The state of psychophysical development of an autistic child. Speech development in children with autism. The neurochemical theory of autism

Specialty: Practicing psychiatrist of the 2nd category.

AUTISM Is a mental disorder characterized by a deficit in social interaction. Autistic children have lifelong developmental disabilities that affect their perception and understanding of the world around them.

At what age can autism appear?

Childhood autism today occurs in 2 to 4 cases per 100,000 children. In combination with mental retardation ( atypical autism) the figure rises to 20 cases per 100,000. The ratio of boys and girls with this pathology is 4 to 1.

Autism can occur at any age. Depending on the age, the clinical picture of the disease also changes. Early childhood autism ( up to 3 years), childhood autism ( from 3 years old to 10 - 11 years old) and adolescent autism ( in children over 11 years old).

The controversy continues to this day over the standard classifications of autism. According to the international statistical classification of diseases, including mental ones, there are childhood autism, atypical autism, Rett syndrome and Asperger's syndrome. According to the latest version of the American classification of mental illness, only autism spectrum disorders are distinguished. These disorders include both early childhood autism and atypical autism.

Typically, childhood autism is diagnosed between the ages of 2.5 and 3 years. It is during this period that speech disorders, limited social communication and isolation are most clearly manifested. However, the first signs of autistic behavior appear in the first year of life. If the child is the first in the family, then the parents, as a rule, later notice his “dissimilarity” from his peers. Most often this becomes apparent when a child goes to kindergarten, that is, when he tries to integrate into society. However, if the family already has a child, then, as a rule, the mother notices the first symptoms of an autistic baby in the first months of life. Compared to an older brother or sister, the child behaves differently, which immediately catches the eye of his parents.

Autism may show up later. The debut of autism can be observed after 5 years. The IQ in this case is higher than in children whose autism debut occurred before the age of 3 years. In these cases, elementary communication skills are preserved, but isolation from the world still dominates. These children have cognitive impairments ( impairment of memory, mental activity, and so on) are not so pronounced. Very often they have a high IQ.

Elements of autism may be in the frame of Rett syndrome. It is diagnosed between the ages of one and two. Cognitive autism, called Asperger's syndrome ( or mild autism), occurs between 4 and 11 years of age.

It is worth noting that there is a certain period between the first manifestations of autism and the moment of diagnosis. There are certain characteristics of the child that the parents do not attach importance to. However, if you focus the mother's attention on this, then she really recognizes "something like that" with her child.

So, the parents of a child who was always obedient and did not create problems recall that in childhood the child practically did not cry, could spend hours looking at a stain on the wall, and so on. That is, certain character traits in a child exist initially. This is not to say that the disease appears as a "bolt from the blue." However, with age, when the need for socialization increases ( kindergarten, school) others join these symptoms. It is during this period that parents for the first time turn to a specialist for advice.

What is special about the behavior of a child with autism?

Despite the fact that the symptoms of this disease are very diverse and depend on age, nevertheless, there are certain behavioral traits that are inherent in all autistic children.

The characteristics of the behavior of a child with autism are:

• violation of social contacts and interactions;
• limited interests and features of the game;
• repetitive behavior ( stereotypes);
• violations of verbal communication;
• disorders of the intellectual sphere;
• impaired sense of self-preservation;
• features of gait and movement.

Disruption of social contacts and interactions

It is the main characteristic of the behavior of children with autism and occurs in 100 percent. Autistic children live in their own world, and the dominance of this inner life is accompanied by a withdrawal from the outside world. They are uncommunicative and actively avoid their peers.

The first thing that may seem strange to a mother is that the child practically does not ask for a hand. Babies ( children under one year old) are distinguished by inertness, inactivity. They do not react as animatedly as other children to a new toy. They have a weak reaction to light, sound, they can also rarely smile. The complex of revitalization, inherent in all young children, is absent or underdeveloped in autists. Babies do not respond to their name, do not respond to sounds and other stimuli, which often imitates deafness. As a rule, at this age, parents first turn to an audiologist ( hearing specialist).

The child reacts differently to an attempt to make contact. Attacks of aggression may occur, fears may form. One of the most famous symptoms of autism is lack of eye contact. However, it does not manifest itself in all children, but occurs in more severe forms, so the child ignores this aspect of social life as well. Sometimes a child can look through a person.
It is generally accepted that all autistic children are incapable of expressing emotions. However, it is not. Indeed, many of them have a very poor emotional sphere - they rarely smile, and their facial expressions are the same. But there are also children with very rich, varied, and sometimes not quite adequate facial expressions.

As they grow up, the child can delve into his own world. The first thing that attracts attention is the inability to address family members. The child rarely asks for help, early begins to serve himself on his own. The autistic child practically does not use the words "give", "take". He does not contact physically - when asked to give one or another object, he does not give it to his hands, but throws it. Thus, he limits his interaction with the people around him. Most children are also intolerant of hugs and other physical contact.

Problems most clearly make themselves felt when the child is taken to kindergarten. Here, when trying to introduce the baby to other children ( for example, put them at the same common table or involve them in one game) it can give various affective reactions. Ignoring the environment can be passive or active. In the first case, children simply do not show interest in the surrounding children, games. In the second case, they run away, hide or act aggressively towards other children.

Limited interests and features of the game

One fifth of autistic children ignore toys and all kinds of play activities. If the child does show interest, then it is, as a rule, to one toy, to one television program. The child does not play at all, or plays monotonously.

Babies can fix their gaze on the toy for a long time, but at the same time do not reach for it. Older children can watch the sunbeam on the wall for hours, the movement of cars outside the window, watch the same film dozens of times. At the same time, the preoccupation of children with this activity can be alarming. They do not lose interest in their occupation, sometimes giving the impression of detachment. When trying to tear them away from the lesson, they express dissatisfaction.

Games that require fantasy and imagination rarely attract these children. If a girl has a doll, she will not change her clothes, sit at the table and introduce her to others. Her play will be limited to a monotonous action, for example, combing this doll's hair. She can do this action dozens of times a day. Even if the child does several actions with his toy, it is always in the same sequence. For example, an autistic girl may comb, bathe, and change her doll, but always in the same order, not otherwise. However, as a rule, children do not play with their toys, but rather sort them. A child can build and sort his toys according to various criteria - color, shape, size.

Autistic children also differ from ordinary children in the specifics of the game. So, they are not occupied with ordinary toys. The attention of the autistic person is more attracted by household items, for example, keys, a piece of material. Typically, these items make their favorite sound or have their favorite color. Usually such children are attached to the selected object and do not change it. Any attempt to separate the child from his "toy" ( because sometimes they can be dangerous, for example, when it comes to a plug) is accompanied by protest reactions. They can be expressed in pronounced psychomotor agitation or, conversely, withdrawal into oneself.

The kid's interest can be reduced to folding and lining up toys in a certain sequence, to counting cars in the parking lot. Sometimes autistic children may even have different hobbies. For example, collecting stamps, robots, hobby for statistics. The difference between all these interests is the lack of social content. Children are not interested in people depicted on stamps or the country from which they were sent. They are not interested in the game, but they may be attracted by various statistics.

Children do not let anyone into their hobbies, even autistic people like them. Sometimes the attention of children is attracted not even by games, but by certain actions. For example, they can turn on and off the tap at regular intervals to watch the water flow, turn on the gas to look at the flames.

Much less often, in the games of autistic children, pathological fantasies are observed with reincarnation into animals, inanimate objects.

Repetitive behavior ( stereotypes)

Repetitive behaviors or stereotypes occur in 80 percent of children with autism. At the same time, stereotypes are observed both in behavior and in speech. Most often these are motor stereotypes, which are reduced to monotonous turns of the head, twitching of the shoulders, bending of the fingers. With Rett syndrome, there is a stereotypical wringing of fingers, hand washing.

Common Stereotypical Activities in Autism:

• turning on and off the light;
• pouring sand, mosaics, cereals;
• swinging the door;
• stereotyped account;
• kneading or tearing paper;
• tension and relaxation of the limbs.

The stereotypes seen in speech are called echolalia. These can be manipulations with sounds, words, phrases. At the same time, children repeat the words heard from their parents, on TV or from other sources without realizing their meaning. For example, when asked “will you have juice?”, The child repeats “will you have juice, will you have juice, will you have juice”.

Or the child may ask the same question, for example:
Child- "Where we are going?"
Mama- "To the store".
Child- "Where we are going?"
Mama- "To the store for milk."
Child- "Where we are going?"

These repetitions are unconscious and sometimes stop only after interrupting the child with a similar phrase. For example, to the question "Where are we going?", Mom answers "Where are we going?" and then the child stops.

Stereotypes in food, clothing, walking routes are often observed. They take on the character of rituals. For example, a child always goes the same way, prefers the same food, clothes. Autistic children constantly tap out the same rhythm, turn a wheel in their hands, swing to a certain beat on a chair, quickly turn the pages of books.

Other senses are also affected by stereotypes. For example, taste stereotypes are characterized by periodic licking of objects; olfactory - constant sniffing of objects.

There are many theories about the possible causes of this behavior. Proponents of one of them view stereotypes as a type of self-stimulating behavior. According to this theory, the body of an autistic child is hyposensitive and therefore self-stimulates in order to energize the nervous system.
Proponents of a different, opposite concept believe that the environment is hyperexcitable for the child. In order to calm the body and eliminate the influence of the outside world, the child uses stereotyped behavior.

Verbal communication disorders

Speech impairment, to varying degrees, occurs in all forms of autism. Speech may develop with a delay or not develop at all.

Speech disorders are most pronounced in early childhood autism. In this case, even the phenomenon of mutism ( complete lack of speech). Many parents note that after a child begins to speak normally, he becomes silent for a certain time ( year and more). Sometimes, even at the initial stages, the child in his speech development is ahead of his peers. Then, from 15 to 18 months, regression is observed - the child stops talking with others, but at the same time fully speaks to himself or in a dream. In Asperger's syndrome, speech and cognitive functions are partially preserved.

In early childhood, humming and babbling may be absent, which, of course, will immediately alert the mother. There is also a rare use of gestures in babies. As the child develops, expressive speech disorders are often noted. Children use pronouns and addresses incorrectly. Most often they call themselves in the second or third person. For example, instead of "wanting to eat", the child says "he wants to eat" or "wants to eat." He also addresses himself in the third person, for example, "Anton needs a pen." Often times, children can use excerpts from conversations heard in adults or on television. In society, a child may not use speech at all, not answer questions. However, alone with himself, he can comment on his actions, declare poetry.

Sometimes the child's speech becomes pretentious. It is replete with quotes, neologisms, unusual words, commands. In their speech, self-dialogue and a tendency to rhyme prevail. Their speech is often monotonous, without intonation, commentary phrases prevail in it.

Also, autistic speech is often characterized by a peculiar intonation with a predominance of high tones at the end of a sentence. Vocal tics and phonetic disorders are often observed.

Delayed speech development is often the reason why the child's parents turn to speech therapists and defectologists. In order to understand the cause of speech disorders, it is necessary to identify whether speech is used in this case for communication. The cause of speech disorders in autism is the unwillingness to interact with the outside world, including through conversation. Anomalies of speech development in this case reflect a violation of the social contact of children.

Intellectual Disorders

In 75 percent of cases, various mental disorders are observed. It can be mental retardation or uneven mental development. Most often, these are various degrees of lag in intellectual development. An autistic child shows difficulties in concentration, purposefulness. He also has a rapid loss of interest, attention disorder. Commonly accepted associations and generalizations are rarely available. An autistic child generally performs well on manipulation and visual skills tests. However, tests that require symbolic and abstract thinking, as well as the inclusion of logic, perform poorly.

Sometimes in children there is an interest in certain disciplines and the formation of certain aspects of the intellect. For example, they have unique spatial memory, hearing, or perception. In 10 percent of cases, the initially accelerated intellectual development is complicated by the decay of intelligence. In Asperger's syndrome, intelligence remains within the age range or even higher.

According to various data, a decrease in intelligence within the range of mild and moderate mental retardation is observed in more than half of the children. So, half of them have an IQ below 50. A third of children have intelligence at the borderline level ( IQ 70). However, the decline in intelligence is not of a total nature and very rarely reaches the degree of deep mental retardation. The lower the intelligence quotient of a child, the more difficult his social adaptation is. The rest of the children with a high IQ have non-standard thinking, which also very often limits their social behavior.

Despite the decline in intellectual functions, many children themselves learn elementary school skills. Some of them learn to read on their own, acquire mathematical skills. Many may retain musical, mechanical and mathematical abilities for a long time.

Disorders of the intellectual sphere are characterized by irregularity, namely, periodic improvement and deterioration. So against the background of situational stress, illness, episodes of regression can occur.

Impaired sense of self-preservation

The impairment of self-preservation, which is manifested by auto-aggression, occurs in one third of autistic children. Aggression is one of the forms of responding to various not entirely favorable life relationships. But since there is no social contact in autism, negative energy is projected onto oneself. Children with autism are characterized by blows to themselves, biting themselves. Very often they lack a "sense of the edge". This is observed even in early childhood, when the baby hangs over the side of the stroller, climbs over the arena. Older children can jump out onto the carriageway or jump from a height. Many of them lack the consolidation of negative experiences after falls, burns, cuts. So, an ordinary child, having fallen or cut himself once, will avoid it in the future. An autistic toddler can do the same thing dozens of times while hurting himself without stopping.

The nature of this behavior is poorly understood. Many experts suggest that this behavior is due to a decrease in the pain threshold. This is confirmed by the absence of crying when the baby hits and falls.

In addition to auto-aggression, aggressive behavior directed at someone can be observed. The reason for this behavior may be a defensive reaction. Very often it is observed if an adult tries to disrupt the child's usual way of life. However, an attempt to resist change can also manifest itself in auto-aggression. A child, especially if he suffers from a severe form of autism, can bite himself, beat himself, deliberately hit himself. These actions cease as soon as the interference in his world ceases. Thus, in this case, such behavior is a form of communication with the outside world.

