Autism is a serious mental disorder that requires immediate treatment because it prevents a person from functioning normally in society. As a rule, autistic disorders appear in childhood. The reasons for the development of this disease have not yet been fully studied, which complicates the process of diagnosing and treating patients with autism.
When diagnosing a disorder, it is customary to use the following criteria:
- Qualitative disruptions of interaction autistic child with the outside world. They manifest themselves in the absence of emotional reactions to what is happening, in the reluctance to make contact with both peers and adults.
- Qualitative violations in the communication sphere. They manifest themselves in problems with oral and written speech: spontaneous speech is practically absent, the child speaks in repetitive, stereotypical phrases.
- Restricted, stereotypical behavior. The child's interests are limited, he feels attached to certain actions and rituals.
The first symptoms of autism usually appear in early childhood. A diagnosis of autism can be suspected if a child has delays in psychomotor and speech development. If the child’s behavior corresponds to any of the criteria, you should immediately consult a doctor.
The psychiatric clinic conducts a comprehensive autism diagnosis, allowing to exclude other mental disorders or, on the contrary, to establish the presence of concomitant diseases. The following methods are used in the process of diagnosing autism:
Special forms and questionnaires
Questioning patients suspected of having autism allows us to determine their personality traits and identify deviations from the norm. When diagnosing, the following are usually used:
- Language assessment scales that help determine how well a child understands and uses language.
- a diagnostic interview that allows you to identify social and communication disorders in the patient’s behavior.
At the moment, questionnaires are the main method for diagnosing autism, since patients with this disorder almost always have impaired language function and problems with social interaction.
Genetic analysis
It involves studying the genetic material of a patient with autism, as well as the medical history of the entire family. Recently, this method has become increasingly popular, as science is actively developing a hypothesis about the genetic origin of autism spectrum disorders. In the near future, it is possible that genetic analysis will take a leading place among methods for diagnosing autism.
Neuroimaging
The use of various devices (MRI, PET, spectroscopy) to diagnose autism, which can detect neuroanatomical signs of autism: an increase in brain volume, a change in the ratio of gray and white matter, etc. In addition, instrumental diagnostic methods make it possible to exclude the presence of organic brain lesions and other mental illnesses in the patient.
When diagnosing, the results are also taken into account electroencephalogram (EEG), with which you can record various types of brain dysfunction, but they are characteristic only of some forms of autistic disorder.
Thus, comprehensive diagnostics allows a more accurate diagnosis and determination of the degree of development of the disease, while excluding the presence of other disorders in the patient.
At the Mental Health Clinic, we conduct a comprehensive diagnosis of the disease using scales and questionnaires, as well as instrumental methods (MRI, EEG). Our clinic employs qualified specialists - child psychiatrists and neurologists - who will give your child an accurate diagnosis and prescribe the necessary treatment.
Have you discovered signs of autism in your child? We will help you and your child!
According to the diagnostic criteria prescribed in generally accepted international diagnostic and classification systems (DSM-IV of the American Psychiatric Association and ICD-10 of the World Health Organization), autism– a pervasive developmental disorder, in which at least six symptoms from the proposed list must be observed: lack of social or emotional reciprocity, stereotypical or repetitive use of speech, constant interest in certain details or objects, etc.
The disorder itself must be present before the age of three and is characterized by developmental delays or abnormalities in social interactions, use of language in communication, and problems engaging in symbolic or imaginative play.
The basis of the diagnosis of autism lies in the analysis of behavior rather than causative factors or mechanisms of the disorder. It is known that signs of autism are sometimes detected from early childhood, when the child does not respond either physically or emotionally to the participation of the adults around him. Later, it is possible to identify significant differences in the child from the age norm: difficulties (or impossibility) in building communication; mastering gaming and everyday skills, the ability to transfer them to a new environment, etc. In addition, the child may exhibit aggression (self-aggression), hysteria for unknown reasons, stereotypical actions and preferences, etc.
Main difficulties early diagnosis of autism are as follows:
the most vivid picture of the disorder appears after 2.5 years. Before this age, symptoms are often mild, in a latent form;
often pediatricians and child psychiatrists do not know the problem and cannot discern developmental abnormalities in the early symptoms;
Parents who notice the “unusuality” of their child, having trusted a non-specialist and not receiving adequate confirmation, stop sounding the alarm.
In addition, autism can occur in conjunction with other disorders that involve impaired brain function, such as viral infections, metabolic disorders, mental retardation and epilepsy. It is important to differentiate between autism and intellectual disability or schizophrenia, as confusion in diagnosis can lead to inappropriate and ineffective treatment.
All examination methods can be divided into the following:
Non-instrumental (observation, conversation);
- instrumental (use of certain diagnostic techniques)
- experimental (game, construction, tests, questionnaires, actions based on a model);
- hardware experimental (information about the state and functioning of the brain, autonomic and cardiovascular systems; determination of physical spatiotemporal characteristics of visual, auditory, tactile perception, etc.).
There are many hardware diagnostic methods:
electroencephalography – EEG, study of bioelectrical activity of the brain and the state of its functional systems
rheoencephalography – REG(cerebral rheography), determination of the state of cerebral vessels, identification of cerebral blood flow disorders
echoencephalography – EchoEG, measurement of intracranial pressure, detection of tumors
magnetic resonance imaging– MRI, non-radiological method for studying internal organs and human tissues
computed tomography – CT, scanning and layer-by-layer imaging of brain structures
cardiointervalography(variation pulsometry), – study of the state of the autonomic nervous system and other methods.
One of the generally accepted methods of instrumental examination of children with autism is the diagnosis of brain structure features. At the same time, the results obtained are very diverse: different people with autism have abnormalities in different parts of the brain, but the specific brain localization of the pathology that is unique to autism has not yet been determined. However, even if no brain pathology is detected, we are still talking about autism as an organic lesion caused, for example, by a disruption of communication between different parts of the brain, which is difficult to detect during diagnosis.
Laboratory research assess the state of the blood, immunity, identify the presence of mercury derivatives and other heavy metals, and the causes of dysbacteriosis. After all, it is known that autistic disorders are often accompanied, for example, by intestinal damage. Of course, it is advisable for every child who is found to have developmental features of the autistic type to undergo an in-depth medical examination, including an assessment of vision and hearing, as well as a full examination by a pediatrician and neurologist. But you should know that today there are no specific laboratory tests to determine autism spectrum disorders.
Abroad, a number of questionnaires, scales and observation techniques are most often used to diagnose early childhood autism.
Among them:
Autism Diagnostic Interview (ADI-R)
Autism Diagnostic Observation Schedule (ADOS)
Vineland Adaptative Behavior Scale (VABS)
Childhood Autism Rating Scale (CARS)
Autism Behavior Checklist (ABC)
Autism Treatment Evaluation Checklist (ATEC)
Questionnaire for diagnosing social diseases and communication disorders (Diagnostic Interview for Social and Communicative Disorders - DISCO)
Autism Severity Scale for Children
Autism Diagnostic Parents Checklist (ADPC)
Behavioral Summarized Evaluation (BSE) observation scale
Checklist for Autism in Toddlers (CHAT).
