Early childhood autism. Ways of rehabilitationO. A. Laisheva, 2020

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) defines autism spectrum disorder. It combines several diseases: Asperger's syndrome, childhood disintegrative disorder, PDD - pervasive developmental disorders. But in first place on the list of autism spectrum disorders is autism, in the context of which early childhood autism (ECA) is distinguished.

Classic autism

Autism is a disease whose core symptoms are impaired social interaction. That is, such a child has an absent or very poorly developed level of communication with others, and sometimes with close people.

Difficulties in communication manifest themselves both verbally and non-verbally. The child’s speech may be practically undeveloped or its accelerated development may be noted. He may have a huge vocabulary, but cannot engage in dialogue.

Nonverbal disorders are associated with difficulties in establishing visual contact, originality of postures, facial expressions, and gestures. An indicative criterion is the lack of empathy, that is, the ability to empathize with other people, understand their feelings, show care, compassion, be sad or rejoice with them.

The classic triad of RDA symptoms are:

• low level of social interaction, mutual communication;
• meager sphere of interests;
• stereotypical movements.

The disease manifests itself up to 3 years of age. Its first signs can be detected in the first year of life, but most parents attach importance to them when the child is 2 years old and older.

Signs of autism remain with a person throughout life to varying degrees. To date, scientists have not yet found a way to completely cure it.

Autism is associated with a disorder of the brain.

Research confirms that the development of the nervous system is influenced by the immune system even in the early stages of embryonic development, or, more precisely, by its insufficient function.

There is a theory that autistic individuals have an underdeveloped mirror neuron system. These cells are excited during motor activity, as well as when observing the activity of other people. For this reason, such people do not have the opportunity to adopt the behavior of others and monitor them.

Despite the large amount of research into the causes of the disease, the question of its nature remains open. Numerous theories reflecting on this problem do not provide a clear and complete answer.

Prevalence

The syndrome is characterized by an indicator of 2-4 patients per 10,000 people with a predominance of its development in boys (more than 2 times).

Clinical manifestations.

The development of this syndrome can begin between the ages of birth and 36 months (3 years) of a child’s life. It is determined by the autistic isolation of children from the real world with the inability to form communication and uneven maturation (asynchrony of development) of the mental, speech, motor and emotional spheres of life. This disease is characterized by the phenomena of protodiacrisis, insufficient discrimination between animate and inanimate objects. The behavior and games of autistic children are characterized by persistent stereotypes, lack of imitation, lack of response to the environment and increased sensitivity to conditions of both discomfort and comfort. The form of communication with relatives (especially with the mother) is symbiotic or indifferent, that is, without an emotional reaction, up to the refusal to communicate with them.

A change in the usual life pattern, the appearance of new objects and strangers cause a reaction of avoidance or dissatisfaction and fear with chaotic aggression and self-injury in autistic children.

In the external appearance of sick children, attention is drawn to frozen facial expressions, a gaze directed into emptiness or as if into oneself, and the absence of an “eye to eye” reaction, but sometimes there is a fleeting fixation of the gaze on surrounding faces and objects.

The motor skills of autistic children are angular with stereotypical movements, athetosis-like movements in the fingers, and walking “on tiptoes.” But along with this, patients with autism may develop quite complex

and fine motor acts. Receptive and especially expressive speech develops poorly; there is no expression, no gestures, echolalia and cliched phrases are preserved, the pronunciation of sounds is impaired, there is no intonation transfer, i.e., a continuous melody of speech, rhythm, tempo. The voice is loud, then suddenly becomes quiet and the child switches to a whisper. The pronunciation of the sound can vary - from correct to slurred, sometimes with unusual modulation. Expressive speech develops with a large lag; incoherent, egocentric speech predominates. Patients are practically incapable of dialogue. The child is deprived of an active desire to learn new phrases and use them. The disturbed syntactic and grammatical structure of speech is complemented by either intonation pretentiousness, babbling speech, or mannered word creation. The latter persists even after the first physiological crisis period. In more severe cases, there is a loosening of associations, a shift in thoughts, and sometimes the disappearance of personal pronominal and verbal forms from phrases; phrases become extremely short and abrupt.

