CHILDHOOD AUTISM
DISORDERS.
Introduction
about children psychiatric problems.
·
It has been observed that
severe disorders may have their onset in infancy and early childhood, or later
in late childhood around eight years and adolescence.
·
Attachment theory focused on
the bond between mother and the child in infancy
·
Difficult family and
environmental situations lead to psychiatric illness.
·
Social isolation of the child
as well as parents
·
Physical surrounding
·
Parents neglect.
Meaning of
Autism Spectrum Disorder
Was first described by Leo Kanner in 1943
Rutter defined
autism as a pattern of delay and deviance in the areas of social and
communication development that were not simply the result of development delay
along with the group of unusual behavior subsumed under the term 'insistence on
sameness'.
Autism spectrum
disorder (ASD) is now defined by the American Psychiatric Association's
Diagnosis and Statistical Manual of Mental Disorders (DSM-5) as a single
disorder that includes disorders that were previously considered separate —
autism, Asperger's syndrome, childhood disintegrative disorder and pervasive
developmental disorder not otherwise specified.
The term
"spectrum" in autism spectrum disorder refers to the wide range of
symptoms and severity. Although the term "Asperger's syndrome" is no
longer in the DSM, some people still use the term, which is generally thought
to be at the mild end of autism spectrum disorder.
The number of
children diagnosed with autism spectrum disorder is rising. It's not clear
whether this is due to better detection and reporting or a real increase in the
number of cases, or both.
While there is no
cure for autism spectrum disorder, intensive, early treatment can make a big
difference in the lives of many children
The fastest growing diagnoses of childhood
Very complex, often baffling developmental disability
"Auto" — children are "locked
within themselves."
For next 30 years, considered to be an
emotional disturbance
Types of ASD
·
Autistic Disorder
·
Asperger's Disorder
·
Pervasive Developmental
Disorder — Not Otherwise Specified (PDD-NOS)
·
Rett's Syndrome
·
Childhood Disintegrative
disorders
1. Autistic
Disorder
·
Impairments in social
interaction, communication, and imaginative play.
·
Apparent before age 3.
·
Also includes stereotyped behaviors,
interests, and activities
2. Asperger's
Disorder
·
Impairments in social
interactions, and presence of restricted interests and activities
·
No clinically significant
general delay in language
·
Average to above average intelligence
·
Hans Asperger — a Viennese
medical student— 1944 — his work not translated into English until 1981 and
entered into the DSM IV in 1994
3. Pervasive
Developmental Disorder — Not Otherwise Specified (PDD-NOS)
·
Often referred to as atypical
autism
·
Used when a child does not meet
the criteria for a specific diagnosis, but there is severe and pervasive
impairment in specified behaviors
Rett's Syndrome
·
Progressive disorder which,
almost exclusively occurs in females
·
Period of normal development
and then the loss of previously acquired skills
·
Also loss of purposeful use of
hands, which is replaced by repetitive hand movements
·
Beginning at age of 1 -2 years,
typically in first 5 months
·
Characterized by head growth
deceleration and loss of previously acquired skills between 5-48 months
4. Childhood
Disintegrative Disorder
·
Normal growth and development
prior to manifesting social interaction (generally the first 2 years)
·
Then significant loss of
previously acquired skills in at least 2 of the following areas (language,
social skills, adaptive behavior, bowel or bladder control, play, or motor
skills) before the age of 10
Over the last 30 to
40 years there has been great increase in the number of diagnosed cases.
·
Autism is the fastest-growing
serious developmental disability in the U.S.
·
Autism is more prevalent in
siblings of those with ASD
Autism is more
prevalent in those with other developmental disorders such as Fragile X syndrome,
Developmental Cognitive Delayed, or Tuberculosis
Autism is not a
modern problem, even though it has only been recognised in modern times. In
view of the short history of psychiatry, and the even shorter history of child
psychiatry, we know that a disorder recently described is not necessarily a
recent disorder. An increase in diagnosed cases does not necessarily mean an
increase in cases."
