What is meant by Autism in children today:
The term “Autism” is frequently used as an umbrella term when referring to conditions that fall on the autism spectrum.
More appropriate is the term ASD (Autism Spectrum Disorder), which includes the following diagnoses:
- Autistic disorder,
- Asperger Syndrome,
- Childhood disintegrative disorder,
- Rett’s Disorder
- Pervasive (global) developmental disorder, including atypical autism.
Autism is not a “disease”
Like pneumonia or hypertension, autism in children involves impairment of the child’s normal development. It involves an atypical neurodevelopmental pattern with disrupted cognitive, social, language-communication, self-serving and even motor development.
The degree of impairment of these developmental milestones can range from mild to severe. When the impairment is severe, the child may not speak and may also associate mental retardation.
In contrast, a child with a mild form may be integrated into a class in a regular school or even not show the characteristics of an autistic person. This may be possible if they have received specific psychotherapeutic intervention early and in a sustained manner.
We can say that no two children have autism and manifest similarly, even if they have been classified with the same diagnosis. Synonyms such as: “high functioning” and “low functioning” to describe the child’s position on the autism spectrum.
Specific causes of autism in children
Although the prevalence of autism is very high (it affects about one in 100 people worldwide), researchers are still working to discover the causes of autism. In addition, it is thought that autism may be triggered by a combination of several factors, not just one.
Specialists have not been able to discover exactly what causes autism. Among the causes thought to be responsible for autism in children could be:
inheritance of chromosomal and genetic abnormalities
use of antidepressants in the first 3 months of pregnancy
nutritional deficiency in early pregnancy and lack of folic acid
mother’s advanced age
low birth weight and neonatal anaemia
some maternal infections during pregnancy (such as rubella)
exposure to chemical pollutants during pregnancy
increased air pollution
oxygen deprivation of the baby’s brain at birth
macrocephaly (abnormal growth of brain nerve matter) is the cause of 20% of autism cases
Simon Baron-Cohen found that exposing the intrauterine foetus to high amounts of testosterone increases the risk of developing autism.
Autism in children as a diagnosis
AUTISM is manifested from the child’s earliest years, there is no medical test to detect autism, the diagnosis is made based on the presence or absence of certain behaviors and abilities.
It is very important to identify early signs and intervene immediately. Most parents realize something is wrong with their child when they reach the age of 2-3. Sometimes parents detect certain signs even earlier.
Autism symptoms in children noticed by parents:
- the little one doesn’t look at them and doesn’t recognize certain familiar faces as would be natural,
- they don’t seem to be interested in the mother’s face and her facial expressions
- the reciprocal smile is absent or does not occur in response to the smile of the reference adult;
- The child may be indifferent and not notice the parents leaving the room
- they do not seem to develop a natural fear of strangers specific to the age of 9 months-1 year and 6 months;
- they lack the ability to imitate adult gestures and actions,
- they do not use reciprocal gestures of greeting, “bye”, or pointing like a typical child who uses nonverbal communication until language emerges.
According to the NIMH there are a number of early manifestations characteristic of autism:
- The child does not make inarticulate sounds, point or make gestures with a specific meaning until the age of one year
- Absence of a meaningful word by the age of 16 months
- The child does not connect two simple words (e.g: “mummy daddy”, “car daddy”) until the age of 2 years
- He/she does not respond when called
- He/she does not make eye contact – only occasionally making eye contact with people they interact with
- He/she loses some of the communication and social skills they have acquired
- He/she doesn’t seem to know the usual way of playing with toys. He/she uses them for other purposes and repetitively, and may be particularly interested in certain parts of toys/objects
- Hhe/she has a tendency to become attached to a particular object or toy (toy fragment)
- He/she does not smile
- He/she doesn’t seem to hear
- Does not understand and execute simple requirements like: “get the kettle and put it on the table”
- He/she can’t show body parts to himself/herself or a doll
- He/she does not identify common objects
Neurotypical children at the age of 2-3 years develop language. They can ask the classic question “Why?” or “What is it?”. They can answer simple questions “Where is he?”/”Who is he?”. They are attracted by picture books. They are interested in being read to. They like to play with other children.