Questionnaire on spectrum disorders of child development (PDD – pervasive developmental disorder)
Some of these diagnostic procedures (CHAT, PDD, ATEC, Weiland scale) are gradually becoming popular in Russia and Ukraine, but we have no information about the adaptation and standardization of these methods, and the translation is most often carried out by the teachers themselves.
Unfortunately, quite often there is a situation when specialists not only in psychological and pedagogical, but also in psychiatric fields “make” a diagnosis, focusing on parents’ oral or written answers to questionnaires. One Kiev mother, who visited 5 psychiatrists with her 2.5-year-old girl, shared her observation of the diagnostic procedure: “They practically don’t pay attention to the child, they ask me the same questions, and I have already caught a pattern: what kind of answers do we receive? can make one diagnosis or another.”
Undoubtedly, there are other, albeit rare, but positive examples when a specialist has not only experience, but the desire and ability to comprehensively examine a child. And one can only dream that we will have more and more such specialists. Indeed, in reality, a diagnosis of autism can only be made after an in-depth clinical assessment based on internationally recognized criteria.
Thank you
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Early signs of autism
Signs autism can be detected already in the first year of life. However, this only applies to early childhood autism, which occurs in children under 3 years of age. As for other autism spectrum disorders, their signs can also be observed in early childhood, but closer to 2–3 years. Symptoms of autism in children under 1 year of age
Symptoms of autism in children under one year of age are criteria for early diagnosis. As a rule, the mother is the first to notice these signs. Parents react especially quickly if the family already has one child. Compared to a healthy older brother/sister, an autistic child looks “weird.”
Symptoms of autism in children under one year of age are (frequency of occurrence):
- impaired or complete absence of eye contact – 80 percent;
- phenomenon of identity – 79 percent;
- violation of the revitalization complex – 50 percent;
- pathological attitude towards close relatives – 41 percent;
- pathological reaction to a new person - 21 percent;
- pathological attitude to verbal treatment - 21 percent;
- pathological attitude towards physical contact – 19 percent.
This symptom manifests itself in the child’s lack of fixation of gaze or active avoidance of it. Parents notice that when trying to attract the child and establish eye contact with him, the baby actively resists this. Sometimes it is still possible to establish eye contact, but at the same time the child seems to be looking past (“looking through”). The gaze may also be motionless or frozen.
The phenomenon of identity
This symptom appears when parents begin to introduce complementary foods into the child’s diet, that is, after 6 months. It manifests itself in the difficulties of introducing complementary foods - in response to new food, the child shows aggression. Difficulties arise not only in nutrition, but also in changing the environment of the place. The baby reacts violently to the new arrangement of furniture and his toys, and resists new clothes. At the same time, a certain rituality appears - he eats food in a certain order, his toys are laid out in a certain pattern. Autistic children react negatively to new premises - a hospital, a nursery, a kindergarten.
Violation of the revitalization complex
Violation of the revitalization complex occurs in every second autistic child at the age of one. The symptom manifests itself in a weak reaction (and in severe cases, its complete absence) to external stimuli - light, the sound of a rattle, surrounding voices. The child reacts poorly to his mother’s voice and does not respond when she calls her. It also reacts sluggishly to a smile and does not become infected in response to an adult’s smile (usually children smile in response to a smile). Children with autism also have a poorly developed motor component - they do not actively jump like other children and do not move towards their mother.
Pathological attitude towards close relatives
This symptom is also most noticeable in children under one year of age. It is expressed in a delay or lack of recognition of the mother - the child does not meet her halfway, does not reach out to her, does not go into her arms. Also, the baby reacts poorly to his mother’s caresses and does not show the need for care. Sometimes such an attitude can manifest itself in relation to other family members, while the child experiences strong attachment to the mother. In general, ambivalence (duality) is observed in the child’s relationships with adults. Strong attachment can be replaced by coldness and hostility.
Pathological reaction to a new person
Every fifth autistic child exhibits a pathological reaction to a new person. This reaction is expressed in anxiety, fear, excitement in response to the appearance of a new person. Sometimes it can be replaced by hyper-sociability, in which the child shows increased interest in a new person.
Pathological attitude to verbal treatment
The symptom manifests itself as a lack of response to verbal communication and often imitates deafness in a child. That is why parents often turn to an otolaryngologist first. Also, autistic children do not use affirmative or negative gestures - they do not nod their heads; do not use greeting or farewell gestures.
Pathological attitude towards physical contact
This symptom is expressed in dislike of physical contact - caresses, “hugs”. When you try to pet the child or hug him, he dodges. Autistic children tolerate only small doses of physical contact and are quite selective in those who give it. Some children may only prefer tossing or spinning.
Symptoms of autism in children under 3 years of age
As the child grows and develops, the parents' attention is attracted by his speech, manner of play, and type of communication with other children.
Symptoms of autism in children under 3 years of age are (frequency of occurrence):
- impaired communication with children – 70 percent;
- attachment to inanimate objects - 21 percent;
- fears – 80 percent;
- violation of the sense of self-preservation – 21 percent;
- speech pathology – 69 percent;
- stereotypies – 69 percent;
- features of intelligence - 72 percent;
- features of the game – 30 percent.
Very often, autistic children avoid the company of their peers. Ignoring communication can be either passive - the child simply isolates himself from other children, or active - aggressive, impulsive behavior appears. Sometimes the circle of friends may be limited to one friend who is a couple of years older, or a relative (brother or sister). An autistic person does not spend long in a general group - in a nursery, on the street, at a birthday party, since he often prefers solitude to company.
Attachment to inanimate objects
Another behavioral feature is attachment to inanimate objects. The attention of autistic children is most often attracted by the ornament of the carpet, some specific piece of clothing, or a pattern on the wallpaper.
Fears
Autistic children also have unusual fears. As a rule, they are not afraid of heights or darkness, but of everyday noises, bright light, and a certain shape of an object. Fears are explained by the increased sensitivity (hyperesthesia) of autistic children.
The fears of autistic children are:
- noises - the noise of an electric razor, vacuum cleaner, hair dryer, water pressure, the sound of an elevator;
- bright, harsh or shiny colors in clothing;
- precipitation - water drops, snowflakes.
Violation of the sense of self-preservation
Every fifth autistic child exhibits a lack of fear. This symptom can manifest itself in childhood, when a child hangs dangerously over the side of a stroller or playpen. Older children can run onto the roadway and jump from great heights. Characteristic is the lack of consolidation of negative experiences of cuts, bruises, and burns. So, an ordinary child, having accidentally burned himself, avoids this object in the future. However, autistic children can “tread on the same rake” many times.
