early diagnosis. Use of diagnostic cards for examination of young children

7. Close cooperation of specialists with parents.

AREAS OF SURVEY

· Organic disorders, laboratory examinations, history of the child's development.

Intellectual development:

o verbal

o non-verbal

o social adaptation

Psychological examination

o baby

Differential diagnosis

Autism must be distinguished from other conditions with similar symptoms. It is very important to determine whether a child is suffering from autism or other autistic-like impairments. The following are developmental abnormalities that could be mistaken for autism:

1. Mental retardation

2. Schizophrenia

3. Specific developmental disorders of speech

4. Tourette's syndrome

5. Landau-Kleffner syndrome

6. Rett syndrome

7. Disorder of attachment

8. Disintegration violation

9. Hyperkinetic disorder with stereotypes

10. Atypical autism

11. Deafness

12. Some other violations

How is autism diagnosed?

The problems of diagnosing autism have been around since the days of Kanner. Even now, when autism has received official recognition, and the official criteria for autism are defined in the main classification systems of diagnostics - ICD-10 and DSS-IV, the situation with the diagnosis of autism leaves much to be desired.

Autism should be diagnosed by trained experienced professionals (psychiatrists, psychologists or pediatricians) who have theoretical knowledge and practical experience in this area Autism diagnosis can be carried out by a team of specialists, including a neuropathologist, psychiatrist, pediatrician, psychologist, speech therapist-defectologist, teacher of autistic children, a social worker with experience working with children with special needs, a consultant with relevant knowledge of the problem The only criterion for including a specialist in the team should be his / her experience, competence and knowledge of the problem, and not just a medical diploma or position in the structure of health care or education ...

Parents, as the most interested party, should have the right to know the level of competence of specialists who determine the fate of their child before they bring the child for examination, in order to avoid trauma to the child and depression and humiliation of the parents.

Below are a few tips and tricks for parents, which will help them distinguish specialists from "specialists":

· Never trust “specialists” who claim to know all about this violation, just because they have a degree from a medical school, a psychology department, etc., or because they occupy the position of a chief health professional, education, etc.

· Never trust "specialists" who refuse to give their last name and sign the statement with your child's diagnosis. Try to even avoid communicating with them, because, as a rule, they are rude, and after meeting them you will not recover from the feeling of humiliation for several days;

· Never trust "specialists" who diagnose your child and assess his capabilities after 5-10 minutes of observing him in an unfamiliar environment and asking him a few questions. The diagnosis will be a foregone conclusion - mental retardation, and the fate of your child will be crossed out;

· Never trust "specialists" who do not listen to their parents, because they consider themselves specialists, and parents are not. Remember, no one knows a child better than his parents, who watch him 24 hours a day;

· Never trust “specialists” who say something like “an autistic child should be isolated from other children”, etc .;

In recent years, an empirical approach has been used to diagnose mental disorders. This means that the purpose of diagnostics is to identify specific disorders that are identified by the presence of a certain set of behavioral symptoms.Modern classification diagnostic systems are also based on the empirical approach - the International Classification of Diseases (ICD-10 (World Health Organization, 1992) and the Diagnostic and Statistical Handbook of Mental Disorders ( DSS-IV) (American Psychiatric Association, 1994) These two systems are phenomenological in their orientation, they are limited to enumerating the clinical features of the disorder, without considering etiology or pathogenesis.

The descriptions of the behavioral characteristics of autism in the two systems are almost identical. They are based on the triad of violations formulated by Lorna Wing (1993).

Both systems have the category "Pervasive (general) developmental disorders" which include 5 disorders, autism, Asperger's syndrome, Rett syndrome, disintegration disorder and atypical autism (ICD-10), nonspecific PND (DSS-IV).

The following are the criteria for defining autism in these two systems:

ICD-10 (WHO, 1992)

84.0 AUTISM

Manifestations of abnormal development up to 3 years of age.

Qualitative impairments in social interaction

(3 of the following 5):

1. lack of eye-to-eye contact, strange body position, facial expressions, use of gestures inappropriate to the situation;

2. inability to establish (in a way adequate for mental development and despite the presence of the necessary opportunity) friendly relations, which would be characterized by mutual interests, activities and emotions;

3. the absence or very rare attempts to find comfort and love in other people in moments of stress or when they feel bad, and / or the inability to express consolation, sympathy or love for others when they feel bad;

4. not showing joy when others do, and / or not trying to share their own joy with others; lack of manifestation of sociality and emotions, expressed in a social reaction to the emotions of other people, and / or lack of behavior change depending on the need for a social context, and / or poor integration of socio-emotional and communicative behavior.

Qualitative violations in communication (2 of the next 5):

1. delay or complete absence of speech, not accompanied by an attempt to compensate for this by alternative means of communication, such as gestures, facial expressions, etc.;

2. inability to start or maintain a conversation (regardless of the presence of speech skills), inability to exchange remarks when communicating with other people;

3. stereotyped and repetitive use of language and / or idiosyncratic use of words and phrases;

5. lack of variety in role play, or, at an early age, in social imitation play.

Restricted, repetitive and stereotyped patterns of behavior, interests and actions (2 of the following 6):

1. all-absorbing stereotypical and limited interests;

2. specific attachment to certain subjects;

3. insisting on adherence to specific, non-functional rituals and established routines;

4. stereotypical and repetitive movement manners, including spinning, flapping, waving hands / fingers, or complex movements of the whole body;

5. persistent attention to parts of objects or non-functional play materials (sniffing, feeling surfaces, listening to the noises they make);

6. upset about small, insignificant changes in the environment.

The clinical picture is not consistent with other pervasive developmental disorders, specific impairment of receptive speech with secondary socioemotional problems, reactive attachment disorder or disinhibited attachment disorder, mental retardation with emotional / behavioral impairment, schizophrenia with unusually early onset, and Rett syndrome.

A.6 (or more) from (1), (2) and (H): at least 2 from (1) and one each from (2) and (3):

1. Qualitative violations of social interaction

1. obvious violations in non-verbal communication, lack of eye-to-eye gaze, strange facial expression, body position, gestures, inappropriate communication situations;

2. inability to establish developmentally appropriate friendships with peers;

4. lack of social or emotional response.

2 ... Qualitative impairments in communication, represented by at least one of the following:

1. delay or complete absence of verbal speech (without any attempts to compensate for this through alternative means of communication, such as gestures or facial expressions);

2. in people with adequate speech, a clear impairment of the ability to start or maintain a conversation with others;

3. stereotypes or repetitions in the language, idiosyncrasy;

4. the lack of variety and changes in the role-playing game or in the game that presupposes social imitation, at a level appropriate for the development of the child.