In connection with the noted features of speech, the process of its development in these cases is of interest. The first words usually appear by 12-18 months, the first phrases by 24-36 months. But already at this age, it is noticeable that children do not ask questions, do not use personal pronouns in relation to themselves, speak about themselves in the second or third person and at the same time there is chanting or, on the contrary, a melodious pronunciation of the syllables of the word, incompleteness of phrases, meaningless and slurred repetition of words, refusal of affirmative and negative words. Children retain early, babbling intonations, stress on the last syllables of words, and drawn-out pronunciation of syllables for a long time. Nevertheless, children (although not all) are able to remember individual quatrains and passages of prose, although they cannot convey the meaning and content of what they read. In the future, along with the correct pronunciation of sounds and words, slurred pronunciation is observed. Gradually, the absence or complete underdevelopment of the generalizing and communicative function of speech becomes more and more clear. The noted speech deficiencies in approximately D cases can be overcome by 6-8 years, while in others, speech, especially expressive speech, remains underdeveloped.

Features of childhood autism are the relative preservation of abstract forms of cognition of reality, which in these cases are combined with primitive protopathic forms, i.e. cognition using predominantly tactile, olfactory and taste receptors, especially in primary orienting reactions. Such reactions to sound and light stimuli at an early age may be absent or sharply distorted. The absence of these reactions gives reason to suspect deafness and even blindness in autistic children.

In patients with Kanner's early autism, play activity is especially sharply changed. It often comes down to monotonous pouring, rearranging objects, tapping objects on objects, touching their faces, sniffing, licking. What attracts attention is the rapid satiety of any game action, the stuckness on the same manipulation, the lack of plot, the complications of the game, its stereotyping. Instead of playing, children can crawl, walk, sometimes jump and spin. After 3 years, the described behavior is sometimes combined with an overvalued attitude towards individual objects (cars, pieces of iron, tapes, wheels, etc.). Over the course of a number of years, games usually do not become more complex, becoming more and more stereotypical, without a single semantic content.

These children have some characteristics and behavior towards their peers and close people. Some children actively avoid their peers, others are indifferent to them, and others experience fear in the presence of other children. The attitude towards loved ones is quite contradictory.

Although autistic children are symbiotically dependent on their family, they do not respond adequately to their presence or absence. Children may become anxious in the absence of their mother and yet show no reaction to her appearance. More rare than an indifferent reaction to the mother is a negativistic reaction, when children drive their mother away from them and show hostility towards her. These forms of communication with the mother can be replaced by one another.

The emotional reactions of people with autism vary. Some children are distinguished by a relatively even mood, others can be cheerful, as evidenced by a satisfied expression on their face, a passing smile, while others are indifferent and show neither dissatisfaction nor joy.

Kanner's early childhood autism is especially characterized by negative reactions to any attempts to change the usual pattern of life - taking him for a walk to a new place, changing clothes, offering new food. All of the above invariably causes protest, negative attitude, moodiness and even anxiety. This peculiar combination of mental rigidity and inertia with extreme sensitivity and affective instability undergoes a slow, partial softening over the years, but these features never completely disappear.

From an early age, with Kanner syndrome, instinctive life is disrupted. Thus, changes in appetite attract attention. Patients have difficulty getting used to a new type of food; for many years they prefer the same types of food. Inversion of the sleep-wake cycle, difficulty falling asleep, and interrupted sleep are observed. Muscle tone is inconsistent - it is either reduced or increased. Some children have virtually no reaction to their surroundings, while others experience increased sensitivity, manifested by anxiety, unreasonable crying, etc.

The course of Kanner's syndrome.

Childhood autism syndrome takes on its most complete form at the age of 3-5 years. In most cases, by this time the final delay in the development of instinctive life, motor skills, especially fine motor skills, disturbances in speech development, play, and emotional spheres, which form autistic behavior as a whole, are determined.