Speech pathology
Features of speech development are observed in 7 out of 10 children suffering from autism spectrum disorder. Even in early childhood, this manifests itself in the absence of a reaction to speech - the child reacts poorly to calls. Further, parents may note that their child prefers quiet and whispered speech. There is a delay in speech development - the first words appear later, the child does not gurgle or babble.
The child’s speech is characterized by the phenomenon of echolalia, which is expressed in the repetition of words. When asked a question, a child can repeat it several times. For example, to the question “how old are you?” the child answers “years, years, years.” There is also a tendency towards declarations, monologues, and very expressive speech. The attention of parents is attracted by the fact that the child begins to talk about himself in the third person (the pronoun “I” is not typical).
Most cases of autism are characterized by initial development of speech followed by regression. Thus, parents note that the child, who was initially talking, suddenly becomes silent. A vocabulary that previously consisted of a dozen words is now limited to two or three words. Speech regression can occur at any stage. More often it is noted at the age of one and a half years, but can also be detected later at the level of phrasal speech.
Stereotypes
Stereotypes are stable repetitions of movements and phrases. In autism spectrum disorder, stereotypic behavior is considered a type of self-stimulating behavior. It should be noted that healthy people also sometimes exhibit stereotypies. For example, this is expressed by winding hair around a finger, tapping a pencil on a table, or passing sand through your fingers. “Healthy stereotypies” differ from pathological ones in the degree of intensity. In autism, stereotyping is observed in movement, speech, and play.
Stereotypes of autism are:
- stereotypical movements– rhythmic swaying or swaying of the body, bending fingers, jumping, turning the head;
- stereotypical visual perceptions– pouring mosaics, turning lights on and off;
- stereotypical sound perceptions– rustling of packages, crumpling and tearing of paper, swinging of door or window sashes;
- tactile stereotypies– pouring cereals, peas and other bulk products, pouring water;
- olfactory stereotypies– constant sniffing of the same objects.
Delays in intellectual development are observed in every third child suffering from autism. There is intellectual passivity, lack of focus and productive activity, and inability to fix attention on anything.
At the same time, acceleration of intellectual development is observed in 30 percent of cases. It is expressed in the rapid development of speech, fantasies, associations, as well as in the accumulation of knowledge in some abstract areas. Autistic children are very selective when choosing sciences - there is an increased interest in numbers, countries, and structures. Auditory memory is very developed. The collapse of intellectual functions is observed in 10 percent of cases. It is expressed in the disintegration of behavioral skills, cognitive activity and previously formed speech.
Game Features
This symptom manifests itself either in the complete absence of play or in the predominance of playing alone. In the first case, the child ignores the toys - does not look at them or examines them without interest. Often the game is limited to elementary manipulations - rolling a bead or pea, twirling a button on a thread. Solo play predominates, usually in a specific location that does not change. The child arranges his toys according to a certain principle, usually by color or shape (but not by functionality). Very often, in his play, a child uses completely non-playing objects.
Diagnosis of autism
Diagnosis of autism includes complaints from parents, medical history and examination of the child. At an appointment with a child psychiatrist, parents first explain the reason for their visit. This may be the child’s lack of speech or its regression, aggressive behavior, fears, or stereotypies. Most often, parents complain that the child does not speak and does not use communication as a means of communication. Frequent complaints from parents are:
- the baby does not respond to treatment, creates the impression of a deaf child;
- the child does not make eye contact;
- the first words, phrases, and addressed speech are missing;
- regression of speech development (when the baby was already speaking, but suddenly fell silent);
- slapping oneself on the cheeks, biting oneself;
- repeats the same words and movements;
- stays away from other children and does not play with them;
- prefers solitude;
- does not like change and reacts aggressively to it.
Examination of a child with suspected autism involves talking with him and observing him. Autistic children, when entering a doctor's office, often rush to the window first. Small children may hide behind chairs, tables, and other furniture. Almost always, any visit to a doctor is accompanied by negative behavior, crying, and hysterics. Such a child rarely enters into dialogue and often repeats the question asked by the doctor. The baby does not react when addressed to him and does not turn his head. Children do not show interest in toys or offers to play; they are passive. Sometimes they may be interested in a puzzle or construction set.
Tests for autism
Tests to identify autistic tendencies are based on observation of the child’s behavior in everyday life, his interaction with peers and parents, and his attitude towards toys. There are a large number of programs for self-determination of autism, but none of them give accurate results. The results of any test are only an assumption, which only a doctor can confirm or refute.Simple test
This test is the simplest of all, but its results are quite vague. Experts recommend carrying out this type of testing in conjunction with other testing methods.
The test consists of two parts, the first of which involves observing the child, the second - jointly performing certain actions.
The questions in the first part of the test are:
- Does the baby like to sit on adults' laps?
- Does the child like parental hugs?
- whether he is interested in children's games;
- whether the child has contact with his peers;
- imitates certain actions or sounds when playing;
- uses the index finger as a pointer in order to draw the attention of others to any object;
- whether the baby brings toys or other objects to draw parental attention to them.
The tasks of the second part of the test are:
- Point your finger at the object, while carefully observing his reaction. The child's gaze should be directed to the indicated object, and not stop at the parent's finger.
- When playing together, observe how often your baby looks into your eyes.
- Invite your child to prepare tea or another dish in a toy bowl. Will this offer arouse his interest?
- Give your child some blocks and ask him to build a tower. Will he respond to this proposal?
CARS (Early Childhood Autism Rating Scale)
This type of testing is the primary tool for screening children whose behavior suggests autism.
CARS includes 15 blocks, each of which affects a separate part of children's behavior in certain situations. For each item there are 4 main answers - normal - 1 point, slightly abnormal - 2 points, moderately abnormal - 3 points, significantly abnormal - 4 points. There are also three intermediate options between each main answer, the value of which is estimated at 1.5 points, 2.5 points and 3.5 points, respectively. Intermediate options are necessary for cases when the parent cannot accurately determine, for example, whether the baby’s reaction or behavior in the situation indicated in the test is slightly abnormal or moderately abnormal.
CARS Test Options
Parameter | Interpretation |
Interaction with society (surroundings)
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Imitation
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Emotional reaction
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Body ownership |
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Using toys |
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Reaction to change
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Visual reaction
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Auditory response
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Taste, smell, touch |
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Feeling of fear, nervousness
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Communication skills |
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Nonverbal communication
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Activity level
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Intelligence
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General impression
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If the total score for this test is in the range from 15 to 30, the child is normal. With a score of 30 to 37, there is a likelihood of mild or moderate autism. If the score was from 37 to 60, there is suspicion of a severe form of autism.