3. Limited, repetitive and stereotyped patterns of behavior, interests, actions, represented by at least one of the following:

1.All absorption by one or more stereotypical models of interest, abnormal in their intensity or focus;

2. a clear, rigid adherence to specific, non-functional ritual activities and established routines;

3. stereotyped and repetitive motor manners (eg, swinging, clapping, twisting the arm or fingers, or complex movements of the whole body);

4. persistent attention to parts of objects.

B. Delayed or abnormal functioning in at least one of the following areas, which manifests itself before 3 years of age:

1.social interaction

2.use of language in social communication

3.Symbolic play or play using imagination

It is important to note that the manifestations of the diagnostic characteristics presented vary. The criteria listed in the classification systems cannot cover all manifestations of the disorder, which complicates the diagnosis. For example, an inexperienced clinician may identify the presence of repetitive stereotypes in a child's lining up of objects or toys, however, he may not identify the child's verbal stereotypes (for example, constant talk about cars regardless of the social situation) as a manifestation of the same phenomenon. Many experts define social interaction disorders if a child avoids communication, and do not notice the same violation if it manifests itself in inappropriate, strange, stereotypical attempts by the child to establish friendships with other children. And, finally, the lack of eye-to-eye contact is easy to determine if the child avoids looking at the interlocutor, however, it is much more difficult to notice the same violation if the child looks at the speaker, but at the same time the use of gaze is noted inappropriate to the situation. It must be remembered that a short-term examination of a child (even by a team of specialists) cannot give a true picture of the violation and an assessment of the child's capabilities. Very often, at first glance, a child with autism may appear mentally retarded. In addition, inaccurate diagnosis can be caused by individual differences in the severity of symptoms; moreover, the same child can show different symptoms at different ages. Often, the diagnosis of autism is complicated by the overlapping symptoms of other disorders. This is where parents can help if they know what their child's behavior means. It is important that professionals encourage parents to participate in the assessment and assessment of their child's capabilities. You should heed the advice of L. Wing, who recommends asking the right questions, and claims that a specialist's conversation with parents, his attention and interest in the problems of the child and family will help establish trust and create optimal conditions for clarifying the diagnosis and correcting the violation. All this takes time - at least 2-3 hours should be spent talking with the parents. If this procedure is carried out in a hurry or formally, and the right questions are not asked, it is unlikely that the correct diagnosis can be made.

And, finally, it is necessary to note the inexpediency and even harm of examining the child in stationary conditions. Placement in a psychiatric hospital, a frightening environment with a large number of new adults and children, separation from loved ones, for an autistic child, obsessed with fear of change, is often fraught with the emergence of psychotic disorders, regression of acquired skills.

Establishing contact with an autistic child.

1 lesson: the game "Pens".

The course of the game. The psychologist takes the child by the hand and rhythmically pats the child's hand with his own, repeating "My hand, your hand ...". If the child actively resists, withdraws his hand, then the psychologist continues to pat himself. If the child agrees to contact with the hands, the psychologist's hand continues to pat the child's hand according to the type "Okay".

Game "Ladies" we offer the following quatrain:

Handles are our handles, you play for us,
Knock and shake you tight right now
We will be friends with you and catch everyone by the hand.

Round dance game.

The course of the game: the psychologist, with the child, holding hands, walks in a circle to the music with the following words:

Become children. Stand in a circle. Stand in a circle. I am your friend. And you are my friend. Good old friend.

Development of activity.

2nd lesson: the game "Guide".

The course of the game: First, the presenter (psychologist) leads the follower (child) with a blindfold on his eyes, avoiding all kinds of obstacles. Then they switch roles.

Game "Birds".

The course of the game: The psychologist says that now everyone is turning into little birds and invites you to fly with them, flapping their arms like wings. After the "birds" gather in a circle and together "peck grains", knocking fingers on the floor.

The game "Catch-up".

The course of the game: the psychologist invites children to run away, hide from him. Having caught up with the child, the psychologist hugs him, tries to look into his eyes and invites him to catch up with him.

Development of contact.

Lesson 3: the game "Pet the cat".

The psychologist and the child select tender and gentle words for the toy "Murka the Cat", while stroking it, can pick it up, snuggle up to it.

Play with a doll.

The course of the game: conducting a role-playing game on various topics, for example: "We go shopping", "Away". In this case, the doll is an assistant in the development of the child's social roles.

Strengthening psychological activity.

Development of perception.

4 lesson:

Exercise to develop spatial coordination(concepts on the left, right, in front, behind, etc.) takes place in the form of a game.

We'll go right now! One two Three!

Now let's go left! One two Three!
Let's join hands quickly! One two Three!
Let's open up just as quickly! One two Three!
We'll sit down quietly! One two Three!
And let's get up lightly! One two Three!
We will hide our hands behind our backs! One two Three!
Turn it over your head !! One two Three!
And we will stomp with our foot! One two Three!

Psychotechnical games.

5 lesson: the game "Find a place for a toy."

The course of the game: the psychologist proposes to alternately put the pins or balls in the box of the desired color and in the corresponding hole cut in the box. A competition can be organized.

Game "Collect balls".

Course of the game: The child, on command, collects and disassembles the balls.

Development of the analytical and synthetic sphere.

6 lesson: Ravenna table.

Lesson progress: the child is invited to patch up the rug. As you complete the tasks, they become more and more difficult.

Graphic dictation.
Course of the lesson: under the dictation of a psychologist, the child is guided on paper.

Continue the row
Course of the lesson: on the basis of the given figures, conduct an analysis, find a pattern and follow it when continuing this series.

Development of attention.

7 lesson: Correction tests. "Girls".

Course of the lesson: the child selects on a sheet of paper on a certain basis, first one type of girls, and then another.

Table.

The course of the lesson: a table of numbers is given, arranged in a scatter, the child's task is to find and name them in order.

Memory development

Lesson 8: Memorize the words.

The course of the lesson: the child is offered several pictures in turn, which he recites from memory or reproduces in a notebook.

Find the difference game.

The course of the lesson: the child is offered two pictures, differing in some details. Find all the different parts.

Development of verbal communication .

Game "Finish the phrase".

Course of the lesson: a familiar poem is read to the child, which he must finish.

Development of personal and motivational sphere

Lesson 10: the game "My family".