The specificity of Kanner's syndrome lies in the combination of complex and primitive reactions within each functioning system - the phenomenon of “interlayering”. If in the first stages of a child’s development this manifests itself mainly in a violation of the physiological hierarchy of simple and complex structures, then later it is also noted in the structure of secondary mental retardation. The IQ of patients in most cases is below 70.

After the child reaches 5-6 years of age, the manifestations of Kanner's syndrome, partially compensated, are smoothed out, but this least of all concerns mental development disorders. Children often develop a pronounced oligophrenia-like defect with autistic forms of behavior. Sometimes, against the background of the main manifestations of Kanner's syndrome, neurosis-like, affective, catatonic or polymorphic disorders occur, which worsen the prognosis.

The presented data on the early onset of childhood autism and its clinical manifestations are typical for congenital mental development delays, and the absence in most cases of pronounced positive symptoms and obvious progression, as well as partial compensation by the age of 6 years, serve as the basis for classifying Kanner syndrome as a developmental disorder occurring through type of asynchronous dysontogenesis.

Etiology and pathogenesis.

There is no generally accepted concept about the etiology and pathogenesis of early childhood autism. The most common ideas about the reasons for its development are divided into two groups - theories of psychogenesis and biological theories.

Theories of psychogenesis.

These concepts arose simultaneously with Kanner's description of early childhood autism, who, as already mentioned, was inclined to believe that autism is an expression of children's innate inability to interact emotionally with others (affective contact defect). But relatively quickly these ideas were transformed into the now quite widespread opinion that childhood autism is a consequence of the lack of maternal warmth and attention and a general affective positive atmosphere in early childhood (from the time of birth). Of particular importance in this case is the interaction in the mother-child system, which is inextricably linked with the constant exposure to a variety of stimuli (stimuli), so necessary for the maturation of the functions of the central nervous system. Apparently, it is hardly possible to explain the development of early childhood autism entirely by psychosocial interactions, but it cannot be denied that they undoubtedly play a significant role in the pathogenesis of the disease. This, in particular, is evidenced by the existence of purely psychogenic (deprivation) autism, which can develop, for example, in orphans.

Biological theories.

These theories include genetic concepts, the theory of brain development disorders, theories related to the action of perinatal factors, as well as neurochemical and immunological concepts.
The most common among them is the genetic theory.
The following data support the special role of genetic factors in early childhood autism: 2-3% of siblings of autistic children suffer from the same disease, which is 50 times higher than the population frequency of early childhood autism; Concordance for childhood autism in pairs of monozygotic twins, according to various authors, ranges from 36 to 89%, while in pairs of dizygotic twins it is 0; the risk of developing early childhood autism in a second child after the birth of the first with autism reaches 8.7%; Among parents of autistic children, the prevalence of autistic symptoms exceeds that in the general population. Despite the presence of such convincing data on the significant role of hereditary factors in the development of early childhood autism, the mode of inheritance remains unknown. It is possible to inherit not the disease itself, but a predisposition to it. Within the framework of the genetic theory, the role of the fragile X chromosome is also considered, since early childhood autism is combined with fragile X syndrome in 8% of cases (fluctuations from 0 to 20%). However, the essence of this connection is not yet entirely clear.

Theories in which the greatest importance is attached to deviations in the development of brain structures

are based both on purely theoretical ideas about the immaturity of brain formations, and on neuroanatomical and computed tomographic observations of recent years. If macroscopically the brain of sick children usually does not have any features, then microscopy reveals a decrease in the size of neurons in the hippocampus, entorhinal cortex, amygdala, mammillary bodies and in some other parts of the brain, including the cerebellum (reduction in the number of Purkinje cells). X-ray computed tomography and magnetic resonance imaging revealed a decrease in the size of the frontal and temporal parts of the brain, especially on the left, and an expansion of the internal liquor spaces. It is assumed that in the prenatal period, disruption of the maturation of neurons, their premature and increased death, as well as migration disturbances under the influence of genetic or “exogenous” factors are possible.

