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

Etiology and pathogenesis

The causes of childhood autism are not fully known.

There are a number of clinically and experimentally provenhypotheses about the etiopathogenesis of the disorder.

1) Weakness of instincts and affective sphere

2) information blockade associated with perception disorders;

3) disruption of the processing of auditory impressions, leading to blocking cade of contacts;

4) disruption of the activating influence of the reticular formation of the brain stem;

5) dysfunction of the frontal-limbic complexSA leading to a disorder of motivation and behavior planning;

6) distortions of serotonin metabolism and the functioning of erotonin-ergic systems of the brain;

7) disturbances in the paired functioning of the cerebral hemispheres brain

Along with this, there are psychological and psychoanalyticsome causes of the disorder. Genetic factors play a significant role, since in families suffering from autism this problemLeaving is more common than in the general population. Autism into some extent associated with an organic brain disorder (hour-then in the anamnesis there is information about complications during the intrauterine perioddevelopment and during childbirth), correlation with epilepsy in 2% of cases (according toAccording to some data, in the general pediatric population, epilepsy is 3.5%).Some patients had diffuse neurological anomaliesmalia - “soft signs”. There are no specific EEG abnormalitiesexist, but various EEG pathologies were found in 10-83% of autistic new children.

Prevalence

The prevalence of childhood autism is 4-5 cases per10,000 children. First-born boys predominate (3-5 timesmore often than girls). But in girls, autism has a more severe course.tion, and, as a rule, in these families there have already been cases with cognitivetive violations.

Clinic

In its original description Kanner highlighted the mainsigns that are still used today.

- Onset of disorder before age 2,5-3 years old sometimes after period of normal development in early childhood. Usually it's beautifultall children with a thoughtful, sleepy, detached face as if drawn with a pencil - “the face of a prince.”

- Autistic loneliness - inability to installwarm emotional relationships with people. Such children do not respond with a smile to the caresses and expressions of love of their parents. They do not like to be held or hugged. They are on parentsreact no more than to other people. They behave the same waypeople and inanimate objects. Practically not detectedAnxiety when separated from loved ones and in unfamiliar surroundings. Typical is the lack of eye contact.

- Speech disorder. Speech often develops with a delaywhich or does not arise at all. Sometimes it develops normally until2 years of age and then partially disappears. Autistic children are fewuse categories of “meaning” in memory and thinking. Somechildren make noise (clicks, sounds, wheezing, nonsense syllables)in a stereotypical manner with a lack of desire to communicate. Speech is usuallybut constructed according to the type of immediate or delayed echolalia or in the form of stereotypical phrases out of context, with incorrect usepronouns. Even by the age of 5-6, most children refer to themselves in the second or third person or by name, without using “I.”

- "An obsessive desire for monotony." Stereotypical and ritualnegative behavior, insistence on keeping everything unchangedand resistance to change. They prefer to eat the samefood, wearing the same clothes, playing repetitive games. De-The activity and play of autistic children are characterized by rigidity,repetitiveness and monotony.

- Bizarre behavior and mannerisms are also typical (for example- measures, the child is constantly spinning or swaying, fiddling with hisfingers or clapping).

- Deviations in the game. Games are more often stereotypical, non-functionalWe are not social either. Atypical manipulation of games predominateshands, lacks imagination and symbolic features. Cancelextreme addiction to games with unstructured material - sand- com, water.

- Atypical sensory reactions. Autistic children respond tosensory stimuli are either extremely strong or too weak(to sounds, pain). They selectively ignore what is addressed tospeech, showing interest in non-speech, often mechanical sounds.The pain threshold is often lowered, or an atypical reaction to pain.

Other symptoms may also occur in childhood autism. Outsidesudden outbursts of anger, or irritation, or fear, not causedfor any obvious reasons. Sometimes such children are either hyper-active or confused. Self-harming behavior in the form ofhead banging, biting, scratching, hair pulling. Sometimes there are sleep disturbances, enuresis, encopresis, and eating problems. In 25%cases there may be seizures in prepubertal orpuberty.

Originally Kanner believed that mental abilitieschildren with autism are normal. However, about 40% of children with autism have IQ below 55 (severe mental retardation); 30% - from 50 to70 (mild retardation) and about 30% have scores above 70.some children show abilities in some specificin the local sphere of activity - “fragments of functions”, despite the decrease in other intellectual functions.

Diagnostics

Criteria:

1) the inability to establish full-fledged relationships with peoplemi from the beginning of life;

2) extreme isolation from the outside world with ignoranceenvironmental irritants until they become painful unidentified;

3) insufficient communicative use of speech;

4) absence or insufficiency of eye contact;

5) fear of changes in the environment (“identity phenomenon” stva" according to Kanner);

6) immediate and delayed echolalia (“gramophone popwicked speech" by Kanner);

7) delayed development of the “I”;

8) stereotypical games with non-game objects;

9) clinical manifestation of symptoms no later than 2-3 years.When using these criteria it is important:

a) do not expand the content;

b) build diagnostics at the syndromic level, and not atthe basis of formal recording of the presence of certain symptoms;

c) take into account the presence or absence of procedural dynamicsdetectable symptoms;

d) take into account that the inability to establishcontact with other people will create conditions for social deprivationvation leading to symptoms of secondary developmental delays and com-pension formations.

Differential diagnosis

Incomplete syndromes are more common. They need to be distinguishedfrom psychoses of childhood, autistic psychopathy Aspirger. Childhood schizophrenia rarely occurs before the age of 7 years. Sheaccompanied by hallucinations or delusions, convulsive seizureski are extremely rare, mental retardation is not typical.

Should be excluded hearing disorders. Autistic children editbabble, while deaf children have relativelynormal babbling up to 1 year. Audiogram and evoked potentialscials indicate significant hearing loss in deaf children.

Developmental speech disorder differs from autism in that itThe child reacts adequately to people and is capable of non-verbal communication.

Mental retardation must be differentiated from children'sautism, since about 40-70% of autistic children suffer fromreal or severe mental retardation. Main differencesexpected features: 1) mentally retarded children are usually classified asto adults and other children in accordance with their age;2) they use speech, which they speak to one degree or another before communicating with others; 3) they have a relatively smooth pro-delay file without “shards” of enhanced functions; 4) in a child withIn childhood autism, speech is more affected than other abilities.

Disintegrative (regressive) psychosis (lipoidosis, leukodystrophy or Heller's disease) usually begins between 3 and 5 years of age. Illdevelopment begins after a period of normal development and progresses overover several months with the development of intellectual impairments in all areasbehavior with stereotypies and mannerisms. The prognosis is unfavorable.

3. Family therapy.

There is a need for diversity, versatility and complexity of treatment and rehabilitation measures with the unity of biological and psychological methods. Medical-pedagogical and psychologicalWhat kind of assistance is most productive at the main stages of formationpersonality development (up to 5-7 years).

Drug treatment.

The pathogenetic effect of medications is maximumup to the age of 7-8 years, after which medications provide symptomaticmatic action.

Currently, amitriptyline is the most recommendedmain psychotropic drug in children preschool age(15-50 mg/day), long courses for 4-5 months. Some researchers assign the role of an etiopathogenetic agent to vitamin B (in additionup to 50 mg/day). Applicable atypical antipsychotics risperidone (rispolept) in doses of 0.5- 2 mg/day for 1-2 years. When taking thembehavioral disorders are reduced, hyperactivity is reduced,stereotypies, fussiness and isolation, learning accelerates.

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

Tranquilizers have no effect on pathogenetic componentsNya. They affect neurotic symptoms. Benzodiazepines are more appropriate.

Traditional antipsychotics have an ambiguous effect on the clinical picture. Preferred drugs withouteffective sedative action (haloperidol 0.5-1 mg/day; triftazin 1-3 mg/day), sometimes small doses of neulsptil are effective. INIn general, neuroleptics did not provide significant and lasting improvement.baked. Replacement therapy (nootropil, piracetam, aminelon, pantogam, baclofen, phenibut) is used deployedsophomores for a number of years.

The prospects for drug therapy depend on the timing of initiation.la, regularity of intake, individual validity and inclusionimportance in the general system of treatment and rehabilitation work.

Third stage– developmental diagnostics: carried out by psychologists and teachers, aimed at identifying the individual characteristics of the child, characterizing his communicative abilities, cognitive activity, emotional-volitional sphere.

A set of techniques is of great research and scientific-practical interest all over the world. PEP(Psychoeducation Profile), proposed by American scientists E. Schopler and R. Reichler et al. in 1979. Currently PEP-3 is used. This technique was created and intended to assess the developmental characteristics of children with autistic disorders. In this methodology, along with a quantitative score, a qualitative assessment of various areas of mental activity of a child with autistic disorders or mental retardation is provided. The psychoeducational test is used to dynamically assess the development of mental functions, the presence of cognitive impairment and the severity of pathological sensory signs. The PEP scale, developed specifically for assessing the mental age and development of children with autistic disorders, mental retardation, allows you to determine the degree of maturity of 7 cognitive areas and parameters of the child’s mental activity: imitation, perception, fine motor skills, gross motor skills, hand-eye coordination, cognitive representations, verbal sphere. Along with this assessment, PEP allows you to assess the severity of autistic disorders in 5 autistic areas: affect, relationships, use of material, sensory patterns, speech features. The total score obtained as a result of completing 12 PEP subscales reflects cognitive (cognitive, intellectual) development and the possibilities of social adaptation and communication in patients with autistic disorders (Schopler E., Reichler R., Bashford A., Lansing M., Marcus L. ,1988).

Experimental psychological (pathopsychological) The study provides information about the individual psychological properties and mental state of a patient with ASD, which are necessary to clarify the diagnosis and select psychotherapeutic tactics. Intelligence scales used Wexler(the original version of WISC-IV, and its domestic modifications for children from 5 years to 15 years 11 months and for preschoolers from 4 to 6.5 years).