Course of the lesson: The child is offered several situations in which roles will be assigned in advance with the help of a psychologist. For example: "Congratulate your mom on her birthday", "Invite a friend to visit." If the child finds it difficult, the psychologist should join the game and show how to behave in a given situation.

11 lesson: the game "Murzik came to play."

The course of the game: the psychologist shows the Cat Murzik, put on his arm. Murzik the cat greets. Then Murzik shows the child a transparent plastic bag with the objects he brought and offers to take any number of figures and place them on the table. Murzik builds a house for a doll or a garage for a car from the offered blocks. The psychologist encourages the child to communicate with Murzik.

Development of an active role-playing game .

12 lesson: the game "Monkey-mischievous".

Course of the game: The psychologist shows the monkey and tells how she likes to imitate. The psychologist raises his hand, then makes the same movement with the monkey, then offers to perform the same movement or on the monkey. Then the movements become more complicated: wave of the hand, clapping, tapping, and so on.

Development of mobile - competitive games.

Lesson 13: the game "Building a house for friends."

The course of the game: The psychologist says that he has two friends: a toy cat Murzik and a dog Sharik. They are very kind and funny, but they have one problem - they don't have a home. Let's help them build a house.

Game: "The most agile".

Course of the game: The psychologist proposes to take turns to throw the ball into the basket, at the end of the game is called the most agile. You can offer other options for outdoor games, the main thing is that the child in these games understands that it is in his power to achieve positive results.

Bibliography

1. Babkin's knowledge. Lesson program for the development of cognitive activity of younger students: A book for a teacher. - M.: ARKTI, 2000.
2. Varga correction of communication disorders of primary schoolchildren \ Family in psychological counseling Edited by, .- M., 1989.
3., Kasatkina children communicate. - Yaroslavl, 1997.
4. Kagan in children. L., 1981.
5. Mamaichuk technologies for children with developmental problems. - SPb., 2003.
6. Ovcharova psychology in elementary school. - M., 1998

The syndrome of early childhood autism is a disorder of the mental development of a child, the main manifestation of which is a deficit in social interaction and the complexity of contacts with people around. Autistic patients have pronounced difficulties in understanding the emotions of others, specific features of verbal and cognitive development.

The main symptoms of the disease appear between the ages of 0 and 3 years. These can be violations of the emotional-volitional sphere, specific features of motor functions (motor stereotypes, irregularity of movements), as well as a delay in cognitive and speech development.

The pathogenic mechanisms of RDA are still poorly understood. In some cases, the disorders are combined and can be caused by certain medical abnormalities, such as tuberous sclerosis, congenital rubella, childhood spasms, etc.

The basis for the diagnosis should be the presence of characterizing factors, regardless of the presence or absence of the above deviations. Nevertheless, each of these conditions must be determined separately, as well as the presence of mental retardation in the pathogenesis.

Diagnosis of Early Childhood Autism (Kanner Syndrome)

To identify classic autism, a number of techniques are used, developed and tested mainly in foreign countries and used in scientific and experimental research.

Diagnostic techniques:

ADOS, Observation Scale for Diagnostics;
ABC Behavioral Questionnaire;
ADI-R, adapted polling option for diagnostics;
RDA rating scale CARS.
The ADOS-G Observation Scale is a generic option.

When making a diagnosis, in this case, the anamnesis data, the results of dynamic observation of the child, the correspondence of the manifestations of the disease to the main diagnostic signs are used:

Qualitative pathologies of social interaction - the inability to establish social ties with others, the inability to model behavior in accordance with the social situation.
Qualitative communicative anomalies - difficulties in establishing emotional contact and lack of spontaneous speech, inability to enter into dialogue and maintain a conversation, difficulties in differentiating between living objects and inanimate objects.
Repetitive behavior, stereotypes - the child is absorbed in monotonous interests and hobbies, adheres to specific rituals in behavior.

The classic syndrome of this disease is characterized by the manifestation of the clinical picture of pathology at an early age - up to 3 years. Additional symptoms appear with age:

psychopathological phenomena - like fears and phobias, sometimes inexplicable and illogical;
pronounced aggression and autoaggression;
disturbances in the process of sleep and food intake;
excessive excitability.

Diagnosis of Autistic Personality Disorder (Asperger Syndrome)

To identify signs of the disease in question in adults, you can use the observation method. The manifestation of the following symptoms can indicate a possible diagnosis:

avoidance of eye contact, absence or weak, expressionless facial expressions and gestures;
monotonous, expressionless speech, limited vocabulary;
poor development of communication skills;
inability to recognize the emotional states of people around;
inability to express their own emotions and feelings, difficulty in expressing and understanding abstract concepts;
misunderstanding or ignorance of the elementary rules of communication;
lack of initiative in conversation, inability to conduct a dialogue;
adherence to stereotypes, monotonous actions and rituals of the same type, which often do not carry a definite meaning;
an acute reaction to the slightest change in life or in the immediate environment.

It is also relevant to use a test called "Reading the Mind in the Eyes", the purpose of which is to detect a decrease in understanding in an adult with a normal level of intelligence.

The technique determines the level of the subject's ability to put himself in the opponent's place and tune in to his mental state. The test consists of 36 photographs of pairs of eyes depicting different emotions. Having a limited amount of data (gaze and the area around the eyes), the subject must provide information about the internal state of the wearer of the eyes.

When diagnosing, the accuracy of the diagnosis is of great importance, since the syndrome of childhood autism in some of its manifestations is similar to other disorders of mental development: a number of genetic diseases, cerebral palsy, childhood schizophrenia, etc.

To make a final diagnosis, a decision of a council of doctors is necessary, which includes a child psychiatrist, neurologist, psychotherapist, speech therapist-defectologist, pediatrician, psychologist and other experts whose activities are aimed at studying children with special needs.

The tests discussed in this article can only be used to confirm suspicions, and not to make a final diagnosis.

The definition of the disease involves a survey of the parents and relatives of the child, the organization of observations of the subject in different everyday situations is relevant. Examination of the child and observation of him should be carried out in his usual conditions, otherwise the diagnostic picture may be distorted due to excessive stress.

To date, a way to completely overcome this complex disorder has not yet been discovered, but timely started complex treatment, correction and rehabilitation work can help a child partially reduce negative symptoms and achieve, in some cases, acceptable social adaptation.

- a complex developmental disorder characterized by a distortion of the course of various mental processes, mainly in the cognitive and psychosocial spheres. Manifestations of early childhood autism are avoidance of contact with people, isolation, perverted sensory reactions, stereotyped behavior, and speech development disorders. The diagnosis of early childhood autism is established on the basis of dynamic observation and satisfaction of the manifestations of the violation with the diagnostic criteria for RDA. Treatment of early childhood autism is based on the syndromic principle; additionally, correctional work is carried out using special pedagogical methods.