Features of gait and movement

Often, autistic children have a specific gait. Most often, they imitate a butterfly, while walking on tiptoe and balancing with their hands. Some, however, move by jumping. A feature of the movements of an autistic child is a certain awkwardness, angularity. The running of such children may seem ridiculous, because during it they swing their arms, spread their legs wide.

Also, children with autism can walk with an additional step, sway while walking or walk a strictly defined special route.

What do children with autism look like?

Children under one year old

The appearance of the baby is distinguished by the absence of a smile, facial expressions and other vivid emotions.
Compared to the rest of the children, he is not so active and does not attract attention to himself. His gaze is often fixed on some ( always the same) subject.

The kid does not reach for his hands, he does not have a revitalization complex. He does not copy emotions - if he smiles, he does not respond with a smile, which is completely uncharacteristic for young children. He does not gesticulate, does not point to the objects that he needs. The kid does not babble like other one-year-old children, does not grumble, does not respond to his name. An autistic breastfeeding child does not create problems and gives the impression of a “very calm child”. For many hours he plays by himself without crying, showing no interest in others.

It is extremely rare in children that there is a lag in growth and development. At the same time, with atypical autism ( autism with mental retardation) concomitant diseases are very often noted. Most often, this is a convulsive syndrome or even epilepsy. At the same time, a delay in neuropsychic development is noted - the child begins to sit late, makes his first steps late, lags behind in weight and growth.

Children from 1 to 3 years old

Children continue to be closed in themselves and unemotional. They speak poorly, but more often than not they do not speak at all. At 15 - 18 months, babies may stop talking altogether. A distant look is noticed, the child does not look into the eyes of the interlocutor. Very early, such children begin to serve themselves, thereby ensuring for themselves more and more independence from the world around them. When they do start to speak, those around them notice that they call themselves in the second or third person. For example, "Oleg is thirsty" or "Thirsty". To the question: "Do you want to drink?" they answer, "He is thirsty." The speech disorder seen in young children manifests itself in echolalia. They repeat passages of phrases or phrases they have heard from other people. Vocal tics are often observed, which are manifested in the involuntary pronunciation of sounds, words.

Children begin to walk, and their gait attracts the attention of the parents. Walking on tiptoes with swinging arms is often observed ( how to imitate a butterfly). Psychomotor children with autism can be hyperactive or hypoactive. The first option is more often observed. Children are in constant motion, but their movements are stereotyped. They swing in a chair, make rhythmic body movements. Their movements are monotonous, mechanical. When studying a new object ( for example, if mom bought a new toy) they carefully sniff it, feel it, shake it, trying to extract some sounds. The gestures seen in autistic children can be very eccentric, unusual, and forced.

The child develops unusual activities and hobbies. He often plays with water, turning on and off the faucet, or with a light switch. The attention of relatives is attracted by the fact that the baby very rarely cries, even when it is hit very hard. Rarely begs or whimpers. The autistic child actively avoids the company of other children. At children's birthdays, matinees, he sits alone or runs away. Sometimes autistic people can become aggressive in the company of other children. Their aggression, as a rule, is directed at themselves, but can also be projected onto others.

Often these children give the impression of being spoiled. They are selective in food, do not get along with other children, they have a lot of fears. Most often, this is the fear of darkness, noise ( vacuum cleaner, doorbell), a certain type of transport. In severe cases, children are afraid of everything - leaving the house, leaving their room, being alone. Even in the absence of certain formed fears, autistic children are always shy. Their fearfulness is projected onto the world around them, since they are unknown to them. Fear of this unknown world is the main emotion of the child. They often throw tantrums to resist the change of scenery and limit their fears.

Outwardly, autistic children look very diverse. It is generally accepted that children with autism have fine, well-defined facial features that rarely show emotions ( prince face). However, this is not always the case. Children at an early age can have very active facial expressions, awkward sweeping gait. Some researchers say that the facial geometry of autistic children and other children is still different - they have wider eyes, the lower part of the face is relatively short.

Preschool children ( from 3 to 6 years old)

For children of this age group, difficulties with social adaptation come to the fore. These difficulties are most pronounced when the child goes to kindergarten or preparatory group. The child does not show interest in peers, he does not like the new environment. He reacts to such changes in his life with violent psychomotor agitation. The main efforts of the child are aimed at creating a kind of "shell" in which he hides, avoiding the outside world.

Your toys ( if any) the baby begins to lay out in a certain order, most often by color or size. People around you notice that, compared to other children, there is always a certain way and order in the room of an autistic baby. Things are laid out in their places and grouped according to a certain principle ( color, type of material). The habit of always finding everything in its place makes the child feel comfortable and secure.

If a child of this age group has not been consulted by a specialist, then he becomes even more self-contained. Speech disorders progress. It is becoming more and more difficult to disrupt the autistic lifestyle. An attempt to take a child out into the street is accompanied by violent aggression. Shyness and fears can crystallize into obsessive behavior and rituals. This can be periodic hand washing, certain sequences in food, in the game.

More often than other children, autistic children have hyperactive behavior. On the psychomotor level, they are disinhibited and disorganized. Such children are in constant motion, they can hardly stay in one place. They have difficulty controlling their movements ( dyspraxia). Also, autistic people often have compulsive behavior - they deliberately perform their actions according to certain rules, even if these rules go against social norms.

Much less often, children may differ in hypoactive movement. At the same time, they may suffer from fine motor skills, which will cause difficulties in some movements. For example, a child may have difficulty tying shoelaces or holding a pencil in his hand.

Children over 6 years old

Autistic schoolchildren can attend both specialized educational institutions and general schools. If the child does not have intellectual disabilities and he copes with learning, then the selectivity of his favorite subjects is observed. As a rule, this is a hobby for drawing, music, mathematics. However, even with borderline or average intelligence, attention deficit is observed in children. They find it difficult to concentrate on tasks, but at the same time they are maximally focused on their studies. More often than others, autistic people have difficulty reading ( dyslexia).

At the same time, in one tenth of cases, children with autism show unusual intellectual abilities. These can be talents in music, art, or a unique memory. In one percent of cases, autistic people have savant syndrome, in which outstanding abilities are noted in several areas of knowledge.

Children who have a decrease in intelligence or significant withdrawal into themselves are engaged in specialized programs. In the first place at this age, speech disorders and social maladjustment are noted. The child can resort to speech only in case of urgent need in order to communicate his needs. However, he also tries to avoid this, starting to serve himself very early. The less developed the language of communication in children, the more often they show aggression.

Deviations in eating behavior can take on the character of serious disorders, up to refusal to eat. In mild cases, the meal is accompanied by rituals - eating food in a certain order, at certain hours. The selectivity of individual dishes is not based on a taste criterion, but on the color or shape of the dish. For autistic children, what the food looks like is very important.

If the diagnosis was made early and treatment measures were taken, then many children can adapt well. Some of them graduate from general educational institutions, master professions. Children with minimal speech and intellectual impairments adapt best.

What tests will help identify autism in a child at home?

The purpose of the tests is to identify the child's risk of autism. The test results are not a basis for making a diagnosis, but are a reason for contacting specialists. When assessing the characteristics of child development, one should take into account the child's age and use the tests recommended for his age.

Tests for diagnosing autism in children are:

• assessment of children's behavior according to general indicators of development - from birth to 16 months;
• M-CHAT test ( modified autism screening test) - recommended for children from 16 to 30 months;
• autism scale CARS ( autism rating scale in children) - from 2 to 4 years;
• screening test ASSQ - intended for children from 6 to 16 years old.

Testing a child for autism tendencies from the moment of birth

Children's health institutes advise parents to observe the behavior of the baby from the moment of his birth and, if any discrepancies are found, contact children's specialists.

Deviations in child development from birth to one and a half years of age are the absence of the following behavioral factors:

• smiles or attempts to express joyful emotions;
• response to a smile, facial expressions, sounds of adults;
• attempts to make eye contact with the mother during feeding, or people around the baby;
• reaction to your own name or to a familiar voice;
• gesticulation, waving hands;
• using fingers to point to objects of interest to the child;
• attempts to start talking ( walk, coo);
• please take him in your arms;
• the joy of being in your arms.

If even one of the above deviations is found, parents should consult a doctor. One of the signs of this disease is super-strong attachment to someone from the family, most often the mother. Outwardly, the child does not demonstrate his adoration. But when there is a threat of interruption of communication, children may refuse to eat, they vomit or have a fever.

M-CHAT test for examining children from 16 to 30 months

The results of this test, as well as other child screening tools ( surveys), do not have one hundred percent reliability, but they are the basis for passing a diagnostic examination by specialists. You need to answer the M-CHAT test items "Yes" or "No". If the phenomenon indicated in the question, when observing the child, manifested itself no more than two times, this fact is not read out.

The questions of the M-CHAT test are:

• №1 - Does the child enjoy being rocked ( on hands, knees)?
• №2 - Does the child develop an interest in other children?
• № 3 - Does the child like to use objects as steps and climb up them?
• № 4 - Does the child enjoy such a game as hide and seek?
• № 5 - Does the child imitate any actions during the game ( talking on an imaginary phone, shaking a non-existent doll)?
• № 6 - Does the child use his index finger when he needs something?
• № 7 - Does the child use their index finger to emphasize their interest in an object, person or action?
• № 8 - Does the child use their toys for their intended purpose ( builds fortresses from cubes, dresses up dolls, rolls cars on the floor)?
• № 9 - Has the child ever focused attention on objects of interest to him, bringing them and showing them to parents?
• № 10 - Can a child maintain eye contact with adults for more than 1 - 2 seconds?
• № 11 - Has the child ever experienced signs of hypersensitivity to acoustic stimuli ( did he cover his ears during loud music, did he ask to turn off the vacuum cleaner)?
• № 12 - Does the child have a response to the smile?
• № 13 - Does the child repeat after adults their movements, facial expressions, intonation;
• № 14 - Does the child respond to his name?
• № 15 - Point your finger at a toy or other object in the room. Will the child look at him?
• № 16 - Does the child walk?
• № 17 - Look at some object. Will the child repeat your actions?
• № 18 - Has the child been seen making unusual finger gestures near his face?
• № 19 - Is the child trying to draw attention to himself and what he is doing?
• № 20 - Does the child give reason to think that he has hearing problems?
• № 21 - Does the child understand what the people around him are saying?
• № 22 - Did it happen that the child wandered or did something without a purpose, gave the impression of a complete absence?
• № 23 - When meeting with strangers, phenomena, does the child look in the parents' face in order to check the reaction?

Decoding of M-CHAT test answers
To determine whether the child passed this test or not, the answers received should be compared with those given in the interpretation of the test. If three common or two critical points coincide, the child needs to be examined by a doctor.

The points of interpretation of the M-CHAT test are:

• № 1 - No;
• № 2 - No ( critical point);
• № 3, № 4, № 5, № 6 - No;
• № 7 - No ( critical point);
• № 8 - No;
• № 9 - No ( critical point);
• № 10 - No;
• № 11 - Yes;
• № 12 - No;
• № 13, № 14, № 15 - No ( critical points);
• № 16, № 17 - No;
• № 18 - Yes;
• № 19 - No;
• № 20 - Yes;
• № 21 - No;
• № 22 - Yes;
• № 23 - No.

CARS Autism Scale for Children 2 to 6 Years of Age

The CARS scale is one of the most used tests to measure the symptoms of autism. The study can be carried out by parents on the basis of observations of the child during his stay at home, in the circle of relatives, peers. Information received from educators and educators should also be included. The scale includes 15 categories that describe all areas of importance for diagnosis.
When identifying matches with the proposed options, the score indicated opposite the answer should be used. When calculating test values, you can also take into account intermediate values ​​( 1.5, 2.5, 3.5 ) in cases where the child's behavior is regarded as an average between the descriptions of the answers.

Items on the CARS rating scale are:

1. Relationship with people:

• no difficulties- the child's behavior meets all the necessary criteria for his age. Shyness or fussiness may occur when the situation is unfamiliar - 1 point;
• easy difficulties- the child shows anxiety, tries to avoid direct glance or suppress conversations in cases where attention or communication is intrusive and does not come from his initiative. Also, problems can manifest themselves in the form of shyness or excessive dependence on adults in comparison with children of the same age - 2 points;
• medium difficulty- deviations of this type are expressed in a demonstration of detachment and ignorance of adults. In some cases, it takes persistence to gain children's attention. A child rarely makes contact at will - 3 points;
• serious relationship problems- the child in the most rare cases responds and never shows interest in what others are doing - 4 points.

2. Imitation and imitation skills:

• abilities are age appropriate- the child can easily reproduce sounds, body movements, words - 1 point;
• imitation skills are slightly impaired- the child repeats simple sounds and movements without difficulty. More complex imitations are carried out with the help of adults - 2 points;
• average level of violations- to reproduce sounds and movements, the child needs support from the outside and considerable effort - 3 points;
• serious problems with imitation- the child makes no attempt to imitate acoustic phenomena or physical actions, even with the help of adults - 4 points.

3. Emotional background:

• emotional response is normal- the child's emotional reaction corresponds to the situation. Facial expression, posture and behavior change depending on the events taking place - 1 point;
• there are minor violations- sometimes the manifestation of children's emotions is not connected with reality - 2 points;
• the emotional background is prone to disorders of moderate severity- a child's reaction to a situation may be delayed in time, be expressed too clearly or, conversely, with restraint. In some cases, the child may laugh for no reason or not express any emotion corresponding to the events taking place - 3 points;
• the child is experiencing serious emotional difficulties- children's answers in most cases do not correspond to the situation. The child's mood remains unchanged for a long time. Reverse situations may occur - the child begins to laugh, cry or express other emotions for no apparent reason - 4 points.

4. Body control:

• skills are age appropriate- the child moves well and freely, the movements have accuracy and clear coordination - 1 point;
• mild disorders- the child may feel some awkwardness, some of his movements are unusual - 2 points;
• average level of deviation- child behavior may include things such as tiptoeing, body pinching, unusual finger movements, pretentious postures - 3 points;
• the child has impressive difficulty in controlling his body- in children's behavior, strange, unusual movements, unusual for age and situations, are often observed, which do not stop even when trying to impose a ban on them - 4 points.