To study cognitive functions, memory studies are used: 10 words (or 5, 7 depending on the age and characteristics of the child), paired associations, methods for tactile and stereognostic memory; to study attention, encryption and Schulte tables are used (at the appropriate age); for the study of thinking include small subject classification, geometric classification, intersection of classes, inclusion of a subclass in a class, design of objects, Koos cubes, etc.; for the study of perception (visual) - Leeper figures, shape identification, perceptual modeling, sectional subject pictures.

To study emotions and personality, graphic samples are used (drawing of oneself, family, RNL and other options), plot pictures simulating everyday situations, recognition of facial expression of basic human emotions (grief, joy, pleasure, displeasure, fear, anger, seal), recognition of emotionally expressive movements, postures and gestures.

Neuropsychological diagnostic study

Aimed at identifying deviations of higher mental functions with analysis of the formation of the so-called. regulatory functions (programming, regulation and control). This allows you to assess the child’s cognitive activity and develop an individual correction program.

Instrumental studies

Among paraclinical methods in a multidisciplinary approach to the study of ASD, it is widely used electroencephalography (EEG). Sick children with both syndromic and non-syndromic (including psychotic) forms of ASD have certain EEG patterns that naturally change as the disease progresses and correlate with the characteristics of clinical conditions. This made it possible to identify unique EEG markers of some forms of ASD, which are used for differential diagnostic clarification. Despite the nosological nonspecificity of EEG, it can be used to detect the connection between certain changes in the electrical activity of the brain and clinical symptoms, and to establish the degree of their pathogenetic significance for resolving issues of diagnosis, prognosis, and selection of therapy.

An accessible and inexpensive EEG method, introduced into the standards of outpatient and inpatient care, allows not only to detect epileptic activity, but also to assess the level of maturity and functional activity of the brain. Sometimes, especially in children with mental development disorders, the functional characteristics of the EEG can be more informative than the results of MRI or PET studies, which often do not confirm abnormalities in brain development.

Neuroimaging methods: computed tomography, magnetic nuclear resonance imaging carried out according to indications.

Biological markers (test systems), along with clinical and pathopsychological data, make a significant contribution to resolving diagnostic issues, selecting individual therapy, and monitoring the condition of patients.

CLINICAL AND TYPOLOGY OF ASD

Kanner syndrome (F84.0)

Classic childhood autism - Kanner syndrome (KS) manifests itself from birth in the form of asynchronous disintegrative autistic dysontogenesis with incomplete and uneven maturation of higher mental functions, inability to form communication and is characterized by the presence of a “triad” of main areas of impairment: lack of social interaction (detachment, rejection, scarcity of eye contact, lack of adequate reactions to the emotions of others people), lack of mutual communication, as well as the presence of stereotypical regressive forms of behavior.

Receptive and expressive speech develops with a delay: there is no gesticulation, humming and babbling are poor. In expressive speech, the first words (in the form of echolalia, repetitions of the last and first syllables of words) appear in the second to fourth years of life and persist in subsequent years. Patients pronounce them melodiously, sometimes clearly, sometimes blurred. The vocabulary is replenished slowly; after three to five years, short cliche phrases are noted, and egocentric speech predominates. Patients with KS are not capable of dialogue, retelling, and do not use personal pronouns. The communicative side of speech is practically absent.

The lack of mutual communication is manifested in the absence of imitation games and creative play with peers.

Gross motor skills are angular with motor stereotypies, athetosis-like movements, walking with support on the toes, and muscular dystonia. The emotional sphere does not develop or develops with a great delay, there is no reaction of revitalization to attempts by parents to take them in their arms (with a pronounced symbiosis with the mother), and the distinction between friends and others is not formed. The revival complex arises spontaneously, within the framework of autistic interests, and is manifested by general motor excitement.

Instinctive activity in the form of eating behavior and inversion of the sleep-wake cycle are disrupted. Mental activity is impoverished, stereotypical with symptoms of identity and lack of imitation. Patients do not develop abstract thinking. In patients with KS, with a pronounced lag in the development of higher mental functions, dissociation and disintegration within individual spheres of mental activity are noted.

Course of the disease, outcome. Autism in severe form persists throughout life and stops the child’s mental development. A weakening of autistic symptoms is noted in the second (6-8 years) delayed critical age period (then a slight positive dynamics in speech development is possible, fine motor skills). Cognitive impairments are noted from infancy; by puberty, intelligence is reduced in 75% of cases (IQ) The absence of pronounced positive (productive) symptoms and obvious progression during the course of the disease serves as the basis for diagnosing the evolutionary-processual Kanner syndrome in the circle of “pervasive developmental disorders.”

Prevalence of Kanner syndrome 2: 10,000 child population.

Infantile psychosis (F84.02)

In childhood infantile psychosis (IP), manifest attacks with leading catatonic symptoms occur in the first 3 years of a child’s life, against the background of dissociated dysontogenesis or normal development. Catatonic disorders (CD), comorbid with ASD (DSM-V, 2013), occupy a leading place in the attack, and in most patients are of a generalized hyperkinetic nature (running in a circle, along a wall, from corner to corner, jumping, swinging, climbing , athetosis, shaking of the hands, walking with support on the toes, variable muscle tone). They have pronounced autonomic reactions and sweating. Motor agitation is accompanied by negativism. Children do not need to communicate with others, family and friends, they often “preserve their own territory”; with intervention, anxiety, aggression, crying, and rejection of communication arise. Speech is slurred, egocentric, incoherent, with perseverations and echolalia. The average severity of autism in a manifest attack on the CARS scale is 37.2 points (the lower limit of severe autism). The combination of catatonic disorders with autism in IP suspends the physiological (ontogenetic) development of the child during the attack and contributes to the formation of mental retardation. The duration of manifest attacks is 2-3 years.

In remission, children cannot sit still, they run, jump, and spin in a chair during classes. Noteworthy are motor clumsiness (violation of the proportionality of movements, disturbances of rhythm and tempo in complex movements, organization of movements in space). Excessive monotonous motor activity in patients is combined with attention disorders: easy distractibility or excessive concentration, “stuck” attention. At this stage of the disease, in a third of cases, patients are mistakenly diagnosed with Attention Deficit Hyperactivity Disorder (ADHD, DSM-5).

Patients are also characterized by stereotypical desires (retention of stool, urination, eating behavior with fixation on certain types of food). During the habilitation, by the age of 7-9 years, hyperkinetic syndrome (with a predominance of hyperactivity and impulsivity) is stopped in patients, mental retardation is overcome. Only under emotional stress does a fleeting “revival complex” arise with repeated stereotypical movements, which can be interrupted with a remark and the patient switched to other types of movements. Patients continue to have problems in independently organizing and planning pastimes. In the absence of outside help, social interaction is disrupted. Patients experience communication difficulties in building a full dialogue. Some patients continue to have a decreased interest in social relationships; attempts to make friends seem strange and usually end in failure. At puberty, patients are burdened by the absence of companions.

When infantile psychosis manifests itself as polymorphic attacks, catatonic disorders are short-term and are observed only at the height of the manifest attack.

Course of the disease, outcome. The dissociated mental retardation formed during the manifest attack in most cases is mitigated and overcome against the background of habilitation. IQ in all patients is > 70. Autism is losing its positive component and has decreased to an average of 33 points (mild/moderate on the CARS scale). In high-functioning autism, it was not determined using the CARS scale. In patients, the emotional sphere develops, developmental delays are overcome, and mild cognitive dysontogenesis remains. The age factor and development factor (positive trends in ontogenesis), rehabilitation contribute to a favorable outcome in 84% of cases (“practical recovery” - in 6%; “high-functioning autism” - in 50%, regressive course - in 28%). Nosology – childhood autism, infantile psychosis.

The prevalence of PV reaches 30–40 per 10,000 children.

Atypical autism (F84.1)

ICD-10 first formulated the concept of “atypical” autism, which has been given great importance in the last 10-15 years. Atypical autism in childhood includes the majority of the most severe forms of autism in various nosologies, in the structure of which autism often acts as a psychotic component (Bashina V.M., Simashkova N.V., Yakupova L.P., 2006; Simashkova N.V. ., 2006; 2013; Gillberg S., Hellgren L., 2004, etc.).

The accompanying ICD-10 research diagnostic criteria state that “autism may be atypical in age of onset (F84.10) and phenomenology (F84.11). Atypical autism (AA) includes psychotic (atypical childhood psychosis) and non-psychotic (moderate mental retardation with autistic features) variants.

1. ADP at the onset of the disease at an “atypical age” - after 3 years. The clinical picture is close to the previously described childhood infantile autism.

2. ADP with atypical symptoms - with onset in the first 5 years of life, the absence of a complete clinical picture of childhood autism, the similarity of the clinical picture of psychoses in different nosologies (schizophrenia, UMO, Rett syndrome, etc.).

3. Syndromic non-psychotic forms of AA, comorbid with UMO, chromosomal genesis in Martin-Bell syndrome, Down syndrome, Williams syndrome, Angelman syndrome, Sotos syndrome and a number of others; metabolic origin (with phenylketonia, tuberous sclerosis and others).

In atypical childhood psychosis, endogenous (F84.11 ) manifest regressive-catatonic attacks occur against the background of autistic dysontogenesis or normal development in the 2-5th year of life. They begin with a deepening of autistic detachment up to “extremely severe” autism (52.8 points on the CARS scale). The leading cause is regression of higher mental functions: speech, motor skills (with partial loss of walking), neatness skills, eating behavior (up to eating inedible things), regression of play. Catatonic disorders occur after negative ones (autistic and regressive). While most days on the move, some patients lie on a short time on the floor, chairs, “freeze”, then continue moving again. In the hands, monotonous movements of the ancient archaic rubro-spinal and striopalidal level are noted: “washing”, folding, rubbing type, hitting the chin, flapping the hands like wings. Their kaleidoscope is so large that behavioral phenotypes often change and are indistinguishable for different nosologies. Regression, catatonia, severe autism stop the child’s mental development . The duration of ADP attacks is 4.5-5 years.

