In general, the Generalized Developmental Disorders, are usually associated with some degree of cognitive deficit. They are characterized by a serious and widespread disturbance of various areas of development: social interaction skills, communication, existence of behaviors, interests and stereotyped activities.
- 1 What is autism spectrum disorder?
- 2 Start and course
- 3 Differential diagnosis
- 4 Treatment
What is the autism spectrum disorder?
The autism is a complex biological disorder of development that generally lasts a lifetime. It is characterized by the presence of a very abnormal or poor development of social interaction and communication. A remarkable affectation of nonverbal behaviors (eye contact, facial expression, postures and body gestures) can be observed. There is also a lack of interest in establishing relationships with other children of their age or the lack of understanding necessary to comply with social conventions.
It is also called developmental disability because it begins before the age of three, during the period of development, and causes delays or problems with many of the different ways in which the person develops or grows.
In many cases, autism causes problems with:
- communication, both verbal (spoken) and non-verbal (not spoken).
- social interactions with other people, both physical (such as hugging or holding) and verbal (such as having a conversation).
- repetitive routines or behaviors, such as repeating words or actions over and over again, following their routines or schedule for their activities obsessively, or having very specific ways to fix their belongings.
Symptoms of the disorder disconnect people with autism from the world around them. Children with autism may not want their mothers to hold them. Adults with autism may not look others in the eyes. Some people with autism never learn to speak. These behaviors not only make life difficult for individuals with autism but also make life difficult for their families, the health professionals who care for them, their teachers and anyone who comes into contact with them.
Subjects suffering from the disorder do not participate in group games, preferring lonely activities and if they participate in games with other people, they use them as objects to use in the game.
The communication alterations they can vary from a total absence of language, to a lack of ability to carry on a conversation with another, through the ecological repetitions, the stereotyped use of phrases or words, or the use of tones that are not consistent with the verbal content, ( ex .: talk with intonation interrogative or in the form of song).
The behavior usually shows stereotyped mannerisms, continuously doing the same act for hours (ex: play with plasticine around the nose). They also often accuse the change of order in the actions they perform and prefer a very structured environment. When changes occur in this environment, even if they are small, they show exaggerated reactions (paddles, self-aggressions and even heteroaggressiveness).
Another characteristic of their behavior includes the lack of adequacy of their reactions to stimuli, sometimes showing an absence of reaction to intense stimuli and in others, an extreme reaction to insignificant stimuli.
Autism is a syndrome that statistically affects 4 out of every 1,000 children approximately.
Currently the figures show that autism occurs in all racial, ethnic and social groups. These statistics also show that boys are three to four times more likely to be affected by autism than girls.
Also, if a family has a child with autism, there is a 5 to 10 percent chance that the family has another child with autism. On the contrary, if a family does not have a child with autism there is only a 0.1 to 0.2 percent chance of the family having a child with autism.
As stated above, in most cases, specifically 75%, there is a cognitive deficit associated.
Sometimes there are irregular cognitive profiles, that is, a child with superior intellectual functioning and autistic disorder, has a level of receptive language well below his intellectual level.
Start and course
Autism is not a disease that one can "catch" in the same way that one gets a flu or a cold. Rather, scientists think that autism has its beginnings before
May the person be born. No one knows the exact cause or causes of autism.
By definition, the disorder begins before 3 years.
The course is continuous, although its manifestations vary over the years, with evolutionary progress in some areas. On other occasions deteriorations appear during adolescence. Only a small percentage of autistic subjects come to live autonomously in their adult life. A third of the cases achieve partial personal independence.
What behaviors indicate the need for a doctor to evaluate a child for autism?
A doctor should evaluate a child to see if he has a autism spectrum disorder, yes:
- Does not babble or hum at 12 months of age
- Does not make gestures (points, greets, grabs, etc.) at 12 months of age
- He doesn't say a single word at 16 months old
- He doesn't say two-word phrases on his own (instead of just repeating what someone says) at 24 months of age
- Suffer any loss of any language or social skill at any age
- It does not respond to his name.
- He can't explain what he wants.
- You have a delay in language or speech skills.
- It does not follow instructions.
- Sometimes he seems deaf.
- He seems to listen sometimes, but sometimes not.
- He doesn't point or can't say goodbye with his hand.