5. Toys and other household items:

• norm- the child plays with toys and uses other objects in accordance with their intended purpose - 1 point;
• slight deviations- weirdness may occur when playing or interacting with other things ( for example, a child can taste toys) – 2 points;
• moderate problems- the child may have difficulty in determining the purpose of toys or objects. He can also pay increased attention to individual parts of the doll or car, get carried away with details and use toys in an unusual way - 3 points;
• serious violations- it is difficult to distract the child from the game or, conversely, to call for this activity. Toys are mostly used in strange, inappropriate ways - 4 points.

6. Adaptability to change:

• the child's reaction is appropriate for the age and situation- when conditions change, the child does not experience much excitement - 1 point;
• there are slight difficulties- the child has some difficulties with adaptation. So, when the conditions of the problem being solved change, the kid can continue to search for a solution using the initial criteria - 2 points;
• average deviation- when the situation changes, the child begins to actively resist this, experiences negative emotions - 3 points;
• the response to changes is not fully consistent with the norm- the child perceives any changes negatively, tantrums may occur - 4 points.

7. Visual assessment of the situation:

• normal performance- the child makes full use of his vision to meet and analyze new people, objects - 1 point;
• mild violations- moments such as "looking into nowhere", avoidance of eye contact, increased interest in mirrors, light sources can be identified - 2 points;
• moderate problems- the child may experience discomfort and avoid direct gaze, use an unusual viewing angle, bring objects too close to the eyes. In order for the child to look at the object, it is necessary to remind him of this several times - 3 points;
• significant problems using vision- the child makes every effort to exclude eye contact. In most cases, vision is used in an unusual way - 4 points.

8. Sound reaction to reality:

• compliance with the norm- the child's reaction to sound stimuli and speech is appropriate for age and environment - 1 point;
• there are minor disorders- the child may not answer some questions, or respond to them with a delay. In some cases, increased sound sensitivity may be detected - 2 points;
• average deviation- the child's reaction may be different to the same sound phenomena. Sometimes there is no answer even after several repetitions. The child may react excitedly to some ordinary sounds ( cover your ears, show discontent) – 3 points;
• the sound response does not fully correspond to the norm- in most cases, the child's reaction to sounds is impaired ( insufficient or excessive) – 4 points.

9. Using the senses such as smell, touch and taste:

• norm- in the study of new objects and phenomena, the child uses all the senses in accordance with age. When painful sensations, it shows a reaction that corresponds to the level of pain - 1 point;
• small deviations- sometimes the child may have difficulty with which senses should be activated ( for example, tasting inedible objects). When experiencing pain, a child may express, exaggerate or underestimate its meaning - 2 points;
• moderate problems- the child can be seen in the fact that he smells, touches, tastes people, animals. Pain response is not true - 3 points;
• serious violations- acquaintance and study of subjects to a greater extent occurs in unusual ways. The child tastes toys, sniffs clothes, and feels people. If painful sensations arise, he ignores them. In some cases, an exaggerated response to minor discomfort may be detected - 4 points.

10. Fears and stress responses:

• natural response to stress and manifestation of fears- the child's behavioral model corresponds to his age and the events taking place - 1 point;
• unexpressed disorders- sometimes the child may be afraid or nervous more than usual in comparison with the behavior of other children in similar situations - 2 points;
• moderate disorders- children's reaction in most cases does not correspond to reality - 3 points;
• strong deviations- the level of fear does not decrease, even after the child has experienced similar situations several times, while it is quite difficult to calm the child down. It can also be noticed that there is no experience in the circumstances that make other children worry - 4 points.

11. Communication skills:

• norm- the child communicates with the environment in accordance with the capabilities characteristic of his age - 1 point;
• slight deviation- slight speech delay may be detected. Sometimes pronouns are replaced, unusual words are used - 2 points;
• mid-level disorders- the child asks a large number of questions, may express concern about certain topics. Sometimes speech may be absent or contain meaningless expressions - 3 points;
• serious violations of verbal communication- speech with meaning is almost absent. Often in communication, the child uses strange sounds, imitates animals, imitates transport - 4 points.

12. Non-verbal communication skills:

• norm- the child makes full use of all the possibilities of non-verbal communication - 1 point;
• minor violations- in some cases, the child may have difficulty communicating his desires or needs with gestures - 2 points;
• moderate deviations- basically, it is difficult for a child to explain without words what he wants - 3 points;
• serious disorders- It is difficult for the child to understand the gestures and facial expressions of other people. In his gestures, he uses only unusual movements that do not have an obvious meaning - 4 points.

13. Physical activity:

• norm- the child behaves in the same way as his peers - 1 point;
• small deviations from the norm- children's activity may be slightly higher or lower than normal, which causes some difficulties in the child's activities - 2 points;
• medium degree of violations- the child's behavior does not correspond to the situation. For example, when going to bed, he is distinguished by increased activity, and during the day he is in a sleepy state - 3 points;
• abnormal activity- the child is rarely in a normal state, in most cases showing excessive passivity or activity - 4 points.

14. Intelligence:

• the child's development is normal- child development is balanced and does not have unusual skills - 1 point;
• mild disorders- the child has standard skills, in some situations his intelligence is lower than that of his peers - 2 points;
• deviation of the mean type- in most cases, the child is not so smart, but in some areas his skills are normal - 3 points;
• serious problems in intellectual development- children's intelligence is below the generally accepted values, but there are areas in which a child understands much better than their peers - 4 points.

15. Overall impression:

• norm- outwardly, the child does not show signs of illness - 1 point;
• mild autism- under some circumstances, the child shows symptoms of the disease - 2 points;
• average level- the child manifests a number of signs of autism - 3 points;
• severe autism- the child shows an extensive list of manifestations of this pathology - 4 points.

Counting Results
By putting a mark in front of each subsection that corresponds to the child's behavior, the points should be summed up.

The criteria for determining the child's condition are:

• number of points from 15 to 30- no autism;
• number of points from 30 to 36- the manifestation of the disease is likely to be mild and moderate ( Asperger's syndrome);
• number of points from 36 to 60- there is a risk that the child has severe autism.

ASSQ test for diagnosing children from 6 to 16 years old

This test method is designed to determine the propensity for autism and can be used by parents at home.
Each question in the test assumes three possible answers - "no", "partly" and "yes". The first answer option is marked with zero, the answer "partially" implies 1 point, the answer "yes" - 2 points.

The ASSQ test questions are:

• Can you use expressions such as “old-fashioned” or “smart beyond his years” in describing a child?
• Do peers call a child a "nutty or eccentric professor"?
• Can we say about a child that he is in his own world with unusual rules and interests?
• Collects ( or remembers) Is the child data and facts on certain topics, not enough or not at all understanding them?
• Was there a literal perception of the phrases spoken in a figurative sense?
• Does the child use an unusual communication style ( old-fashioned, artsy, florid)?
• Was the child noticed that he comes up with his own speech expressions and words?
• Is a child's voice unusual?
• Does the child use such techniques as screeching, grunting, sniffing, and screaming in verbal communication?
• Was there a marked success for the child in some areas and a strong lag in other areas?
• Is it possible to say about a child that he uses speech well, but at the same time does not take into account the interests of other people and the rules of being in society?
• Is it true that the child has difficulty understanding other people's emotions?
• Is a child typical of naive and embarrassing statements and comments?
• Is the type of eye contact abnormal?
• Does the child feel desire but cannot build relationships with peers?
• Is it possible to stay with other children only on his terms?
• Doesn't the child have a best friend?
• Can we say that the child's actions lack common sense?
• Are there any difficulties in team play?
• Were awkward movements and awkward gestures noted?
• Did the child have involuntary body and face movements?
• Are there any difficulties in performing daily duties in view of obsessive thoughts visiting the child?
• Does the child have a commitment to special order?
• Does the child have a special attachment to objects?
• Is the child exposed to weed by peers?
• Does the child use unusual facial movements?
• Has the child noticed any strange movements with his hands or other parts of his body?

Interpretation of the received data
If the total score does not exceed 19, the test result is considered normal. With a value that ranges from 19 to 22, the likelihood of autism is increased, over 22 - high.

When should you see a child psychiatrist?

A doctor should be consulted at the first suspicion of elements of autism in a child. A specialist, before testing a child, observes his behavior. The diagnosis of autism is often straightforward ( stereotypes are present, there is no contact with the environment). At the same time, making a diagnosis requires careful collection of the child's medical history. The doctor is attracted by details about how the child grew and developed in the first months of life, when the mother's first worries appeared and what they are associated with.

Most often, before coming to a child psychiatrist or psychologist, parents have already visited doctors, suspecting the child of deafness or dumbness. The doctor specifies when the child stopped talking and what caused it. The distinction of mutism ( lack of speech) in autism from another pathology is that in autism, the child initially begins to speak. Some children start talking even earlier than their peers. Next, the doctor asks about the child's behavior at home and in kindergarten, about his contacts with other children.

At the same time, the patient is being monitored - how the child behaves at the doctor's appointment, how he orients himself in a conversation, whether he looks into the eyes. The lack of contact may be indicated by the fact that the child does not hold objects in his hands, but throws them on the floor. Hyperactive, stereotypical behavior speaks in favor of autism. If the child speaks, then attention is drawn to his speech - whether there are repetitions of words in it ( echolalia), whether monotony or, conversely, pretentiousness prevails.

Ways to identify symptoms suggestive of autism are:

• monitoring the child in society;
• analysis of non-verbal and verbal communication skills;
• studying the interests of the child, the characteristics of his behavior;
• conducting tests and analyzing the results obtained.

Deviations in behavior change with age, so the age factor should be taken into account when analyzing children's behavior and the characteristics of its development.

The relationship of the child with the outside world

Social disorders in children with autism can manifest themselves from the first months of life. From the outside, autistic people appear more calm, undemanding and withdrawn in comparison with their peers. Being in the company of strangers or unfamiliar people, they experience severe discomfort, which, as they grow older, ceases to anxiety. If a person from the outside tries to impose their communication or attention, the child may run away, cry.

Signs by which you can determine the presence of this disease in a child from birth to three years are:

• lack of desire to make contact with the mother and other close people;
• strong ( primitive) attachment to someone from family members ( the child does not show adoration, but when separated, he may become hysterical, the temperature may rise);
• unwillingness to be in the arms of the mother;
• lack of anticipatory posture when the mother approaches;
• Expressing discomfort when trying to make eye contact with your child
• lack of interest in the events taking place around;
• demonstration of resistance when trying to fondle a child.

Problems with building relationships with the outside world remain at a later age. The inability to understand the motives and actions of other people makes autistic people bad interlocutors. In order to reduce the level of their feelings about this, such children prefer solitude.

Symptoms that suggest autism in children between the ages of 3 and 15 include:

• inability to make friendships;
• demonstration of detachment from others ( which can sometimes give way to the emergence of strong attachment to one person or a narrow circle of people);
• lack of desire to make contact on their own initiative;
• difficult understanding of emotions, actions of other people;
• difficult relationships with peers ( bullying by other children, using offensive nicknames in relation to the child);
• inability to take part in team games.

Verbal and non-verbal communication skills in autism

Children with this disease begin to talk much later than their peers. Subsequently, the speech of such patients is characterized by a reduced number of consonants, replete with mechanical repetition of the same phrases that are not related to the conversation.

Deviations of speech and non-speech communication in children aged 1 month to 3 years with this disease are:

• lack of attempts to interact with the outside world using gestures and facial expressions;
• lack of babbling before the age of one year;
• non-use of single words in a conversation for up to one and a half years;
• inability to build full-fledged meaningful sentences under the age of 2;
• lack of a pointing gesture;
• weak gesticulation;
• inability to express your desires without words.

Communication disorders that may indicate autism in a child over 3 years of age are:

• speech pathology ( inappropriate use of metaphors, permutation of pronouns);
• use of screeching, shouting in conversation;
• the use of words and phrases that do not fit the meaning;
• strange facial expressions or its complete absence;
• an absent gaze directed to "nowhere";
• poor understanding of metaphors and speech expressions, said in a figurative sense;
• coming up with your own words;
• unusual gestures that have no obvious meaning.

Interests, habits, behavioral characteristics of a child with autism

Children with autism have a hard time understanding the rules of playing with toys that are understandable to their peers, such as a toy car or a doll. For example, an autistic person may not roll a toy car, but spin its wheel. It is difficult for a sick child to replace some objects with others or use fictional images in play, since poorly developed abstract thinking and imagination are some of the symptoms of this disease. A distinctive feature of this disease are disorders in the use of the organs of vision, hearing, taste.

Deviations in the behavior of a child under 3 years of age, which indicate a disease, are:

• concentration when playing not on a toy, but on its individual parts;
• difficulties in determining the purpose of objects;
• poor coordination of movements;
• hypersensitivity to sound stimuli ( crying a lot over the sound of a working TV);
• lack of response to an appeal by name, requests from parents ( sometimes it seems that the child has a hearing problem);
• studying objects in an unusual way - using the senses for other purposes ( the child can smell or taste toys);
• using an unusual viewing angle ( the child brings objects close to his eyes or looks at them with his head tilted to one side);
• stereotyped movements ( swing your arms, swing your body, rotate your head);
• non-standard ( insufficient or excessive) response to stress, pain;
• sleep problems.

Children with autism at an older age retain the symptoms characteristic of this disease, and also show other symptoms as they develop and grow up. One of the characteristics of autistic children is the need for a specific system. For example, a child may insist on walking along a route he has drawn up and not change it for several years. When trying to make changes to the rules established by him, the autistic person can actively express dissatisfaction and show aggression.

Symptoms of autism in patients whose age ranges from 3 to 15 years are:

• resistance to change, tendency to uniformity;
• inability to switch from one activity to another;
• aggression towards oneself ( according to one study, about 30 percent of children with autism bite, pinch, and cause other types of pain);
• poor concentration of attention;
• increased selectivity in the choice of dishes ( which causes digestive problems in two thirds of cases);
• narrowly isolated skills ( memorization of facts that do not matter, passion for topics and activities that are unusual for age);
• poorly developed imagination.