To pathogenetically significant perinatal factors

include various negative impacts in the neonatal, during childbirth and early postnatal periods. These are bleeding in the mother during pregnancy, her consumption of excessive amounts of medications, and other toxic and infectious effects on the fetus. Immunovirological theories are closely related to this group of ideas. Immunological theories include, in particular, assumptions about the possible presence of autoantibodies in the blood of mothers (for example, to some serotonin receptors, neurofilament proteins, etc.) that disrupt the development of the corresponding elements of nervous tissue. Of the viral infections, the most attention is drawn to the viruses of rubella, herpes simplex, influenza and cytomegalovirus infection, which are especially dangerous in the early stages of fetal development.

Neurochemical theories

focused on the function of the dopaminergic, serotonergic and opiate systems of the brain. The results of a number of biological studies have given reason to assume that the function of these systems is increased in early childhood autism. It is believed that many clinical manifestations (autism, stereotypies, etc.) of the disease may be associated with the hyperfunction of these systems. The validity of such assumptions is evidenced by the successful use of haloperidol, antidepressants and naltrexone in many cases.

It is easy to see that all of the listed theories are fully correlated with those in schizophrenia. Therefore, it is still possible that childhood autism is part of the range of endogenous mental disorders of the schizophrenia spectrum. It must be said that the development of ideas about the pathogenesis of childhood autism was greatly influenced by the work of domestic child psychiatrists on studying the structure of developmental disorders in children with schizophrenia, since they noted a number of variants of these disorders, namely the types of stigmatized (schizotypal), distorted (schizoid) and delayed development [Yuryeva O.P., 1973]. To these can be added a type of asynchronous development, which, as a rule, is accompanied by developmental delay [Bashina V.M., 1970, 1980, 1989]. From our point of view, Kanner's childhood autism syndrome should be considered in the continuum of the pathology of personal development: constitutional schizotypal and schizoid variants - intermediate (Kanner's early autism syndrome) states - post-ictal, schizophrenic types of personality changes.

Particular attention is paid to the asynchrony of the development of functional systems, i.e., the disintegrative type of development of the central nervous system in autism [Bashina V. M., 1970, 1980, 1989; Kozlovskaya G.V., 1996; Mahler M, 1952; Fish V., 1975, etc.].

Some authors believed that the main manifestations of early childhood autism may be associated with underdevelopment of the activating systems of the brain [Mnukhin S.S., Zelenetskaya A.E., Isaev D.N., 1967; Kagan V.E., 1981; Bosch L., 1962; Rutter M., 1966; Diatkine A., 1970].

There are also ideas about disorders of adaptation mechanisms in an immature personality with instability and weakness of integration processes in the child’s nervous system. The asynchronous nature of development in childhood autism may have common origins with the phenomena of “splitting” in schizophrenia. Due to the immaturity of the central nervous system, the latter in childhood autism may have a different clinical expression. In other words, the uniqueness of classic childhood autism lies in the fact that in its structure one can detect features of a general developmental disorder, its asynchrony, and developmental disorders of an endogenous nature. This is why childhood autism occupies an intermediate position in the above continuum of disorders.

Story

The concept of “autism” was first described in 1911 by Eugen Bleuler, but it was considered in the context of schizophrenia, as one of its symptoms. Translated from Latin, it means “abnormal narcissism.” With this term, the psychiatrist tried to indicate the patient’s withdrawal into his inner world, isolation from the intrusive interference of outsiders, and separation from reality. In its modern interpretation, it began to be used at the suggestion of Hans Asperger, after whom one of the autism spectrum disorders, Asperger syndrome, was named.