Classification of autism according to ICD-10
There are several classification options for autism that take into account the onset, manifestations and course of the disease. According to the International Classification of Diseases (ICD), there are 6 types of autism.Classification of autism according to the ICD
Species name | Disease code | Characteristic |
Childhood autism | It manifests itself as developmental anomalies in children under 3 years of age, deviations in the following areas - social interaction, communication and behavior. The child's behavior is stereotypical, limited and monotonous. The clinical picture is complemented by sleep disorders, eating disorders, aggression, and multiple fears. |
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Atypical autism | The clinical picture of atypical autism is characterized by the absence of one of the criteria from the classic triad of autism ( impairment of social interaction, communication and behavior). As a rule, it is accompanied by profound mental retardation. |
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Rett syndrome | This variant of autism occurs only in girls. Psychomotor development is characterized by partial or complete loss of speech, skills in using hands, and slower growth. All these disorders are detected between the ages of 7 and 24 months. Despite the fact that social development has been suspended, interest in communication remains. This syndrome is also accompanied by severe mental retardation. |
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Other childhood disintegrative disorder | Before the first signs of the disorder appear, psychomotor development is normal. However, soon after the onset of the disease, a loss of all acquired skills is noted. At the same time, interest in the world around them is lost, behavior becomes stereotypical and monotonous. Disorders are noted in the sphere of social interaction, communication, and intellectual development. |
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Hyperactive disorder with mental retardation and stereotypic movements. | Occurs in children whose intelligence is below 50 IQ. They exhibit hyperactive and stereotypical behavior and decreased understanding of speech addressed to them. Children with hyperactive disorder and stereotypic movements do not respond well to drug therapy. |
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Asperger's syndrome | As with the previous disorder, the causes of Asperger's syndrome are unknown. The syndrome is not characterized by a stop in psychospeech development ( what is observed in childhood autism). The pathology is characterized by clumsiness, stereotyping in activities and interests. There may be psychotic episodes at an early age. |
In addition to the generally accepted classification, there is also a classification proposed by the psychologist Nikolskaya in 1985. This classification takes into account the main characteristics of autism and divides it into four groups.
Classification of autism according to Nikolskaya
Group | Characteristic |
First group (8 percent)with a predominance of detachment from the outside world. | Already in the first year of life, children are sensitive to changes in the environment of a place and to new people. They often remain in passive contemplation of some objects. In the second year of life, there is a loss of all the skills acquired in the first year - speech, reaction to treatment, visual contact. |
Second group (62 percent)with a predominance of rejection of the environment. | Multiple motor, speech, and tactile stereotypies are observed. The sense of self-preservation is impaired, multiple fears and a pronounced “identity phenomenon” are noted. This type of autism is often combined with schizophrenia, epilepsy and other pathologies of the central nervous system. |
Third group (10 percent)with a predominance of overvalued interests and fantasies. | The child’s interests and activities are extremely abstract in nature, and there are also overvalued passions. Attitude towards family and friends with elements of aggression, fears are delusional in nature. |
Fourth group (21 percent)with extreme vulnerability and timidity. | Children from early childhood are very vulnerable, fearful, and have a low mood. At the slightest change in the environment, fearfulness increases. Children are often very inhibited and unsure of themselves, and therefore are characterized by increased attachment to their mother. |
Autism therapy
Today there are no specific therapeutic methods to permanently get rid of autism. At the same time, according to medical statistics, it has been established that timely training with specialists, supported by a special diet and pharmacotherapy, significantly increases the level of development of an autistic person. There are many types of therapy that are used individually or in combination for autism. Depending on the goals and methods used, all types of therapy are divided into several groups. The groups into which methods of correction of autism are divided are:
- behavioral therapy;
- biomedicine;
- pharmacological therapy;
- controversial methods.
Behavioral therapy for autism
This group includes programs whose goal is to correct defects in the behavioral pattern of an autistic person that prevent him from adapting to life.Behavior correction methods are:
- speech therapy;
- occupational therapy;
- social skills therapy;
- developmental therapy;
- alternative communication.
Many children with autism are partially or completely speechless. Often the problems are not due to the fact that the child cannot pronounce words, but to the inability to use verbal skills to meet people. Communication training is carried out according to an individual program that takes into account the level of speech skills and the individual characteristics of the autistic person.
Occupational therapy
This method of autism correction is aimed at developing in the child skills that will help him in everyday life. Since such patients experience significant difficulties with self-care, occupational therapy plays a large role in this disease. During classes, an autistic person acquires basic self-care skills - brushing teeth, getting dressed, combing one's hair. Physical activity performed during classes develops the child’s fine motor skills and coordination. Gradually, the child’s behavior becomes more conscious, he learns to concentrate on individual tasks and becomes more adapted to life.
Social Skills Therapy
In such classes, therapists teach autistic people how to meet new people, build dialogues, and behave in accordance with the rules established in society. Social skills therapy helps children with autistic tendencies interact more easily with peers and others in their environment.
Developmental therapy
A characteristic feature of such classes is that the emphasis in them is not on mastering specific skills, but on the overall development of the child. Work with the patient is carried out in a playful way, when the therapist joins the autistic person in the game, encouraging his actions and encouraging him to establish contact.
Alternative communication
The goal of this type of therapy is to replace spoken language with images or symbols that are more understandable to the patient. In classes, patients are taught to express their desires, thoughts and needs using special sign language, pictures or cards with words written on them. Electronic equipment may also be used that plays individual words or entire phrases aloud when keys are pressed. The optimal alternative communication program is selected individually. This method is most justified in cases with autistic people who speak poorly or do not speak at all.
One of the most common alternative communication programs is PECS. During classes, the child is taught to select and show to others cards that depict the object he needs or the action he wants to perform. Many experts recommend that parents of autistic people practice this type of therapy at home. The book “Alternative Communication Card System (PECS)” by Laurie Frost and Andy Bondi will help with this.
Biomedicine for autism
The key focus in this type of treatment is the physiological needs of the body. The biomedical approach involves adjusting the diet and is often used as an additional type of therapy. There are several theories about which foods enhance or, conversely, weaken the manifestations of this disease. The main biomedical directions of autism therapy are built on the basis of these theories.The groups of most commonly used drugs include:
- Nootropics– substances that stimulate brain nutrition and improve metabolism in it. Examples: pantogam, encephabol, cortexin.
- Neuroleptics– drugs that eliminate hyperactive behavior and agitation. Examples: risperidone, sonapax.
- Thymoleptics– drugs that stabilize the emotional background. Examples: Depakine, lithium preparations.