Autism tests and analysis of their results

Depending on the age, parents can use special tests to help determine the presence of this pathology in a child.

Tests for determining autism are:

• M-CHAT test for children aged 16 to 30 months;
• the CARS autism rating scale for children 2 to 4 years old;
• ASSQ test for children from 6 to 16 years old.

The results of any of the above tests are not the basis for making a final diagnosis, but are an effective reason to contact a specialist.

Interpretation of M-CHAT results
To pass this test, parents are asked to answer 23 questions. The responses obtained from observations of the child should be compared with the options that support autism. If three matches are identified, it is necessary to show the baby to the doctor. Particular attention should be paid to critical points. If the child's behavior meets two of them, consultation with a specialist in this disease is required.

Interpreting the CARS Autism Scale
The CARS Autism Scale is a voluminous study that consists of 15 sections, covering all areas of a child's life and development. Each item assumes 4 answers with corresponding points. If the parents cannot choose the proposed options with firm certainty, they can stop at an intermediate value. To complete the picture, observations are needed from those people who surround the child outside the home ( educators, educators, neighbors). Having summed up the scores for each item, you should compare the total amount with the data provided in the test.

The rules for determining the final diagnostic result on the scale CARS are:

• if the total amount varies in the range from 15 to 30 points, the child does not suffer from autism;
• the number of points ranges from 30 to 36 - there is a possibility that the child is sick ( mild to moderate autism);
• the value of points exceeds 36 - there is a high risk that the child has severe autism.

ASSQ Test Results
The ASSQ screening test consists of 27 questions, each of which offers 3 types of answers ( "No", "sometimes", "yes") with the corresponding award of 0, 1 and 2 points. If the test results do not exceed 19, there is no cause for concern. With a total of 19 to 22, parents should consult a doctor, as there is an average likelihood of illness. When the outcome of the study exceeds the 22 point mark, the risk of the disease is considered high.

The professional help of a doctor is not only about medication correction of behavioral disorders. First of all, these are special educational programs for autistic children. The most popular programs in the world are ABA and Floor Time ( game time). ABA includes many other programs that aim to master the world step by step. Learning outcomes are considered to be effective if the learning time is at least 40 hours per week. The second program uses the interests of the child to establish contact with him. In this case, even "pathological" hobbies are taken into account, for example, pouring sand or mosaics. The advantage of this program is that any parent can master it.

Treatment for autism also boils down to visits to a speech therapist, speech pathologist and psychologist. Behavioral disorders, stereotypes, fears are corrected by a psychiatrist and psychotherapist. In general, treatment for autism is multifaceted and focuses on the developmental areas that are affected. The earlier an appointment with a doctor was undertaken, the more effective the treatment will be. It is believed that it is most effective to undertake treatment up to 3 years of age.

This article is useful for teachers of special correctional schools. It examines the clinical aspects of the onset of autism, presents the classification of O. Nikolskaya and the blocks of work on the correction of this group of children.

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educational institution for students, pupils with

disabilities - special (correctional) general education boarding school №115 g. Samara

Development features of children with autism

Educator-psychologist

G.V. Trifonova

Samara

2014

Autism - "detachment from reality, withdrawal into oneself, absence or paradoxicality of reaction to external influences, passivity and overprotectiveness in contacts with the environment" (KS Lebedinskaya).

Autism as a symptom occurs in many mental illnesses and disorders, but in some cases it manifests itself very early (in the first years and even months of a child's life), occupies a leading place in the clinical picture and has a severe negative impact on the entire mental development of the child. In such cases, they talk about RDA (early childhood autism syndrome). With RDA, the distorted mental development of the child, for example:

Fine motor skills are well developed, and general movements are angular, awkward;

Not for age, rich vocabulary, and communication skills are not at all developed;

In the mind resolves 2437 * 9589, and to solve the problem: You have two apples. Mom gave three more. How many apples have you got? Can not;

In some cases, not all clinical characteristics are observed for establishing the diagnosis of RDA, but, according to K.S. Lebedinskaya, V.V. Lebedinsky, O.S. Nikolskaya, correction should be carried out using the methods adopted in work with autistic children. In such situations, they often talk aboutautistic personality traits, autistic behavior.

The World Health Organization (WHO) notes the following EPA criteria:

1. qualitative violations in the field of social interaction;
2. qualitative violations of the ability to communicate;
3. limited repetitive and stereotyped patterns of behavior, interests and activities.

The data on the prevalence of autism is mixed because:

Lack of certainty of diagnostic criteria, their qualitative nature;

Differences in the assessment of age limits (in Russia not older than 15 years, in Japan, in the USA there are no age restrictions);

Differences in understanding the causes of RDA, the mechanism of its development, definitions.

For every 10,000 newborns, 15 - 20 children with RDA, and in boys 4 - 4.5 times more often than in girls. Currently, the number of these children is growing all over the world, which is a serious common human problem.

Autism causes

The causes of autism are not well understood.

1. Most of the RDAhereditary... But not only one gene is involved here, but a group of genes. This means that the gene complex does not provide for the transmission of this pathology, but only provides a predisposition to it, which can manifest itself during infection, fetal intoxication, birth trauma, the age of the mother. All this explains the diversity of the clinical picture of RDA.

This hypothesis also explains the fact that the number of people with autism is growing, although it does not reproduce itself.

Currently, the genetic mechanism is poorly understood.

1. Organic damage to the central nervous system.

This hypothesis has been considered for 50 years. However, the origin, qualifications, localization of damage have not been determined due to the poor knowledge of the material. Nevertheless, the majority of children with EDD have signs of organic lesions of the central nervous system.

1. In the USA and Western Europe, within the framework of the psychoanalytic approach, they considerpsychogenic factor: the unwillingness of the mother to have a child during pregnancy or "mother - refrigerator", that is, rigid, dominant, with cold activity suppressing the development of the child's own activity. Domestic scientists adhere to the first hypothesis, where unfavorable heredity (even some features in the behavior of grandparents) is combined with pathology of childbirth, mother's illness during pregnancy, and Rh is a conflict.

There are RDA options:

1. Kanner's syndrome - atypical autism with intact intelligence;
2. Rett syndrome - found only in girls. Here, a pronounced UO, a peculiar movement of the hands, difficulty in eating, violent laughter;
3. schizophrenic autism- children are distinguished by strange, ridiculous behavior, unexpected reactions to the surrounding phenomena, unusual interests, psychomotor disorders, violation of contacts with the outside world. There may be delusions and hallucinations. This is a progressive form of the disease;
4. organic autism- for various diseases of the central nervous system.

Clinical - psychological - pedagogical characteristics

The main signs of RDA syndrome are a triad of symptoms:

1. Autism with autistic experiences. Violation of contact, social interaction with people around and the world;
2. Stereotypical, monotonous behavior with elements of obsession;
3. A peculiar violation of speech development.

1. Violation of contact, social interaction is manifested as follows:

A) avoiding contact. The child likes to be alone, alone with himself. He is indifferent to others. He has selectivity in contacts, more often it is a mother or grandmother. There is a symbiotic nature of attachment here. Mom cannot leave the child even for one hour.

B) These children do not like to be in their arms, they do not have the posture of being ready to be picked up. They treat everyone the same: is it their own person, or a stranger.

C) In communication, they avoid eye contact or their gaze is short-lived. Such children often look over their heads or their gaze “through you”. When communicating, peripheral vision is also used.

2. Stereotyped behavior is typical for children with RDA syndrome.L. Kanner called this behavior identical (Kanner's syndrome). It is very important for children that everything is as usual, without changes. Constant mode, constant bathing time and temperature. A specific menu (a narrow range of food). Clothing problems: it is impossible to remove any item.

Rituals are typical for children. On the way to school, they go to the same store, circle the hall with a loaf in hand or with another object, but not a toy.

Children are characterized by a large number of movements: rocking, running in a circle, jumping on two legs, making movements with their hands, twitching individual parts of the body, licking lips, grinding teeth, smacking, biting lips.

With these children, work is complicated by a large number of fears:

1. Local ... Fear of a specific object: a knife, a car, a dog, white objects, the hum of a light bulb.
2. Generalized.Fear of change permanence. For example, a child goes for a walk in the park at 17.00. But today there is a very heavy rain, a storm, and instead of walking, reading books.

Children with RDA syndrome have a special interest in sensory manifestations: they are fascinated by the sounds of a coffee grinder, a vacuum cleaner, they listen for hours to classics, Akhmatova, there is a certain rhythm. These children have a special interest in music.

Other children have an interest in signs: they do not accept images, but look at letters, diagrams, tables. At three years old, they count to 100, they know the alphabet, geometric shapes.

3. Special development of speech.

In children with EDD, speech develops with a delay. The dictionary is divorced from what the child sees in everyday life: the moon, a leaf. “Mom” is a table, not a loved one.

Echolalia. The child repeats a word or phrase said by another person. Echolalia makes it impossible to communicate with such a person. A large number of words - cliches ("parrot" speech). These cliches are well preserved in the child's speech, he often uses them in the right place in the dialogue, and everything creates the illusion of developed speech. Mom puts the child in a corner, and he: "Well, now your darling is happy", "Have mercy, sovereign - fish", "What to argue with the damned woman? The old woman scolds even more ”. The child is asked: "Did you have a dream?"

Late appearance in speech of personal pronouns (especially "I"), violation of grammatical structure, violation of prosodic components of speech, speech is monotonous, inexpressive, emotionally poor. The dictionary has been expanded to be excessive or narrowed "to literality."

In our country, O. Nikolskaya, Doctor of Psychology, deals with the problem of children with RDA syndrome. She distinguishes 4 groups of autism and is based on the severity of the violation of contact with the environment.

Group I. The hardest. Children with detachment from the outside world.

These children are speechless. The child is 12 years old, and he does not speak. Hearing and vision are normal. The humming and babbling of such a child is of a peculiar nature, does not fulfill a communicative function.

Sometimes these children are humming, babbling, with the first words at 8 - 12 months. These words are divorced from real needs: wind, moon. There are no words MAMA, BABA, or they call any objects. At 2 - 2.5 years, speech disappears. She may never show up. This is mutuality. Sometimes, very rarely, a breakthrough of mutism by word or phrase can occur. For example, a child was silent for 5 years, then, listening to the complaints of his mother, he said: "I'm tired of it already" - and fell silent again. It is believed that they understand speech. All this requires long-term observation, and if you look closely, he understands everything. With such a child, you cannot discuss his problems. These children do not respond to requests in their own names. The child has field behavior, that is, he moves aimlessly in space. The child takes toys, throws them. He is motor disinhibited. He has no reactions to hunger, pain. These children are helpless. They need constant control, a "conductor for life."

With intensive corrective work, we can:

1. develop self-service skills;
2. teach elementary reading skills to oneself (global reading technique);
3. teach elementary counting operations.

The adaptation of such children is very difficult: he can fall out of the window, run away from the house without making out the road. In this case, the prognosis is poor.

They are somatically healthy. Less painful.

Group II. Children with environmental rejection.

This option is easier than group 1, but these are also disabled children.

The first words appear in the period from one to three years. The child begins to speak whole formulaic words, phrases. Vocabulary accumulates very slowly, due to rote memorization, and is consolidated due to the child's tendency to stereotypy. Phrases are agrammatical. No adjectives are used. The child speaks about himself in the 2nd and 3rd persons. He quotes many songs, fairy tales, but does not connect them with the environment. It is very difficult to come into contact with such a child. He, not wanting to communicate, begins to sing a song. Echolalia is roughly expressed.

In terms of behavior, these children are more difficult than the first. They are dictators, they set their own conditions. They are selective in communication, they have a symbiotic bond with their mother on a physical level. Through autostimulation, they fight fears: mooing, rocking in a chair, listening to the same songs for four hours, licking all objects that are sometimes completely inappropriate for this, busting fingers around the face, etc.

The prognosis is better than in group 1. With intensive corrective work, self-service skills can be formed. Adapted only at home. Here, as in group 1, the intellect suffers, therefore, the diagnosis is often revised at the city PMPK and sent to school of the VIII type, where he receives primary education.

III group Children with substitution of the surrounding world.

Children have early speech development. Parents are happy that the child speaks the first words at 8 - 12 months, a phrase a year and a half. The child has a well-developed mechanical memory, the vocabulary is rapidly accumulating. There are many turns in his speech: apparently, we believe that. His speech is stereotyped, it reflects the speech of an adult. People around admire: "He thinks like an adult." He has very long monologues on topics that are significant to him: insects, transport, marine predators. He is a "walking encyclopedia" within the framework of one topic. Dialogue with him is impossible, looping makes it difficult to work with him.

Such children have complex forms of protection: fantasies, overvalued interests, over-addictions.

These children study in SKOU VIII type or individually in a mass school.

IV group. Children with increased vulnerability to overbraking.

This child requires the support of adults: a mother, a psychologist.

At the age of 2 - 2, 5 years, the child's speech activity sharply decreases, speech regression occurs, but does not end with complete mutism. Speech development is suspended until 5-6 years. The result is a poor vocabulary. Children are often diagnosed with UO. Children do not answer the questions asked, but only repeat it echolally. Despite the fact that the child speaks little, his passive vocabulary exceeds the age norm. The phrase is agrammatical. Speech is spontaneous, less stamped. These children are partially gifted: they have mathematical, musical abilities, they draw beautifully, etc.

The child has a lot of fears. Lack of contact with strangers. He is emotionally dependent on his mother, on his relatives.

Children go to mainstream school and are often not diagnosed with this diagnosis. Simply, everyone knows that they are not of this world. They have higher education. In adulthood, they write: “We are originally different. We cannot be like you. Don't touch us "

Working with children with RDA syndrome includes several blocks:

I. Medical correction.

Observation by a psychiatrist. Special treatment regimen. General strengthening therapy (low immunity, lethargy).