- He could say a few words or babble but now he doesn't.
- It has intense or violent lollipops.
- It has rare movement patterns.
- He is hyperactive, uncooperative or gives a lot of opposition.
- He doesn't know how to entertain himself with toys.
- It does not return smiles.
- Has difficulty making eye contact.
- He remains "stuck" in certain things, performing them over and over again, unable to continue to other tasks.
- It seems that he prefers to play alone.
- Bring things just for him.
- He is very independent for his age.
- It does things "first" than other children.
- He seems to be in his "own world."
- It seems to be disconnected from others.
- He is not interested in other children.
- Walk on the toes.
- Show an exaggerated attachment to toys, objects or schedules (for example, you are always holding a rope or you have to put on your socks before
- Spend a lot of time aligning things or putting them
in a certain order
It is distinguished from Rett Disorder in that the latter has only been diagnosed in women and shows a slowdown in cranial growth, and loss of previously acquired skills.
Childhood Disintegrative Disorder differs in that in this, after two years of normal development, an evolutionary regression appears.
In Asperger Syndrome there is no delay in language development.
The differential diagnosis with schizophrenia is made because it occurs after several years of normal development, and with Selective Mutism because children who suffer from the latter have their communication and social interaction skills preserved, except for the expressive verbal aspect, and show no strange behavior patterns.
Till the date, there is no cure for autism. However, there are a number of treatments that can help people with autism and their families lead more normal lives.
Intense individualized interventions, which begin as early as possible, give people with autism the best chance to progress. Doctors suggest that these treatments be started before the child turns 2 or 3 years old to get the best and longest lasting results. In some cases, treatment can help people with autism to function at normal or near normal levels.
Many families of children and adults with autism are finding new hopes in a variety of treatments. The list below does not include all possible treatments for autism. If you have a question about treatments, you should speak with a health professional who specializes in caring for people with autism. Some treatments include:
- The Individualized Educational Programs (IEP) is an effective way to prevent behavioral problems typically associated with autism. IEPs involve a variety of interventions, including some of those mentioned below, and are designed to help the child or adult with autism overcome their specific problems. Children with autism seem to respond very well to IEPs that have been properly designed and systematically implemented.
- The Comprehensive Treatment Programs They comprise a number of different theories about the treatment of autism. These programs range from specific learning methods to the analysis of applied behavior, to achieving certain development goals. In general, children need to be in this type of program for about 15 to 40 hours a week, for two or more years, to change their behavior and avoid problems.
Applied Behavior Analysis (ABA) generally focuses on decreasing specific problem behaviors and teaching new skills. Recently ABA programs have expanded their reach to include what should be done before or between incidents of problem behavior, in addition to what should be done during or after these episodes. When children or adults with autism are taught to handle situations such as a change in schedule, furniture that has moved or become familiar with new people, ABA deactivates these situations so that they do not cause problematic behavior.
Interventions and Support for Positive Behavior (PBS) is an approach that tries to increase positive behaviors, decrease problem behavior, and improve the lifestyle of the person with autism. The PBS method looks at the interactions between people with autism, their environment, their behavior and their learning processes to develop the best lifestyle for them.
Medications can also be effective in improving the behavior or skills of a person with autism. In general, these medications are called "psychoactive" because drugs affect the brain of the person with autism. The medication is often used to treat a specific behavior, such as to reduce the behavior of harming oneself, which would allow the person with autism to concentrate on other things, such as learning.
The type of intervention that is established according to the different areas is the following:
Intervention in the social area
The development in the social knowledge of autistic children is not achieved by the means in which others achieve it. The student with autism is not that he does not want to learn social knowledge (or that he learns it but refuses to manifest it), it is that he does not know, he cannot learn it through natural means. Therefore, it is necessary to program the express teaching of this knowledge.
Characteristics of the intervention in this area
The intervention objectives are not given in advance, but arise individually for each person, from the observation of that person, in different contexts, of certain social categories (Olley, 1986). This process to establish individualized objectives consists of four phases:
- Assessment of social skills;
- interview with parents to determine their point of view on the child's social skills and priorities for change (search for goals agreed with families);
- set priorities and express them in the form of written objectives;
- Based on these objectives, make an individualized design for social skills training.