Drug name | Main effects | How to take? |
Pantogam | Improves metabolic processes in nervous tissue, increasing the absorption of glucose and oxygen. Stimulates the development of cognitive processes, memory, attention. | The dose of the drug is selected individually depending on the child’s body weight. |
Cortexin | Stimulates speech development, leads to improved intellectual activity. | Children under 6–7 years of age: 5 milligrams intramuscularly daily for 10 days. The injections are given in the first half of the day. Children over 7 years old: 10 milligrams deep into the muscle. |
Encephabol | Concentrates attention, improves memory and thinking. However, it can provoke excitability. | It is prescribed in the form of a suspension or in tablet form. |
Phenibut | In addition to improving metabolic processes, it also has an anti-anxiety and calming effect. | 250 milligrams twice a day for children over 10 years of age. For children of primary preschool age, half a tablet ( 125 milligrams each) twice a day. |
Risperidone | Eliminates psychomotor agitation, restlessness, hyperexcitability. | The starting dose is 0.15 – 0.25 milligrams per day. Then the dose is increased to 1 - 2 milligrams per day. |
Depakin | Participates in balancing the emotional background, eliminates outbreaks of aggression. | It is calculated according to the scheme 20 – 30 milligrams per kilogram of body weight. So, for a child weighing 20 kilograms, the dose will be 400 milligrams per day. The received dose is divided into 2 – 3 doses. |
Other groups of medications are also used for autism. For example, tranquilizers or anti-anxiety drugs are used in children with severe fears. Atarax and diazepam are rarely used in the treatment of autism today.
Studies have been conducted on the use of lithium in children with autism. According to these studies, lithium significantly reduces mood swings, being a good behavior corrector. However, the main problem in its use is the complexity of dosing. Treatment should always be accompanied by measurement of lithium concentration in the blood.
If you have difficulty falling asleep, drugs with a hypnotic effect are often used. From the group of antipsychotics, in addition to risperidone, haloperidol (approved for use from 3 years) and Sonapax (approved for use from 4 years) can be used.
Controversial techniques in autism therapy
In addition to generally accepted methods for correcting autism, which have proven effective, other methods of treating this disease are described in the medical literature. Their effectiveness has not been proven, and their use causes conflicting comments among specialists.Controversial treatments for autism include:
- aversion therapy;
- chiropractic (treatment by influencing the spine);
- cranial osteopathy (massaging the skull).
One controversial technique is aversion therapy. This method involves using electric shock to correct the behavior of an autistic person. Punishments alternate with encouragement, but, nevertheless, this technique is one of the most cruel and has a large number of opponents.
Chiropractic (treatment by manipulating the spine)
According to this branch of alternative medicine, the cause of autism is a dislocation of one of the vertebrae. Therapy involves using chiropractic techniques to reduce the dislocation. Tapping with a special instrument is also used. This theory has no scientific confirmation, but is quite common in some countries.
Cranial osteopathy (skull massage)
Manual manipulation of the skull bones is another controversial method used in the treatment of autism. The use of this method is based on the theory that slight displacement of the sutures of the skull can improve the circulation of cerebrospinal fluid and normalize the patient's condition. Many patients with autism spectrum disorders become calmer after such procedures, their communication skills improve, and eye contact becomes longer.
Other ways to work with children with autism
There are other ways of working with autistic people, which are used in conjunction with the main methods of treating this disease.Additional therapeutic practices include:
- sensory integration;
- hypnosis;
- pet therapy (treatment with the participation of animals).
Sensory integration is a popular area in the fight against autism spectrum disorders. A healthy person knows how to combine feelings with the sensations of his body to get a complete picture of the world around him. In autism, this ability is impaired, as people with this disease suffer from increased sensitivity or deficiency. Therapists conducting sensory integration sessions set themselves the goal of teaching the patient to correctly perceive the information they receive through the senses. So, if an autistic person has problems with the sense of touch, during classes he is encouraged to become familiar with various objects by touch.
Examples of sensory integration tasks include:
- passage of the tunnel– develops orientation in space;
- dancing to musical accompaniment– train the hearing system;
- rotational movements on a chair– trains coordination and vision;
- hanging on the bar– teach you to feel the balance of the body.
Hypnosis is most effective in treating late childhood autism. A significant advantage of this approach is that there is a closer contact between the instructor and the patient than with other types of therapy. Hypnosis is used in combination with other correction methods, and its main goal is to increase the effectiveness of the main therapy.
Pet therapy (treatment with the participation of animals)
There is scientific evidence that playing and other forms of interaction with animals can make you less aggressive, improve your sleep, and improve your overall well-being. When treating autism, they most often resort to the help of dogs and horses, less often cats and dolphins.
Autism programs
An autism program is a set of specific activities and exercises that a child performs together or under the supervision of adults (parent, therapist). The goal of such programs is to improve the communication and adaptive abilities of an autistic person. The most common autism programs are:
- ABA program;
- FLOOR Time - game time;
- other programs for autism.
ABA program for autism correction
ABA has been around for over 30 years and is based on the principle that every action has consequences. If the patient likes these consequences, he will repeat this behavior. The purpose of the classes is to teach autistic people basic self-care skills and interaction with other people. Also, in the process of ABA therapy, the patient is taught to think logically and figuratively, express his desires, and use speech correctly. First, classes are conducted under the circumstances familiar to the child (at home, with family and friends). The acquired skills are then generalized and repeated to reinforce them in an unfamiliar environment.The main principles of this program are:
- ABA brings the greatest benefit to children under 5 years of age;
- The program is especially effective in teaching speech skills to autistic people;
- One-on-one sessions have the best results;
- exercises must be carried out regularly and often - from 20 to 40 hours a week, regardless of whether the child attends kindergarten or school;
- it is systematically necessary to undergo monitoring by a specialist in order to monitor the effectiveness of classes and adjust them if necessary;
- The child must like all the activities conducted - this is the most important condition of this program.
This program includes various classes on non-verbal and verbal communication, the development of gross and fine motor skills, naming objects and actions. Sessions can be conducted by both a specialist and parents. To conduct self-study, you must purchase a program manual (Robert Schramm’s book “Childhood Autism and ABA”). The program can also be downloaded on the Internet from specialized resources.
The principle of the classes is that all skills that are difficult for a child (speech, gaze, contact with other people) are broken down into small blocks that are unlearned. Then the learned actions are combined into one complex action. Moreover, every time an autistic person completes a task, he receives a reward. The study of any action takes place in 4 stages.
Stages of the ABA program
First stage
called understanding. The adult gives the child a task, for example, to extend his hand forward. Then the parent or therapist gives a hint - helps the autistic person complete the exercise and rewards him for this with candy, praise, or another method that affects the baby. Having completed several joint actions, the leader gives the child the opportunity to lend a hand. If the little patient does not complete the task on his own, he is again given help. The exercise is considered completed when, when asked to extend a hand, the child performs the action independently without prompting or delay. Then begins mastering the second movement, which should be similar to the previous one (raise your hand up, nod your head). This exercise is practiced in a similar way to the first task.
Second stage is a complication. It is started after the child in 90 percent of cases begins to complete both tasks of the first stage without hesitation or prompting. At the second level, exercises begin to alternate among themselves in any arbitrary order. Then, returning to the first stage, a new action is introduced - take a certain object in your hand, extend your hand to an adult. After mastering 3 exercises, they return to the complication again, starting to alternate all the learned tasks.