II. Psychological correction.

1. overcoming negative forms of behavior: aggressiveness, selfishness, emotional coldness to the experiences, problems of other people;
2. the formation of purposeful behavior. Since the child has stereotypes in behavior, he will work this way, demonstrate his attitude to work, as he was taught. And society will receive a person responsible for its work from a physicist - theorist to a garbage collector;
3. mitigation of emotional and sensory discomfort, reduction of fears, anxiety;
4. the formation of communication skills.

III. Pedagogical correction.

1. the formation of self-service skills, since further socialization is impossible if children do not know how to hold a spoon, use the toilet, and dress. This is very difficult, as children with PDA are more lazy than others;
2. propaedeutic training (correction of attention, motor skills, speech therapy work).

IV. Family work.

O. Nikolskaya and her laboratory have identified the signs that exclude the possibility of teaching a child at school:

1. lack of purposeful activity like an apathetic defect. These are children of the 1st group with detachment from the outside world. They have no reaction to their voice, their name. They are constantly swaying.

The presence of field behavior with the impossibility of fixing attention and gaze: it is difficult to seat the child, he runs, does not look, does not follow the instructions of an adult. All this makes learning difficult. After drug treatment, behavior changes, the "field" ones become calmer. If there are no positive dynamics, then we are talking about the malignant course of the disease, about schizophrenia;

1. lack of speech up to 5 years. Speech in the form of inarticulate sounds, screams of different intonations, the presence of separate words that are not addressed to real situations, even in cases of vital needs. The child says the phrase: "And she turns." For what? Unclear. This is not speech;
2. the presence of constant unmotivated polar affective reactions at the level of manifestations of pleasure - displeasure, anger, expressed violently with general psychomotor agitation. The child's behavior is disorganized. Unteachable;
3. complete insubordination, negativism of behavior. The child behaves the way he wants. He may be smarter for several years ahead than his peers;
4. long-term preservation of the primitive level of exploratory behavior: hand - mouth. The child tries everything to the teeth. He can eat plasticine, buttons, 38 screws, drink glue.

In some cases, there are autistic behavioral traits in children with severe intellectual disabilities (imbecility, idiocy).

There is another option: in addition to autistic disorders, the child has brain damage and intellectual disability caused by it, most often moderate or severe. Working with such a student is extremely difficult, since there is a complex defect (autism and intellectual underdevelopment). The use of classical methods of oligophrenopedagogy turns out to be unsuccessful due to pronounced autistic personality traits, and the methods of toning the emotional environment are not comprehended due to low intelligence. Nevertheless, O. Nikolskaya recommends teaching children with a complex defect (RDA + SD) as children with RDA syndrome.

Literature

1. Autistic child: problems in everyday life / Ed. S.A. Morozov. - M., 1998.
2. Isaev D.N. Psychology of mentally retarded children and adolescents.
3. Lebedinskaya K.S., Nikolskaya O.S. Diagnosis of early autism. - M., 1991.
4. Nikolskaya O.S. and others. Autistic child. Ways to help. - M., 1997.
5. Special pedagogy / Ed. N.M. Nazarova. - M., 2000.

Features of children with RDA.

Until now, child autism is one of the most controversial issues in child psychiatry, despite numerous studies of this phenomenon. For the first time the syndrome of "early childhood autism" was isolated back in 1943 by L. Kanner.

On clinical grounds, autism is classified as a distorted development. The very concept

"RDA" can be considered as "uneven development of the psyche with a violation of predominantly social interpersonal perception and communication function."

There is no unity in both domestic and foreign clinical psychology

opinions on the reasons for the emergence and development of RDA. The most widespread are the following

Genetic conditioning;

Organic brain damage;

Violation of communication between the mother and the child, her alienation and emotional coldness

ness, lack of maternal affection.

Typical manifestations of RDA include:

Constant withdrawal of the child from any contact, both with adults and with a peer

Unreasonable fear of any change or something new;

Refusal to use speech or peculiar speech with impaired communication

focus;

stereotyping actions;

Pathological daydreaming;

Hand manipulation;

Immersion in the world of your own experiences;

Emotional coldness in relation to loved ones, avoidance of tactile contacts

and eye contacts.

Children with PDA seek to protect their loneliness and actively resist attempts

kam violate their space, up to outbursts of aggression. Such children are characterized by outwardly monotonous, inappropriate physical activity, which can

can manifest itself in running in a circle, rhythmically repeating jumps, etc.

anxiety is combined with periods of lethargy, freezing in one position. Suddenly and for a very long time, the attention of children with RDA can be drawn to some

any object with which children can manipulate the clock (pouring water from bowls

into the cup, turn on and off the lamp, open and close the lid of the box, etc.).

The level of development of children's speech is varied, but everyone has its features:

adequate to the meaning of speech;

Lack of the place "I", ie. the child speaks about himself in the second and third person;

Speech for himself (the child enjoys manipulating words, repeating them

rhenium), in some cases speech may be completely absent.

Many children with RDA have a fear of common household items.

yes, e.g. vacuum cleaner, coffee grinder, etc.

Currently, the most common classification identified by the group

scientists under the leadership of O.S. Nikolskaya. The basis for organizing autistic groups

children are the methods of protection developed with children with PDA.

1st group... –Emotional contact is absent;

The reaction to external stimuli is weak;

A mimic mask of deep rest is typical;

Field behavior, such as aimless movement around the room, is characteristic;

Active speech can be saved;

Avoiding strong stimuli that cause fear (noise, bright light, touching

venia, etc.)

This is the most profound form of autism.

Group 2.-There is a reaction to unpleasant physical sensations (pain, cold,

The speech is dominated by the same type of clichés-commands;

It is possible to fulfill the mother's requests;

Excessive attachment to the mother;

The combination of emotional coldness towards others with increased sensitivity

an affinity for the state of the mother;

Stereotyped actions aimed at stimulating the sense organs (shur-

shaking paper, rotating objects in front of your eyes, etc.);

Stimulating the vestibular apparatus by swinging, etc.;

Ritualization of everyday life.

Group 3-Presence of speech in the form of an emotionally rich monologue;

Ability to express your needs through speech;

Conflict;

Absorption in the same activity;

Large vocabulary of a "bookish" character;

A paradoxical combination of anxiety and fearfulness with the need for repetition

rnomal experience of traumatic impressions;

4 group- Ability to communicate and intellectual functions are preserved;

Excessive need for protection and emotional support from ma

The presence of ritual forms of behavior;

The social circle is limited to close adults;

Difficulty learning motor skills.

The RDA syndrome is not widespread; children with certain autistic traits are much more common. According to statistics, RDA is more common in boys

Due to the blurred awareness of the boundaries of his body and the lack of perception of his

"I" children with PDA experience significant difficulties in the formation of self-

service.

Diagnostics of the RDA.

Timely diagnostic examination of a child with RDA is a prerequisite for setting a favorable prognosis for his development. However, it is the diagnosis of RDA-od-

but from the underdeveloped areas of activity of a practical psychologist. Needed

I can remember that "autism" is a medical diagnosis, and the primary diagnosis should be carried out by medical professionals whose goal is to differentiate RDA from other

their developmental disorders (oligophrenia, alalia, schizophrenia, etc.).

The main directions of correctional work

children with RDA .

Complex clinical, psychological and pedagogical correction of RDA includes the following

sections.

Psychological correction:

- establishing contact with adults;

- mitigation of the general background of sensory and emotional discomfort, anxiety,

- stimulation of mental activity aimed at interaction with adults

mi and peers;

- the formation of purposeful behavior;

- overcoming negative forms of behavior, aggression, negativism, disinhibition;

ness of drives.

Pedagogical correction RDA:

- formation of active interaction with the teacher;

- formation of self-service skills;

- teaching propaedeutics (correction of specific underdevelopment of perception,

motor skills, attention, speech; the formation of skills of visual activity

Medication correction of RDA:

- supportive psychopharmacological and restorative therapy.

Family work:

Family members psychotherapy;

Familiarization of parents with a number of mental problems of the child;

Drawing up individual programs for the upbringing and training of an autistic child in

home conditions;

Teaching parents how to raise an autistic child, organizing his regime,

developing self-service skills, preparing for school.

Corrective work with autistic children can be roughly subdivided into

two stages.

At stage 1, the main tasks are:

Establishing emotional contact;

Overcoming the child's negativism towards communicating with an adult;

Easing emotional discomfort

Neutralizing fears.

An adult needs to remember about five "not":

Don't speak loudly;

Do not make sudden movements;

Do not stare into the eyes of the child;

Do not speak directly to the child;

Don't be too active and intrusive.

To organize the initial stages of communication, an adult is recommended calmly, but enthusiastically

doing something that can attract the child's attention (painting pictures

ku, sprinkle the mosaic, etc.) At the beginning, the requirements should be minimal (success

task, his attention should be switched to an easier, more enjoyable task, in no

In this case, you cannot insist, bring the baby to a negative reaction. At the end of the

denmark it is better to rejoice together at the successful completion.

At stage 2, the main tasks are:

Overcoming the difficulties of the purposeful activity of the child;

Teaching the child social norms of behavior ;

Development of the child's abilities.

Purposeful activity is extremely difficult for children with PDA. Children quickly

get tired, get distracted from even the most interesting and favorite activities.

dima frequent change of activities, taking into account the desire and readiness of the child to interact

socializing with an adult An adult needs to be guided by interests and passions

child. At the initial stages of training, the stereotypes of the child are actively played out. In

During the training, the adult is behind the child, providing the necessary assistance.

a child with autism needs constant approval, but praise needs to be

bed. A specific feature of a child with PDA is the need for constancy.

environment or firm adherence to a habit.

It is necessary to strictly adhere to the regime and schedule.

Unfortunately, most autistic children have a hard time, and some do not.

even higher feelings disappear: sympathy, compassion, empathy. Overcoming

correction of these problems, corrective work is directed to the development of the emotional sphere

ry child:

Establishing a positive emotional contact;

Overcoming negative reactions;

Developing a positive emotional response to classes;

Correction of affective manifestations, their use and stereotyped actions of re-

Benka for communication through the game. The child learns the "language of feelings".

with children with RDA.

Sensory games aimed at establishing contact with children.

Playing with paints and water (pouring, splashing, bathing dolls, washing dishes).

Bubble games.

Candle games (birthday).

Games with light and shadows ("Sun bunny", flashlight "dark light").

Ice games.

Games with cereals (buckwheat, peas, beans, rice in a deep cup).

“Where are my hands”, “Pouring the groats”, “Lunch for a doll”.

Games with plastic materials (plasticine, clay, dough).

Sound Games

Pay attention to sounds in the world around you (door creak, spoon knocking on

Boxes with different cereals ("find the same").

Children's muses. instruments (drum, tambourine, metallophone, pipe, accordion, piano

Games with movement and tactile sensations.

“Braking. Fuss ".

"Catch up, catch up."

"Snake" (ribbon, skipping rope, rope, etc.).

"Airplanes" (circling the baby).

"Let's throw the ball into the basket of balls."

"Let's go, let's go."

During games, do not drag out the storyline, maintain a logical structure, complete

play a game action, summarize, repeat cliché phrases after the child.

Psychodramatic games.

Playing situations, drawing.

Games aimed at correcting the emotional-volitional and motor spheres.

"Kangaroo".

Ball Race.

Seeing Fingers.

"Blow up, bubble."

"Let's get acquainted".

" How to get?".

Find a toy.

"Mouse".

" Caterpillar".

" Let's talk".

"Palm to palm".

"Come up with words."

Games aimed at correcting the cognitive sphere.

"Matchbox pattern".

" Aquarium".

"How to get to the goal?"

"Arithmetic ball"

"Draw the figures."

"Wonderful Forest".

" Town".

"A journey into the world of sounds."

"Recognizing fingers".

"How did the sticks fall?"

"Suitable - not suitable."

" Train".

"Find out what subject I'm knocking on."

Overcoming the manifestations of autism is possible only with the participation of parents. Their main task is to create a comfortable environment for the child, to provide a sense of security.

ty and confidence.

Observe a clear mode of life for the child and the family as a whole.

Maintain an emotionally warm relationship.

When teaching a child, use schemes and models.

Learn to analyze the child's behavior in order to determine the verbal

and non-verbal cues about their discomfort.

5) Use tactile contact everywhere, but insist on it in case

refusal. Don't give up trying.

6) Rely on the capabilities and abilities of the child, use them for his development

7) To eradicate the cause of fears, to think over ways of defeating

8) Introduce everything new into a child's life gradually, dosed.

9) In moments of outbursts of aggression, control yourself.

10) Accept the characteristics of your child, eradicate the feeling of guilt in yourself.

The latter is one of the most important conditions, since acceptance is understanding that opens the way to the child's recovery.

Bibliography.

"Workshop for a child psychologist", G. A. Shirokova, E. G. Zhadko

"Autism: age characteristics and psychological assistance", O.S. Nikolskaya,

E.R.Baenskaya, M, M, Liebling.

“Psychologist's help to children with autism”, I, I, Mamaychuk.

"Psychocorrectional technologies for children with developmental problems."

One and the same circumstance is constantly noted in the stories about such children: they never look into the eyes of another person. Such children avoid communication with people in any way. It seems that they do not understand or do not hear at all what is being said to them. As a rule, these children do not speak at all, and if this happens, then most often such children do not use words to communicate with other people. In their manner of speaking, another feature of speech is noted: they do not use personal pronouns, the autistic child speaks about himself in the second or third person. There is also such a noticeable feature as a great interest in all kinds of mechanical objects and an extraordinary dexterity in handling them. On the other hand, they show obvious indifference to society, they have no need to compare themselves with other people or with their own “I”. Still, autistic children’s overpowering antipathy towards other people is mitigated by the joy they often experience when they are treated as little ones. In this case, the child will not shy away from affectionate touch until you start insisting that he look at you or talk to you. Very often, such children have a symbiotic relationship with their parents (more often the mother).