Course of the disease and outcome. The course of the disease is 80% progressive and malignant. Remissions in endogenous ADP are of low quality, with the persistence of severe autism (42.2 points), cognitive deficit. Catatonic motor stereotypies are a continuous symptom throughout the course of the disease in the form of subcortical protopathic motor stereotypies. Habilitation is ineffective. Gross motor skills (walking skills) improve statistically significantly. Own speech is not formed; a third of patients develop echo speech. Thinking remains concrete, abstract forms of cognition are not accessible, and the emotional sphere does not develop. Delusions and hallucinations in patients do not appear in childhood, and an oligophrenia-like defect is difficult to distinguish from a pseudoorganic one 3-4 years after the onset of the disease. In 30% of cases, patients with ADP are trained in a type VIII correctional program, the rest are adapted to stay with a family or placed in social protection boarding schools. Atypical childhood psychosis according to ICD-10 criteria is encrypted under the heading of “general disorders of psychological development” with decreased intelligence (F84.11). Negative dynamics during the course of the disease and an increase in cognitive deficit allow us to make a diagnosis of malignant childhood schizophrenia (F20.8xx3) - a cultural aspect of the Russian Federation (ICD-10, 1999). In the USA, childhood schizophrenia is extremely rarely diagnosed before the age of 14, in Europe - before the age of 9. In ICD-10 (1994), the childhood form of schizophrenia is not distinguished; the differential diagnosis of childhood schizophrenia with atypical childhood psychosis is still relevant throughout the world. The diagnosis of DS should be made already at the stage of manifest regressive-catatonic psychosis without fear of “stigma in psychiatry.”

Psychotic syndromic forms of atypical autism with decreased intelligence (F84.11, F70) have a phenotypically universal clinical picture and in catatonic-regressive attacks do not differ from endogenous ADP (they go through similar stages in development: autistic - regressive - catatonic). They differ phenotypically in a set of motor stereotypies: subcortical catatonic - in patients with Down syndrome, archaic catatonic stem - in patients with ADP with Rett and Martin-Bell syndrome. They are united by the increase in asthenia from the stage of “regression” and the persistence of characteristic stereotypies throughout life.

Syndromic non-psychotic forms of AA, comorbid with UMO or “mental retardation with features of autism” can be traced in selected genetic syndromes (Martin-Bell, Down, Williams, Angelman, Sotos, etc.) and diseases of metabolic origin (phenylketonia, tuberous sclerosis, etc.), in which autism is comorbid with UMO ( F84.11, F70) .

There are no data on the prevalence of atypical autism in general in the medical literature.

Rett syndrome (F84.2)

A verified degenerative monogenic disease caused by a mutation in the MeCP2 regulatory gene, which is located on the long arm of the X chromosome (Xq28) and is responsible for 60-90% of cases of CP. Classic CP begins at 1-2 years of life with a peak of manifestation at 16-18 months and goes through a number of stages in its development:

In the first “autistic” stage (lasting 3-10 months), detachment appears, cognitive activity is disrupted, and mental development stops.

In stage II - “rapid regression” (from several weeks to several months), against the background of increasing autistic detachment, movements of an ancient, archaic level appear in the hands - a “washing” type, a rubbing type; there is a regression in the activities of all functional systems; slower head growth.

Stage III “pseudo-stationary” (up to 10 years or more). Autistic detachment weakens, communication, speech understanding, and pronunciation of individual words are partially restored. Regressive catatonic stereotypies persist. Any activity is short-term, patients are easily exhausted. In 1/3 of cases, epileptic seizures occur.

Stage IV – “total dementia” is characterized mainly by neurological disorders (spinal atrophy, spastic rigidity), complete loss of walking.

Course of the disease, outcome: unfavorable in 100% of cases, cognitive deficit increases. Death occurs at different times (usually 12-25 years after the onset of the disease).

Prevalence of SR : 1 in 15,000 children aged 6 to 17 years (orphan disease).

Other disintegrative disorders of childhood, Heller's syndrome (F84.3)

Heller's dementia is the loss or progressive deterioration of language, intellectual, social and communication abilities during childhood. Appears at the age of 2-4 years. Children are characterized by increased irritability and withdrawal. Their speech becomes incomprehensible, memory and perception disorders, anxious moods or aggressiveness are noted. Patients do not navigate social situations and often lose previously acquired neatness skills; they exhibit stereotypical movements. As a result of regression in behavior and impaired communication function, the assumption of childhood autism arises. The full clinical picture of dementia gradually develops.

Despite severe dementia, the patients’ facial features do not become coarse. In general, the disorder is progressive in nature. Prevalence of Heller syndrome: 0.1: 10,000 child population (orphan disease).

Hyperactive disorder associated with mental retardation and stereotypic movements (F84.4) V They are also extremely rare (less than 1: 10,000 children), and are classified as orphan diseases.

Asperger's syndrome (F84.5)

Evolutionary-constitutional Asperger syndrome develops from birth, but is usually diagnosed in patients in situations of integration into society (attending kindergarten, school).

Patients have deviations in two-way social communications, in non-verbal behavior (gestures, facial expressions, manners, eye contact), and are not capable of emotional empathy. They have early speech development, a rich vocabulary, good logical and abstract thinking. Patients with AS are characterized by original ideas. The communicative side of speech suffers, they speak when they want, do not listen to the interlocutor, often carry on a conversation with themselves, peculiar deviations in the intonation of speech and unusual turns of speech are typical for them.

Patients with AS strive, but do not know how to establish contacts with peers and older people, do not keep distance, do not understand humor, react with aggression to ridicule, and are not capable of emotional empathy.

Severe disturbances of attention, motor clumsiness, disharmony in development, poor orientation in people, in society, unceremoniousness in the realization of their desires lead to the fact that they easily become the object of ridicule and are forced to change schools, despite their good intelligence. Monomaniacal stereotypical interest in specific areas of knowledge, one-sided narrowly specific interests with directed training can form the basis of a future specialty and contribute to socialization.

Course of the disease, outcome. By the age of 16–17 years, autism softens, in 60% a schizoid personality with sensitive character traits is formed. Patients are successful in their chosen specialty; By the age of 30-40 they start a family.

In 40% of patients with SA, the condition may worsen during critical periods of development with the addition of phase-affective, obsessive disorders, masked by psychopathic-like manifestations, which are relieved with timely and effective pharmacotherapy and rehabilitation without further deepening personal identity.

DIFFERENTIAL DIAGNOSIS

Differential diagnosis of autism spectrum disorders should be carried out primarily within the ASD group, and then differentiated with other nosologies, using the capabilities of a modern clinical and biological approach. Classic evolutionary-processual childhood autism - Kanner's syndrome - should be differentiated from evolutionary-constitutional Asperger's syndrome. Similar in the type of dysontogenesis (which in both observations has a disintegrative, dissociated nature), they differ primarily in the time of verification of the onset of the disease, in the areas of speech and intellectual development, as well as in the characteristics of the motor sphere (see Table 1).

Table No. 1. Clinical differentiation of developmental autism

Asperger's syndrome		Kanner syndrome
Autism	Light/medium; softens over the years, social awkwardness persists	Severe autism persists for life, changes mental development
Speech	Early development of grammatically and stylistically correct speech	Patients begin to speak late, speech does not perform a communicative function (echolalia) and in 50% it develops poorly
Motor skills	Motor clumsiness	Gross motor skills are angular with motor stereotypies, athetosis-like movements, walking with support on the toes, muscular dystonia
Intelligence	High or above average. Patients are trained in general education program, receive higher education. After 35-40 years they start a family.	Cognitive impairment from birth. By puberty, intelligence is dissociatedly reduced (IQ They are trained according to a type VIII correctional program.

From a paraclinical point of view, these two types of non-psychotic autism are also different. In patients with AS, the main neurophysiological marker is the dominance of the alpha rhythm at a higher frequency than normal. The EEG in patients with KS shows a delay in the formation of the alpha rhythm, which is clearly visible at a younger age. As patients with KS grow older, EEG parameters become normal.

Pathopsychological indicators in Asperger syndrome are dissociative in nature within the framework of unexpressed cognitive dysontogenesis; in Kanner syndrome there is a distinct cognitive deficit.

Full text

In 1999, the WHO revision of ICD-10 (1994) was adapted for the practice of domestic psychiatry. The following section was introduced for the first time: General (pervasive) mental development disorders (F84.0), which includes: childhood autism, as a separate disorder, and a number of other types of autistic disorders, and, in particular, atypical autism (F84.1). Similar manifestations of autism previously had a slightly different verification and interpretation: “early childhood autism” (Kanner L, 1943; Wing L., 1972; Bashina V.M., Pivovarova G.N., 197); “autistic disorder” (Rutter M., 1979), “childhood or infantile psychosis” (Mahler M., 1952), “early childhood schizophrenia” (Vrono M.S. Bashina V.M., 1975 Bender L., 1972) ; autistic-like disorders" (Szatamari P., 1992, Bashina V.M. et al., 1999).

Term "pervasive" for the first time became used in American psychiatry (Campbell M., Shay J., 1995), and was introduced back in 1987 in the DCM-III-R, American Psychiatric Association (APA). Many specialists in childhood autism, such as L, Wing (1989 ), Ch. Gillberg (1995), B. Rimland (1996), considered this term unsuccessful, since this definition emphasized the distortion of mental development, and, as it were, leveled the structure of autistic conditions, it removed such a main symptom as autism beyond the scope of the main definition . Therefore, some psychiatrists have proposed calling the entire group of different autistic disorders “autism spectrum disorders,” or defining them as “autism-like disorders.” The wish remained unrealized.

Definition "atypical autism" was also formulated for the first time by the APA, introduced into the DCM-III - R in 1987, and borrowed from there into the ICD-10.

Purpose of this publication - consider the current state of the problem of atypical autism in children, give clinical and psychopathological characteristics of its forms studied to date. In accordance with this, the results of a clinical and dynamic study and treatment of sick children with different types of autistic disorders (about 7000 people) were used on the basis of outpatient and inpatient departments for autistic children at the National Center for Autistic Children of the Russian Academy of Medical Sciences, in the period 1984 - 2007. An attempt will be made to briefly outline the basic approaches to the main range of therapeutic and rehabilitation interventions for atypical autistic disorders in children.