The concept of “early childhood autism syndrome” was introduced into psychiatry by Leo Kanner. In 1943, he introduced the term “autism” into a completely new context by describing the stories of 11 children and diagnosing them with infantile autism. He pointed out that this condition is markedly different from schizophrenia in children. In the picture of the disease, he noted the presence of symptoms such as stereotypical movements and echolalia. One of the variants of ASD, Kanner syndrome, was also named in honor of Leo Kanner.

Forecast and prevention of early childhood autism

The impossibility of completely curing early childhood autism causes the persistence of the syndrome in adolescence and adulthood. With the help of early, constant and comprehensive therapeutic and correctional rehabilitation, it is possible to achieve acceptable social adaptation in 30% of children. Without specialized help and support, in 70% of cases children remain deeply disabled, incapable of social contacts and self-care.

Considering the uncertainty of the exact causes of early childhood autism, prevention comes down to generally accepted rules that a woman preparing for motherhood must follow: carefully plan the pregnancy, eliminate the influence of unfavorable exogenous factors, eat right, avoid contact with infectious patients, follow the recommendations of an obstetrician-gynecologist, etc.

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Clinical picture

The main symptoms of RDA appear in infancy, in children in the first year of life. The following signs are noteworthy:

• late onset of babbling;
• smile little;
• do not fix their gaze on other people;
• lack of reaction in response to an adult’s appeal;
• do not respond to their own name;
• react sharply to weak stimuli, for example, minor noise, with strong negative emotions: crying, screaming, fear. But they react weakly to strong stimuli;
• After feeding, the baby does not express pleasure. There is no impression of a contented, satisfied baby.

Children with signs of autism have a perverted animation complex. This is the name of the emotional-motor response of a baby to the activity of an adult towards him. This simple form of behavior is formed by the end of the first month. It persists and intensifies until 4 months of age, and then disappears.

The structure of the revitalization complex includes the following components:

• prolonged fixation of gaze on an adult;
• smile addressed to the parent;
• verbal expression of emotions - cooing, humming, exclamations;
• motor reactions in the form of swinging arms and legs, head movements, and bending of the body.

In children with ASD, the reactions of the complex, as already mentioned, are perverted, very weakly expressed or completely absent. Such a child does not ask to be held, does not calm down when his mother takes him in her arms.

Another option is also possible, when the reactions of the revitalization complex are fully manifested, but not to an adult, but to any object, for example, a favorite toy or a pattern on wallpaper, a light bulb.

An autistic infant reacts poorly to parents and other loved ones, looks as if through them, does not express positive emotions in their presence, and does not come into contact with them. There is a disturbance in the baby's activity. Such children are called comfortable - they are too calm and undemanding.

As for motor development, it does not initially cause concern. All significant motor skills develop on time: independently holding the head, turning from back to stomach and back, sitting down. Children also begin to get up and walk on time, but there may be a time gap between walking with support and stomping independently—often it lasts up to six months.

In the further development of motor skills, the following tendency is observed: they are sluggish, unrhythmic, uncoordinated, characterized by stiffness, tightness and tension. Children often walk on their toes.

However, there are children with ASD, on the contrary, who are particularly nimble and flexible. They are very mobile. They tumble and easily climb heights. They keep their balance well. They say about these people: they can get through everywhere.

Can they be mistakenly diagnosed with autism - how to check

The symptoms of autism spectrum disorder can be easily confused with similar conditions. More recently, the diagnosis of “autism” was made extremely rarely, since most often all the signs were assigned to “schizophrenia.”

Autism with reduced intelligence is often confused with mental retardation - these are different diseases.

The disorder is diagnosed at three years of age. But the signs begin to appear earlier; it’s just that not every parent, or even pediatrician, will be able to recognize them in a timely manner.

The main problem of patients diagnosed with ASD is the lack of communication skills. Often they do not show speech abilities and are closed in “their personal world.” An autistic child, especially one with atypical autism, is misdiagnosed as “schizophrenic” and “mentally retarded.” They are not accepted in society, and their parents try to protect them from the outside world as much as possible.