Etiology of
ASD
Currently no
medical test to confirm. A diagnosis is made by behavioral observations
·
Neurological : No single, known
cause
·
Genetic Problems
o
Depending on the gene, a child
may be more susceptible to the disorder
o
Can affect the way brain cells
communicate
o
Can affect the severity of the
symptoms
·
Environmental Problems
o
Exploring whether or not
trigger autism
o
i.e. air pollutants and viral
infection
·
Others
o
Perinatal CNS insult
o
Epilepsy
o
Ventricular dilatation (Brain)
o
Increased serotonin level
(5-HT)
o
Chromosomal abnormality
§ Deletion-A mutation in which a gene or other section of DNA, is
removed from a chromosome
§ Duplication- process of divine natural growth
·
Inversion-a segment of DNA in
context of a chromosome
Clinical
features of childhood autism disorders
Impairment in social interaction and
communications
·
Fails to respond to his or her
name or appears not to hear you at times
·
Resists cuddling and holding
and seems to prefer playing alone — retreats into his or her own world
·
Has poor eye contact and lacks facial expression
·
Doesn't speak or has delayed speech, or may lose previous ability to say
words or sentences
·
Can't start a conversation or
keep one going, or may only start a conversation to make or label items
·
Speaks with an abnormal tone or
rhythm —a may use a singsong voice or robot-like speech
·
May repeat words or phrases
verbatim, but doesn't understand how to use them
·
Doesn't appear to understand
simple questions or directions
·
Doesn't express emotions or
feelings and appears unaware of others' feelings
·
Doesn't point at or bring
objects to share interest
·
Inappropriately approaches a
social interaction by being passive, aggressive or disruptive
Abnormal behavior
Mental retardation
Associated
features
·
Cognitive impairment,
·
Abnormal responses to sensory
stimuli,
·
Self-injurious behavior
Repetitive and stereotyped patterns of behavior
·
Twirling, flapping of hands,
rocking
Restricted range of interest (Patterns of
behaviour)
·
Performs repetitive movements,
such as rocking, spinning or hand-flapping, or may perform activities that
could cause harm, such as head-banging
·
Develops specific routines or
rituals and becomes disturbed at the slightest change
·
Moves constantly
·
May be uncooperative or
resistant to change
·
Has problems with coordination
or has odd movement patterns, such as clumsiness or walking on toes, and has
odd, stiff or exaggerated body language. May be fascinated by details of an
object, such as the spinning wheels of a toy car, but doesn't understand the
"big picture" of the subject
·
May be unusually sensitive to
light, sound and touch, and yet oblivious to pain
·
Does not engage in imitative
or make – believe play
·
May become fixated on an object
or activity with abnormal intensity or fœus
·
May have odd food preferences,
as only a few or eating only foods with a certain texture.
Medical management
Selective
serotonin reuptake inhibitors (SSRIs) include:-
Citalopram
Fluoxetine
Sertraline.
Antipsychotic
medicines, such as
haloperidol,
risperidone,
Thioridazine -reduce
tantrums, aggression, and behaviour in children with autism.
Other Medications:
Clonidine,
guanfacine- treat impulsive and aggressive behaviour
Lithium and
anticonvulsants- carbamazepine, valproic acid
Nursing management
It is important to
seek professional advice about suitable treatment strategies for people with
ASD. The age of the person, and the severity of their difficulties are both
important factors to consider when deciding on what can help. Listed below are
some strategies that can be put in place to assist parents and other carers of
people with ASD.
Provide
a reasonable level of daily structure through the use of a daily or weekly
diary and prepare the person for any changes to their routine. When a
significant change is going to happen, spend time prior to the event talking to
the child or adult about what is going to happen and ensure that they have
support to manage any anxiety. This may help them cope with change more easily.
Give
a step-by-step list of instructions for completing everyday activities, such as
getting ready for school or taking a shower. A wall chart with pictures
illustrating each step can be a good way to present this information. This can
be helpful for higher functioning children and adults.
Develop
a regular routine for the day including set times for meals, activities and
sleep. Once a routine is in place,
avoid changing it if possible. Children and adults with ASD can become
extremely upset if their routine is changed.
Provide instructions
in simple language allowing time for the individual to absorb the information
and respond. Try not to use phrases such as "pull your socks up" or
"it's raining cats and dogs" because people with ASD often take
things literally. If an appropriate response is not given it is helpful to
check that the person has understood.
Provide visual
cues such as pictures or a story outline to support communication. For example,
when giving instructions or setting up a daily diary use pictures to
demonstrate tasks and to help understanding.
Teach and
practise social 'rules' such as turn-taking and how to greet people, and
provide opportunities for the individual to interact with others. Strategies
such as roleplays can be a useful way of helping the person to learn new social
skills.
Seek help when
family issues arise. Raising a child or supporting an adult with ASD can be
difficult and stressful. Family assistance and treatment can improve outcomes
for both the person with ASD and those around them.
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