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
· 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
o Perinatal CNS insult
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
· 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.
Selective serotonin reuptake inhibitors (SSRIs) include:-
Antipsychotic medicines, such as
Thioridazine -reduce tantrums, aggression, and behaviour in children with autism.
Clonidine, guanfacine- treat impulsive and aggressive behaviour
Lithium and anticonvulsants- carbamazepine, valproic acid
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.