General information

Causes of early childhood autism

To date, the causes and mechanisms of early childhood autism are not fully understood, which gives rise to many theories and hypotheses of the origin of the disorder.

A gene theory of origin links early childhood autism with genetic defects. It is known that 2-3% of the offspring of autists also suffer from this disorder; The probability of having a second autistic child in the family is 8.7%, which is many times higher than the average population frequency. Children with early childhood autism are more likely to have other genetic disorders - phenylketonuria, fragile X syndrome, Recklinghausen's neurofibromatosis, Ito's hypomelanosis, etc.

According to the teratogenic theory of early childhood autism, various exogenous and environmental factors affecting the body of a pregnant woman in the early stages can cause biological damage to the central nervous system of the fetus and subsequently lead to a violation of the general development of the child. Such teratogens can be food components (preservatives, stabilizers, nitrates), alcohol, nicotine, drugs, drugs, intrauterine infections, stress, environmental factors (radiation, exhaust gases, heavy metal salts, phenol, etc.). In addition, the frequent association of early childhood autism with epilepsy (in about 20-30% of patients) indicates the presence of perinatal encephalopathy, which can develop as a result of toxicosis of pregnancy, fetal hypoxia, intracranial birth trauma, etc.

Alternative theories link the origins of early childhood autism to fungal infection, metabolic, immune and hormonal disorders, and older parenting age. In recent years, there have been reports of a link between early childhood autism and prophylactic vaccination of children against measles, mumps and rubella, but recent research has convincingly refuted a causal relationship between vaccination and illness.

Classification of early childhood autism

According to modern concepts, early childhood autism is included in the group of pervasive (general) mental development disorders, in which the skills of social and everyday communication suffer. This group also includes Rett syndrome, Asperger's syndrome, atypical autism, hyperactive disorder with ID and stereotyped movements, and childhood disintegrative disorder.

According to the etiological principle, early childhood autism is distinguished as endogenous-hereditary, associated with chromosomal aberrations, exogenous-organic, psychogenic and unclear genesis. On the basis of the pathogenetic approach, hereditary-constitutional, hereditary-procedural and acquired postnatal dysontogenesis are distinguished.

Taking into account the prevailing nature of social maladjustment in early childhood autism, K. S. Lebedinskaya identified 4 groups of children:

with detachment from the environment(complete lack of need for contact, situational behavior, mutism, lack of self-service skills)
with rejection of the environment(motor, sensory, speech stereotypes; hyperexcitability syndrome, impaired sense of self-preservation, hypersensitivity)
with the replacement of the surrounding(presence of overvalued addictions, originality of interests and fantasies, weak emotional attachment to loved ones)
with overbraking in relation to the environment(fearfulness, vulnerability, mood lability, rapid mental and physical exhaustion).

Early Childhood Autism Symptoms

The main "classic" manifestations of early childhood autism include: child's avoidance of contact with people, inadequate sensory responses, behavioral stereotypes, impaired speech development and verbal communication.

Disorders of social interaction in a child with autism become noticeable already in early childhood. An autistic child rarely smiles at an adult and responds to his name; at an older age - avoids eye contact, rarely approaches strangers, including other children, practically does not show emotions. Compared to healthy peers, he lacks curiosity and interest in new things, the need to organize joint play activities.

Sensory stimuli of the usual strength and duration cause inappropriate responses in a child with early childhood autism syndrome. So, even quiet sounds and a dim set can cause increased fearfulness and fear, or, on the contrary, leave the child indifferent, as if he does not see or hear what is happening around. Sometimes autistic children selectively refuse to wear a certain color or use certain colors in productive activities (drawing, appliqué, etc.). Tactile contact, even in infancy, does not cause a response or provokes resistance. Children quickly get tired of activities, get fed up with communication, but they tend to "get stuck" on unpleasant impressions.

The lack of the ability to flexibly interact with the environment in early childhood autism determines the stereotyped behavior: uniformity of movements, actions of the same type with objects, a certain order and sequence of actions, greater attachment to the environment, to the place, and not to people. In autistic children, general motor awkwardness and underdevelopment of fine motor skills are noted, although in stereotyped, often repeated movements, they demonstrate amazing accuracy and accuracy. The formation of self-service skills is also delayed.

Speech development in early childhood autism is unique. The dolinguistic phase of language development proceeds with a delay - late (sometimes completely absent) humming and babbling, onomatopoeia appear, the reaction to the appeal of adults is weakened. Independent speech in a child with early childhood autism also appears later than the usual normative terms (see "Delayed speech development"). Characterized by echolalia, stamped speech, pronounced agrammatism, the absence of personal pronouns in speech, the intonational poverty of the language.

The peculiarity of the behavior of a child with early childhood autism syndrome is determined by negativism (refusal to learn, joint activities, active resistance, aggression, withdrawal, etc.) Physical development in autistic children usually does not suffer, but intelligence in half of the cases is reduced. Between 45 and 85% of children with early childhood autism experience digestive problems; they often have intestinal colic, dyspeptic syndrome.

Diagnosing early childhood autism

According to ICD-10, the diagnostic criteria for early childhood autism are:

1) qualitative violation of social interaction
2) qualitative violations of communication
3) stereotyped forms of behavior, interests and activity.

The diagnosis of early childhood autism is established after a period of observation of the child by a collegial commission consisting of a pediatrician, child psychologist, child psychiatrist, child neurologist, speech therapist and other specialists. Various questionnaires, instructions, tests for measuring the level of intelligence and development are widely used. Clarifying examination may include electroacupuncture

Prediction and prevention of early childhood autism

The impossibility of a complete cure for early childhood autism determines the persistence of the syndrome in adolescence and adulthood. With the help of early, constant and comprehensive medical and corrective rehabilitation, it is possible to achieve acceptable social adaptation in 30% of children. Without specialized help and support, in 70% of cases, children remain deeply disabled, incapable of social contacts and self-service.

Given the uncertainty of the exact causes of early childhood autism, prevention comes down to a generally accepted rule that a woman preparing for motherhood must follow: carefully plan pregnancy, exclude the influence of unfavorable exogenous factors, eat right, avoid contact with infectious patients, follow the recommendations of an obstetrician-gynecologist, etc.