Several main stages can be distinguished in the development of the problem of atypical autism. The first of them covers the period after the definition of the concept of “autism as a symptom” in adult patients with schizophrenia (Bleuler E., 1911, 1920). When the possibility of the formation of similar signs of autism was established in the range of childhood schizophrenia, schizoidia (Simson T.P., 1929; Sukhareva G.E., 1930), “empty autism” in children (Lutz J., 1937). The second stage covers 40–50 years, L. Kanner in 1943 described “autism” as a separate pathological condition in children, in which, from the first years of life, they showed an inability to make verbal, affective contact with loved ones and surrounding people, monotonous behavior, stereotypies in motor skills (such as “twirling with arms and jumping”), behavior, speech disorders and delayed mental development. This complex of symptoms came to be called “early childhood autism” (ECA), “Kanner childhood autism” or “Kanner syndrome”.

L. Kanner (1943) suggested that this syndrome is based on congenital disturbances of affectivity, and later, in 1977, based on follow-up studies, he suggested that this pathology refers to “schizophrenia spectrum disorders”, but is not identical to schizophrenia.

Further careful study of autism in children showed that it can represent not only a specific clinically defined syndrome - such as early childhood autism, but can be seen as separate features in Asperger's syndrome, Rett syndrome, schizophrenia, and, most importantly, be detected in a range of diseases caused by endogenous, and other chromosomal, metabolic pathology, organic brain lesions (Mnukhin S.S., Isaev D.N., 1969; Marincheva G.S., Gavrilov V.I., 1988; Krevelen van Arn D., 1977). Lately attention is drawn to autistic conditions that develop in connection with exogenous causes, post-stress situations in children from orphanhood, single-parent homes (Proselkova M.O., Bashina V.M., Kozlovskaya G.V., 1995; NissenG, 1971). As a result, by the age of 70-90, the idea had developed that autistic disorders constitute a group with a heterogeneous, heterogeneous background, against which only partially clinically similar manifestations of autism arise. Atypical autism was isolated from this group, which is reflected in the corresponding national and international classifications.

Epidemiology of atypical autism. The prevalence of atypical autism is 2 cases per 10,000 population (Popov Yu.V., Vid V.D. (1997). The prevalence of autistic disorders, including atypical forms of autism, is 54 or higher per 10,000 child population, Remschmidt H. (2003 ).

The introduction of ICD-10, WHO (1999) into the practice of domestic psychiatry, led to a sharp increase in the prevalence of autistic disorders in both domestic and foreign psychiatry, the incidence of schizophrenia in children significantly decreased (clinicians were essentially forced to impose new approaches to standardization and systematization of autistic disorders).

Classification atypical autistic disorders was developed not only by WHO, APA, in a number of other countries, but also in domestic psychiatry, Scientific center mental health RAMS (1999, 2004).

In order to reveal the essence of new trends in the interpretation of autism in children, we will consider in a comparative aspect ICD-10, WHO (1999) and the latest classification of autistic disorders of the Scientific Center for Mental Health of the Russian Academy of Medical Sciences (Tiganov A.S., Bashina V.M., 2005).

1. Childhood autism is endogenous:

1.1 Childhood autism, evolutionary, non-processual:

(Kanner syndrome, infantile autism, autistic disorder)

1.2 Childhood autism procedural:

1.21 - developing in connection with schizophrenic psychosis with onset before 3 years of age (early childhood schizophrenia, infantile psychosis)

1.22 - developing in connection with schizophrenic psychosis, in the period from 3 to 6 years (early childhood schizophrenia),

2. Asperger's syndrome (constitutional), development of schizoid psychopathy

3. Autism is non-endogenous, atypical:

3.1 - with organic damage to the central nervous system (cerebral palsy, etc.)

3.2 - with chromosomal pathology (Martin-Bell syndrome (X-FRA), Down syndrome, tuberous sclerosis)

3.3 - for metabolic disorders (phenylketonuria)

4. Rett syndrome

5. Psychogenic autism, exogenous (deprivation autism)

6. Autism of unknown origin

The taxonomy of autistic disorders of the National Center for Psychological Disorders of the Russian Academy of Medical Sciences (2005), was created, as in previous years, on the basis of evolutionary-biological and clinical-nosological theoretical concepts (Snezhnevsky A.V., 1972, Smulevich A.B., 1999, Tiganov A.S. , 1999, Panteleeva G.P., 1999). Taking these ideas into account, endogenous and non-endogenous types of autism have been identified. Endogenous childhood autism, in turn, was divided into - childhood autism, evolutionary, non-processual and procedural childhood autism, in connection with endogenous psychosis (attacks of early childhood schizophrenia, in the period from 0 to 3 years and from 3 to 6 years). Non-endogenous forms of autism correspond to its atypical types (previously defined as autistic-like) and are divided, depending on the soil in which they arise, into genetic (chromosomal), metabolic, organic groups of atypical autism. Asperger's, Rett's, and psychogenic autism syndromes are highlighted in separate sections, the description of which will not be discussed in this message.

F84 General disorders of psychological development

F 84.0 Childhood autism (onset 0 to 3 years),

F 84.02 Processual autism (beginning before 3 years of age)

F 84.1 Atypical autism

Atypical childhood psychosis (onset between 3-5 years),

Moderate mental retardation (MRD) with autistic features.

F 84.2 Rett syndrome.

F 84.3 Other disintegrative disorder of childhood (disintegrative psychosis; Heller syndrome; childhood dementia; symbiotic psychosis)

F 84.4 Hyperactive disorder associated with mental retardation and stereotypic movements

F 84.5 Asperger's syndrome

The construction of ICD-10 (1999) is based primarily on syndromic and age-related principles. At the same time, we can say that both classifications turned out to be close in terms of coverage of different types of autism, and in approaches to assessing the nature and genesis of psychopathologically similar autistic disorders, they were noticeably different. Main feature ICD-10 (1999), and its difference from both ICD-9 and the Classification of Autism of the National Center for Autism of the Russian Academy of Medical Sciences is the rejection of attempts to consider the origin, genesis of autistic disorders from an endogenous perspective, the rejection of clinical and nosological approaches, in the aspect of which until now in general Russian psychiatry, the nature of schizophrenia, autism, and Kanner's schizophrenia spectrum are considered.

The introduction of a new section into ICD-10: “Pervasive (general) disorders of psychological development” (F84.), which includes all types of autistic disorders and a new group of so-called atypical autism, clearly confirms the refusal to consider the autistic range of disorders in the aspect of psychoses of the schizophrenia spectrum. Not only atypical autism, but also other autistic disorders (childhood autism, childhood procedural autism), in this classification are removed from the circle of endogenous disorders, or “schizophrenia spectrum disorders according to Kanner.” In addition, the very principle of including autistic disorders in “atypical autism” F84.1 turned out to be unclearly defined not only in terms of nosology, but also in the syndromic and age-related assessment of these disorders. Thus, childhood psychosis, with onset at 3-5 years, classified as atypical autism, differs from childhood procedural autism, beginning at 0-3 years, only in the age of onset of psychosis, but not structurally psychopathologically. Another group of disorders, introduced into the rubric of atypical autism, as “UMD with autistic features,” remains insufficiently developed, in which the supposed genesis of autism seems to correlate with different pathological soils - organic, genetic, metabolic types, against which these types of atypical autism arise . In these cases of atypical autism, the question of the reason for their psychopathological similarity is explained by the result of phenocopying, equifinality (Mnukhin S.S., Isaev D.N., 1969, Simashkova N.V. et al., 2007), the question of the possible comorbidity of the actual manifestations of autism with disorders of a different nature remains undeveloped (Tiganov A.S., Bashina V.M., 2004).

The evolution of views on the nature of autism in domestic and foreign child psychiatry, as we see, is especially noticeable when comparing autistic disorders included in both of these taxonomies: ICD-10, WHO (1999) and the Classification of Autism of the Scientific Center for Clinical Prevention of the Russian Academy of Medical Sciences (2005). In conclusion, we can once again emphasize that if in previous definitions of autism, starting with Bleuler E.. and Kanner L., the provision about the schizophrenic nature of autism was fundamental, then in the latest classification of ICD-10 WHO (1999) this provision is about endogenous genesis or “schizophrenic spectrum of childhood autism” according to Kanner was excluded. In the deontological aspect, such an approach may have its advantages, but in therapy and prognosis it is not without its drawbacks.

It can be assumed that the recognition of different types of autistic disorders, with the ongoing revision of their clinical essence and ongoing attempts to make changes in approaches to their verification of the boundaries of treatment in foreign and domestic psychiatry, most of all reflects the continuing lack of knowledge of this problem, knowledge of the causes of different types of autism that arise during childhood...

Etiology and pathogenesis. As can be seen from the discussion of classifications of autism, there is no generally accepted concept of the etiology and pathogenesis of autistic disorders at this stage; the most common theories are psychogenesis and biological ones.

"Atypical Autism" (AA) (F84.1).

It includes: atypical childhood psychosis (group 1) and UMO with autistic features (group 2).

“Atypical childhood psychosis” (group 1).

It includes childhood psychosis, which develops in children between 3 and 5 years of age.

Clinical picture. Psychosis develops after a period of normal, stigmatized, or distorted mental development. Autochthonous changes of the autistic type are formed - in behavior, communication, arrest in mental development, but in some cases psychosis is provoked by exogenous, stressful, somatic factors. Psychotic manifestations deepen gradually. At the very beginning, features of detachment appear, communication disappears, speech regresses, play, interaction with others is impoverished and gradually or subacutely, erased neurosis-like, more defined in some cases, affective disorders are added, then features of regression or arrest (freezing in development) become noticeable. In development, all children develop catatonic, catatonic-hebephrenic, polymorphic positive symptoms characteristic of childhood schizophrenia.