Autistic children, in comparison with healthy peers, complain much less often. As a rule, they react to a conflict situation by shouting, aggressive actions, or take a passively defensive position. Seeking help from elders is extremely rare. Many of these children suffer from severe eating disorders. Sometimes they refuse to eat at all. (What the parents of a four-year-old girl did not try to awaken her appetite. She refused everything, but at the same time lay down on the floor next to the dog, took the same position and began to eat from a dog's bowl, taking food only with her mouth). But this is an extreme case. More often you have to deal with a preference for a certain type of food. Similarly, autistic children can suffer from severe sleep disorders. It is especially difficult and sometimes impossible for them to fall asleep. The period of sleep can be reduced to an absolute minimum, moreover, there is no regularity of sleep. Some children cannot fall asleep alone; they must have a father or mother with them. Some children cannot fall asleep in their own bed, they fall asleep in a certain chair, and only in a sleepy state can they be transferred to bed. Many ordinary surrounding objects, phenomena and some people cause them a constant feeling of fear. Signs of intense fear in these children are often caused by reasons that seem inexplicable to a superficial observer. If, nevertheless, try to understand what is happening, then it turns out that often a feeling of fear arises as a result of an obsession. For example, children are sometimes obsessed with the idea that all things should be arranged strictly in order in relation to each other, that everything in the room should have its definite place, and if they suddenly do not find this, they begin to experience a strong feeling of fear and panic. Autistic fears deform the objectivity of perception of the surrounding world.

Autistic children also have unusual addictions, fantasies, drives and they seem to completely capture the child, they cannot be distracted, away from these actions. Their range is very wide. Some children sway, twist their fingers, pull on a string, tear paper, run in circles or from wall to wall. Others show unusual addictions to traffic patterns, street plans, electrical wiring, etc. Some have fantastic ideas for transforming into an animal or fairy-tale character. Some children strive for strange, seemingly unpleasant actions: they climb into garbage dumps in basements, constantly draw cruel scenes (executions), show aggressiveness in actions, and reveal sexual attraction. These special actions, addictions, fantasies play an important role in the pathological adaptation of such children to the environment and to themselves. The developmental distortion of autistic children can manifest itself in a paradoxical combination, ahead of age norms, in the development of mental operations and, on their basis, one-sided abilities (mathematical, constructive, etc.) and interests, and at the same time inconsistency in practical life, in the assimilation of everyday skills, methods actions, special difficulties in establishing relationships with others.

For some children with autism, rigorous testing can produce results that are largely outside their age range; but with some children, testing is simply not possible. So, you can get the IQ in the range between 30 and 140. The monotonous and one-sided nature of the development of the abilities and hobbies of these children draws attention: they like to re-read the same books, collect monotonous objects. By the nature and content of the relationship of these hobbies to reality, two groups can be distinguished:

Detachment from reality (writing meaningless poetry, "reading" books in an incomprehensible language);

Associated with certain aspects of reality, aimed at productive activities (interest in mathematics, languages,

chess, music) - which can lead to the further development of abilities.

Children with autism traits at no age stage do not play plot games with their peers, do not accept social roles and do not reproduce situations in games that reflect real life relationships: professional, family, etc. They have no interest and inclination to reproduce this kind of relationship. ... Insufficient social orientation, generated by autism, in these children manifests itself in a lack of interest not only in role-playing games, but also in watching movies and TV shows reflecting interpersonal relationships. In autism, the phenomena of asynchrony in the formation of functions and systems are most clearly manifested: the development of speech often outstrips the development of motor skills, "abstract" thinking outstrips the development of the visual - effective and visual - figurative.

The early development of formal - logical thinking enhances the ability to abstraction and contributes to limitless possibilities for mental exercises, not limited by the framework of socially significant assessments.

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What is Autism?

Autism- this is mental disorder accompanied by a violation of communication with the outside world. Since there are several variants of this disease, the most commonly used term is autism spectrum disorder.
The problem of autism attracts not only scientists and psychiatrists, but also teachers, kindergarten teachers and psychologists. You need to know that the symptoms of autism are characteristic of a number of mental illnesses (schizophrenia, schizoaffective disorder). However, in this case, we are not talking about autism as a diagnosis, but only as a syndrome in the frame of another disease.

Autism statistics

According to statistics provided in 2000, the number of patients diagnosed with autism ranged from 5 to 26 per 10,000 children. After 5 years, the rates increased significantly - one case of this disorder accounted for 250-300 newborns. In 2008, statistics provide the following data - among 150 children, one suffers from this disease. Over the past decades, the number of patients with autistic disorders has increased tenfold.

Today in the United States of America, this pathology is diagnosed in every 88 children. If we compare the situation in America with that of 2000, the number of autistic people has increased by 78 percent.

There are no reliable data on the prevalence of this disease in the Russian Federation. According to existing information in Russia, one child out of 200,000 children suffers from autism, and it is obvious that these statistics are far from reality. The lack of objective information about patients with this disorder suggests that there is a large percentage of children in whom it is not diagnosed.

Representatives of the World Health Organization declare that autism is a disease, the prevalence of which does not depend on gender, race, social status and material well-being. Despite this, according to existing data in the Russian Federation, about 80 percent of autistic people live in families with a low level of income. This is because treating and supporting a child with autism is expensive. Also, raising such a family member requires a lot of free time, so most often one of the parents is forced to give up work, which negatively affects the level of income.

Many autistic patients are raised in single parent families. The high cost of money and physical effort, emotional experiences and anxiety - all these factors cause a large number of divorces in families where a child with autism is brought up.

The causes of autism

Research on autism has been carried out since the 18th century, but it was only in 1943 that the psychologist Kanner identified autism as a clinical unit. A year later, a research paper on autistic psychopathy in children was published by Australian psychotherapist Asperger. Later, a syndrome was named in honor of this scientist, which refers to autism spectrum disorders.
Both scientists already then determined that in such children the main characteristic was the problems of social adaptation. However, according to Kanner, autism is a congenital defect, and according to Asperger, it is constitutional. Scientists have also highlighted other characteristics of autism, such as an obsessive desire for order, unusual interests, isolated behavior and avoidance of social life.

Despite numerous studies in this area, the exact cause of autism has not yet been clarified. There are many theories that address biological, social, immunological, and other causes of autism.

Theories for the development of autism are:

• biological;
• genetic;
• post-vaccination;
• theory of metabolism;
• opioid;
• neurochemical.

Biological theory of autism

Biological theory views autism as a consequence of brain damage. This theory replaced the psychogenic theory (popular in the 50s), which argued that autism develops due to the cold and hostile attitude of the mother towards her child. Numerous studies of both the past and the present century have confirmed that the brains of children with autism differ in both structural and functional features.

Functional features of the brain
Impaired brain function is confirmed by electroencephalogram data (a study that records the electrical activity of the brain).

The features of the electrical activity of the brain in autistic children are:

• a decrease in the seizure threshold, and sometimes foci of epileptiform activity in the associative parts of the brain;
• strengthening of slow-wave forms of activity (mainly theta rhythm), which is a characteristic of the depletion of the cortical system;
• increased functional activity of underlying structures;
• delayed maturation of the EEG pattern;
• weak severity of the alpha rhythm;
• the presence of residual organic centers, most often in the right hemisphere.

Structural features of the brain
Structural abnormalities in autistic children have been investigated using MRI (magnetic resonance imaging) and PET (positron emission tomography). These studies often reveal asymmetry of the cerebral ventricles, thinning of the corpus callosum, expansion of the subarachnoid space, and sometimes local foci of demyelination (absence of myelin).

Morphofunctional changes in the brain in autism are:

• decreased metabolism in the temporal and parietal lobes of the brain;
• increased metabolism in the left frontal lobe and left hippocampus (brain structures).

Genetic theory of autism

The theory is based on numerous studies of monozygotic and dizygotic twins and siblings of autistic children. In the first case, studies have shown that the concordance (number of matches) for autism in monozygotic twins is ten times higher than in dizygotic twins. For example, according to a study by Freeman, in 1991, concordance in monozygotic twins was 90 percent, and in dizygotic twins it was 20 percent. This means that 90 percent of the time both identical twins develop autism spectrum disorder, and 20 percent of the time, both fraternal twins will have autism.

The study also included close relatives of a child with autism. So, the concordance among the brothers and sisters of the patient is from 2 to 3 percent. This means that a brother or sister of an autistic toddler is 50 times more likely to get sick than other children. All of these studies are corroborated by another study by Laxon in 1986. It included 122 children with autism spectrum disorder who were subjected to genetic analysis. It turned out that 19 percent of the children examined were carriers of the fragile X chromosome. Fragile (or fragile) X syndrome is a genetic abnormality in which one of the ends of the chromosome is narrowed. This is due to the expansion of some single nucleotides, which, in turn, leads to a deficiency of the FMR1 protein. Since this protein is necessary for the full development of the nervous system, its deficiency is accompanied by various pathologies of mental development.

The hypothesis that the development of autism is due to a genetic abnormality was also confirmed by a multicenter international study in 2012. It included 400 children with autism spectrum disorder who underwent DNA (deoxyribonucleic acid) genotyping. During the study, children showed a high mutation rate and a high degree of gene polymorphism. Thus, numerous chromosomal aberrations have been found - deletions, duplications and translocations.

Post-vaccination theory of autism

This is a relatively young theory that does not have sufficient foundation. However, the theory is widespread among parents of children with autism. According to this theory, the cause of autism is intoxication with mercury, which is a preservative for vaccines. Most of all "got" polyvalent vaccine against measles, rubella and mumps. In Russia, both domestically produced vaccines (abbreviation KPK) and imported (Priorix) are used. This vaccine is known to contain a mercury compound called thimerosal. On this occasion, in Japan, the United States and many other countries, studies have been conducted on the relationship between the occurrence of autism and thimerosal. In the course of these studies, it turned out that there is no connection between them. However, Japan has phased out the use of this compound in the manufacture of vaccines. However, this did not lead to a decrease in the incidence rate both before the use of thimerosal, and after it had ceased to be used, the number of sick children did not decrease.

At the same time, despite the fact that all previous studies deny the relationship between vaccines and autism, parents of sick children note that the first signs of the disease are noted after vaccination. Perhaps the reason for this is the age of the child when the vaccination is given. The MMR vaccine is given in one year, which coincides with the first signs of autism. This suggests that vaccination in this case acts as a stress factor that triggers pathological development.

Metabolic theory

According to this theory, the autistic type of development is observed in some metabolic pathologies. Autism syndromes are observed in phenylketonuria, mucopolysaccharidosis, histidinemia (a genetic disease in which the exchange of the amino acid histidine is impaired) and other diseases. Most often, Rett syndrome is noted, which is clinically diverse.

Opioid theory of autism

Proponents of this theory believe that autism develops as a result of overloading the central nervous system with opioids. These opioids appear in a child's body as a result of incomplete breakdown of gluten and casein. A prerequisite for this is the defeat of the intestinal mucosa. This theory has not yet been confirmed by research. However, there are studies that prove the relationship between autism and a disturbed digestive system.
Part of this theory is supported by the diet given to children with autism. Thus, autistic children are advised to exclude casein (dairy products) and gluten (cereals) from the diet. The effectiveness of such a diet is controversial - it cannot cure autism, but according to scientists, it can correct certain disorders.

The neurochemical theory of autism

Proponents of the neurochemical theory believe that autism develops as a result of hyperactivation of the dopaminergic and serotonergic systems of the brain. This hypothesis is supported by numerous studies that have shown that autism (and other diseases) is accompanied by hyperfunction of these systems. To eliminate this hyperfunction, drugs are used that block the dopaminergic system. The most famous such drug used in autism is risperidone. This drug is sometimes very effective in the treatment of autism spectrum disorders, which proves the validity of this theory.

Autism Research

The abundance of theories and the lack of a common point of view regarding the causes of autism has become a prerequisite for the continuation of numerous studies in this area.
A 2013 study by researchers at the University of Guelph, Canada, concluded that there is a vaccine that can control the symptoms of autism. This vaccine is developed against the bacteria Clostridium bolteae. It is known that this microorganism is found in increased concentration in the intestines of autistic children. It is also the cause of gastrointestinal tract disorders - diarrhea, constipation. Thus, the availability of the vaccine supports the theory of the relationship between autism and digestive disorders.

According to the researchers, the vaccine not only relieves symptoms (which affect more than 90 percent of children with autism), but also can control the development of the disease. The vaccine has been tested in a laboratory setting, and according to Canadian scientists, it stimulates the production of specific antibodies. The same scientists published a report on the effects of various toxins on the intestinal mucosa. Canadian scientists have concluded that the high prevalence of autism in recent decades is due to the effects of bacterial toxins on the gastrointestinal tract. Also, toxins and metabolites of these bacteria can determine the severity of autism symptoms and control its development.

Another interesting study was carried out jointly by American and Swiss scientists. This study looks at the likelihood of developing autism in both sexes. According to statistics, the number of boys with autism is 4 times higher than the number of girls with this ailment. This fact was the basis for the theory of gender injustice in autism. The researchers concluded that the female body has a more reliable defense system against light mutations. Therefore, men are 50 percent more likely to develop intellectual and mental disabilities than women.

Development of autism

Autism develops differently for each child. Even in twins, the course of the disease can be very individual. However, clinicians identify several options for the course of autism spectrum disorders.

The options for the development of autism are:

• Malignant development of autism- characterized by the fact that symptoms appear in early childhood. The clinical picture is characterized by a rapid and early decay of mental functions. Social disintegration increases with age, and some autism spectrum disorders can progress to schizophrenia.
• The undulating course of autism- characterized by periodic exacerbations, which are often seasonal in nature. The severity of these exacerbations can be different each time.
• Regular course of autism- characterized by a gradual improvement in symptoms. Despite the stormy onset of the disease, the symptoms of autism gradually regress. Nevertheless, signs of mental dysontogenesis persist.

The prognosis for autism is also very individual. It depends on the age when the disease debuted, the degree of the breakdown of mental functions and other factors.

Factors influencing the course of autism are:

• the development of speech before the age of 6 is a sign of a favorable course of autism;
• visiting special educational institutions is a favorable factor and plays an important role in the adaptation of the child;
• mastering the "craft" allows in the future to realize himself professionally - according to research, every fifth autistic child is able to master a profession, but does not do it;
• attending speech therapy classes or kindergartens with a speech therapy profile has a positive effect on the further development of the child, because according to statistics, half of adults with autism do not speak.

