Autism Symptoms in Children
Infantile Autism was first described by L. Kanner.Manifestations of early childhood autism long before that describe GE Sukharev (1925) and TP Simeon (1929).For Kanner's syndrome is characterized by a triad of symptoms:
1. The inability to establish relationships with others, especially with the mother.There is no emotional reaction to it (autistic form), or the child's mother repels from itself (negativistic form).He does not notice their peers and seeks solitude.There is the same relationship as human beings and to inanimate objects ( "protodiakrizis" Monakova).
2. Disorders of speech expressed in egocentric speech, verbigeration, echolalia, mutism.Children are not used in relation to itself and form pronouns in the first person (for example, expressing the desire to get a toy, she says: "Writing"), specificity is a stand-alone speech.Used the opening words ( "as they say. You see ..."), sophisticated speech forms.For example, a child of five years, corrects the doctor: "I must say is not boring, an
3. Violations of behavior are linked not only to autism, but also the characteristic disorders of motor skills in the form of stereotyped movements (rocking the head and torso, rhythmic flexion and extension of the fingers, spinning on its axis, waving motion with your fingers or the entire brush, jumping, runningon tiptoe), impulsivity, movement obsessions and rituals.Significantly delayed the development of demonstrative gestures, gestures "greeting-farewell" (eg, waved her back to the doctor).The special features include facial expressions of her poverty, tension, sometimes fixed "scared" look, or celebrate the beautiful person ( "Prince's face").
Intelligent failure due to delayed development is considered an optional feature.According to the procedure Wechsler general intellectual figure is lower than that of children with normal development, but higher than with mental retardation.
to emotional reactions predominate disturbing tensions or severe anxiety when trying to change the existing order of life, the game, the location of objects in the room, time and space walks, meals, choice of clothing (the phenomenon of "identity").
game has a character stereotypical action (spinning toys before my eyes, shifting from place to place, tapping the floor and sniffing, licking).Child hampers fashion, often it tends to strip naked.Unusual taste preferences are expressed in the form of craving for inedible.Characterized by aggressive and autoaggressive action.
term "autism" is mostly used to refer to negative symptoms and related social failure.On the other hand, the different aspects of the autism phenomenon described as old and modern writers in different forms, types of flow and stages of schizophrenia.The latter indicates the relevance of the concept of "autism", according to its original meaning of the clinical reality.
as the main factors adversely affecting the development of autism issues, advocates the absence of a clear understanding of the links between the conceptual and clinical aspects.Autism is not got own clinical niches for sustainable and well-defined position in the clinical structure of schizophrenia.Autistic phenomena approached and identified with other psychopathological disorders - depersonalization, delusions, pathological personal response forms.Autism is thus turned into an additional, optional sign, and its detection depended on theoretical research installation.
in both international classifications of mental disorders (ICD-10 and DSM-4) specify the criteria that can be used as the basis for diagnosis.
Qualitative disorders of social behavior.
quality communication disorders.
specific interests and stereotyped behavior.
manifestation of symptoms before the age of three.
In addition, the ICD-10 identified a number of non-specific problems, such as fears, phobias, sleep disorders and eating habits, rage, aggression, self-injury.
When observing the behavior of children suffering from early infantile autism, according to the behavioral features (symptoms) the criteria listed in the classifications pronounced 3 below.
pronounced shut off from the outside world (encapsulation).
Commitment usual routine of life (fear of change).
specific speech disorders.