Course of psychosis of varying length: from several months, on average from 6 m to 2 - 3 or more years, can be continuous, paroxysmal - progressive, with exacerbations and paroxysmal character. In addition to the positive psychotic symptoms During the course of psychosis, a stop in mental and speech development, the appearance of motor stereotypies, a disorder of self-awareness, symptoms of identity, emotional impoverishment with persistent autism are detected. The recovery from psychosis is usually drawn out. As a result, in the clinical picture, autistic manifestations slowly become erased and the features of mental retardation and changes in the motor sphere, in the form of remaining athetosis-like and other types of motor stereotypies, begin to be partially overcome. With active learning, speech, cognitive functions are restored, emotional recovery. Special deficiency states are formed with varying degrees of severity of the defect, similar to childhood autism syndrome, psychopathic manifestations as well as deeper personality changes of the Ferschroben type, symptoms of infantilism, mental retardation and other deficit-type damage.

In these cases, residual positive disorders of a catatonic, affective, neurosis-like type may be observed, which tend to revive again in exacerbations, become more complex and subside. A similar course is found in the states of childhood procedural autism, with the onset of the disease in the period from 0 to 3 years, as well as in atypical childhood psychosis, with the onset of 3 to 5 years. In the latter cases, the positive symptoms in the psychosis itself are more formalized and polymorphic, due to the higher mental development of the child preceding the psychosis. In these cases (in terms of the ideas prevailing in general psychiatry), as we see, an acquired deficiency state is formed, similar to YES, but not identical to it. It is characterized by a different onset and a more psychopathologically complex picture of psychosis, as well as a complex of residual psychopathological disorders, than those characteristic of DA.

The considered “atypical autism (F84.1), “atypical childhood psychosis”, according to the classification of autism by the National Center for Psychological Disorders of the Russian Academy of Medical Sciences (2005) occurs as a procedural disorder of the autistic circle, and accounts for approximately 50% of cases in the general cohort of patients with autistic disorders.

Atypical autism (F84.1) Various forms of UMO with autistic features ( 2nd group). According to ICD-10, manifestations of autism in the structure of mental retardation with autistic traits are comorbid with mental retardation of various origins. This type of disorder has not yet been studied enough and continues to be researched; a definitive list of such disorders has not been established (Bashina V.M., 1999; Simashkova N.V., Yakupova L.P., Bashina V.M., 2006; Simashkova N.V. 2006; Gillberg C., Coleman M., 1992).

J. Martin, J. Bell, X-FRA syndrome with autistic features. This syndrome was first described in 1943. In 1969, H. Lubs discovered in this disease an X chromosome with a gap in the subtelomeric region of the long arm of CGG in Xq27.3. Hence the main name of the syndrome - fragile X chromosome syndrome. In 1991, it was possible to show that in this syndrome there are multiple repeats of the CGG sequence in Xq27.3, which cause local hypermethylation and damage to protein synthesis. In the general population, healthy individuals have from 5 to 50 such trinucleotide repeats. Carriers of the mutant FMR1 gene have from 50 to 200 repeats. If the number of repeats exceeds 200, then the full phenotype of fragile chromosome syndrome - X is formed, and the methylated FMR1 gene does not produce protein. The functions of the protein are unknown; it is only assumed that the developmental processes of the central nervous system are distorted in such cases. In the brain, this protein is present in all neurons and is most fully represented in the gray matter. During embryonic development, FMR1 concentrations are especially high in the basal ganglia (giant cell nuclei), which supply cholinergic neurons to the limbic system. Males with a complete mutation are less intact than females; in 30% of cases, the latter do not have mental retardation. Frequency of occurrence 1: 2000 in males and from 2.5 to 6 per 100 among individuals suffering from UMO.

Clinical picture. Patients are characterized by a specific psychophysical phenotype, determined by special dysontogenetic stigmas. IQ varies from 70 to 35. In the first months of life, children usually develop normally, but by six months a mental retardation becomes noticeable, the formation of speech, gross motor acts, and walking slows down.

At this stage, limited communication gradually appears, rejection of tactile contact with the mother, the formation of an eye reaction and tracking is delayed, which is combined with timidity and avoidance of gaze. After the development of walking, motor disinhibition and attention deficit may be detected. By the age of 2–3 years, there is a noticeable lag in the formation of fine motor skills of the hands. Motor acts are impoverished, primitive, stereotypical movements in the fingers are possible, vaguely reminiscent of mannerisms in the fingers and hands of children with DA. Play activity is primitive and occurs alone. Behavior is autistic, with refusal of social interactions with family and peers.

Flow. Features of autism in FRA-X include the oscillating nature of detachment over short periods of time, with a periodic tendency to restore more complete communication. Against the background of a sluggish course, periods of more defined psychotic states are possible. Over the years, interests and activities become simplified, becoming more monotonous, torpidity increases in thinking and actions, and behavior acquires a stereotypical cliché-like character. Mastery of new forms of activity drops sharply. Reactions of protest and outbursts of irritability easily arise. The structure of mental underdevelopment is simplified, has a fairly uniform character, with a tendency to further aggravation.

Diagnosis is based on signs characteristic of the underlying disease (genetic and somatic markers) and on autistic symptoms inherent in this group of patients.

Down syndrome with a utistic features , (or trisomy on chromosome 21, in 5% a translocation is detected between chromosomes 21 and 14). AA in DS is observed in no more than 15% of cases (Gillberg Ch., 1995), after 2-4 years; according to Simashkova N.V., Yakupova L.P. (2003) in 51% of cases, from an early age. Then a refusal to communicate, withdrawal from peers, and stereotypical repetition of the same actions in protopathic games are typical. The severity of autistic manifestations varies, from small, easily autochthonously leveled at different stages of ontogenesis, to significant - approaching the character of DA, with some leveling in the prepubertal period. In other cases, in children with DS, namely in puberty, dysthymic disorders, empty manias with disinhibition of drives, anxiety, elementary deceptions close to abortive undeveloped psychotic states and severe psychoses are possible. Autistic manifestations in this age period in patients are more likely to resemble symptoms of autism in the structure of erased psychotic episodes.

Tuberous sclerosis (TS) with autistic traits. The clinical picture is characterized by an increase in dementia from the first years of life, lesions of the skin and other organs, and the presence of convulsive seizures. In almost half of the cases, these patients, from the second year of life, experience periodic motor agitation and general restlessness, which resembles field behavior with DA. Children become detached, refuse to play, and have difficulty moving from one activity to another. Detected low level motivations, negative reactions. Stereotypes in motor skills replace manual skills. Periodically, lethargy sets in, reaching immobility. Depressed mood with dissatisfaction is replaced by dysphoric mood - with foolishness. Characteristic sleep disorders: difficulty falling asleep, waking up at night. Over the years, these children experience increasing emotional devastation through detachment and withdrawal into themselves.

The combination of symptoms of underdevelopment and decay of acquired skills, speech that is absurd in content, used in an emotionally significant situation, creates a complex picture of a mental defect, with disorders of the autistic type. In such cases, an erroneous diagnosis of childhood autism is often made.

Phenylketonuria with autistic behavioral traits (PKU). The disease was first described in 1934 by pediatrician A. Foling. In 1960 S.E. Benda in PKU revealed autistic manifestations similar to early childhood autism in schizophrenia. Subsequently, similar facts were reported in the works of many authors (Marincheva G.S., Gavrilov V.I., 1988; Bashina V.M., 1999; Gillberg Ch., 1995, etc.). These children at birth have somatic and mental development is close to those in the normal child population. From 2-3 months, hypersensitivity and tearfulness appear, later - signs of mental retardation, from borderline to severe. After a year, the desire for communication disappears, up to active avoidance with detachment. Emotional deepens impoverishment, joylessness. Stereotypes in hand motor skills are characteristic. Hyperkinetic symptoms with impulsivity are replaced by states of akinesia with detachment. Drowsiness during the day is combined with difficulty falling asleep.

D diagnostics these conditions is difficult. In addition to autistic phenomena, asthenia with irritable weakness, prolonged dysthymia with dissatisfaction, hysteroform reactions, hyperesthesia, neurosis-like symptoms in the form of enuresis, stuttering, and fears are always found. In 1/3 of cases, epileptiform syndromes occur.

UMO in cases of combination of organic damage to the central nervous system with autistic features. The clinical picture contains signs characteristic of an organic lesion, the depth of autistic detachment is insignificant, the ability to more uniformly mental development(Mnukhin I.S. et al., 1967, 1969; Skvortsov I.A., Bashina V.M., Roitman V.A., 1997; Krevelen van Arn D., 1977). Clinical conditions in patients of this group in ICD - 10 (1999), with their great severity, are often verified as “Hyperactive disorder, combined with mental retardation and motor stereotypies.” This condition does not meet the criteria for “Childhood Autism” (F84.0), or “ Hyperkinetic disorder with attention deficit” (F90).

Differential diagnosis among different forms of autistic disorders.

In order to differentiate different forms of autism, the structure of dysontogenesis and symptoms of autism in children with childhood autism, atypical autism, and psychogenic autism was clarified. Along with psychopathological autistic manifestations, indicators of the development of cognitive, speech, motor, emotional, play areas of the child’s activity were analyzed, in dynamics age development, which allowed us to come to the following conclusions (Bashina V.M., 1980).

I). Childhood autism, or “classical childhood autism of the schizophrenia spectrum” according to L. Kanner, it is determined by disintegration, asynchrony in the development of the main areas of activity. At the same time, the displacement of archaic functions - by more highly organized ones - in the process of child development is upset. It is the disintegrative, dissociated type of dysontogenesis that is the main diagnostic marker of childhood autism of an endogenous nature. A.V. Snezhnevsky (1948) emphasized that the pathogenetic difference between dementia and psychosis is that dementia is characterized by persistent loss, and psychosis by disintegration, i.e. reversible mental disorder. This is precisely where dysontogenesis differs in nosologically different (endogenous and non-endogenous) groups of autistic disorders. The disintegrative process in the circle of childhood autism is not always reversible.

A similar type of dysontogenesis, i.e. also disintegrative dissociated - observed in atypical autism due to psychosis.