Autism symptoms

The clinical picture of autism is very diverse. Basically, it is determined by such parameters as uneven maturation of the mental, emotional-volitional and speech spheres, persistent stereotypes, lack of response to treatment. Children with autism differ in their behavior, speech, intelligence, as well as their attitude to the world around them.

Symptoms in autism are:

• speech pathology;
• features of the development of intelligence;

• pathology of behavior;
• hyperactive syndrome;
• disturbances in the emotional sphere.

Speech for autism

Features of speech development are noted in 70 percent of cases of autism. Often, the lack of speech is the first symptom for which parents turn to defectologists and speech therapists. The first words appear on average by 12-18 months, and the first phrases (but not sentences) by 20-22 months. However, the appearance of the first words can be delayed up to 3-4 years. Even if the vocabulary of a child by 2 - 3 years old and corresponds to the norm, attention is drawn to the fact that children do not ask questions (which is typical for small children), do not talk about themselves. Usually children hum or mumble something unintelligible.

Very often the child stops speaking after the speech has formed. Although a child's vocabulary can be enriched with age, speech is rarely used for communication. Children can conduct dialogues, monologues, declare poems, but do not use words for communication.

The characteristics of speech in autistic children are:

• echolalia - repetition;
• whispering or, conversely, loud speech;
• metaphorical language;
• play on words;
• neologisms;
• unusual intonation;
• permutation of pronouns;
• violation of facial expression;
• lack of response to the speech of others.

Echolalia is the repetition of previously pronounced words, phrases, sentences. At the same time, the children themselves are not able to build sentences. For example, to the question "how old are you", the child answers - "how old are you, how old are you." On the offer “let's go to the store”, the child repeats “let's go to the store”. Also, children with autism do not use the pronoun "I", rarely refer to their parents with the words "mom", "dad".
In their speech, children often use metaphors, figurative phrases, neologisms, which give a bizarre shade to the child's conversation. Gestures and facial expressions are very rarely used, which makes it difficult to assess the emotional status of the child. A distinctive feature is that by declaring and chanting large texts, children can hardly start a conversation and maintain it in the future. All these features of speech development reflect impairments in communicative spheres.

A core disorder in autism is the problem of understanding addressed speech. Even with retained intelligence, children have difficulty responding to speech addressed to them.
In addition to problems with understanding speech and difficulty with its use, autistic children often have speech defects. These can be dysarthria, dyslalia and other disorders of speech development. Children often stretch words, put stress on the last syllables, while maintaining babbling intonation. Therefore, speech therapy classes are a very important point in the rehabilitation of such children.

Intelligence in Autism

Most autistic children show peculiarities of cognitive activity. That is why one of the problems of autism is its differential diagnosis with mental retardation (PDD).
Studies have shown that the intelligence of autistic children is, on average, lower than that of children with normal development. At the same time, their IQ is higher than with mental retardation. At the same time, the unevenness of intellectual development is noted. The general store of knowledge and the ability to understand some sciences in autistic children is below normal, while vocabulary and mechanical memory are developed above normal. Thinking is specific and photographic, but its flexibility is limited. Autistic children may show an increased interest in such sciences as botany, astronomy, and zoology. All this suggests that the structure of an intellectual defect in autism differs from the structure in mental retardation.

Abstraction is also limited. The decline in school performance is largely due to behavioral abnormalities. Children have difficulty concentrating and often exhibit hyperactive behavior. It is especially difficult where spatial concepts and flexibility of thinking are needed. At the same time, 3-5 percent of children with autism spectrum disorders demonstrate one or two “special skills”. It can be exceptional mathematical abilities, recreating complex geometric shapes, virtuoso playing a musical instrument. Also, children may have an exceptional memory for numbers, dates, names. Such children are also called “autistic geniuses”. Despite the presence of one or two of these abilities, all other signs of autism persist. First of all, social isolation, impaired communication, difficulties in adaptation dominate. An example of such a case is the film "Rain Man", which tells the story of an adult autistic genius.

The degree of intellectual delay depends on the type of autism. Thus, in Asperger's syndrome, intelligence is preserved, which is a favorable factor for social integration. Children in this case are able to graduate from school and get an education.
However, in more than half of cases, autism is accompanied by a decrease in intelligence. The level of decline can vary from deep to light delay. More often (60 percent) there are moderate forms of lagging, 20 percent - mild, 17 percent - intelligence is normal, and in 3 percent of cases - intelligence is above average.

Behavior in Autism

One of the main characteristics of autism is impaired communication behavior. The behavior of autistic children is characterized by isolation, isolation, and lack of adaptation skills. Autistic children, refusing to communicate with the outside world, go into their inner fantasy world. They find it difficult to get along in the company of children and, in general, do not tolerate crowded places.

The characteristics of the behavior of children with autism are:

• autoaggression and heteroaggression;
• commitment to consistency;
• stereotypes - motor, sensory, vocal;
• rituals.

Auto-aggression in behavior
As a rule, the behavior is dominated by elements of auto-aggression - that is, aggression against oneself. The child shows this behavior when something does not suit him. This can be the appearance of a new child in the environment, a change of toys, a change in the environment of a place. At the same time, the aggressive behavior of an autistic child is directed at himself - he can hit himself, bite, hit on the cheeks. Autoaggression can also turn into heteroaggression, in which aggressive behavior is directed at others. Such destructive behavior is a kind of protection against possible changes in the habitual way.

The greatest difficulty in raising an autistic child is going to a public place. Even if the child does not show any signs of autistic behavior at home, then “going out to people” is a stressful factor that provokes inappropriate behavior. At the same time, children can commit inappropriate actions - throw themselves on the floor, beat and bite themselves, scream. It is extremely rare (almost in exceptional cases) that autistic children respond calmly to changes. Therefore, before going to a new place, parents are advised to familiarize the child with the upcoming route. Any change of scenery should be carried out in stages. This primarily concerns integration into a kindergarten or school. First, the child must familiarize himself with the route, then with the place where he is going to spend time. Adaptation in the kindergarten is carried out starting from two hours a day, gradually increasing the hours.

Rituals in the behavior of autistic children
This commitment to consistency applies not only to the environment, but also to other aspects - food, clothing, play. A change in dish can be a stressful factor. So, if a child is used to eating porridge for breakfast, then an omelette served suddenly can provoke an attack of aggression. Eating, putting on things, playing and any other activity is often accompanied by peculiar rituals. The ritual may consist in a certain order of serving dishes, washing hands, getting up from the table. The rituals can be completely incomprehensible and inexplicable. For example, touch the stove before sitting down at the table, jump before going to bed, go to the store porch while walking, and so on.

Stereotypes in the behavior of autistic children
The behavior of autistic children, regardless of the form of the disease, is stereotyped. There are motor stereotypes in the form of swaying, whirling around its axis, jumps, nods, finger movements. Most autistic people are characterized by athetosis-like movements of the fingers in the form of touching, bending and extending, folding. Such movements as shaking, bouncing, pushing off from the fingertips, walking on tiptoes are no less characteristic. Most motor stereotypes resolve with age and are rarely seen in adolescents. Voice stereotypes are manifested in the repetition of words in response to a question (echolalia), in the declaration of poems. There is a stereotypical account.

Hyperactivity disorder in autism

Hyperactivity disorder occurs in 60 to 70 percent of cases. It is characterized by increased activity, constant movement, restlessness. All this can be accompanied by psychopathic phenomena such as disinhibition, excitability, screaming. If you try to stop the child or take something from him, then this leads to reactions of protest. During such reactions, children fall to the floor, scream, beat, hit themselves. Hyperactivity disorder is almost always accompanied by attention deficit, which causes certain difficulties in behavior correction. Children are disinhibited, unable to stand or sit in one place, unable to concentrate on anything. With severe hyperactive behavior, drug treatment is recommended.

Emotional Disorders in Autism

From the first years of life, children have emotional disorders. They are characterized by an inability to identify their own emotions and understand others'. Autistic children cannot empathize or enjoy something, and they also have difficulty expressing their own feelings. Even if a child learns the name of emotions from pictures, he is not able to subsequently apply his knowledge in life.

The lack of an emotional response is largely due to the child's social isolation. Since it is impossible to go through an emotional experience in life, then it is impossible for a child to further comprehend these emotions.
Emotional disorders are also expressed in a lack of perception of the surrounding world. So, it is difficult for a child to imagine his room, even knowing by heart all the objects that are in it. Having no idea of ​​his own room, the child also cannot imagine the inner world of another person.

Development features of children with autism

Features of a one-year-old child are often manifested in a delay in the development of the skills of crawling, sitting, getting up, and taking the first steps. When the child begins to take the first steps, the parents note some peculiarities - the child often freezes, walks or runs on tiptoe with arms outstretched ("butterfly"). The gait is distinguished by a certain woodiness (the legs do not seem to bend), impulsiveness and impulsiveness. Children are often clumsy and baggy, however gracefulness can also be observed.

The mastery of gestures is also delayed - there is practically no pointing gesture, difficulties in greeting-farewell, affirmation-denial. The facial expressions of children with autism are characterized by inactivity and poverty. Often there are serious faces, with traced features ("prince's face" according to Kanner).

Disability in Autism

With such a disease as autism, a disability group is required. It is necessary to understand that disability involves not only cash payments, but also assistance in the rehabilitation of the child. Rehabilitation includes placement in a specialized preschool, such as a speech therapy school, and other benefits for children with autism.

Benefits for disabled children with autism are:

• free admission to specialized educational institutions;
• registration in a speech therapy garden or in a speech therapy group;
• tax deductions for treatment;
• benefits for spa treatment;
• the opportunity to study according to an individual program;
• assistance in psychological, social and professional rehabilitation.

In order to register a disability, it is necessary to be examined by a psychiatrist, a psychologist, and most often inpatient treatment is required (to lie down in a hospital). You can also be observed in a day hospital (come only for consultations), if there are any in the city. In addition to hospital observation, it is necessary to undergo examination by a speech therapist, neuropathologist, ophthalmologist, otorhinolaryngologist, as well as pass a general urine test and a blood test. The results of specialist consultations and test results are entered into a special medical form. If a child attends a kindergarten or school, a characteristic is also needed. After that, the district psychiatrist supervising the child sends the mother and the baby to a medical commission. On the day of the commission, you must have a testimonial for the child, a card with all specialists, analyzes and diagnosis, parents' passports, and a child's birth certificate.

Types of autism

When determining the type of autism, modern psychiatrists in their practice are most often guided by the International Classification of Diseases (ICD).
According to the international classification of diseases of the tenth revision, children's autism, Rett syndrome, Asperger's syndrome and others are distinguished. However, the Diagnostic Manual of Mental Illness (DSM) currently addresses only one clinical unit - Autism Spectrum Disorder. Thus, the question of autism options depends on which classification the specialist uses. In Western countries and the USA, DSM is used, so there is no longer a diagnosis of Asperger's or Rett's syndrome in these countries. In Russia and some countries of the post-Soviet space, the ICD is more often used.

The main types of autism identified in the International Classification of Diseases include:

• early childhood autism;
• atypical autism;
• Rett syndrome;
• Asperger's syndrome.

The rest of the types of autism, which are quite rare, are classified under the heading "other types of autistic disorders."

Early childhood autism

Early childhood autism is a type of autism in which mental and behavioral disorders begin to manifest themselves from the first days of a child's life. Instead of the term "early childhood autism", medicine also uses "Kanner's syndrome". Of ten thousand infants and young children, this type of autism occurs in 10-15 babies. Boys suffer from Kanner's syndrome 3-4 times more often than girls.

Signs of early childhood autism can begin to appear in the early days of an infant's life. In such children, mothers note a violation of the reaction to auditory stimuli and a retardation of reaction to various visual contacts. In the first years of life, children have difficulty understanding speech. They also have a delay in speech development. By the age of five, a child with early childhood autism has difficulties with social relationships and persistent behavioral disturbances.

The main manifestations of early childhood autism are:

• autism itself;
• the presence of fears and phobias;
• lack of a stable sense of self-preservation;
• stereotypes;
• special speech;
• impaired cognitive and intellectual abilities;
• special game;
• features of motor functions.

Autism
Autism, as such, is primarily characterized by impaired eye contact. The child does not fix his gaze on someone's face and constantly avoids looking in the eyes. He seems to be looking past or through a person. Sound or visual stimuli are not able to revive the child. A smile rarely appears on the face, and even the laughter of adults or other children is unable to cause it. Another prominent feature of autism is a special attitude towards parents. The need for a mother is practically not manifested in any way. Children with a delay do not recognize the mother, therefore, when she appears, they do not begin to smile or move towards. There is also a weak reaction to her departure.

The appearance of a new person can cause expressed negative emotions - anxiety, fear, aggression. Communication with other children is very difficult and is accompanied by negative impulse actions (resistance, flight). But sometimes the child just completely ignores anyone who is around him. The reaction and response to verbal appeal is also absent or severely inhibited. The child may not even respond to his name.

Presence of fears and phobias
In more than 80 percent of cases, early childhood autism is accompanied by the presence of various fears and phobias.

The main types of fears and phobias in early childhood autism

Types of fears	The main objects and situations causing fear
Overvalued fears (associated with reassessment of the significance and danger of certain objects and phenomena)	loneliness; height; stairs; strangers; darkness; animals.
Fears associated with auditory (auditory) stimuli	household items - vacuum cleaner, hair dryer, electric shaver; noise of water in pipes and toilet; the hum of the elevator; sounds of cars and motorcycles.
Fears associated with visual stimuli	bright light; flashing lamps; abrupt change of the frame on the TV; shiny objects; fireworks; bright clothes of people around.
Fears associated with tactile stimuli	water; rain; snow; things made of fur.
Delusional fears	own shadow; objects of a certain color or shape; any holes in the walls ( ventilation, sockets); certain people, sometimes even parents.

