Children’s Autism is a specific disorder in their mental development, manifested by difficulties that a child experiences in communication and social interaction. The autistic development is truly specific: an autistic child, though possessing sufficient speech and intellectual potentials – still does not seek to use them in real life, in his interaction with the others.
Currently, the world sees a significant increase in the number of children with Autism Spectrum Disorders. If for example, 20 years ago only 3-4 cases of children with autism were recorded per 10 000 children, now this amount constitutes up to 10 to 20 cases per 10 000 children’s population. The increase of autism in the world nowadays can be already compared in scale to the epidemic. Kazakhstan is also identifying the increasing amount of children with autism. According to the statistics of the regional of the PMPCs (Psychological, Medical and Pedagogical Counsels) in 2002 there were 93 children with autism, while in 2010 the amount has increased to 465 children.
The increase in the number of autistic children necessitates providing them with adequate and timely correctional support. An autistic child is constantly in need of support and stimulation for more successful development and social adaptation. This can be achieved if a family of an autistic child meets the understanding of their needs and demands from the side of the society and of the various public institutions: kindergartens, schools, social environment. To ensure such an understanding in the society - it is important to increase awareness in it and competence in the field of education and social development of autistic children.
Children’s autism. What it that?
Determining children's autism.
Children’s Autism is a specific disorder in their mental development, manifested by difficulties that a child experiences in communication, social interaction and followed by a range of peculiar ‘stereotypical’ behaviors.
The autistic development is truly specific: an autistic child, though possessing sufficient speech and intellectual potentials – still does not seek to use them in real life, in his interaction with the others.
Children’s Autism as a separate disorder of mental development was first highlighted by Dr. Leo Kanner in 1943. He described a special type of abnormal development in children, calling it a syndrome of ‘infantile autism’ (Kanner's Syndrome), the main manifestations of which are:
- significant difficulties by a child in establishing emotional contact with others;
- obsessive desire for repetitive, monotonous behaviors;
- excessive focusing on the actions with certain objects;
- absence of speech, with still available and potential opportunities to learn (mutism), or some type of an alternative ‘language’ used to deal with other people;
- good cognitive abilities in certain areas.
Important to know
The diagnostic criteria for autism
According to the International Classification of Diseases 10 (ICD-10), children’s autism – is a disorder in his/her psychological development related to pervasive (common, pervasive, plural) disorders. It is manifested in all sides of psycho- mental development: sensory and motor development, cognitive and emotional sphere, and uncontrolle behavior, consciousness and personality.
There are three main and inherent features of the syndrome of infantile (children’s) autism:
- qualitative communication disorders;
- qualitative impairments of social interaction;
- stereotypical’ behaviors.
Other important criteria include:
- The inherent early onset of disorders (in infancy or in early childhood)
- Biological origin (associated with organic deficiency in development of central nervous system);
- A constant flow of condition without remissions and relapses distinctive to psycho- illnesses. In the International Classification of Diseases 10 (ICD-10), the childhood autism syndrome is not associated with and even differentiated from symptoms of other psycho-mental illnesses (like schizophrenia) or conditions originated from the adverse effects of stressful social factors (psychogenic autism, paraautizm)
Children’s autism - is an non-synchronous and distorted development in which certain sides of the psyche develop in a timely manner, the others – faster and some others - with a significant delay; wherein the sequence of their development does not coincide with the normal or the abnormal, delayed development. Autistic children have a disproportion in intellectual- and emotional development, a combination of advances in some areas with underdevelopment in others.
The fundamental (mandatory) diagnostic criteria for ASD.
impairments in social interaction.
impairments in communication.
and ‘stereotypical’ behaviors,
interests and activities.
Symptoms of autism
1. Qualitative impairments of social interaction:
a) the absence of reaction to the emotions and appeals of other people, lack of the behavioral change in accordance with the context of the situation;
b) the inability to adequately use: eye-contact, mimic facial expressions, gestures for social interaction and communication;
c) the inability to establish interaction with peers, to play with them;
d) the lack of emotional and social mutuality in communication, absence of common interests with other people.
2. Qualitative impairments in communication:
a) the absence of communicative use of speech, no attempts to compensate this lack by use of voice-tone or expressive voice, gestures and facial expressions;
b) a relatively common failure to initiate or sustain a conversation (at any level of the language-development), insufficient flexibility in speech expressions, repetitive and ’stereotypical’ speech;
c) behavior problems in role- games and social-simulation games, poor synchrony and lack of reciprocity in communication.
3. Limited, repetitive and ’stereotypical’ behaviors, interests and activities:
a) the desire to establish once-and-forever, a hard routine or certain order in many aspects of everyday life; a special affection to certain objects, actions (rituals), interests;
b) self-preoccupation, obsession with ’stereotypical’ routine and limited activities and interests;
c) motor stereotypical behaviors (movements)
d) increased attention to the parts of objects or non-functional elements of toys (to their smell, to their surfaces/touching them again and again, to the noise or vibration these objects produce – listening to it on and on).