2) Atypical autism in the range of UMO with autistic traits of metabolic, chromosomal, organic origin (with Martin-Bell, Down, Rett, TS, PKU syndromes) o is determined primarily by the features of total, uniformly delayed and deeper dysontogenesis. In the structure of such grossly disrupted development, almost no features of asynchrony or manifestations of interlayering are revealed. Stigmas of dysgenesis in the physical status of the child, specific to a given nosological soil, are always found.

3) For psychogenic autistic conditions characterized by shallow, uniformly distorted dysontogenesis, mainly without features of asynchrony.

As we see, convincing facts have been obtained confirming that in the circle autistic disorders specifically dissimilar types of dysontogenesis such as disintegrative, dissociated underdevelopment are formed; - uniform, total underdevelopment; - uniform distorted development, which are diagnostic criteria for their demarcation. The difference between different types of autism, as already emphasized earlier, is confirmed by other psychopathological clinical, specific genetic and neurophysiological signs.

At the same time, it turned out that in the range of autistic disorders under consideration, with nosologically different backgrounds, the main manifestations of “autism” itself, as a sign - phenotypically relatively similar those. it notes the features of equifinality and clinically they are determined primarily mental symptoms detachment, immersion of the child into himself, isolation from the surrounding reality, transition to stereotypical, primitive forms of behavior and activity, up to the protopathic and even more ancient archaic levels in all spheres (motor, emotional, somatic, speech, cognitive).

(Let us present the diagnostic criteria for childhood autism in ICD-10 (1999), represented by a number of basic signs. 1. In children with childhood autism under the age of 3 years, the following are impaired: a) social (for communication purposes, the use of receptive and expressive speech, b) functional and symbolic gaming activity, c) development of mutual interaction; 2. Among pathological signs at least six of the following symptoms. Of these, at least two signs belong to the first subgroup and at least one to the others - a) qualitative changes in social interaction: - inability to use gaze, facial reactions, gestures and posture in communication for the purpose of mutual understanding, - inability to form social interaction with peers based on common interests, activities, emotions, - inability, despite the existing formal prerequisites, to establish age-appropriate forms of communication, - inability to socially mediated emotional response, absence or deviant type of response to the feelings of others, impaired modulation of behavior in accordance with the social context, or unstable integration of social, emotional, and communicative behavior - inability to spontaneously empathize with joy, interests, or activities with others; b) qualitative changes in communication - a delay or complete stop in the development of spoken language, which is not accompanied by compensatory facial expressions, gestures, as an alternative form of communication, - relative or complete inability to enter into communication or maintain verbal contact, at the appropriate level, with other persons, - stereotypies in speech, or inadequate use of words and phrases, word contours, - lack of symbolic games, in early age games with social content; c) limited and repeated, stereotypical patterns in behavior, interests, activities - attention to one or more stereotypical interests, abnormal in content, fixation on non-specific, non-functional behavioral forms, or ritual actions, stereotypical movements in the upper extremities, or complex movements the whole body, - predominant occupation with individual objects or non-functional elements of the game material; 3) the clinical picture does not meet the criteria for other developmental disorders, specific receptive language impairment, secondary socio-emotional problems, reactive or disinhibited attachment disorder of childhood, mental retardation, with emotional or behavioral disorders, with features of autism, schizophrenia. Rett syndrome).

Differential diagnosis.

With predominantly perceptual speech impairments, there are no symptoms of autism, no rejection of others, there are attempts at non-verbal forms of contact, articulation disorders are less typical, and there are no speech stereotypies. They have no manifestations of disintegration, a more even IQ profile.

Children with hearing impairments do not reject their relatives; they prefer to be in a crib rather than in their arms.

With UMO without autism features, the intellectual decline is more total and uniform, children use the meaning of words, and the ability to communicate emotionally is revealed, especially with Down syndrome.

With Rett syndrome, there are specific stereotypical violent movements in the hands, such as “washing, rubbing”, and progressive neurological pathology increases.

Patients with Tourette's syndrome have more intact and different speech skills, awareness of the painful nature of behavioral disorders and the ability to mitigate tics and violent movements in therapy (cited from ICD-10).

Additionally, the basis for the differential diagnosis of childhood autism with atypical autism is The principle of the presence or absence in the clinic of pathological signs of organic, genetic, metabolic, exogenous genesis is laid down, as is the case with an atypical autism background of cerebral palsy, with Down syndrome, X-PRA, phenylkentonuria, para-autistic conditions due to early orphanhood and other exogenous pathology.

Treatment and organization of assistance to patients with different types of autism. There is no specific therapy for autistic disorders, and therefore therapy is predominantly symptomatic. .

The combination in the vast majority of cases of atypical autism of mental retardation of varying degrees of severity, with dissociation and disintegration in the formation of individual spheres of mental activity, as in a number of forms of atypical autism (atypical psychosis) - the presence of positive psychopathological disorders, has raised the need for the use of complex pharmacotherapy, including not only antipsychotics, but also substances with neuroprotective, neurotrophic effects (I.A. Skvortsov, V.M. Bashina, N.V. Simashkova, M.G. Krasnoperova et al., 1993, 2000, 2002, 2003). The main goal of treating these patients is to influence psychopathological symptoms and associated behavioral disorders, as well as somatoneurological manifestations of the disease, stimulate the development of functional systems, cognitive functions, speech, motor skills, necessary skills or maintain their preservation, create prerequisites for learning opportunities. For these purposes, pharmacotherapy is used (psycho- and somatotropic drugs, in combination with nootropic drugs). Complex method in addition, it necessarily includes specific sensory stimulation of the analyzers of vision, hearing, and motor system, through the use of hardware influences and methods of psychological, pedagogical, and speech therapy correction (by working with a speech therapist, defectologist, psychologist).

All types of therapeutic interventions for childhood autism are applied on an individual basis. clinical assessment condition of the patients. When conducting psychopharmacotherapy special caution is necessary, since patients with autistic disorders, due to age-related immaturity and the nature of the disease itself (the structure of which includes numerous somatic and neurological abnormalities), are often hypersensitive to drug effects. To prevent the latter, in all cases it is necessary thorough examination, including biochemical blood tests, liver and kidney function, computed tomography, electroencephalographic and other examinations.

The presence of autistic disorders in children, leading to a delay and arrest of mental development, serves as the basis for the rehabilitation of these groups of patients and the constant search for new therapeutic approaches.

Pharmacotherapy in patients with autism it is indicated for severe aggressiveness, self-injurious behavior, hyperactivity, catatonic stereotypies and mood disorders. In these cases, antipsychotics, tranquilizers, antidepressants and sedatives are used.

To correct sleep disorders, tranquilizers can be used for short periods due to addiction to them, hypnotics and drugs aimed at normalizing the circadian rhythm of sleep - wakefulness.

Nootropics, biotics, amino acids (instenon, glycine, cogitum, biotredin, gliatilin and others) have already proven themselves quite well, as well as complex drugs such as Cerebrolysin, Cortexin, which carry nerve growth factors and influence the development and functional restoration of higher nervous activity.

Psychotherapy in case of autism, it is aimed both at the child himself and at his relatives. In the first case, its goal is to correct behavioral disorders and relieve anxiety and fears in the child, in the second - to alleviate emotional tension and anxiety among family members, especially parents, and involve them in everyday work with the child after familiarizing themselves with the techniques of proper handling with him, learning the peculiarities of education.

Psychotherapy for childhood autism is an integral part of multifaceted, general correctional work and is therefore carried out by various specialists. The optimal composition of a group of specialists providing treatment and psychological and pedagogical correction for autistic children: child psychiatrists, neurologists, speech therapists, psychologists, defectologists, teacher educators, nurse educators, music workers (eurythmists).

At the preliminary stage in correctional programs Based on the simplest tactile, pantomimic and other types of contacts with the child in conditions of free choice and field behavior, the level of his development, stock of knowledge and behavioral skills is assessed by specialists of various profiles. This assessment serves as the basis for developing an individual plan for pedagogical correction work.

Corrective work in general, can be considered as rehabilitation, covering physiologically favorable periods for the child’s development - in the period of 2-7 years. Corrective measures must be continued in all subsequent years (8-18 years), they must consist of systematic pedagogical and speech therapy correctional classes, daily for months and years, because only in this case can social adaptation of patients be achieved.

It is advisable to complement clinical and pedagogical work throughout its entire duration with neurophysiological research (electroencephalography, which allows us to objectify the structural and functional maturation of the central nervous system in children with autism in the process of ontogenesis and therapy.

Bashina V.M. General mental development disorders. Atypical autistic disorders // Childhood autism: research and practice. pp. 75-93. Copy

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Original nootropic drug for children from birth and adults with a unique combination of activating and sedative effects

Effective pharmacotherapy and rehabilitation of patients with autism spectrum disorders

Published in the magazine:
"Neurology and Psychiatry"; No. 3; 2011; pp. 14-22.

Doctor of Medical Sciences N.V. Simashkova
Scientific Center for Mental Health of the Russian Academy of Medical Sciences

Autism spectrum disorders (ASD) in childhood are attracting increasing attention from researchers and clinicians general practice due to their high prevalence (50-100 per 10,000 children), resistance to pharmacotherapy, insufficient development of habilitation approaches, and disability of patients. Experts are unanimous that therapy should be “multimodal”; doctors, psychologists, social educators, parents, and teachers should actively participate in the development of treatment and rehabilitation programs. This helps to improve the social adaptation of children with autistic disorders.

An analysis of the literature data, taking into account the latest reviews on drug therapy, showed that, despite some progress in this area, at the present stage, pharmacotherapy has not become a causal (pathogenetic) method of treating ASD. This is explained by the fact that medications do not act on the cause of the disorder; they are prescribed for symptomatic treatment of various syndromes and forms of ASD. Clinical observations show that none of the treatment methods is effective for all patients, in addition, each method has its own disadvantages. Autism is characterized by a disorder of mental development, an autistic form of contact with others, speech and motor disorders, stereotypic activity and behavior, which lead to persistent social maladjustment. That is why autism must be diagnosed as early as possible in order to begin habilitation measures on time and not to miss sensitive periods of child development, when autistic symptoms become established and progress. When diagnosing ASD, we relied on ICD-10, adapted for practice in the Russian Federation. ASD can be presented as a continuum of autistic disorders, on one side of which there is developmental-constitutional Asperger's syndrome, on the other - atypical childhood psychosis of schizophrenic origin; childhood psychosis occupies a central position (Fig. 1).