Problems identified – Autism in children in age 2-3 years
- He/she doesn’t respond when you call his/her name and doesn’t generally react?
- He/she doesn’t use his/her index finger to show you what he wants or to indicate something
- He/she has intermittent or no eye contact
- He/she doesn’t talk yet or doesn’t talk anymore
- He/she has a strange or inexplicable way of speaking, repeating words, phrases, questions or sounds
- He/she has odd or idiosyncratic, repetitive and purposeless/functional behavior (e.g., clapping, twirling, snapping)
- He/she does it show a regression in general, here entering the behavioral skills needed in game or social interaction?
- Does he/she have frequent seizures that are disproportionate in intensity or difficult for the parent to justify and comfort?
- Is he/she extremely attracted and does he channel his attention predominantly towards certain categories of objects (fans, light bulbs, cogs, parts of objects)?
- Does he/she seem distant and not interested in people, but rather in objects?
Doesn’t play with toys, but is drawn to objects?
- Does he/she have an unusual attachment to objects that he can carry around with him/her all the time without using them for a purpose?
- Does he/she have obsessive and repetitive manifestations (e.g. opening/closing doors, turning on/off lights, lining up objects)?
- Does he/she have ritualistic manifestations, performing certain actions in an inflexible sequence?
- Does he/she play alone, the game being simple, repetitive and not looking for a play partner?
- Doesn’t he/she bring and show toys to the adult?
- Doesn’t he/she rejoice at seeing his/her parent again or protest when her mother leaves the room?
- Does he/she resist change and insist on sticking to the things he is/she is used to, does he/she want to keep certain routines?
- Does he/she exhibit behaviors that harm himself (hitting, biting, etc.)?
* Doesn’t anticipate the dangers and seem not to feel the pain?
- Doesn’t like to be hugged, petted or touched?
- Is it hypo- or hyperactive?
- Do he/she show hypo-sensitivity or hypersensitivity to different stimuli (sound, touch, visual stimuli)?
- Does he/she have difficulty falling asleep or not sleeping well at night?
- Does he/she only eat certain foods selectively?
Who can correctly determine autism in children?
Most parents will contact their paediatrician when they suspect a developmental problem or suspect their son/daughter has autism. The paediatrician can apply screening tests that indicate a significant score for suspected autism in children. Even if the paediatrician recognises these manifestations as a developmental disorder, you need to see a specialist (psychiatrist, neurologist or psychotherapist). He/she will complete the diagnosis with further investigations to specify the exact diagnosis, severity and possible co-morbidities. Thus, audiograms, genetic tests, EEG, MRI, blood tests, etc. may be required.
Diagnosis is primarily clinical, based on the symptoms and behavioral patterns of autism in children. It should always be reinforced by specific psychometric tests (ADI-r, ADOS, Carolina, Portage). It should also be accompanied by other paraclinical investigations to identify possible co-morbidities.
Autism causes 30% of them to have epileptic seizures.
Sometimes seizures manifest themselves in children in the form of idiosyncratic or odd behavior. They may initially be mistaken for symptoms typical of autism in children. Unlike malingering behavior, which can be triggered by over-stimulation or anxiety, seizures occur suddenly, apparently triggered by nothing.
Standard treatment for autism in children
The main therapeutic approach aimed at recovering deficits in autism is applied cognitive-behavioral therapy (ABA). Its effectiveness is scientifically proven. This ensures the recovery and improvement of the child’s functioning in all areas of deficit (cognitive, communication-language, social interaction, self-service skills). Its effectiveness is maximized in the context of early initiation in a sustained and intensive setting. It uses the involvement and empowerment on these therapeutic techniques and family members.
In ABA therapy, different procedures are used to help children acquire new functional skills. We’re talking about language, eye contact, symbolic play, self-service skills. Dysfunctional/disruptive behaviours (self/hetero-aggression, stereotypes, behavioural patterns, etc.) are reduced.
The best known of these techniques is ‘baby steps training’. Within this there is a fragmentation of the task, with separate learning of each sequence.