Third stage – generalization. It is started when enough learned monosyllabic movements have accumulated in the child’s arsenal in order to combine them into one action. For example, take an apple in your hand and treat your mother to it. In this case, exercises are carried out in a new place for the baby. You can start from another room, then try to conduct it on the street, in a store. Then they begin to change the people taking part in the process. These could be relatives, neighbors, other children.
The fourth stage is a way out into the world. When the baby begins to independently use the acquired skill in order to satisfy his needs, he can move on to mastering other skills.
Features of ABA therapy
Before you start practicing, you need to prepare training materials. Many of the activities in this program require the use of educational games, flashcards, drawing boards, and other similar items.
In addition to the financial costs of purchasing gaming materials, proper use of the ABA program requires significant time expenditure. Many parents are not able to devote 5 to 6 hours to classes every day. Therefore, it is recommended, if possible, to conduct ABA therapy in specialized institutions. You can also combine classes at home and with a therapist.
FLOOR TIME – game time
The author of this technique assumes that every healthy child goes through 6 stages of development - interest in the world, attachment, two-way communication, self-awareness, emotional ideas, emotional thinking. With autism, children do not go through all the levels, stopping at one of them. The purpose of this program is to help the child move through all stages of development through play.During the game, the therapist begins to repeat all the child’s actions, creating certain obstacles or asking questions so that the autistic person makes contact. The adult does not impose new ideas for play on the child, but develops those that the child offers. At the same time, even the most unusual and pathological actions are supported - sniffing objects, rubbing glass. The therapist pretends not to understand what is happening, encouraging the child to give explanations, which develops his thinking and communication abilities. The author of the program does not recommend interrupting the game even when the child begins to show aggression. Because in this way he learns to cope with and manage his emotions.
The program can be carried out either by a therapist or by parents at home. To practice this method on your own, it is recommended to consult a specialist who practices FLOOR TIME.
Other autism correction programs
One autism program that is different from other programs is the TEACH system. Its developers believe that the fight against autism should not consist in changing the child, but in creating special conditions to improve the quality of his life. TEACH does not provide the patient with a high level of adaptation to the outside world, but allows him to independently satisfy his needs in conditions specially created for him. Most often, the primary environment is the autistic person's home, so this program involves significant work with parents and relatives.Other autism programs include:
- MBA therapy– motivation of an autistic person through encouragement;
- Early Bird– assistance to the patient through his parents;
- RDI– development of partnerships;
- Son-Rise– integration of adults into the world of an autistic child.
The quality of life in autism can be significantly improved if the environment takes an active part in adapting the patient to the circumstances around him. A primary role in this is given to the parents of an autistic person, who must devote time not only to the child, but also to their own awareness of this disease and its characteristics. The following will help in raising an autistic child:
- autism schools;
- autism centers;
- books on autism.
Autism schools
Attendance at school is mandatory for a child diagnosed with autism. In this institution, he not only receives the required knowledge, but also acquires skills to interact with peers. Children with autistic tendencies can study in a regular school, provided that specialized specialists and parents additionally work with them. Professional help is especially important in middle school, as at this age children begin to understand differences, and cases of ridicule of autistic people are common.The best option is to attend specialized schools or separate classes for autism. In such institutions, children are taught not only standard school subjects, but also other skills that help them adapt to life outside of school. Classes are held on a flexible schedule, teaching methods are used both traditional and non-standard. Schools for autism can be public or private (fee-paying).
Autism Centers
Rehabilitation centers are an effective alternative if it is not possible to attend a special school. Such organizations can be municipal or private.Rehabilitation centers carry out correctional and educational work with children. The purpose of the classes is to overcome or reduce the influence of deficiencies in mental and physical development. In such institutions, modern methods of autism therapy are used, the prescription of which is carried out in accordance with the individual characteristics of the child.
Examples of classes offered at autism centers include:
- neurocorrectional (motor and breathing exercises)– aimed at improving fine and gross motor skills, increasing performance and reducing fatigue;
- art therapy (music, drawing, modeling, theater performances)– helps children express their feelings and develop communication skills;
- holding therapy (hug therapy)– the purpose of the classes is to embrace the child by the mother and establish long-term physical and visual contact.
Books on autism
Special books will help create a harmonious atmosphere that will help improve the quality of life not only for the autistic child, but also for other family members. The information presented in such publications will help you understand the characteristics of this disease and provide your child with competent assistance in various areas of his life.Useful books on autism are:
- Developing Fundamental Skills in Children with Autism (Tara Delaney). The book contains more than 100 games aimed at improving children's communication skills and increasing their level of knowledge about the world around them.
- Autism. A practical guide for parents, families and teachers. (Fred Volkmar and Lisa Weisner). The book provides information on the latest research and developments in the field of autism. All information is presented in clear and accessible language.
- Opening the doors of hope. My Experience with Autism (Temple Grandin). The author of the book suffers from autism, but the disease did not prevent her from getting an education, becoming a professor and achieving many heights in life. This book was also made into a feature film of the same name.
- Children whose brains are starving (Jacqueline McCandless). The book focuses on describing the disease from a physiological point of view. The writing is dominated by a lot of medical terms, so it is quite difficult to absorb the information. The value of the work lies in the fact that the author’s granddaughter suffered from this disorder, so the book contains a lot of practical advice on education and therapy.
- A tag with the address and parental phone number should be attached to the child’s clothing;
- if possible, the child should memorize data with his own first and last name, as well as the address and telephone number of the parents;
- It is recommended to systematically (once every 2-3 months) take fresh photos of the child and have them with you in case he gets lost;
- before visiting a new place, the child must be familiarized with the route;
- before going to the theater, cinema, or circus, it is recommended to purchase tickets in advance to avoid a queue in which the child will be uncomfortable;
- when leaving home with the baby for a long time, parents need to take with them a toy or other favorite thing of the child to help him cope with anxiety;
- if adults decide to send the child to a sports section or creative club, several individual lessons should be held;
- for overly active children, it is worth choosing the least traumatic sports;
- Before starting their own business, parents should organize leisure time for the child so that he does not feel lonely.
Before use, you should consult a specialist.
In a preschool educational institution, a teacher-psychologist does NOT make a diagnosis. If there is a suspicion that a child needs special educational conditions, a conversation is held with the child’s parents and a recommendation is given to visit a pediatrician. If parents do not agree to visit a doctor, work with the child is carried out according to the main kindergarten program.
The teacher-psychologist can give this rating scale to the parent if the latter agrees to further work.
CARS scale is one of the most used tests to determine symptoms of autism. The study is carried out by parents on the basis of observations of the child during his stay at home, among relatives and peers. Information received from educators and educators should also be included. The scale includes 15 categories that describe all areas that are relevant for diagnosis.