For additional diagnostic symptoms of children autism, you can also pay attention to some non-specific problems, which can be a sign of it, too: various fears, sleeping disorders and eating disorders, outbursts of anger and aggression, including self-injury.
There are no deliriums and no hallucinations in case of children's autism. It is important to determine whether autistic regression had taken place (a loss of already well-elaborated mental functions, skills). As children's autism might be accompanied with visual impairments, hearing impairment.
The classification of autism
Nowadays, the “children's autism” is classified as a group of non-specific syndromes of different origin, which were given the definition of ASD – Autistic Spectrum Disorders (ASD). They include:
1. Kanner’s Sindrom) – a “classic” or typical syndrome of infantile autism, in which specific abnormalities in the development of a child should appear in the first three years of his life: qualitative impairments of social interaction and communication; restricted, repetitive and stereotypical behaviors combined with a strong, albeit uneven delay in mental and speech development: unwillingness to speak during ability to speak, lack of speech, or the originality/specificity of speech - echolalia, cliché-words, distorted use of personal pronouns. Often there is mental retardation, too. Only 25% of autistic children with this syndrome reach the lower limit of the intellectual performance standards. But many autistic children have a good intellectual capacity, high ability in some areas.
2. Asperger’ Sindrom – is a syndrome characterized by the similar of the same qualitative communication disorders, poor social interaction and stereotypical activities and interests, but there is no delay in speech and mental development. Most of the children have normal general intelligence. Only in their physical appearance something can be noticeable: the detached/indifferent facial-expression, inexpressive (frozen) mimics, gestures, clumsiness, awkwardness in movements . Most of the children with autism lack the spontaneity, flexibility, imitativeness and creativity in both intellectual activities and communication, while in decision-making it is difficult for them to use common concepts, in spite of having the ability to do so. Knowledge, including given in school – they absorb selectively; they feel it difficult to reproduce and to use it in a social experience. Communicative function of their speech is weak, and their speech manner is unusually modulated, very specific in sound and melody, in rhythm and tempo; in general, it often sounds like a recitation. They tend to create new words, they demonstrated craving for autistic games and activities. There is a steadfast preservation of autistic features further in adolescence and adulthood.
3. Autism Spectrum Disorders/ASD: atypical autism, autistic and autistic-similar syndromes, and others. Usually Autism Spectrum Disorders are the associated symptoms accompanying other diseases: organic brain diseases, chromosomal abnormalities, genetic syndromes, inborn metabolic disorders, endocrine disorders and others.
In these cases, a smoothed picture of autism can be observed and it is not presented by all the symptoms that are inherent to “classic autism”. In comparison to the Kenner’s autism (Kenner’s syndrome), the ability to communicate and interact with other people is much less affected in children with ADS; children with ASD often maintain eye-contact, they are more emotional with his mother and family. As a rule, they don’t show asynchrony in development of various spheres of life. With ASD autistic symptoms may often worsen or conversely - soften, then becoming almost invisible due to the dynamics of the underlying disease.
The prevalence of autism
Only 20-10 years ago in different countries, the prevalence of children’s autism ranged from 4 to 26 cases per 10 000 of the child population. According to the majority of epidemiological surveys, the two main basic types of infantile/children’s autism – the Asperger’s syndrome and the Kanner’s constitute 4-5 cases per 10,000 child population. In recent years, due to the wider detection of (similar to autism, but still a bit different) Autistic Spectrum Disorders is shoing a significant prevalence: these disorders represent 30-60 cases per 10 000 children population.
In Kazakhstan, according to the statistical reports of the regional PMPCs/Psychological, Medical and Pedagogical Counsels in 2014 only, 1456 kids were identified as children with autism and with Autistic Spectrum Disorders.
According to various estimates, the children with Kanner's syndrome represent the following in gender-division: 3: 1 or 4: 1 – e.g. those are boys, 3-4 times more than girls. The following has been observed - the wider the spectrum of autistic disorders is, the larger the ratio of children in gender-division changes toward boys 13: 1, 13: 1.5.
Causes of Autism
A unequivocal cause of autism have never been identified. Researchers from different countries cannot come to a one unified theory of the origin and formation mechanisms of autism. It is believed that autism is caused by the presence of several disorders simultaneously that have emerged as a result of the influence of many factors, which affect all, or some of the brain’s functional systems at an early stage of development. There are more than thirty factors, altogether causing the development of autistic disorder. There are three main groups of possible causes.
The 1st group of causes is associated with heredity. Some experts believe that autism is a genetic abnormality and is inherited genetically. Partially, there is a confirmation to it, since most autistic symptoms are observed in families. However, scientists still have not identified the genes responsible for autism.
The 2nd group of causes is grouping around various chromosomal (genetic) mutations and congenital (in-born) metabolic diseases. Some genetic syndromes and metabolic diseases in addition to a variety of clinical symptoms may include autistic, too. These diseases include: vunerable ("a fragile") X chromosome, Rett’s syndrome, Moebius’s syndrome, and Phenylketonuria (PKU - an inborn error of metabolism involving impaired metabolism of phenylalanine, one of the amino acids), Mucopolysaccharidosis (MPS - a group of metabolic disorders caused by the absence or malfunctioning of lysosomal enzymes needed to break down molecules called glycosaminoglycans - long chains of sugar carbohydrates in each of our cells that help build bone, cartilage, tendons, corneas, skin and connective tissue) and others.