Rice. 1. Autism spectrum disorder continuum

Asperger's syndrome
Asperger's syndrome (F84.5) occurs in 30-70 children out of 10,000. Evolutionary-constitutional autism usually manifests itself upon integration into society (attending kindergarten, school). Patients exhibit deviations in bilateral social communication, nonverbal behavior(gestures, facial expressions, mannerisms, eye contact); patients are not capable of emotional empathy. Severe impairments of attention and motor skills, lack of effective communication in society make them an object of ridicule, forcing them to change schools even if the child has good intellectual abilities. Patients with Asperger's syndrome have early speech development, a rich vocabulary, the use of unusual speech patterns, unique intonations, good logical and abstract thinking, as well as a monomanic stereotypical interest in specific areas of knowledge. By the age of 16-17 years, autism softens, in 60% of cases a diagnosis of schizoid personality disorder (F61.1) can be made; in 40% of patients, the condition worsens during critical periods of development with the addition of phase-affective, obsessive disorders, often masked by psychopathic manifestations. With timely and effective pharmacotherapy, a favorable outcome of the disease is observed without further aggravation of personality disorders.

Kanner syndrome
Clinical manifestations of the evolutionary-processual Kanner syndrome (F84.0) are determined by asynchronous disintegrative dysontogenesis with incomplete maturation of higher mental functions. Kanner syndrome manifests itself from birth and is characterized by the presence of the following disorders: a lack of social interaction, communication, and the presence of stereotypical regressive forms of behavior. Receptive and expressive speech develops with a delay, there is no gesticulation, echolalia, cliched phrases, and egocentric speech are preserved. Patients with Kanner syndrome are not capable of dialogue, retelling, and do not use personal pronouns. The level of intellectual development is reduced in more than 75% of cases (IQ< 70). Крупная моторика, угловатая, с атетозоподобными движениями, ходьбой с опорой на пальцы ног. Отмечаются негативизм, мышечная дистония. Нарушения инстинктивной деятельности проявляются в форме расстройств пищевого поведения, инверсии цикла сна и бодрствования. Аутизм в тяжелой форме сохраняется на протяжении всей жизни. Отсутствие выраженных позитивных симптомов, прогредиентности, тенденция к частичной компенсации интеллектуального дефекта к 6 годам служат основанием для выделения синдрома Каннера в отдельную подрубрику классического детского аутизма в рамках «общих нарушений психического развития». Распространенность синдрома Каннера в популяции - 2 случая на 10 000 детей.

Childhood psychosis
Manifest catatonic attacks occur in the first 3 years of life against the background of dissociated dysontogenesis or normal development. Catatonic disorders occupy a leading place in psychosis and are hyperkinetic in nature. Patients are excited, run in circles or in a straight line, jump, sway, climb up with the agility of a monkey, and make stereotypical movements (athetosis, shaking hands, clapping). Speech is slurred, with echolalia and perseverations. The severity of autism on the CARS scale is 37 points (the lower limit of severe autism). The duration of attacks is 2-3 years. The combination of catatonia with autism suspends the physiological development of the child during the attack and contributes to the formation of secondary mental retardation. In remission, patients exhibit hyperdynamic syndrome as a secondary negative disorder at the exit from catatonia. Affective and psychopathic-like (aggression, eating disorders, stool retention, urination) disorders, cognitive dysontogenesis with impaired attention, slowness of thought processes, motor clumsiness, with good cognitive activity are observed. When childhood psychosis manifests itself as polymorphic attacks, catatonic disorders, along with affective, neurosis-like disorders, are noted only in the manifest attack. Autism in remission loses its positive component and decreases to an average of 33 points (mild/moderate according to CARS). The age factor and development factor (positive trends in ontogenesis), timely habilitation contribute to a favorable outcome in 84% of cases (6% - practical recovery, 50% - high-functioning autism, 28% - regressive course). This allows us to consider childhood psychosis as a separate nosological unit “childhood autism” (F84.0), outside the diagnosis of schizophrenia.

Atypical autism
ICD-10 identifies several types of atypical autism (F84.1). If the disease begins to develop after the age of 3 years, then the clinical picture of atypical childhood psychosis (ACP) does not differ from childhood psychosis. Manifest regressive-catatonic attacks occur against the background of autistic dysontogenesis in the 2-3rd year of life. They begin with a deepening of autistic detachment with rapid regression of speech, gaming skills, neatness, and eating disorders (eating inedible things). Catatonic disorders, mainly in the form of motor stereotypies, occur after negative symptoms, against the background of asthenia. In the hands, movements of the ancient archaic level are noted: washing, folding, rubbing type, hitting the chin, flapping the hands like wings. The duration of attacks in atypical childhood psychosis is 4.5-5 years. Regression, catatonia, severe autism contribute to the formation of an irreversible oligophrenia-like defect already during the period of a manifest attack. Remissions in atypical childhood psychosis are short-term, of low quality, with the preservation of catatonic stereotypies. Autism as a primary negative symptom of deficiency is observed in patients with ADP throughout the course of the disease in severe form (an average of 46 points on CARS). The outcome of the disease is unfavorable. All patients are uneducable, in 1/3 of cases they are placed in boarding schools of the social security system. Negative dynamics during the course of the disease with an increase in cognitive deficit allows us to consider atypical childhood psychosis within the framework of childhood schizophrenia (F20.8). Atypical psychoses within the framework of identified genetic syndromes for mental retardation (MR) (F84.11, F70) have a phenotypically universal clinical picture in regressive-catatonic attacks. They can be traced in selected genetic chromosomal syndromes (Martin-Bell, Down, Williams, Angelman, Sotos, etc.) of metabolic origin (phenylketonuria, tuberous sclerosis, etc.), where autism is comorbid with UMO. They are also united by the increase in asthenia from the “regression” stage. They differ in a set of motor stereotypies: subcortical catatonic type - in patients with atypical psychosis in Down syndrome, archaic catatonic brainstem - in patients with Rett and Martin-Bell syndromes.

Rett syndrome
Rett syndrome (F84.2) is a verified degenerative monogenic disease caused by a mutation in the MeCP2 regulatory gene, which is located on the long arm of the X chromosome (Xq28) and is responsible for 60-90% of cases of the disease. The prevalence of Rett syndrome is 1 in 15,000 children aged 6 to 17 years. Classic Rett syndrome manifests itself at 1-2 years of life with a peak at 16-18 months and goes through a number of stages in its development:

in I, “autistic”, detachment appears, cognitive activity is disrupted, mental development stops;

in stage II of “rapid regression” of all functional systems, movements of the ancient, archaic level - washing, rubbing type - appear in the hands; head growth slows down;

on Stage III, “pseudo-stationary” (up to 10 years or more), autistic detachment weakens, communication, speech understanding, and pronunciation of individual words are partially restored. However, any activity is short-term in nature and is easily exhausted. In 1/3 of cases, epileptic seizures occur;

Stage IV of “total dementia” is characterized by neurological disorders (spinal atrophy, spastic rigidity, complete loss of walking) and is observed only in non-psychotic SR.

Death occurs 12-25 years after the onset of the disease.

Treatment and rehabilitation of patients with ASD
In connection with the improvement of psychiatric care, the expansion of the range of indications for the prescription of psychotropic drugs, the emergence of new dosage forms, the characteristics of drug pathomorphosis, and the influence of the age factor on the results of therapy, the issues of pharmacotherapy and rehabilitation of ASD are of particular relevance. Habilitation efforts are aimed at relieving positive symptoms of the disease, reducing cognitive impairment, mitigating the severity of autism, social interaction, stimulating the development of functional systems, and creating the prerequisites for learning opportunities. In each case, before prescribing drug therapy, a detailed diagnosis and careful analysis of the relationship between the desired effect and undesirable ones is required. side effects. The choice of drug is made taking into account the characteristics of the psychopathological structure of the disorder, the presence or absence of concomitant mental, neurological and somatic disorders. The difficulties of conducting psychopharmacotherapy for ASD lie primarily in the fact that new generation drugs (atypical neuroleptics, antidepressants) are not recommended for use in childhood for one reason or another (lack of drug testing, evidence of effectiveness, etc.). That is why the arsenal of drugs for the treatment of ASD is limited. When choosing a drug, you should be guided by the list of registered medicines approved for use in children and the recommendations of manufacturing companies in accordance with the laws of the Russian Federation (Table 1, 2, 3). If there are pronounced fluctuations in affect (affective disorders) in the clinical picture, mood stabilizers should be prescribed, which also have an antipsychotic effect (Table 4). Sodium valproate is also used to relieve motor and behavioral stereotypies. For all types of ASD, nootropics and substances with nootropic effects are widely used (Table 5).

Table 1.

The most commonly used antipsychotics in patients with ASD

International nonproprietary name
Alimemazine, tab.	from 6 years old
Haloperidol, drops	from 3 years of age, with caution for children and adolescents
Haloperidol, tab.	from 3 years
Clopixol
Clozapine, tab.	from 5 years old
Levomepromazine, tablet.	from 12 years old
Periciazine, caps.	from 10 years old with caution
Periciazine, drops	from 3 years old
Perphenazine	over 12 years old
Risperidone, oral solution	from 15 years old
Risperidone, tablet.	from 15 years old
Sulpiride	from 6 years old
Trifluoperazine	over 3 years old, with caution
Chlorpromazine, tablet, dragee	from 5 years old
Chlorpromazine, solution	after 3 years
Chlorprothixene, table.	no exact data

Table 2.

The most commonly used antidepressants in patients with ASD

Table 3.

The most commonly used tranquilizers and hypnotics in patients with ASD

Table 4.