In order to accurately determine the diagnosis, the following studies are prescribed:

• MRI;
• EEG,
• consultation with an audiologist (to determine the abnormality of the auditory canals);
• consultation with a speech therapist (to determine abnormalities in speech development).

Further development

By the end of the first year of life, it can be noticed that autistic children suffer from such a developmental component as joint activity between an adult and a child, which includes common experiences of pleasure and interest in joint activities and play.

Such kids have difficulty getting involved in joint activities. They find it difficult to connect emotionally with adults. It is significant when a child is pointed at an object with his hand, but he only looks at the hand; the object itself is uninteresting to him. For his part, he rarely points to an object on his own in order to share emotions. The pointing gesture is not formed or the child may point to something with an adult’s hand.

Because of this, children poorly develop such components of mutual coordination as following the parent’s gaze, imitating his behavior, and responding to his own name. The child does not respond to even the most banal request.

1 year is a crisis period in the life of all children. It is especially difficult for an autistic child. The possibility of independent movement leads to regression of even the slightest communications that took place.

In the baby's poses there is no request to pick him up, while healthy children at this age clearly demonstrate this with a familiar gesture: for example, they stop and extend their arms to the parent.

By the age of 3, children with ASD already have a clear formation of this syndrome. At the same time, the manifestation of negativism intensifies. Protest is expressed against innovations and attempts to organize their activities. For example, a child with autism resists changing the decor in his room. Everything must remain in its place with meticulous precision.

There is a lack of spontaneity in interacting with people. There is a paucity of emotions towards the other person. Imitative behavior is difficult.

A child with ASD falls into the power of his stereotypes. Monotonous, repetitive behavior is an important symptom in the picture of the disease. It can manifest itself in the form of repetitive movements. Such a special baby walks in a circle for a long time or sits in place, swaying back and forth, hangs upside down, jumps on outstretched legs. Stereotypical movements intensify at times of emotional stress or joy.

Ritual behavior is expressed in the daily repetition of monotonous actions. Perhaps this is folding clothes: they are arranged in a certain order and sequence.

Stereotypical behavior is characterized by acting according to certain rules. For children, this is most often arranging toys in a monotonous manner, for example, by size or in a row. They pay attention to small objects and love to play with matches, buttons, and mosaics. More primitive actions involve pressing on the eyeballs, making certain sounds, and manipulating paper.

Little autistic children also have a uniqueness of interests, expressed in fixation on one activity or object. The baby loves to eat from one specific plate. If he is offered other dishes, he refuses to eat. Or he has a favorite toy that should always be with him.

There is selectivity in food. Many products are rejected. At the same time, there is an overly picky attitude towards the dishes offered: the child takes them apart into pieces and sniffs them. On the other hand, there is a tendency to absorb inedible objects.

It should be noted that a child with ASD often finds himself in a dangerous situation. This is due to his involvement in stereotypical programs. For example: a child runs out onto a busy highway after seeing a car of a certain color and following it.

It is very difficult for little autistic children to master even basic self-care skills. All areas of the process suffer: coordination, orientation in space, holding a pose, repetition. The awkwardness intensifies especially when there is a positive attitude towards the activity and interest in it. In this case, the joint activity of the parent and the baby in the following mode helps a lot. The adult takes the baby's hands in his hands and begins to perform the manipulation with him from start to finish. Thus, after a series of repetitions, the child remembers the action pattern.

If an adult removes his hands at the wrong time and gives his child free reign, he may stop repeating the skill.

Homeopathy and raccotherapy

Confusion with diagnoses, low detection rate, as well as an acute shortage of qualified specialists in behavioral disorders have led to great popularity in Russia (as, indeed, in many other countries) of unscientific - in the sense of unproven effectiveness - programs for helping people with developmental disabilities. They propose to fight autism (and often at a considerable cost) with the help of diets, dolphin therapy, raccoon therapy, art therapy, homeopathy, folk remedies and at home. None of these remedies currently have scientifically proven effectiveness.