When identifying correspondence with the proposed options, you should use the score indicated opposite the answer. When calculating test values, you can also take into account intermediate values (1.5, 2.5, 3.5
) in cases where the child’s behavior is assessed as average between the descriptions of the answers.
The CARS rating scale items are:
1 .Relationships with people:
· no difficulties- the child’s behavior meets all the necessary criteria for his age. Shyness or fussiness may occur in cases where the situation is unfamiliar - 1 point;
· mild difficulties- the child shows anxiety, tries to avoid direct gaze or suppress conversations in cases where attention or communication is intrusive and does not come on his initiative. Problems can also manifest themselves in the form of embarrassment or excessive dependence on adults in comparison with children of the same age - 2 points;
· moderate difficulties- deviations of this type are expressed in demonstrating detachment and ignoring adults. In some cases, perseverance is required to gain children's attention. The child very rarely makes contact of his own accord - 3 points;
· serious relationship problems- the child rarely responds and never shows interest in what those around him are doing - 4 points.
2. Imitation and imitation skills:
· abilities correspond to age- the child can easily reproduce sounds, body movements, words - 1 point;
· imitation skills are slightly impaired- the child repeats simple sounds and movements without difficulty. More complex imitations are carried out with the help of adults - 2 points;
· average level of violations- to reproduce sounds and movements, the child needs outside support and significant effort – 3 points;
· serious problems with imitation- the child does not attempt to imitate acoustic phenomena or physical actions, even with the help of adults – 4 points.
3. Emotional background:
· emotional response is normal- the child’s emotional reaction corresponds to the situation. Facial expression, posture and behavior change depending on the events taking place - 1 point;
· there are minor violations- sometimes the manifestation of children's emotions is not connected with reality - 2 points;
· emotional background is subject to moderate disturbances- a child’s reaction to a situation may be delayed in time, expressed too brightly or, conversely, restrained. In some cases, the child may laugh for no reason or not express any emotions corresponding to the events taking place - 3 points;
· the child is experiencing serious emotional difficulties- children's answers in most cases do not correspond to the situation. The child’s mood remains unchanged for a long time. The opposite situations may occur - the child begins to laugh, cry or express other emotions for no apparent reason - 4 points.
4. Body control:
· skills are age appropriate- the child moves well and freely, movements are precise and well-coordinated – 1 point;
· disorders in a mild stage- the child may experience some awkwardness, some of his movements are unusual – 2 points;
· average deviation level- the child’s behavior may include such things as tiptoeing, pinching the body, unusual finger movements, pretentious poses – 3 points;
· the child experiences significant difficulties with control of his body- in children's behavior, strange movements are often observed, unusual for their age and situation, which do not stop even when trying to impose a ban on them - 4 points.
5. Toys and other household items:
· norm- the child plays with toys and uses other objects in accordance with their purpose – 1 point;
· slight deviations- strange things may occur when playing or interacting with other things ( for example, a child can taste toys) – 2 points;
· moderate problems- the child may have difficulty determining the purpose of toys or objects. He may also pay increased attention to individual parts of a doll or car, become very interested in details and use toys in an unusual way - 3 points;
· serious violations- it is difficult to distract a child from playing or, conversely, to encourage him to do this activity. Toys are increasingly used in strange, inappropriate ways - 4 points.
6. Adaptability to change:
· the child's reaction is appropriate to the age and situation- when changing conditions, the child does not experience much excitement - 1 point;
· there are minor difficulties- the child has some difficulties with adaptation. So, when the conditions of the problem being solved change, the child can continue searching for a solution using the original criteria - 2 points;
· average level deviations- when the situation changes, the child begins to actively resist it and experiences negative emotions - 3 points;
· the response to changes does not fully correspond to the norm- the child perceives any changes negatively, hysterics may occur - 4 points.
7. Visual assessment of the situation:
· normal indicators- the child makes full use of vision to meet and analyze new people and objects – 1 point;
· mild disorders- such moments as “looking into nowhere”, avoidance of eye contact, increased interest in mirrors, light sources can be identified – 2 points;
· moderate problems- the child may experience discomfort and avoid direct gaze, use an unusual viewing angle, or bring objects too close to the eyes. In order for a child to look at an object, you need to remind him about it several times - 3 points;
· significant problems using vision- the child makes every effort to avoid eye contact. In most cases, vision is used in an unusual way - 4 points.
8. Sound reaction to reality:
· compliance with the norm- the child’s reaction to sound stimuli and speech corresponds to age and situation – 1 point;
· there are minor disorders- the child may not answer some questions, or respond to them with a delay. In some cases, increased sound sensitivity may be detected - 2 points;
· average level deviations- a child’s reaction may be different to the same sound phenomena. Sometimes there is no response even after several repetitions. The child may react excitedly to some ordinary sounds ( cover your ears, show displeasure) – 3 points;
· the sound response does not fully meet the norm- in most cases, the child’s reaction to sounds is impaired ( insufficient or excessive) – 4 points.
9. Use of the senses such as smell, touch and taste:
· norm- in exploring new objects and phenomena, the child uses all senses in accordance with age. When experiencing pain, it exhibits a reaction that corresponds to the level of pain - 1 point;
· small deviations- sometimes a child may have difficulty knowing which senses to use ( for example, tasting inedible objects). When experiencing pain, a child may express or exaggerate its meaning - 2 points;
· moderate problems- the child can be seen smelling, touching, tasting people and animals. The reaction to pain is not true - 3 points;
· serious violations- getting to know and studying subjects mostly occurs in unusual ways. The child tastes toys, smells clothes, touches people. When painful sensations arise, he ignores them. In some cases, an exaggerated reaction to slight discomfort may be detected - 4 points.
10. Fears and stress response:
· natural response to stress and fears- the child’s behavioral model corresponds to his age and current events – 1 point;
· unexpressed disorders- sometimes a child may become scared or nervous more than usual compared to the behavior of other children in similar situations – 2 points;
· moderate impairment- children's reaction in most cases does not correspond to reality - 3 points;
· strong deviations- the level of fear does not decrease, even after the child experiences similar situations several times, and it is quite difficult to calm the baby down. You may also notice a complete lack of worry under circumstances that cause other children to worry - 4 points.
11. Communication skills:
· norm- the child communicates with the environment in accordance with the capabilities characteristic of his age – 1 point;
· slight deviation- A slight speech delay may be detected. Sometimes pronouns are changed, unusual words are used - 2 points;
· mid-level disorders- the child asks a large number of questions and may express concern about certain topics. Sometimes speech may be absent or contain meaningless expressions - 3 points;
· severe impairment of verbal communication- speech with meaning is almost absent. Often in communication the child uses strange sounds, imitates animals, imitates transport - 4 points.
