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Syndrome of early childhood autism
Medical expert of the article
The complex of clinical symptoms of abnormal development of the nervous system in a child of the first five years appearing in a number of neurocognitive and affective disorders is defined in psychiatry and neurology as a syndrome of early childhood autism (Kanner's syndrome) and captures a wide range of pathological processes in the central nervous system.
As a rule, in children with autism spectrum disorders (PAS or ASD), some signs of developmental delay are noted already during the first year of life, and in the majority of cases this syndrome occurs in boys.
According to the US Centers for Disease Control and Prevention (CDC), in 2014, the number of diagnosed autism spectrum disorders in children was a record for the past 35 years - one child per 70 children. True, experts are not sure that there are more autistic children: maybe the doctors just started to reveal pathology better.
Studies in Asia, Europe and North America have shown that the prevalence of early childhood autism is 1% of the child population.
The cause may lie in the chromosomal mutation associated with the epigenetic process of inactivation (breaking) of the paternal X chromosome in boys. Pathology may also be responsible for the inherited or spontaneous mutation of the SHANK3 gene that encodes special postsynaptic density proteins (PSDs) that connect the mediator receptors, ion channels, G-protein excitatory synapses, and also ensure the maturation of dendrites of the fetal spine neurons in the perinatal period of pregnancy.
In general, scientists tend to think that autism, as a complex CNS disorder, occurs for a number of reasons, but genetic factors are more than 90%.
For the past half-century, researchers have been trying to find out the exact causes of the syndrome of early childhood autism and point to a number of possible factors - genetic, metabolic and neurological, as well as other problems. The causality theory of autism does not exclude prenatal factors of the environment, in particular, teratogenic effects on the embryo and fetus of heavy metals of exhaust gases, phenolic compounds, pesticides, components of pregnant women's medications (especially in the first trimester of pregnancy).
Infectious factors include rubella virus, genital herpes virus and cytomegalovirus in the mother (especially in early pregnancy), which activate her immune response and significantly increase the risk of autism and other mental disorders in the child. The cause may be extreme prematurity of the child, that is, birth until 26-28 weeks of pregnancy.
Studies have revealed deviations in the cerebellum, which are believed to occur during the early development of the brain in the fetus and can lead to the onset of early childhood autism syndrome.
Another version of the pathogenesis of autism is based on the assumption that the brain in children with this pathology in early childhood is damaged by oxidative stress, which adversely affects the Purkinje cells in the cerebellar cortex after birth, which causes the level of total glutathione (antioxidant intracellular substance) to drop, and the levels of oxidized glutathione increase, which indicates an increased toxicity in the cells.
But, first of all, the pathogenesis of PAC is associated with a genetic predisposition, because the symptoms of autism are revealed in 57% of siblings (siblings).
Although the syndrome of early childhood autism is difficult to diagnose in the first year of life of children, since they manifest themselves in 12-18 months, parents can notice the first signs of pathology in a 6-month-old baby. The study, published in the Journal of Abnormal Child Psychology, notes that infants who later have early childhood autism syndrome are less likely to smile than those who do not have the syndrome. Therefore, this may be an early marker of the risk of this CNS disorder.
The following symptoms of the syndrome of early childhood autism in infants and toddlers are considered key:
- the child seems very calm and even listless and does not scream to attract attention;
- during feeding does not look at mum (absence of eye contact);
- the sound of a familiar voice does not react;
- in response to a smile and the treatment of relatives does not smile and does not express joy (at 6 months);
- to the arms, when they take him in their hands, does not react at all;
- Do not follow the moving objects (toys) or the gesturing gesture of an adult;
- does not stretch to take a toy (at 7-8 months);
- does not imitate the sounds or facial expressions of adults (at 9 months);
- does not imitate gestures and does not use gestures for communication (at 10 months);
- does not react to his name (at 12 months);
- does not babble (to 10-12 months);
- Do not pronounce individual words (by 16 months);
- does not speak a phrase from two words (in 18-24 months).
Complications and consequences
The consequences of early autism appear in older children in the form of a lack of social skills: these children do not communicate and do not play with other children, avoid group games, and are not interested in others. They have limited facial expressions, verbal and non-verbal communication and understanding of signs, extremely difficult to master speech and many language problems are extremely difficult. For example, children with autism can mechanically repeat words in the absence of a communicative goal. Also, the characteristic signs are a negative reaction to touch, a fear of loud sounds, repetitive movements of the same type (clapping hands, blows, rocking the body, etc.).
All this leads to the fact that complications arise. First of all, this is inflexible behavior and inability to adequately express their emotions: a child can start screaming, crying or laughing for no apparent reason, and at times becomes aggressive. Children are difficult to communicate, adapt to any changes, understand the feelings of others and express their own way accordingly.
With a clear syndrome of early childhood autism, the child is practically not interested in anything, it seems detached. Nevertheless, children with ASD, as a rule, have a good memory, even with the deficiencies of abstract thinking.
The syndrome of early childhood autism varies widely in terms of intensity of manifestation, which makes it difficult to diagnose. As doctors say, two children with this diagnosis can be very different when it comes to their behavior and abilities.
Diagnosis of the syndrome of early childhood autism is carried out by a children's neurologist after a sufficiently long observation of the behavior of the child - in order to identify and objectively assess the characteristics of his social interaction and communication skills. Tests in the form of game assignments can be conducted to assess the level of general development and speech, the degree of development of motor skills and the speed of response.