— The causes of autism are most likely genetic. We know that many genes—about two hundred—are associated with the onset of this disorder. But there is no test or study that can diagnose autism. The diagnosis is made by a specialist based on his own observations of the child’s behavior. And when the cause of the disorder is unclear and the diagnosis is made in the subjective opinion of a specialist, a lot of speculation, myths and alternative non-scientific approaches arise, explains Tatyana Morozova.

Experts have lamented that some of these approaches are being promoted at the highest academic levels. Thus, the Institute of Correctional Pedagogy of the Russian Academy of Education recommends the so-called “holding therapy” to help children with autism. Holding - from the English hold (“hold, hold”). In practice, it looks like this: a parent forcibly holds a child in his arms for hours, who, of course, tries to avoid this, screams, cries, and breaks away. This is painful for both the adult and the child, but it is believed that if both endure the stage of rejection, then it will be easier for the parent to establish contact with the child.

“To date, there is not a single study that would prove the effectiveness of this method,” says Connie Casari, professor of psychology at the University of California, Los Angeles. — And none of the specialized scientific institutions in the USA or Europe recommends this method.

— How can parents understand the methods and separate the effective from the useless and dangerous?

— In medicine, the gold standard for evaluating effectiveness is a documented study using control groups. Many methods of helping people with developmental disabilities have undergone such testing - information about them appears in scientific publications, explains Kazari.

Of course, it is not easy for a person without special education to understand this information. But, as doctors say, patients’ relatives are usually the most advanced specialists. In addition, NGOs that support people with developmental disabilities help. In Russia, these are, for example, “Naked Hearts”, “Exit”, “Downside Up”. Such organizations always have professional scientific consultants.

What methods have proven effectiveness? At the moment, as far as one can judge from the speeches of scientists at the forum, there are no medications that can cure autism. A number of proven support programs have been developed to help people with autism learn new skills and function more effectively. Most of these programs are based on ideas from applied behavior analysis. Behavioral therapy gradually teaches children social, behavioral and cognitive skills in a playful, step-by-step manner, rewarding each success. These programs are long-term (most often last a lifetime), intensive (several hours of classes per day) and are aimed at improving the quality of life, including the environment for a person with autism - through working with families and inclusive education.

“The ultimate goal of any assistance program is for children with special needs to get into the educational system - kindergartens and schools, so that in the future they find work, start families, and live the life they choose for themselves. This cannot be achieved by easy and quick methods. Anyone who promises this is probably a charlatan, says Dr. Thomas Higbee, a well-known American expert in the field of behavior analysis, professor of special education and rehabilitation at the University of Utah.

Speech, intelligence, worldview

Children with autism have impaired perception of the overall picture of the world. They analyze the object not as a whole, but divide it into details. They are interested in the car not as a form of transport, but only because its wheel moves.

Such children are not characterized by the desire to understand the world, study the properties of an object, its purpose. They choose attractive elements for themselves and follow them. Cognitive questions “why, why” lag in time.

Autistic children have a hard time getting interested in toys, but they focus on sensory stimuli. For example, a baby loves classical music so much that already at one year old he finds the right record in a stack and puts it in the player.

However, what is amazing is the ability of such children to remember what they, looking from the outside, do not pay attention to, hear what they do not listen to, see what they do not look closely at. When it is subsequently possible to establish verbal contact with them, the children talk about many things that, as it seemed, did not interest them.

As for memory, it can be said to be selective. They remember very well what is significant to them: the situation in the apartment, habits in the family, etc. Therefore, any violation of the routine causes indignation in them. Children are also good at remembering events that made them feel afraid.

A special feature of little autistic children is mechanical memory. They perfectly remember poetry, reproduce complex drawings and songs.

The speech of autistic children also has its own characteristics. In infancy, they are not characterized by humming and babbling. They appear very late. The first words are spoken on time, but these are not the usual “mother”, but completely different words that are not used for direct communication.

Many children's speech is either very poor, with a small vocabulary, or practically not developed at all. They hum, smack, and speak their own language. The words are incoherent and may use expressions taken from the cartoons they have watched.