Encapsulation manifested severe violation contact.The relationship to others, to events and objects are different from the norm.Almost no signs of all normal contact with the child's parents, especially her mother: no answering smile, eye contact, the child does not distinguish parents from other people, no anticipating gestures (eg, the child does not stretch his hands to his highly raised).On the contrary, children are often actively come into contact with inanimate objects.When they get older, clearly reveals the unwillingness to participate in a collective game and the inability to establish friendly relations with other children, as well as the inability to empathize with others.
desire to adhere to the usual order due to anxiety, manifested in the development of children in the state of fear and panic, if their habitual environment that is changing.
include speech disorders should mention delayed speech development in about half of the children, as well as the tendency to form new words and echolalia (repeating words or syllables followed by others, such as echo).Children with autism, talk about themselves in the third person and only later learn to say to yourself "I am."Almost all children have speech and movement patterns, as well as a number of echo-symptoms.They did not occur or is delayed, "the age issues," and they are stereotypically ask the same questions, the answers to which they are known.Many autistic children who have learned to speak, can not use it in communicative purposes, and do so only mechanically.In their speeches a lot of grammatical errors, some kids come up with new words (neologisms), having particular importance to them.
For many children with autism Kanner characterized by disorders of intonation: this little modulated, intonation design words or phrases often inadequate, monotonous voice, and the rhythm is chanted character.
Some children revealed obsessions and a number of other symptoms, such as preference for certain games, aggression and autoaggression, and there is no fear of the real dangers.
1.Kachestvennye impaired social interaction (eg, inadequate assessment of the social and emotional signals, insufficient use of social signals)
2. Qualitative disorders of communication (eg, insufficient use of speech for the purpose of communication, lack of emotional resonanceon verbal and nonverbal rapprochement with others, changed the melody of speech) 3.Spetsificheskie interests and stereotyped behavior (eg, rigidity and adherence to routine procedure in daily activities, resistance to change)
4. Non-specific problems - fears, phobias, sleep and violationseating habits, rage, aggression, self-injury
5. The manifestation of symptoms before the age of three
1.Kachestvennye impaired social interaction (for example, when such non-verbal methods of communication, such as eye contact, etc.., in establishing contacts with peers, expression of feelings)
2.Kachestvennoe violation of communication skills (eg, delay or stop the development of speech, speech patterns, the lack of age-appropriate role-playing and simulation games)
3.Spetsificheskie repetitive or stereotyped behaviors, interests and activities
4. Start before the age of 3 years and delays or anomalies
functional abilities in the development of many children with early childhood autism symptoms observed transformation: reduced sensitivity to particular sounds, rarely bother panic attacks, agitation,sleep disorders, weakening the habit of touching objects and people around.
diagnosis of infantile autism set according history and the results of observation of the child in different situations.In this case, the diagnosis is based on criteria for both international classifications of mental disorders and diseases of the ICD-10 [WHO, 1992] and DSM-4 [APA, 1994].
supplementary aids are standardized surveys of parents or relatives, as well as the observation scale, allowing more accurately and efficiently evaluate certain behavioral symptoms.
When collecting data history parents often report that even during pregnancy, the mother had difficulty observed complications of pregnancy and abnormalities in the child's development in the first months of life.Parents especially pay attention to it in cases where the child is autistic is not the first, and so they have the opportunity to compare.Mothers, for example, reported the following: the child from the beginning avoided physical contact and convergence, did not smile in response, did not respond to hails or other sounds.V parents the impression that the child is deaf.In kindergarten, he showed no interest in other children, playing alone, preferred to play with inanimate objects, not people, use things not on purpose, rotating through them.He was happy only when engaged with other objects, and no contact with other children.It either did not develop, or a marked delay in speech development.At the stage of the development of speech, the child not only lagged behind the others, but it has been observed already described the speech disturbances.These symptoms can be identified both in the direct observation , and clarified using standardized questionnaires and scales of observation.
Currently, there are a number of interviews, scales and techniques of observation, designed exclusively for the diagnosis of infantile autism, developed mainly in English-speaking countries and are used in scientific research.Some of these techniques have been translated into German.Here are some of them.
Early diagnosis is based on the following criteria:
1. Violations of the relationship mother-child in the form of indifference to the mother and the absence of emotional reactions in her care.
2. Lack of differentiated types of crying, weeping before the age of 6 months, reduction or complete absence of vocal expressions.
3. monotonous behavioral acts.
4. Low level of motivation.
From the age of 6-8 years after the level of adaptation of children increases, however, noted above qualities are not completely disappear.Heavier forecast expressed in the form of intellectual defect occurs when the residual-organic form of autism.