In May 2006, CDC figures confirmed what many parents and educators already knew: Autism is indeed high. According to Dr. José Cordero, director of the National Center for the Study of Birth Defects and Malformations at the Centers for Disease Control, autism has become a "high priority public health concern." As recently as 12 years ago, autism spectrum disorder (ASD) was so rare that there was only 1 case in 10,000 deliveries (1). Today, these disorders, characterized by a number of learning difficulties and social problems, occur in every 166th child (2), with no signs of a downward trend.

Outside the US, autism has skyrocketed. It is a global phenomenon occurring in industrialized countries around the world. In the UK, according to educators, one in 86 primary school students needs special education because of the problems associated with autism spectrum disorders (3).

Everything from "emotionally cold" mothers (denied) to vaccines, genetics, immunological disorders, environmental toxins and maternal infections have been blamed for the onset of autism.

Most researchers today assume that autism is caused by a complex interplay of genetic and environmental triggers. One plausible cause worth investigating is the widespread use of ultrasound in prenatal diagnosis, which can cause potentially dangerous thermal effects.

Medical professionals working with pregnant women have reasons to be concerned about the use of ultrasound. Although proponents of the latter claim that ultrasound has been used in obstetrics for 50 years and that early research has shown that it is safe for both mother and baby, there is a fair amount of research linking ultrasound to neurodevelopmental disorders that warrants serious study.

In 1982, at a World Health Organization conference sponsored by the International Radiation Protection Association (IRPA) and other organizations, an international panel of experts stated: studies can be criticized for a number of reasons, including the lack of a control group or insufficient sample size, exposure to [ultrasound] after a period of major organogenesis, all of which invalidates the findings ”(4).

Early studies showed that the subtle effects of neurological damage associated with ultrasound were responsible for an increase in the incidence of left-handedness (an indicator of brain impairment, unless it is hereditary) in boys and speech delays (5). In August 2006, Pasco Rakich, chair of the Department of Neurobiology at Yale University School of Medicine, announced the results of a study of the effects of ultrasound of various durations in pregnant mice (6). In the brain of the offspring of the test animals, damage was observed, similar to that found in the brains of people with autism. The study, funded by the National Institute of Neurological Disorders and Stroke, also links ultrasound to neurodevelopmental disorders in children, such as dyslexia, epilepsy, mental retardation, and schizophrenia, with more damage to brain cells the longer the ultrasound was exposed (7).

Dr. Rakic's study, which pushed the boundaries of a previous 2004 study with similar results (8), is only one of many experiments with humans and animals in recent years. Their results indicate that prenatal ultrasound can be harmful to babies. While some questions still remain unanswered, supported by the available information, healthcare providers need to take seriously the potential implications of routine and diagnostic use of ultrasound and electronic fetal heart monitors, which are possibly neither non-invasive nor safe. These technologies, despite all of them, have little or no proven benefit. If pregnant women knew all the facts, would they expose their unborn children to this technology, which, despite the "promoted" position in modern obstetrics, does not bring any benefit or, in any case, which is not proven?

Sound and heat problems

One of the problems faced by the ultrasound operator is caused by the fact that he holds the transducer over the part of the embryo's body that he is trying to visualize. When the embryos move away from the stream of high-frequency sound waves, they may feel vibrations, heat, or both. The Food and Drug Administration (FDA) warned in 2004: "Ultrasound is a form of energy, and even at low levels, laboratory studies show that it can have physical effects on tissues, such as sudden fluctuations and high temperatures." ). This is consistent with a 2001 study in which an ultrasonic sensor aimed directly at a miniature hydrotelephone placed in a woman's womb recorded a sound “as loud as the whistle of a subway train arriving at a station” (10).

The fact of an increase in the temperature of the embryonic tissue (especially since the expectant mother cannot even feel it) would not have caused our alarm if it were not for research data, according to which an increase in temperature can cause significant damage to the central nervous system of the developing embryo (11). It has been shown that in various mammalian species, an increase in the body temperature of the mother or embryo leads to birth defects in the offspring (12). The extensive literature on maternal hyperthermia in various mammals demonstrates to us that “defects in the central nervous system are the most common consequence of hyperthermia in all species, and cell death or delayed proliferation of neuroblasts (embryonic cells that develop into cells of the nervous system) are considered the main explanations for these effects. " (thirteen).

Why should women expecting a baby be bothered by defects in neural tissue formation in rats or other animals? But because researchers at Cornwell University proved in 2001: the development of the brain of "many species of mammals, including human babies" occurs in a similar way (14). The group of researchers found “95 milestones in the development of the nervous system” that helped them accurately determine the sequence of the stages of brain growth in different species (15). Therefore, if repeated experiments show that the high temperature caused by ultrasound damages the brains of embryos in rats and other mammals, it is logical to assume that it could harm the human brain as well.

When creating such an image in commercial organizations, the risk to the child is potentially significantly higher: due to the higher acoustic load required to obtain high-quality images, the longer "hunt" for technical personnel for a suitable angle and the use of the work of ultrasound operators, who may not have any basic medical education or qualification training. These factors, along with issues such as cavitation (the bubble formation effect caused by ultrasound that can damage cells) and on-screen safety indicators, which can be inaccurate in a wide range of 2 to 6, make the effect of ultrasound questionable even in experienced hands. ... Indeed, if ultrasound can harm babies, it can cause the same damage when used for both entertainment and diagnosis.

The FDA and professional medical associations really know that prenatal ultrasound can be dangerous to humans, otherwise they would not strongly warn against non-medical studio ultrasound portraiture, a “keepsake” service that has cropped up in shopping malls all over the world. country (16).

The use of ultrasound commercially carries with it a potentially greater risk to the child due to the higher acoustic load required to obtain high quality images, the longer hunt for suitable angles by technicians, and the use of personnel who may not have any basic medical education or proper preparation. These factors, along with cavitation (the “bubbling” effect of ultrasound, which can damage cells) and on-screen safety indicators, which can be inaccurate over a wide range of 2 to 617, obscure the consequences of ultrasound use, even in experienced hands.

Increased maternal temperature is the cause of birth defects

Understanding what happens if the fetal temperature increases due to an increase in maternal core temperature or the more localized effect of ultrasound is key to understanding the prenatal risks of ultrasound. A person's body temperature changes throughout the day for various reasons: circadian rhythms, hormonal fluctuations, and physical causes. Although a person's temperature can vary by 1.5 ° F on either side of what is considered a normal primary temperature, the overall average is 98.6 ° F (36.6 ° C). An increase of only 1.4 ° F to 100 ° F (37.8 ° C) can cause headaches, body aches and fatigue, enough to get a person off work. A temperature of 107 ° F (41.6 ° C) can cause brain damage or death.