Echolalia is observed - repetition of words addressed to the autistic person. Sometimes very complex expressions are repeated, but purely automatically, without understanding the meaning. There is a reversal of pronouns; when a child with ASD is asked what your name is, he answers: “Your name is Petya.”

The meaning of the speech of an autistic child is understandable only to close people, since he operates with abstract concepts. For example, when mom is angry, she answers her: “Have mercy, madam.”

Even if the baby’s speech is quite well developed, and his vocabulary is very rich, he is still incapable of dialogue. He speaks only about what interests him, in the form of a monologue, while the intonation of his statements suffers.

Autistic people easily learn foreign languages. But, as teachers note, they also master their native language as a foreign one.

In general, speech with RDA is also stereotypical. It is often incomprehensible to others, as it expresses the personal interests of its bearer. Spontaneous speech used in communication is poorly developed; children better perceive indirect speech addressed to others. They can speak clearly and without hesitation, using complex expressions, in the form of a monologue or echolalia, but they stumble, get confused and speak blurredly when trying to start a dialogue.

General picture of behavior and diagnostic criteria

Common signs of autism spectrum disorders include:

• inability to communicate normally;
• repetitive behavior for the purpose of autostimulation;
• lack of imagination.

Signs that parents may notice include:

• in the monotony of some movements;
• in the absence of an emotional response to the parent’s emotion (sometimes this developmental feature is confused with hearing impairment);
• the ability to clearly focus on a task;
• in violation of communication and speech development, mutism - stubborn silence;
• aggression when trying to contact;
• avoiding eye contact;
• in a violent reaction, irritability, emotional tension when entering an unknown situation;
• in the absence of understanding of the threat and assessment of the situation, accepted social rules.

These symptoms should be considered in close relationship with each other. In general, there is no adequate 100% diagnostic method. Behavior is considered in its entirety, that is, a diagnosis cannot be made based on one symptom.

Broken communication

Impaired communication depends on the severity of the disorder. In severe cases, the baby does not communicate with others at all and does not respond to his name. In mild forms, the child may demonstrate communicative ability, but not to establish emotional contact, but to satisfy the needs for food, care, and movement. Such children do not react to the appearance of an interesting object (animal, airplane, etc.).

The ability to ask is an important communication skill. Its deficiency is suspicious. A typical autistic reaction to new people is avoidance, which is confused with extreme shyness.

The skill of making eye contact is especially important for diagnosis at an early age. Normally, a child’s gaze is projected “eye to eye.” If the gaze goes past the eyes, despite attempts to attract attention, this will help diagnose autistic disorder.

Normal children at 2.5 years old should have a minimum vocabulary, and by the age of 3 they should be able to speak in sentences. Autistic children pronounce complex phrases heard from adults. This is called reflected speech, when the child meaninglessly repeats what he heard.

With age, the speech of little autistic children becomes fast, choppy, and interrupts other speakers. Many children with Kanner syndrome do not use speech at all.

Monotonous behavior

Repetitive, unnatural behavior is often found within autism spectrum disorders and appears to be repeated:

• spinning around its axis;
• movement along one route;
• rocking

It is necessary to distinguish naturalness from anomaly. The line passes where movements are in no way connected with the situation and arise spontaneously.

Toys will help diagnose pathology. Autistic people have a predilection for laying out details in a certain order, out of the established order. Children will be interested not in the toy itself, but in the part that they want to play with for hours. They replace imagination and play with monotonous movements that do not lead to proper development.

Change of scenery

Little autistic people do not like and are afraid of any changes. Traveling with parents becomes a disaster with a series of tantrums for the latter.

The baby is characterized by persistent habits. Parents are advised to prepare their child in advance for travel and a change of scenery with the help of illustrative examples.

The disease cannot be diagnosed by blood, urine or hormone tests. Diagnosis with a certain probability is carried out from 1.5 years, and the diagnosis is made based on the behavioral characteristics of the baby.