It uses a reward system that motivates and encourages the child to learn new skills and abilities. No penalties apply. In the case of a wrong answer, the child receives no reward or the wrong answer is ignored. Only the correct answer is rewarded.
Different forms of modelling/guidance of the child by the therapist are used for learning. Proceed so that the child can perform the task with the minimum of help necessary. Help will be gradually reduced as the child gains independence, accuracy and responsiveness. When the child learns something new, he/she will be rewarded for trying.
Quality ABA programs include both therapist-initiated and child-initiated interventions. This ensures spontaneity and increases the likelihood that a skill learned in therapy will be used in another context in life.
In addition to learning basic skills, ABA therapy also encourages:
- game-related skills;
- social communication relations;
- forming relationships based on a model (by involving other children in the session).
A correct source of information can be found at Autism Parenting Magazine
There is no drug that “cures” autism in children. There are pharmaceuticals that relieve some symptoms associated with autism (inattention, anxiety, depression). They can accentuate and optimise the results achieved in therapy. A child with a high degree of hyperactivity will have difficulty collaborating in the session. He/she has a large number of behaviors that interrupt or disrupt specific therapy.
Occupational therapy is used to help children acquire skills that are needed in all areas of life. It provides support to children with autism who have sensory, motor, neuromuscular, visual impairments. Through occupational therapy children can acquire skills. E.g. maintaining balance, reacting to touch, communicating and carrying out everyday tasks related to self-service and self-care.
The occupational therapy specialist can use swings, seesaws, trampolines, climbing walls. These are needed to solve problems related to the coordination of gross motor activity or sensory problems. Occupational therapy is also useful for fine motor activities (writing, drawing).
(Picture Exchange Communication System)
A method of developing an alternative communication system that helps nonverbal children acquire communication skills. Sometimes it has proven effective in promoting spoken language itself. It also reduces frustration by making it easier to extinguish bouts of affect by facilitating the ability to make wishes known.
It is one of the newest ways of working with autism in children. It involves extending the principles of ABA, but takes into account the child’s intrinsic motivation towards a particular area or activity. This optimizes language skills and reduces inappropriate or problematic reactions.
Sensory integration therapy
It is another compensatory method that helps and supports the underlying progress achieved through ABA therapy, PRT. These techniques help the child to better process sensory information: tactile (touch), vestibular (of movement) and proprioceptive (body position). Children with autism often have a sensory system that is not functioning properly. That is, one or more senses react either too much or too little to different sensory stimuli.
Practicing and stimulating social skills helps children with autism to make friends, build relationships and maintain appropriate conversation or social interaction.
It helps your child improve pronunciation of certain sounds, breathing or chewing problems. Moreover, it also helps to create grammatical structure and syntax for those with a developed language.
It encourages the creation of an environment adapted to the needs of the child with autism, thus maximizing the child’s autonomy and coping skills.
As most children with autism have vitamin and mineral deficiencies, supplements are needed. These deficiencies are aggravated when selective eating behaviors are associated. Sometimes it is common to completely exclude certain foods. Supplements often include vitamin B6 and magnesium complex, as well as fish oil-based preparations, cod liver.
However, when it comes to autism in children, what helps one may exacerbate another. There may be hyperkinetic components, thus reducing cooperation and disrupting the therapy programme. Therefore, the parent should administer even these non-pharmacological preparations only when indicated by the specialist.
Period of treatment
It is difficult to say at the time of diagnosis what time frame will be needed for early, sustained and well-coordinated intervention so as to maximize the benefit on recovery of deficits.
The time horizon can be from 6 months – 1 year in the mildest cases, up to several years. The prognosis will be easier to estimate once therapy is initiated, depending on the rate of recovery.
The first 6 months of specific intervention in the follow-up of autism in children are the main ones.
If he makes progress in most areas of functioning, including language and communication, he/she has a very good prognosis. Parents can expect a quality recovery.
At the opposite pole is autism in children who are low-functioning. They associate the co-morbidity of mental retardation, ADHD or other conditions (epilepsy). The pace of recovery is slower. He/she has deficits mainly in language and adaptive behavior, which may persist into adult life. For the latter, it is necessary to adapt therapeutic programmes to their developmental needs.