Core temperature, approximately 98.6 ° F (36.6 ° C), is important because it is where many important enzymatic reactions take place. Temperature affects the shape of the proteins that make up the enzymes, and malformed proteins are unable to do their job correctly. As the amount of heat or the duration of its exposure increases, the efficiency of enzymatic reactions decreases, up to their constant inactivation, with the inability to return to proper operation, even if the temperature is normalized (18).

Because temperature is important for the enzyme reactions to work properly, the body has its own methods to regulate core temperature. For example, when it is too low, the trembling heats up the body; when it is too high, sweating reduces it. For obvious reasons, fetuses cannot cool down by sweating. However, they have another defense against rising temperatures: Each cell contains something called heat shock proteins, which temporarily stop enzyme production when temperatures reach dangerously high levels (19).

Complicating the problem is the fact that ultrasound heats bone, muscle, soft tissue, and amniotic fluid in different ways (20). Further, as the bones harden, they absorb and store more heat. During the third trimester, a baby's skull can heat up 50 times faster than the surrounding tissue (21), exposing the parts of the brain that are close to the skull to secondary heating that can continue after the ultrasound is over.

An elevated temperature, only temporarily affecting the mother, can have devastating consequences for the developing embryo. A 1998 article in the medical journal Cell Stress & Chaperones reported that "a heat shock reaction can be triggered early in the life of the embryo, but it fails to protect the embryo from damage at certain stages of development." The authors note: "With the activation of the heat shock reaction, normal protein synthesis is suspended ... but survival is achieved through normal development" (22).

Autism, Genetics, and Twin Research

What is the link between fever and autism? Geneticists are trying to unravel the DNA mysteries behind autism spectrum disorders. Recently, researchers have linked two mutations of the same X chromosome genes to autism in two different families, although it is not yet clear at what stage the genes were damaged (23). Since studies of siblings and twins show a higher prevalence of autism among children in families with one child already with autism, geneticists expected to find hereditary factors. However, despite the millions of dollars invested in research, there is no clear indication that autism spectrum disorders are inherited. Perhaps scientists need to look no further than the thermal effects of ultrasound for many of the answers.

If prenatal ultrasound is responsible for some cases of autism, then it is possible to assume that if one twin were autistic, the other would also be more likely to suffer, since they were both exposed to ultrasound at the same time. In both identical and fraternal twins, one may suffer more than the other if he or she takes the brunt of heat or sound waves at the time of the study. In the case of fraternal twins, since autism affects male twins 3 to 5 times more often than female twins, the gender of the twins can also make a difference.

A 2002 study showed that twins are generally significantly more likely to have autism, declaring “twinning” a risk factor (24). Could the increased risk for twins be explained by the practice of mothers with multiple pregnancies performing more ultrasounds than those expecting only one child? Although it is too early to deny the role of genetics in the problem of autism, the possible impact of prenatal ultrasound deserves serious consideration.

Unnoticed warnings

The idea that prenatal ultrasound can be dangerous is not new. The previously cited WHO report, in its summary, Effects of Ultrasound on Biological Systems (1982), states that “animal studies suggest that exposure to ultrasound may cause neurological, behavioral, immunological, hematological changes, developmental disabilities and a decrease in fetal weight. "(25).

Two years later, when the National Institutes of Health (NIH) held a conference to assess the risks of ultrasound, he reported that when birth defects occurred, the acoustic stress was intense enough to generate significant heat. Although the Institute of Health has since stated that the report “is no longer viewed ... as a guide to modern medical practice,” the facts remain unchanged (26).

Despite the results of these two extensive scientific papers, in 1993 the FDA approved an eightfold increase in the potential acoustic exposure generated by ultrasound equipment (27), greatly increasing the potential for overheating-related adverse pregnancy outcomes. Could it be a coincidence that this increase in potential heat effects happened during the same time span that autism rates increased 60-fold?

Hot baths, steam rooms, saunas and maternal fevers

If the accused has a fever, what is known about other situations in which fever affects pregnancy? A study entitled "The Effects of High Temperature on Embryos and Fetuses" and published in 2003 in the International Journal of Hyperthermia states that "hyperthermia during pregnancy can cause fetal death, abortion, growth retardation, and developmental defects" (28). And further: "... A 2 ° C (3.6 ° F) increase in maternal body temperature for at least 24 hours during fever can cause a number of developmental defects" (29). It has been noted that there is not enough data to draw conclusions about exposure times of less than 24 hours (30), which leaves open the possibility of adverse effects on embryos of increased maternal temperature for shorter periods.

A study published in the Journal of the American Medical Association (JAMA) found that "women who took hot baths or saunas in early pregnancy tripled their risk of having babies with spina bifida or brain defects" (31). Hot baths are more dangerous than other thermal treatments, such as saunas and steam rooms, because immersion in water interferes with the body's attempt to cool down through sweat, much in the same way that fetuses cannot escape the rise in temperature in the uterus.

All this taken together establishes the following fact: heat, which is a consequence of an increase in maternal temperature or the result of too long exposure to ultrasound on one area, can give an impetus to the damaging effect on a developing child. From the point of view of common sense, on what basis, in fact, is it believed that the invasion of the continuous, integral development of the embryo, which for millions of years was completed without any help, can pass without consequences?

Discussion around vaccines and thiomersal

Despite the long established fact that ultrasound induces thermal effects that can harm the development of the fetal brain, the cause of autism remains so elusive to researchers that many autism organizations use a puzzle piece as part of their emblems. Particularly embarrassing is the fact that the epidemic of autism spectrum disorders affects children from highly educated, high-income families who receive the best obstetric care money can buy. Why did women who took prenatal vitamins follow healthy diets, refrain from smoking and drinking alcohol, regularly visit obstetricians before giving birth, and have children with deep neurological problems?

Some believe that the cause of autism is childhood vaccines, which were initially available only to those who could afford them. Many vaccines contained thimerosal, a mercury-containing preservative thought to have a cumulative neurotoxic effect on children, especially since the number of childhood vaccines increased during the same period as autism increased. However, in an exhaustive study in 1999, the FDA found no evidence of harm from the use of thimerosal in childhood vaccines (32).

Despite these results, in the same year, the FDA, National Institutes of Health, Centers for Disease Control, Health and Medical Services Administration (HRSA), and the American Academy of Pediatrics (AAP) collectively called on vaccine manufacturers to reduce thimerosal levels or withdraw his from childhood vaccines (33). Pharmaceutical companies agreed and ultimately reduced the effects of thimerosal in infants by 98% (34).