Lack of a sustainable sense of self-preservation
In some cases of early childhood autism, the sense of self-preservation is impaired. In 20 percent of sick children there is no "sense of the edge". Babies sometimes hang dangerously over the side of strollers or climb over the walls of the arena and crib. Often, children can spontaneously run out onto the road, jump from a height or go into the water to dangerous depths. Also, many do not have a negative experience of burns, cuts and bruises. Older children lack protective aggression and are unable to stand up for themselves when they are bullied by their peers.

Stereotypes
In early childhood autism, more than 65 percent of patients develop different stereotypes - frequent repetitions of certain movements and manipulations.

Stereotypes of early childhood autism

Types of stereotypes	Examples of
Motor	rocking in a stroller; monotonous movements of the limbs or head; prolonged jumping; stubborn swinging on a swing.
Speech	frequent repetition of a certain sound or word; constant counting of items; involuntary repetition of heard words or sounds.
Behavioral	choosing the same food; ritual in choosing clothes; unchanging route of walks.
Sensory	turns on and off the light; pours small items ( mosaic, sand, sugar); rustles with candy wrappers; sniffs the same objects; licks certain items.

Special speech
In early childhood autism, speech development and acquisition is delayed. Babies start to pronounce the first words late. Their speech is illegible and not addressed to a specific person. The child has difficulty understanding or ignores verbal directions. Gradually, the speech is filled with unusual words, commentary phrases, neologisms. The features of speech also include frequent monologues, dialogues with oneself and constant echolalia (automatic repetition of words, phrases, quotes).

Impaired cognitive and intellectual abilities
In early childhood autism, cognitive and intellectual abilities lag behind or accelerate in development. In about 15 percent of patients, these abilities develop within normal limits.

Impaired cognitive and intellectual abilities

Special game
Some children with early autism completely ignore toys, and there is no play at all. For others, the game is limited to simple manipulations of the same type with the same toy. Often, the game involves foreign objects that are not toys. At the same time, the functional properties of these objects are not used in any way. Games usually take place in a secluded place alone.

Features of motor functions
More than half of patients with early childhood autism have hyperexcitability (increased physical activity). Various external stimuli can provoke pronounced motor activity - the child begins to stamp his feet, wave his arms, fight back. Awakening is often accompanied by crying, screaming, or erratic movements. In 40 percent of sick children, the opposite manifestations are observed. Reduced muscle tone is accompanied by low mobility. The babies suck sluggishly. Children react poorly to physical discomfort (cold, moisture, hunger). External stimuli are not able to cause adequate reactions.

Atypical autism

Atypical autism is a special form of autism in which clinical manifestations can be hidden for many years or be mild. With this disease, not all of the main symptoms of autism are detected, which complicates the diagnosis at an early stage.
The clinical picture of atypical autism is represented by a variety of symptoms that can appear in different patients in different combinations. All the many symptoms can be divided into five main groups.

Typical groups of symptoms of atypical autism are:

• speech disorders;
• signs of emotional distress;
• signs of social maladjustment and insolvency;
• thinking disorder;
• irritability.

Speech disorders
People with atypical autism have difficulty learning a language. They have difficulty understanding other people's speech, taking everything literally. Due to a small vocabulary that does not correspond to age, the expression of one's own thoughts and ideas is difficult. Learning new words and phrases, the patient forgets the information learned in the past. Patients with atypical autism do not understand the emotions and feelings of those around them, so they lack the ability to empathize and worry about their loved ones.

Signs of emotional failure
Another important symptom of atypical autism is the inability to express your emotions. Even when the patient has internal experiences, he is not able to explain and express what he feels. It may seem to others that he is simply indifferent and unemotional.

Signs of social maladjustment and insolvency
In each individual case, the signs of social maladjustment and insolvency have a different degree of severity and their own special character.

The main signs of social maladjustment and insolvency include:

• tendency to loneliness;
• avoiding any contact;
• lack of communication;
• difficulties in establishing contact with strangers;
• inability to make friends;
• Difficulty eye contact with an opponent.

Thought disorder
People with atypical autism have limited thinking. It is difficult for them to accept any innovations and changes. A change of scenery, a failure in the established daily routine or the appearance of new people causes confusion and panic. Attachment can be observed in relation to clothing, food, certain smells and colors.

Irritability
In atypical autism, the nervous system is more sensitive to various external stimuli. From bright lights or loud music, the patient becomes nervous, irritable and even aggressive.

Rett syndrome

Rett syndrome refers to a special form of autism, in which severe neuropsychiatric disorders appear against the background of progressive degenerative changes in the central nervous system. The cause of Rett syndrome is a mutation in one of the genes on the sex X chromosome. This explains the fact that only girls are sick. Almost all male fetuses with one X chromosome in the genome die in the womb.

The first signs of the disease begin to appear 6 to 18 months after the birth of the child. Until this time, the growth and development of the baby does not differ in any way from the norm. Psycho-neurological disorders develop through four stages of the disease.

Stages of Rett Syndrome

Stages	Child's age	Manifestations
I	6 - 18 months	the growth of individual parts of the body slows down - hands, feet, head; diffuse hypotension appears ( muscle weakness); interest in games decreases; the ability to communicate with the child is limited; some motor stereotypes appear - swaying, rhythmic flexion of the fingers.
II	1 - 4 years	frequent bouts of anxiety; sleep disturbance with screaming on awakening; acquired skills are lost; difficulties in speech appear; motor stereotypes become more; walking is difficult due to loss of balance; seizures with convulsions and convulsions appear.
III	3 - 10 years old	The progression of the disease is suspended. The main symptom is mental retardation. During this period, it becomes possible to establish emotional contact with the child.
IV	from 5 years	body mobility is lost due to muscle atrophy; scoliosis appears ( rachiocampsis); speech is disturbed - words are used incorrectly, echolalia appears; mental retardation is aggravated, but emotional attachment and communication persist.

Due to severe movement disorders and pronounced neuropsychiatric changes, Rett syndrome is the most severe form of autism that cannot be corrected.

Asperger's Syndrome

Asperger's Syndrome is another type of autism related to the general developmental disabilities of the child. Among the patients, 80 percent are boys. There are 7 cases of this syndrome per one thousand children. Symptoms of the disease begin to appear from 2 to 3 years, but the final diagnosis is most often made at 7 to 16 years.
Among the manifestations of Asperger's syndrome, there are three main characteristics of a violation of the psychophysiological state of a child.

The main characteristics of Asperger's syndrome are:

• social disorders;
• features of intellectual development;
• violations of sensing (sensitivity) and motor skills.

Social disorders
Social disorders are caused by deviations in non-verbal behavior. Due to peculiar gestures, facial expressions and mannerisms, children with Asperger Syndrome are unable to establish contact with other children or adults. They cannot empathize with others and are unable to express their feelings. In kindergarten, such children do not make friends, keep apart, do not participate in common games. For this reason, they are ranked among the egocentric and callous personalities. Social difficulties also arise from the intolerance of other people's touch and eye-to-eye contact.

When interacting with peers, children with Asperger Syndrome try to impose their own rules, not accepting other people's ideas and not wanting to compromise. In response to this, others are reluctant to come into contact with such children, exacerbating their social isolation. This leads to depression, suicidal tendencies and various types of addiction during adolescence.

Features of intellectual development
Asperger's syndrome is characterized by a relative preservation of intelligence. It is not characterized by gross developmental delays. Children with Asperger's Syndrome are able to graduate from educational institutions.

The features of the intellectual development of children with Asperger's syndrome include:

• normal or above average intelligence;
• excellent memory;
• lack of abstract thinking;
• precocious speech.

In Asperger syndrome, IQ is usually normal or even higher. But sick children have difficulties with abstract thinking and comprehension of information. Many children have phenomenal memory and extensive knowledge in their area of ​​interest. But often they are not able to use this information in the right situations. Despite this, children with Asperger become very successful in areas such as history, philosophy, geography. They are completely devoted to their work, becoming fanatical and fixated on the smallest details. Such children are constantly in their own world of thoughts and fantasies.

Another feature of intellectual development in Asperger's syndrome is rapid speech development. By the age of 5 - 6, the child's speech is already well developed and delivered correctly grammatically. The rate of speech is slow or fast. The child speaks in a monotone and with an unnatural timbre of voice, using a variety of speech patterns in a book style. A story about a subject of interest can be long and very detailed, regardless of the reaction of the interlocutor. But children with Asperger's Syndrome cannot support a conversation on any topic outside their area of ​​interest.

Motility and sensory disorders
Sensory impairment in Asperger's syndrome includes an increased sensitivity to sounds, visual stimuli, and tactile stimuli. Children avoid other people's touches, loud street sounds, bright lights. They have obsessive fears of the elements (snow, wind, rain).

The main motor disorders in children with Asperger Syndrome include:

• lack of coordination;
• clumsy gait;
• difficulty tying shoelaces and buttoning up;
• sloppy handwriting;
• motor stereotypes.

Excessive sensitivity also manifests itself in pedantry and stereotyped behavior. Any changes in the established routine of the day or habitual practice cause anxiety and panic.

Autism syndrome

Autism can also manifest itself as a syndrome in the structure of a disease such as schizophrenia. Autism syndrome is characterized by isolated behavior, isolation from society, and apathy. Autism and schizophrenia are often referred to as the same disease. This is because although both diseases have their own characteristics, socially they share certain similarities. Also, a couple of decades ago, autism was hiding under the diagnosis of childhood schizophrenia.
Today it is known that there are clear differences between schizophrenia and autism.

Autism in schizophrenia

A characteristic of schizophrenic autism is a specific disintegration (disunity) of both the psyche and behavior. Research has shown that symptoms of autism can mask the onset of schizophrenia for a long time. Over the years, autism can completely define the clinical picture of schizophrenia. This course of the disease can continue until the first psychosis, which, in turn, will already be accompanied by auditory hallucinations and delusions.

Autism in schizophrenia primarily manifests itself in the patient's behavioral characteristics. This is expressed in the difficulties of adaptation, in isolation, in being "in your own world." In children, autism can manifest itself in the form of "over-social" syndrome. Parents note that the child was always quiet, obedient, never bothered the parents. Often these children are considered "exemplary". At the same time, they practically do not react to comments. Their exemplary behavior does not lend itself to change, children are not flexible. They are closed and completely absorbed in the experiences of their own world. They rarely manage to be interested in something, to involve them in some kind of game. According to Kretschmer, such exemplaryness is an autistic barrier from the outside world.

Differences between autism and schizophrenia

Both pathologies are characterized by impaired communication with the outside world, behavioral disorders. In both autism and schizophrenia, stereotypes, speech disorders in the form of echolalia, ambivalence (duality) are observed.

A key criterion in schizophrenia is impaired thinking and perception. The former appear in the form of discontinuity and inconsistency, the latter in the form of hallucinations and delirium.

Basic symptoms in schizophrenia and autism

Schizophrenia	Autism
Thought disorders - torn, inconsistent, and incoherent thinking.	Communication impairment - not using speech, not being able to play with others.
Emotional disorders - in the form of depressive episodes and bouts of euphoria.	Striving for isolation - lack of interest in the world around, aggressive behavior towards changes.
Perceptual disorders - hallucinations ( auditory and rarely visual), nonsense.	Stereotypical behavior.
Intelligence is usually preserved.	Delayed speech and intellectual development.

Autism in adults

The symptomatology of autism does not diminish with age, and the quality of life of a person with this condition depends on their skill level. Difficulties with social adaptation and other symptoms characteristic of this disease provoke great difficulties in all aspects of autistic adult life.

Personal life
Relationship with the opposite sex is an area that causes great difficulties for autists. Romantic courtship is not typical for autists, as they do not see the point in it. They perceive kisses as useless movements, and hugs as an attempt to restrict movement. At the same time, they may experience sexual desire, but most often they remain alone with their feelings, since they are not mutual.
In the absence of friends, autistic adults take a lot of information about romantic relationships from films. Men, after watching pornographic films, try to put into practice such knowledge, which frightens and repels their partners. Women with autistic disorders are more informed on TV shows and, due to their naivety, often become victims of sexual violence.

According to statistics, people with autism spectrum disorders are much less likely than others to create full-fledged families. It should be noted that recently the possibilities of an autistic adult to arrange his personal life have significantly increased. With the development of the Internet, various specialized forums have begun to appear where a person diagnosed with autism can find a mate with a similar disorder. Information technology, which allows for establishing contact by correspondence, contributes to the fact that many autistic people get to know and develop friendships or personal relationships with their own kind.

Professional activity
The development of computer technology has significantly increased the opportunities for professional self-realization of autists. One of the popular solutions is remote work. In many patients with this disease, the level of intelligence allows them to cope with tasks of a high degree of complexity. The absence of the need to leave the comfort zone and interact live with work colleagues allows autistic adults not only to work, but also to develop professionally.

If skills or circumstances do not allow doing remote work on the Internet, then the standard forms of activity (work in an office, shop, at a factory) cause great difficulties for an autistic person. Most often, their professional success is significantly lower than their actual abilities. These people are most successful in areas where attention to detail is needed.

Living conditions
Depending on the form of the disease, some autistic adults may lead an independent life in their own apartment or house. If in childhood the patient underwent appropriate corrective therapy, then growing up he can cope with everyday tasks without assistance. But most often, autistic adults need the support they receive from their relatives, loved ones, medical or social workers. Depending on the type of illness, the autistic person may receive a cash benefit, information about which should be obtained from the appropriate authority.

In many economically developed countries, there are houses for autists, where special conditions have been created for their comfortable living. In most cases, such houses are not only housing, but also a place of work. For example, in Luxembourg, residents of such houses make postcards and souvenirs, grow vegetables.

Social communities
Many autistic adults are of the opinion that autism is not a disease, but a unique life concept and therefore does not require treatment. To protect their rights and improve the quality of life, autistic people unite in various social groups. In 1996, an online community was formed called NZHAS (Independent Life on the Autistic Spectrum). The main goal of the organization was to provide emotional support and practical assistance to autistic adults. The participants shared stories and life advice, and for many, this information was very valuable. Today there are a large number of similar communities on the Internet.

Before use, you must consult a specialist.