12. Non-verbal communication skills:
· norm- the child makes full use of all the possibilities of non-verbal communication – 1 point;
· minor violations- in some cases, the child may have difficulty indicating his wants or needs with gestures – 2 points;
· moderate deviations- basically, it is difficult to explain to a child without words what he wants - 3 points;
· serious disorders- it is difficult for a child to understand the gestures and facial expressions of other people. In his gestures, he uses only unusual movements that have no obvious meaning - 4 points.
13. Physical activity:
· norm- the child behaves in the same way as his peers - 1 point;
· slight deviations from the norm- children’s activity may be slightly higher or lower than normal, which causes some difficulties in the child’s activities – 2 points;
· average degree of violation- the child’s behavior does not correspond to the situation. For example, when going to bed, he is characterized by increased activity, and during the day he remains in a sleepy state - 3 points;
· abnormal activity- the child is rarely in a normal state, in most cases showing excessive passivity or activity – 4 points.
14. Intelligence:
· child development is normal- child development is balanced and does not differ in unusual skills – 1 point;
· mild impairment- the child has standard skills, in some situations his intelligence is lower than that of his peers – 2 points;
· deviations of average type- in most cases the child is not so smart, but in some areas his skills correspond to the norm - 3 points;
· serious problems in intellectual development- children's intelligence is below generally accepted values, but there are areas in which the child understands much better than his peers - 4 points.
15. General impression:
· norm- outwardly the child does not show signs of illness – 1 point;
· mild manifestation of autism- under some circumstances the child shows symptoms of the disease - 2 points;
· intermediate level- the child exhibits a number of signs of autism – 3 points;
· severe autism- the child shows an extensive list of manifestations of this pathology - 4 points.
Calculation of results:
By placing a rating in front of each subsection that corresponds to the child’s behavior, the points should be summed up.
The criteria for determining the child’s condition are:
· number of points from 15 to 30– no autism;
· number of points from 30 to 36– the manifestation of the disease is likely to be mild to moderate ( Asperger's syndrome);
· number of points from 36 to 60– there is a risk that the child has severe autism.
The main method for diagnosing early childhood autism is dynamic observation of behavior, which is carried out either directly or indirectly through interviews with loved ones. In addition to the main method, psychological, physical, neurological and other examinations are carried out.
Observing a child's behavior is the most important source of information. Because the behavior of a child with autism varies greatly depending on the situation and place, he needs to be observed both in a specially organized and in a normal everyday environment. For children, it is necessary to create, whenever possible, relaxed play and learning situations. To organize direct observation ofa child with early childhood autism has a number of requirements:
Presence of parents;
Clear order and structure of actions;
Limited range of environmental stimuli;
Using familiar material;
The use of highly stimulating materials;
Hazard prevention;
Clear and unambiguous communication, if necessary using additional communication means (objects, photographs or drawings, pictograms, gestures);
The use of material amplifiers depending on needs (favorite food, drink, object).
During the survey of loved ones, information is collected in the following areas:
the presence of autistic symptoms in the child’s behavior in various life situations;
developmental history and medical history,
functional level of the child;
family health problems;
family situation, social data and previous experience related to diagnosis and provision of medical and psychological-pedagogical assistance.
Diagnosis of early childhood autism includes three stages.
The first stage is screening.
Developmental deviations are identified without their precise qualification.
Screening is the rapid collection of information about the social and communicative development of a child in order to identify a specific risk group from the general population of children, assess their need for further in-depth diagnostics and provide the necessary treatment.
rectoral assistance. Since screening is not used to make a diagnosis, it can be carried out by teachers, pediatricians and parents themselves. Let us list the main indicators of early childhood autism, the observation of which requires further in-depth diagnosis of the child.
Indicators of autism in early childhood:
Absence of single words at 16 months;
Absence of two-word phrases at 2 years;
Lack of non-verbal communication (in particular, pointing gesture) at 12 months;
Loss of speech or social abilities.
Indicators of autism in preschool age:
Absence of speech or delay in its development;
Special eye contact: infrequent and very short or long and motionless, rarely direct into the eyes, in most cases peripheral;
Difficulty imitating actions;
Performing monotonous actions with toys, lack of creative play;
Lack of social response to other people's emotions, lack of behavior change depending on the social context;
Unusual reaction to sensory stimuli;
Indicators of autism at school age:
Lack of interest in other people, contacts with peers;
Great interest in inanimate objects;
Lack of need for consolation in situations of psychological necessity;
Having difficulty waiting in social situations;
Inability to maintain dialogue;
Passion for one topic;
Performing activities filled with little creativity and imagination;
Strong reaction to changes in the usual daily schedule;
Any concern about the child's social or speech development, especially if there are unusual interests or stereotypical behavior.
The following standardized screening tools have long been developed and widely used in the world: CHAT - Scale for Early Recognition of Autism, STAT - Autism Screening Test, ADI-R - Diagnostic Interview for Parents.
For example, SNAT is a short screening tool designed for the initial assessment of child development between the ages of 18 and 36 months.
The first part of the test includes nine questions for parents that record whether the child exhibits certain types of behavior:
social and functional play, social interest in other children, joint attention, and some motor skills (pointing, unusual movements).
The second part of the test contains questions about observing five short interactions between the researcher and the child, which allow the specialist to compare the child's actual behavior with data obtained from the parents.
A positive screening result should be accompanied by an in-depth differentiated examination.
Second stage- actual differential diagnosis, i.e. in-depth medical, psychological and pedagogical examination of the child in order to determine the type of developmental disorder and the corresponding educational route. It is carried out by a multidisciplinary team of specialists: a psychiatrist, a neurologist, a psychologist, a teacher-defectologist, etc. This stage includes a medical examination, an interview with parents, psychological testing, and pedagogical observation. The differential diagnosis is made by a psychiatrist.
Abroad, ADOS (Diagnostic Observation Scale for Autistic Disorders) and CARS (Childhood Autism Rating Scale) are used as the main tools for the differential diagnosis of autism. For example, CARS is a standardized instrument based on direct observation of the behavior of a child aged 2 years and older in 15 functional areas (relations with people, imitation, emotional reactions, communication).
tion, perception, anxiety reactions and fears, etc.).
And finally third stage- diagnostics of development: identification of the child’s individual characteristics, characteristics of his communication capabilities, cognitive activity, emotional-volitional sphere, performance, etc. The identified characteristics should be taken into account when organizing and conducting individual correctional and developmental work with him. Diagnosis of the development of a child with early childhood autism is carried out by a speech pathologist. For this purpose, the standardized test PEP-R - Child Development and Behavior Profile - is used abroad. PEP-R
consists of two scales: development and behavior. Specifically, the developmental scale assesses a child's level of functioning relative to his peers in seven areas (imitation, perception, fine motor, gross motor, hand-eye coordination, cognition, communication, and expressive language).
Inna Minenkova (Belarus)