However, not only did the incidence of autism not decrease - it continued to increase. The 10-17% increase in the incidence of autism spectrum disorders each year, according to the American Society for Autism Research (35), indicates that thimerosal is not to blame. *

Thimerosal was not the only hot spot for autism and vaccines. Many believed there was a link between the MMR (mumps, measles, and rubella) trivial vaccine and autism spectrum disorders. However, a large retrospective epidemiological study of over 30,000 children in Japan between 1988 and 1996. showed that the autism curve continued to rise after the vaccine was withdrawn.36 ** These results were not different from the findings of a 1999 study published in The Lancet, which did not show a corresponding spike in autism in the UK following the introduction of the MMR37 vaccine. ***

A 2001 study published in the Journal of the American Medical Association examining the incidence of autism and MMR vaccination coverage in California states that the results “do not support an association between MMR vaccine immunization in children and increased autism incidence” (38). While concerns about vaccines and mercury should not be dismissed, there is no evidence to date that this is one of the main contributors to the spike in the incidence of autism spectrum disorders.

The global epidemic of autism

Statistics on the rise in autism among industrialized countries around the world show that the disease has only manifested itself in the last few decades, in different natural conditions and among very different cultures. What unites countries and regions with such different climates, diets and environmental conditions - the USA, Japan, Scandinavia, Australia, India and the UK? No common factor in water, air, local pesticides, diet, or even building materials and clothing can explain the occurrence and continuous increase in the incidence of this lifelong serious neurological disorder.

What all industrialized countries really have in common is a quiet but pervasive change in obstetric care. All of them routinely use prenatal ultrasound for pregnant women.

In countries with nationalized health care, where virtually all pregnant women undergo ultrasound scans, the incidence of autism is even higher than in the United States, where, due to differences in income and thus the type of health insurance, approximately 30% of pregnant women do not yet undergo ultrasound scans.

Changes in ultrasound examinations

Considering the early studies showing that prenatal ultrasound is safe, consideration should be given to the constant change in technology and use of the latter, as well as how this potentially affected the unborn child. In addition to the huge increase in acoustic loading in the early 1990s, the following changes in technology made the field of prenatal ultrasound more dangerous than ever:

The number of ultrasound examinations performed during each pregnancy has increased; however, women are often subjected to two or more studies, even in low-risk situations (38). “High-risk” women may be exposed to even more research, which, ironically, may further increase this risk.
The time period for the development of the embryo or embryo when ultrasound is performed was reduced to very early in the first trimester and increased to very late, right up to delivery, in the third. Fetal heart monitors, which are used sometimes for hours during labor, have not been shown to reduce neurological problems and may have exacerbated them (40).
Developing the practice of vaginal examination, which places the sound source much closer to the embryo or fetus, can significantly increase the risk.
The use of Doppler ultrasound to study blood flow or monitor a baby's heartbeat is becoming more common. According to the 2006 Cochrane Database of Systematic Reviews, “conventional Doppler ultrasound during pregnancy has no health benefits for the woman or infant and may cause some harm” (41).

Increasing incidence of birth defects

Dr. Rakich's research team, cited earlier in this article in connection with a recent study on mouse brain and ultrasound, indicated that “the probe remained immobile for up to 35 minutes, that is, essentially the entire brain of the mouse embryo was continuously exposed to ultrasound within 35 minutes ... in stark contrast to the duration and intensity of ultrasound exposure to the brain of a human embryo, when ultrasound usually does not stay on a specific tissue for more than one minute ”(42).

One of the most popular non-medical uses of ultrasound for its medically prolonged exposure time is to determine the sex of the baby.

Could this be due to an increase in birth defects of the genitals and urinary tract? March Ov Dimes states that these types of birth defects affect “1 in 10 babies,” adding that “the specific causes of most of the conditions that define these defects are not known” (43).

Continuing in this direction, let us take into account that serious malformations of other organs and parts of the body, also carefully investigated by technical personnel using ultrasound, such as, for example, the heart, in the period 1989-1996. began to register more often by almost 250% (44)! The list of unexplained birth defects is long, and in light of the information that is becoming known about prenatal ultrasound, scientists should take a different look at all recent trends, as well as the thirty percent increase in the number of preterm births since 1981 (45). this is 1 in 8 newborns, many of whom subsequently develop neurological damage (46).

While many argue that the benefits of ultrasound outweigh the risks, this claim has no foundation and there is a lot of evidence to the contrary. A large randomized trial of 15,151 pregnant women conducted by the RADIUS research team found that in low-risk cases, high-risk subgroups, and even multiple pregnancies or serious abnormalities, the use of ultrasound did not lead to an improvement in pregnancy outcome (47). The argument that ultrasound calms a parent or provides early connectivity to a child pales in the face of potential risks as new data becomes available. Parents and healthcare providers will likely find it difficult to abandon this “window into the womb” and resume using more traditional obstetrics. However, with the alarming rise in autism and other equally disturbing and unexplained trends associated with childbirth, it makes little sense to blindly use technology that is not truly safe for unborn babies.

Note from the editor of Midwifery Today magazine

Center for Speech Neurology "DoctorNeyro" has developed a comprehensive program of examination of children with an unknown diagnosis "autism».

The program was developed on the basis of clinical guidelines and protocols of the Ministry of Health of the Russian Federation.

The relevance of the program is explained by the difficulties in diagnosing a number of diseases with an autistic-type manifestation. And also the need to apply an interdisciplinary approach, involving the cooperation and interaction of specialists from several directions when working with each patient.

Autism: Diagnostic Errors.

Autism is often misdiagnosed.

This happens because the definition of "autism" (more precisely, "early childhood autism", RDA, since the diagnosis of "autism" can be given to a child only at middle school age) includes a general set of behavioral symptoms. The main (but not all) of which are:

a pronounced tendency to compulsive (intentional adherence to rules), stereotyped behavior ("aimless" repetitive actions),
a certain sequence of actions (ritual behavior),
excessive selectivity (for example, to certain colors or in food),
changes in the emotional background,
isolation,
limited interests,
difficulties in interacting with the outside world,
unwillingness to play with peers,
unwillingness to communicate with adults,
underdevelopment or lack of speech.

If a child behaves in a certain way (and even more so, several specific features are noted in his behavior at once), then with a high degree of probability he can be diagnosed with autism. And it doesn't matter what kind of pathology underlies such behavior, the diagnosis is often made without taking into account the causes of the pathology.