According to researchers, early childhood autism syndrome is observed in schizophrenia, autistic psychopathy constitutional and residual-organic brain disease.In schizophrenia manifestation of infantile autism syndrome is an expression of the initial stage of the process or as a result of the change postprotsessualnym transferred in early childhood latent attack.
literature analysis gives grounds for concluding that the contradictory situation in autism research.On the one hand, traced a departure from the views of modern psychiatry E. Bleuler.
Infantile Autism should be primarily distinguished from syndrome Asperger (autistic personality disorder).The differences between the autistic syndromes are primarily but since the beginning of the disease in the areas of speech and intellectual development as well as in the motor areas of the features: Children with Asperger's syndrome begin talking before, their speech is often well developed, and the level of intellectual development corresponds to age norm or exceedsher.Often these children have expressed specific interests, which they dedicate almost all my time, and when they become older, they often suffer from obsessions.
should be a differential diagnosis also Rett syndrome.In this syndrome unlike both variants showed regression autism loss acquired capabilities that is combined with various neurologic symptomatology, as well as classical stereotyped movements (rotational movements of the hands).
autistic syndrome should also be differentiated from defects senses and mental retardation. first can be eliminated by a detailed study of the senses.When autistic symptoms of mental retardation is not central to the clinical picture and is accompanied by intellectual underdevelopment.In addition, in mentally retarded children and adolescents are less disturbed or not disturbed at all emotional attitude to animate and inanimate objects of the surrounding world.Often also celebrated speech and motor manifestations of early infantile autism.
practical clinical importance is the differential diagnosis with schizophrenia . It can be carried out on the basis of symptoms, and on the basis of medical history and dynamics.Children with schizophrenia, unlike autistic children often show symptoms of delusional or hallucinating, but up to the moment of their appearance is usually unremarkable medical history;In any case, it concerns the actual psychotic symptoms.
Finally, autism must be differentiated from hospitalism (deprivation syndrome).Under hospitalism understand the disorder that develops as a result of neglect and a pronounced shortage of factors that stimulate growth.These children may also interfere with the ability to touch, but it manifests itself in a different way: more often in the form of depressive symptoms.Sometimes there is no distance in the behavior, but there are no typical symptoms of childhood autism.
The diagnosis is difficult, for the reasons listed below.
ongoing study of early childhood autism (a diagnosing area, therapy and speakers), as well as progress in the field of human genetics are making it increasingly urgent question, can you explain some of these factors, the influence of heredity.For example, for a long time there was debate about whether artistic disorder is inherited as such, or only certain components - cognitive, verbal, or emotional disorders.
Arguments in favor of the genetic nature of early childhood autism rely heavily on family and twin, and more recently also on molecular biological studies [Rutter, 2000].
value of damage and impaired brain functions in the event of autistic disorders is confirmed by the study of a variety of neurological abnormalities and diseases.Thus emerged the theory of "autistic deficit";for example, talk about the functional disorders of the left hemisphere of the brain [Fein et al., 1984], anomalies of the brain stem, causing the disturbances of attention [Fein, Skoff, Mirsky, 1981] Abuse interpretation of stimuli and signals (sensory modulation) [Ornitz,1983, 1987], pathology processes of brain maturation [Bauman, Kemper, 1985].Speak some specific hypotheses, such as the underdevelopment of the cerebellar vermis [Courchesne et al., 1988].Recent observations indicate the presence of disease, depending on the other, at the same time maturing brain systems that are significantly associated with memory and emotional behavior.In addition, make judgments that hypoplasia of the cerebellar vermis is associated with cognitive and motor disorders and that, perhaps, there are connections with other brain structures responsible for the regulation of attention and sensory vibrations.
analyzing the time of occurrence of the disorder, other researchers found that 54% of autistic children are abnormalities of the cerebral cortex, which developed until the sixth month of pregnancy and the lack of children without symptoms of autism .