The 3d group of causes links with organic damages of the human central nervous system as a result of the:
a) effects of different pathogens during pregnancy and childbirth: neuro-infections and viral infections, traumas, asphyxia and so on. In these cases, autism is considered to a residual-organic condition of the nervous system after an illness.
b) biochemical, neuro-chemical and metabolic disorders. Special studies (the study of cerebrospinal fluid, blood and urine tests) found that autistic symptoms may be due to metabolic disorders of physiologically active substances (serotonin, catecholamine, and dopamine). There are researches that establish a link between biochemical changes and autistic symptoms.
In other cases, autism is associated with the occurrence of metabolic disorders which may lead to an excess of the opioid in the blood, resulting in either increased permeability of the intestinal tissue or of the blood-brain/ hematoencephalic barrier, or incomplete fission of certain nutrients, in particular: wheat gluten, milk casein. These substances have a toxic effect on certain brain-structures, which may give rise to autistic symptoms. A range of researches point out a positive effect of special diet therapy that excludes from the diet of children with autism such products, which can cause a change of opioid activity level.
c) toxic effects of heavy metals (mercury, plumbum, cadmium) due to vaccination, poor ecology, poor nutrition, and others. The results of a number of studies have shown that a reason that provokes symptoms of autism can be a poisoning - by heavy metals, toxins in the environment and foods. Some researchers were conducted to establish links between immune dysfunction and child-vaccination as a possible cause of autism. It is presumed, that the source of poisoning may be in vaccines containing mercury component as a preservative. There is evidence that the restriction to use of mercury-containing vaccines in California (USA) has led to a reduction of new cases of autism by 25%. At the same time, a considerable number of children with autism have not received any vaccinations and do not have elevated mercury levels in blood.
It should be pointed out, that all of the above-mentioned possible causes of autism are ‘nonspecific” i.e. are characteristic not only to autism spectrum disorders, but to other disorders of mental development. There is not only one, but a number of causal factors (hereditary, organic, biochemical, social) that affect on a child's body in certain periods of his/her development. At the same time, hereditary and organic factors– play a crucial role in emergence of autism, while the psychogenic are only triggering, provoking or complicating the symptoms of autism.
Mechanisms of formation of the syndrome of children’s autism
Organic deficiency of the human brain creates specific pathological conditions, where an autistic child develops. As for formation of the psychological structure of the autistic syndrome, there are two, (the most important) biological factors: an increased sensitivity of a child and his activeness/activity disorders (K.S.Lebedinskaya, O.S.Nikolskaya, 1991).
1. An increased sensitivity of sensory and affective (emotional) spheres:
- an increased threshold of sensitivity towards visual, auditory, tactile/touching stimuli. For autistic children, environmental influences often are too excessive and represent a source of unpleasant sensations and of discomfort. Often they show a painful reaction to the usual sounds, light, color, or touch. Especially, the increased sensitivity and vulnerability are observed in contacts with another person, which they demonstrate intolerance to somebody’s looking at them/eye-contact, a voice, a touch. Some longer interaction, even with their beloved ones, causes a discomfort in them.
Lower threshold for sensory and affective discomfort leads to a ‘long-term fixation’ on unpleasant experiences. Which later may provoke the formation of a variety of fears in them, prohibitions and strict restrictions in contacts with the outer world.
2. Activeness/activity disorders are reflected in the low mental tonus of such children and accordingly – in their reduced capacity to interact actively with the environment. Due to the weak energy potential of their brain, which is peculiar to an autistic child, he may respond by a deep mental exhaustion and fatigue, passiveness/in-activeness, indifference to the environment, lack of active researching interest to his surrounding world.
Especially, such a shortage of mental tonus and activity is detected while trying to deliberately focus an autistic child's attention, to organize his behavior spontaneously. The dysfunction of his activeness is also evident in his inability to actively and selectively perceive and to process speech and social information, to link it to his past experience; in his inflexibility to use it in his experience, but to reproduce it in an imposed-by-others-from-outside, manner.
These two inborn biological factors (hypersensitivity of sensory and of affective systems, low mental activity) force an autistic child to find ways to adapt to the world around him. In these pathological conditions of development he has to choose the most radical ways to protect himself against the unknown, uncomfortable and frightening world – into autism. Thus, avoiding contacts with the outside world and self-focusing into limited, ‘stereotypical’ (familiar and understandable) types of activities.
Thus, Children’s Autism in children, is not rather an inherent pathological symptom, but more a method and means of self-protection against excessive environmental influences. The syndrome of Children’s Autism should not be considered as a mere psychological disorder, based on deliberate unwillingness to communicate or a refusal to interact with others. Multiple psychological studies and observations by parents of autistic children have shown that autistic children not only do want to be with people, but they also can be deeply attached to people.
An autistic child wants, but simply cannot independently absorb the standard methods of communication and interaction with people, what that other children learn effortlessly in everyday life.