Despite the fact that in modern medicine and correctional pedagogy there are a large number of diagnostic techniques and algorithms, situations of "substitution" of one violation for another occur quite often.

RAS and RDA are not the same thing.

First of all, even within the “autism” category itself, it is unacceptable to use the equal sign between the diagnoses of RDA (early childhood autism) and ASD (autism spectrum disorder).

RDA has at least three or four features from the entire symptomatology of the autism spectrum. As a rule, these are the difficulties of interacting with other people, even the closest ones, as well as the inability to express their own emotions. The speech of such children also has its own characteristic features: echolalia, agrammatism, the absence of pronouns, stamping, intonational monotony. If such children begin to speak, then with a pronounced delay.

RAS , at first glance, appears to be very similar. But with all the external similarity of symptoms, ASD and RDA are not the same thing.

Despite the fact that ASD and RDA have similar manifestations, they are completely different in terms of the very nature of the disorder. Unlike RDA, ASD is not an independent disease as such, and is always a consequence of organic damage to the child's central nervous system, mental status or genetic disorder. That is, ASD as an independent manifestation, without any reason, cannot exist. And a fatal diagnosis error may be the reason that RDA will be attributed to those children who do not actually suffer from autism.

RAS can also be confused with alalia or mutism. Indeed, at a certain age, these disorders are quite similar in their manifestations. From 4-4.5 years of age, sensory alalia can appear similar to the autism spectrum. Why is this happening?

Mutism.

Mutism is based on classical neurosis. A physically healthy child without any organic pathologies and deviations in intellectual development does not speak: does not answer questions, does not show his ability to speak in principle. It looks like the child has deliberately "made a vow of silence."

Most often, the state of mutism appears in resentful, sensitive and vulnerable children. But a positive, open-minded child can also shut up and shut up if he had to face an unexpected stimulus: trauma, unexpected fright, a sharp change in the environment. Distinguish between total mutism (the child does not speak under any circumstances), selective (manifests itself only in certain places or with certain people), phobic (the child is afraid to look unsightly) and depressive (against the background of a general decrease in activity, gloom).

It is very important to understand that with all the external similarity of symptoms, they are all completely different diseases. The effectiveness of all further work on the rehabilitation of the child depends, first of all, on how correctly the diagnosis is made.

Sensory alalia is a disorder with autosimilar manifestations.

Sensory alalia is manifested by speech impairment, and sometimes its complete absence. The child does not understand the addressed speech. If explained in simple language, the alalik child's speech perception is impaired - speech sounds to him like a set of incomprehensible foreign words, all phonemes merge into one. He cannot perceive the speech addressed to him and, as a result, does not understand the very meaning of verbal communication. In the end, he gets used to dispensing with speech.

Thus, alalia is "disguised" as an ASD. The child's behavior acquires self-similar features, namely all the same: problems of interaction with the outside world, isolation, unwillingness to play with peers and communicate with adults, etc.

Both in the case of sensory alalia and in the case of autism spectrum disorder, organic damage to the central nervous system will necessarily be present. But the structure of the defect in ASD will be fundamentally different from alalia.

Conclusions:

Autism is a medical diagnosis and in no case can only be established by a speech therapist.
There are many organic diseases that have similar symptoms that can be mistaken for autism. And it is very important to differentiate such diseases, since further treatment and correction depend on this. Unfortunately, not always one neurologist (or one psychiatrist) alone can assess the level of higher mental functions.
The diagnosis of autism (or up to a certain age of RDA) must necessarily be pre-established by a commission of doctors and correctional specialists. If you suspect autism, it is recommended to undergo a comprehensive examination by specialized doctors.
It is very difficult for parents to go through all the doctors and initiate a joint discussion to make a single decision.
The Speech Neuroscience Center "DoctorNeuro" has developed a program for a comprehensive in-depth analysis of autism spectrum disorders. Five highly qualified specialists - a pediatric neurologist, a pediatric psychiatrist / neuropsychiatrist, a geneticist, a neurorehabilitologist, a speech therapist-defectologist, as a result of a collegial discussion, make a single agreed diagnosis.

The technique is designed for children from 2.5 to 12 years old.

Stages of the program:

Pediatric neurologist consultation

The neurologist determines the presence or absence of damage to the nervous system - disorders of the functions of the cranial nerves, reflexes and their changes, extrapyramidal disorders, cerebellar pathology and disorders of coordination of movements, sensitivity, disorders of the function of the autonomic nervous system.

An expert neurologist will determine what the root cause is - a neurological disorder and, as a possible consequence, an acquired autism spectrum or psychiatric / genetic pathology.

Electroencephalography (EEG)

EEG - basic and highly informative survey method. Based on the analysis of the biometric activity of the brain. EEG allows you to exclude (or, conversely, to confirm) various disorders and latent diseases (for example, an episode). Also, a neurophysiologist analyzes coherence - an indicator of the effectiveness of the functioning of certain areas of the brain.

Child psychiatrist / neuropsychiatric consultation

The psychiatrist determines the patient's mental status and systematizes the identified phenomena, their psychopathological classification for a holistic analysis.

Neuropsychologist consultation

A neuropsychologist is a specialist who assesses the functional state of the child's brain, the maturity of the psychoemotional sphere in accordance with age and identifies the prerequisites that led to the disease, determines the structure of the disorder.

The object of the neuropsychologist's research: the cortex, subcortex and brain stem, as well as the interaction of the cerebral hemispheres.

Speech therapist-defectologist consultation

A speech therapist-defectologist conducts diagnostics of speech development aimed at identifying the individual characteristics of a child, characterizing his communicative abilities, cognitive and emotional-volitional spheres.

Joint conclusion of speech therapist-defectologist and neuropsychologist

At the final stage, a consultation of specialists collectively analyzes all the results of examinations and studies, and then draws up a single conclusion with the appointment and development of a correction route.

Consilium

At a joint council of doctors who participated in the examination, a collegial discussion of the patient takes place, the formation of clinical and pedagogical conclusions. Parents receive an extended document describing the structure of the violation, the cause of its occurrence and individual recommendations for correcting the identified violations.

Repeated consultation of a neurologist (face-to-face / Skype-consultation)

At the final stage, the neurologist analyzes all the results of examinations and studies, and then draws up a single conclusion with the appointment of drug therapy and corrective exercises.

Cost of the program "Autism: Comprehensive Diagnostics": 16.500 rubles

After a diagnostic examination and identification of an accurate diagnosis, we recommend that parents undergo a course of treatment according to