Symptoms detected in a specific child should meet certain criteria and be compared with a clearly defined intensity of symptomatology.
Also, the doctor - in the process of determining the diagnosis - may involve the parents of the child or caregivers who know him well.
Differential diagnosis is conducted to distinguish the syndrome of early childhood autism from other psychiatric disorders, such as Asperger syndrome in children, Rett syndrome, schizophrenia, hyperkinesis in children.
Experts emphasize that the timely diagnosis of the syndrome of early childhood autism, coupled with rapid and effective intervention, is of paramount importance for achieving the best prognosis for the child.
To date, the treatment of the syndrome of early childhood autism is to maximize the child's ability to support his development and learning, and to ensure the functioning of the central nervous system by reducing the symptoms of the disease.
The strategy of cognitive-behavioral therapy of children 2-8 years is based on:
- psychological and pedagogical correction of behavior and communication;
- highly structured educational programs;
- speech therapy classes on development and correction of speech;
- gaming lessons on learning new skills;
- music and art therapy;
To get a positive result, we need daily individual lessons with the child of his parents and other family members, during which appropriate ways of interpersonal interaction and communication, as well as everyday life skills, are taught.
Autism Science Foundation experts believe that no medicine can save the child from the main symptoms of this disorder, but some pharmacological agents can help control them. For example, antidepressants can be prescribed with increased anxiety, antipsychotics are sometimes used to correct serious behavior abnormalities. Medicines should be prescribed and monitored by a physician with the appropriate qualifications.
Regarding the use of these drugs in the treatment of early childhood autism syndrome, there is no consensus, since this issue is under study, and the safety and efficacy of such pharmacological agents for autistic children has not been confirmed by randomized trials. In addition, the prescription of psychotropic drugs to children, according to WHO guidelines, is possible only if they have mania, schizophrenia with hallucinations and delirium, and also with strong psychomotor agitation. Medicines-neuroleptics can give unpredictable results, because - given the size of the infant's liver - their metabolism changes, and side effects are amplified.
Thus, a neurotropic drug Rispolept (Risperidone) in the form of a solution can be prescribed at 0.25 mg per day (with a body weight of up to 50 kg) in cases of prolonged aggression and psychopathic seizures. Side effects of this drug are expressed in headache, nausea, vomiting, diarrhea, enuresis, epigastric pain, insomnia, tremor, increased heart rate, nasal congestion, weight gain, upper respiratory tract infections. Rispolept should not be administered in case of feneteonuria, pregnancy and children under 5 years.
An antipsychotic agent is Aripiprazole (Arip, Aripiprex) for the treatment of such symptoms of schizophrenia and bipolar disorders as aggression, irritability, hysterics and frequent mood changes. This drug FDA and EMEA were allowed to use, "to help children and adolescents with autism, when other methods of treatment do not work." Among the contraindications aripiprazole indicated only hypersensitivity to the drug. Side effects can be expressed in increasing body weight, sedative effect, fatigue, vomiting, sleep disturbance, tremor, convulsions. The minimum daily dose is 5 mg.
Nootropic drug Pantogam (in the form of syrup) is prescribed for neuroleptic syndromes and intellectual underdevelopment of children 250-500 mg 2-3 times a day for 3-4 months. Among the side effects of the drug appear allergic rhinitis, hives and inflammation of the conjunctiva.
Dimethylglycine (DMG) is a glycine-amino acid derivative necessary for the synthesis of many important substances in the body, including amino acids, hormones and neurotransmitters. Contraindications to its use are individual intolerance, pregnancy and lactation. The usual dose is 125 mg per day, the course of treatment is not more than 30 days.
The vitamins B1, B6, B12 are prescribed for this pathology. Also carried out physiotherapy (hydrotherapy, magnetotherapy, electrophoresis); children need physical exercise in the form of physical education, see - Exercises for children 2 years.
Official medicine does not approve of alternative treatment for such a complex neurological pathology as the syndrome of early childhood autism, especially since therapy should be comprehensive, with behavioral correction and development of the child's mental capabilities.
And not all home methods can be used by a child. There is a recipe for the drink, which is prepared from boiled water, the juice of pink grapefruit and juice squeezed from fresh ginger root, in a ratio of 5: 3: 1. Take recommended for tea, dessert or a tablespoon (depending on the age of the child). In grapefruit juice contains the antioxidant lycopene, and in the ginger root all the vitamins of group B are collected, and also there are omega-fatty acids and a number of essential amino acids (tryptophan, methionine, etc.). But ginger can not be children up to two years old.
To calm the child, it is advised to give to autistic children microscopic doses of sedative properties and improving cerebral circulation of ground nutmeg, dissolving it in a small amount of milk. However, this nut contains safrole, which is a psychotropic substance, and it is better for children not to give it without the knowledge of a doctor.
Herbal treatment is most often based on the use of melissa herbs and cornflower herbs, as well as leaves of ginkgo biloba. The broth is prepared from the calculation of 5 g of dry grass (crushed roots) per 250 ml of water, boiled for 10-15 minutes and in a cooled state give 1-2 tablespoons three times a day (25-30 minutes before meals).
The forecast is individual. If a child is treated and developed, he can improve his language and social skills. Children with autism spectrum disorders tend to continue to learn and compensate for problems throughout their lives, but most still require a certain level of support. In this case, the syndrome of early childhood autism in adolescence can exacerbate problems with behavior.