The most commonly used anticonvulsants in patients with ASD

Table 5.

The most commonly used nootropic drugs in patients with ASD

Name	Age of permitted use
from 1 year of life
Phenibut	from 2 years
Nootropil	from 1 year
Cortexin	from 1 year
Cerebrolysin	from 1 year of life
Semax	from 3 years old
Glycine	from 3 years old
Biotredin	from 3 years old
Multicomponent drugs
Instenon	childhood
Drugs that improve metabolism and blood circulation in the brain
Elkar	from 1 year
Actovegin	from 1 year
Gliatilin	from 3 years old
Vinpocetine	from 3 years old
Cinnarizine	from 3 years old
Akatinol-memantine	children's age, no exact data

Pharmacotherapy of patients with Asperger's syndrome
In the treatment of Asperger's syndrome, preference is given to course treatment with nootropics (Phenibut, Pantogam 250-500 mg/day); neuropeptides and their analogues (Cerebrolysin - 1.0 No. 10, Cortexin - 5-10 mg 2.0 No. 10, Cerebramin - 10 mg/day for 1 month, Semax 0.1% - 1 drop in the nose for 1 month), as well as cerebrovascular means (Cavinton, Stugeron). For AS with phase affective disorders masked by psychopathic-like, obsessive-compulsive symptoms, antidepressants are administered: Anafranil (25-50 mg/day), Zoloft (25-50 mg/day), Fevarin (25-50 mg/day); mood stabilizers, anticonvulsants - Finlepsin, Tegretol (200-600 mg/day); sodium valproate (Depakine, Konvulex up to 300 mg/day).

Pharmacotherapy of patients with Kanner syndrome
In patients with Kanner syndrome, complex treatment is used. Neuroleptics aimed at developing cognitive functions (Triftazine - 5-10 mg/day, Etaperazine - 4-8 mg/day, Azaleptin - 6.2525 mg/day), combined with a course of nootropics (Phenibut, Pantogam) - 250-500 mg /day; neuropeptides and their analogues (Cerebrolysin, Cortexin, Cerebramin, Semax 0.1%); multicomponent medicines(Instenon - 0.5-1 tablet/day for 1 month, Actovegin - 1 tablet/day for 1 month); cerebrovascular drugs (Cavinton, Cinnarizine, Stugeron); amino acids (Glycine 300 mg/day, Biotredin 100 mg/day); to stimulate the main analytical systems, the glutamatergic drug akatinol-memantine is used - 1.25-2.5 mg/day.

Pharmacotherapy of patients with psychotic forms of autism
Patients with psychotic forms of autism (childhood psychosis, atypical childhood psychosis, atypical psychosis in UMO) are also prescribed complex treatment with the basic use of antipsychotics. When excited, typical antipsychotics with a sedative effect are prescribed: Aminazine (25-75 mg/day), Tizercin (6.25-25 mg/day), Teraligen (5-25 mg/day), Sonapax (20-40 mg/day) ; Chlorprothixene (15-45 mg/day); Haloperidol (0.5-3 mg/day), etc. To overcome cognitive deficit, typical antipsychotics are used (Triftazine 5-10 mg/day, Etaperazine 4-8 mg/day), atypical antipsychotics (Azaleptin 6.25-25 mg/day , Rispolept 0.5-1 mg/day). To overcome developmental delays during an attack, and especially in remission, nootropics, neuropeptides, amino acids, and drugs of other pharmacological groups with elements of nootropic activity are administered (Elkar). Among the nootropic drugs, one can highlight the drug Pantogam with a wide range of clinical applications, which in combination with Elkar is used for the treatment of attention deficit hyperactivity disorder (ADHD) upon recovery from catatonic attacks in remission. The use of Pantogam helps relieve asthenia, improve cognitive functions (cognitive activity, attention, memory), increases the speed of mental processes; mitigating the manifestations of neurolepsy, which is especially important in childhood. Elkar as a means for correction metabolic processes used to treat eating disorders (one of the forms of psychopathic-like disorders in ASD). For the treatment of psychotic forms of ASD, mood stabilizers and anticonvulsants are used - Carbamazepine, Finlepsin, Tegretol (200-600 mg/day); sodium valproate (150-300 mg/day); tranquilizers are used - Seduxen, Relanium, Sibazon (2.5-5 mg/day), Clonazepam (0.5-1 mg/day); antidepressants - Amitriptyline (6.25-25 mg/day), Anafranil (25-50 mg/day); Ludiomil (10-30 mg/day); Zoloft (25-50 mg/day); Fevarin (25-50 mg/day). A new stage in the pathogenetic treatment of DP and ADP of schizophrenic origin both in Russia and abroad is the combined use of neuroleptics with immunotropic drugs, which allows overcoming therapeutic resistance and promotes the development of higher mental functions.

Treatment of Rett syndrome and atypical autism in UMO
Therapy for Rett syndrome and atypical autism in UMO includes the use of neuropeptides and their analogues (Cerebrolysin, Cortexin, Cerebramin, Semax); amino acids (Glycine, Biotredin), cerebrovascular agents (Cavinton, Cinnarizine, Stugeron), anticonvulsants - carbamazepine (Finlepsin, Tegretol); sodium valproate (Depakine, Konvulex). An indispensable tool for correcting metabolic processes, especially those disturbed in the late stages of Rett syndrome, is Elkar (a drug related to B vitamins).

Non-drug correction
The integrated use of drug and non-drug treatment methods in combination with neuropsychological and psychological-pedagogical correction, social work with the patient and his family is one of the fundamental principles of the supervision of autistic disorders in children. Corrective work should begin at an early stage of the formation of autistic disorders, at a time physiologically favorable for the child’s development (from 2 to 7 years - the period of active ontogenesis), continue in subsequent years (8-18 years) and be carried out by a team of specialists (child psychiatrists, physical therapy doctors , psychologists, speech therapists, speech pathologists, music workers, etc.).

Specialized assistance for children with autism
Inpatient care is provided in child psychiatry departments, where beds are open for the mother and child to stay together, and in day hospitals. The main principle of treatment is a biosocial integrated approach, including medication, psychotherapeutic, defectological assistance according to the programs of the National Center for Rehabilitation of the Russian Academy of Medical Sciences - TEACCH; behavioral therapy - ABA, etc. The outpatient stage of care follows the inpatient stage or is independent and includes, along with drug therapy, more extensive pedagogical correction in centers for psychological, medical and social support, speech therapy, audiology, correctional kindergartens, schools, and mental health centers. Music lessons have a positive effect on the communication abilities of a child with autism. By communicating with animals (horses, dogs, dolphins), children with ASD learn to establish relationships with people. Receiving an adequate education is one of the main and essential conditions for the successful socialization of children with ASD. Currently in Russia, in the existing structure of school education, patients with ASD can be taught in special (correctional) educational institutions: for children with severe speech impairments (V type), for children with mental retardation (VII type), for mentally retarded children (VIII type), schools for individual education at home for disabled children. In addition, in Russia, the process of integrating children with ASD in general educational institutions is developing (correctional classes in general educational institutions and teaching children with ASD in the same class with children who do not have developmental disorders). It is possible to train patients with ASD according to an individual curriculum or an individual correctional training program.

Working with the child's family and environment
Parents of patients with ASD also need help: psychotherapeutic support, training in skills to overcome a crisis situation, ways of constructive interaction between all family members. Psychoeducational training for parents, focused on the needs of a particular child with autism, is one of the components of a multimodal family assistance program. Without specialized habilitation, the majority of autistic children (75-90%) become severely disabled, while with timely and adequate correction, up to 92% have the opportunity to study according to the school curriculum, and almost all can adapt to the family environment. The results of clinical follow-up observation (more than 20 years) of a cohort of 1,400 patients aged 3 to 7 years with autistic disorders who received care in a semi-inpatient facility for patients with autism at the Scientific Center for Mental Health of the Russian Academy of Medical Sciences (1984-2010, show that 40% of patients were able to study under the program of mass and correctional schools for children with severe speech impairments (type V), 30% - in schools for children with mental retardation (type VII), 22% - in correctional schools for mentally retarded children (type VIII). Only 8% of sick children with malignant forms of autistic disorders are placed in boarding schools of the district social protection department.

conclusions
Autism in childhood remains a pressing problem in psychiatry at present. Autistic disorders in children due to dissociation in the development of higher mental functions with asynchrony and the influence of positive trends in ontogenesis outside of exacerbations of the disease can be corrected with effective pharmacotherapy and rehabilitation. In the treatment of ASD, much attention is paid to nootropic drugs, means of correcting metabolic processes, among which Pantogam, Elkar are widely used in combination with antipsychotics and drugs of other pharmacological groups. More economical outpatient forms assistance based on a multimodal approach occupy a leading place in the habilitation of patients.

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Atypical psychosis in children Various psychotic disorders in children younger age, characterized by some manifestations characteristic of early childhood autism. Symptoms may include stereotypic repetitive movements, hyperkinesis, self-injury, speech delay, echolalia and disturbance social relations. Such disorders can occur in children with any level of intelligence, but are especially common in mentally retarded children.

Brief explanatory psychological and psychiatric dictionary. Ed. igisheva. 2008.

See what “Psychosis in children is atypical” in other dictionaries:

"F84.1" Atypical autism- A type of pervasive developmental disorder that differs from childhood autism (F84.0x) either by age of onset or by the absence of at least one of three diagnostic criteria. So, this or that sign of abnormal and/or impaired development for the first time... ... Classification of mental disorders ICD-10. Clinical descriptions and diagnostic guidelines. Research diagnostic criteria

List of ICD-9 codes- This article should be Wikified. Please format it according to the article formatting rules. Transition table: from ICD 9 (chapter V, Mental disorders) to ICD 10 (section V, Mental disorders) (adapted Russian version) ... ... Wikipedia

Delirium- (Latin delirium – madness, insanity). Syndrome of confusion, characterized by severe visual true hallucinations, illusions and pareidolia, accompanied by figurative delusions and psychomotor agitation, violations... ... Explanatory dictionary of psychiatric terms