Intervention in the social area must have as a starting point a structured environment, predictable and with a high degree of coherence. An intrusive style is necessary, which implies "forcing" the child to the contexts and situations of interaction that are designed for him, without forgetting to favor the social skills he already has. It is necessary to design the environment with concrete and simple keys that help the child to structure space and time (eg, giving information in advance -feedforward- through posters with pictograms of the activity to be carried out below, in addition to express it verbally). In another place we have proposed specific environmental structuring systems for classrooms of autistic children (Tamarit et al., 1990) and we have emphasized that, as in other alterations, such as motor ones, the elimination of architectural barriers is considered, in the In the case of autism and serious and profound mental retardation, it is necessary to consider and project the elimination of cognitive barriers, that is, to modify the complex keys that exist everywhere, changing them to others that are more in line with the level and characteristics of these students.
Some specific intervention objectives in this area
- Teaching basic rules of conduct: e.g. not undress in public, keep the appropriate distance in an interaction, etc.
- Teaching social routines: greetings, farewells; contact initiation strategies, contact termination strategies, etc.
- Training of socio-emotional keys: through video show emotions; use of emotional expression lotuses; strategies for adapting emotional expression to context, etc.
- Strategies for responding to the unforeseen: teaching social "muletillas" to "get out of the way", etc.
- Training social cooperation strategies: make a construction having half of the pieces one student and the other half another, or the teacher.
- Teaching games: teaching rules games, simple board games, etc.
- Encourage peer support: teach them concrete tasks of assistant teachers of students from another classroom or level; favor this help by taking advantage of external activities, such as excursions, visits, etc.
- Design tasks of distinction between appearance and reality: for example, filling someone with rags: "he looks fat but in reality he is thin".
- Teaching access paths to knowledge: designing tasks for teaching verbal routines about knowledge of the type "I know it because I have seen it" "I do not know it because I have not seen it".
- Adopt another person's perceptual point of view: for example, discriminate what a partner is seeing even when he does not see it, etc.
In students with a lower level of development, the use of simple instrumental strategies will be encouraged, in which the instrument is physical or social. Likewise, the perception of contingency between their - actions and the reactions of the environment will be encouraged (in this sense the counter-imitation - imitation on the part of the adult of what the child does - can be, among others, a good way to achieve it).
Intervention in the area of communication
The intervention is aimed more at favor communication skills than language skills, and therefore there is a close relationship between intervention in the social area and intervention in the communicative area. However, the latter is characterized by trying to promote expressive, functional and generalizable communication strategies, using as the vehicle of that communication the most appropriate support at the child's level (be it the word, signs, pictograms, simple acts, undifferentiated actions, etc.). The so-called Alternative Communication Systems have meant a huge advance in the intervention. In the specific case of autism, the Total Communication program (Schaeffer et al, 1980) has been perhaps the most used and the one that has offered the best results. This program emphasizes spontaneity and expressive language and is structured through the learning of the linguistic functions of: expression of desires, reference, concepts of person, request for information, and abstraction, symbolic play and conversation.
Intervention for behavioral problems
Among those that are normally considered relevant criteria for the determination of a behavior as a problem are:
- the one that produces damage to the individual or others;
- that these behaviors interfere with the educational plans that child requires for their development;
- that these behaviors have an important physical or psychological risk for the person or for others;
- that the presence of these behaviors prevents that person from moving to less restrictive environments.
At the moment it is considered that a behavior rather than being a problem (which would indicate a kind of "guilt" in the person who carries it out) is said to be a challenging behavior (in that it challenges the environment, services and professionals, to plan and redesign those environments so that the person who performs these behaviors fits in them and so that the most appropriate response for the modification of those behaviors can be offered within them).
There must be a close relationship of professionals who offer an educational response to these children with their families. One of the objectives to be pursued with this relationship is to carry out the same education guidelines at home and at school, teaching parents the most appropriate ways of acting before their child's actions. But another objective should be to give psychological support to these families, in which the fact of having a member with autism puts them in a situation of vulnerability and risk.
Many people with autism have other treatable conditions, in addition to their autism. It is common for people with autism to also have sleep disorders, seizures, allergies and digestive problems, but these problems can often be treated with medication. Treatment for these conditions may not cure autism, but it can improve the quality of life of people with autism and that of their families.
All Psychological Therapies