Autism is a developmental disorder characterized by problems with social interaction and communication and by limited and repetitive behavior. Parents usually notice signs in the first two or three years of their child's life. These signs often develop gradually, although some children with autism achieve their developmental milestones at normal speeds and then worsen.
Autism is caused by a combination of genetic and environmental factors. Risk factors include certain infections during pregnancy, such as rubella, as well as valproic acid, alcohol or cocaine use during pregnancy. Controversy surrounds other proposed environmental causes, such as the vaccine hypothesis, which has proven to be untrue. Autism affects the processing of information in the brain by changing how nerve and synapse cells connect and regulate; how this happens is not well understood. In DSM-5, autism is included in the autism spectrum (ASD), along with Asperger's syndrome, which is less severe, and an unspecified pervasive developmental disorder (PDD-NOS).
Speech or early behavioral interventions can help autistic children get personal care, social skills, and communication skills. Although no drug is known, there are cases of children who have recovered from the condition. Not many autistic children live independently after reaching adulthood, although some succeed. Autistic culture has developed, with some individuals seeking drugs and others believing autism should be accepted as a difference and not treated as a nuisance.
Globally, autism is expected to affect 24.8 million people by 2015. In 2000, the number of affected people is estimated to reach 1-2 per 1,000 people worldwide. In developed countries, about 1.5% of children are diagnosed with ASD by 2017, more than doubling from 0.7% in 2000 in the United States. It happens four to five times more often in boys than girls. The number of people diagnosed has increased dramatically since the 1960s, partly because of changes in diagnostic practice; the question of whether the actual increase rate is not solved.
Video Autism
Characteristics
Autism is a very varied neurodevelopmental disorder that first appears during infancy or childhood, and generally follows a stable course without remission. People with autism may experience severe impairment in some ways but normal, or even superior, in others. Clear symptoms begin gradually after the age of six months, formed at the age of two or three years and tend to continue into adulthood, though often in a calmer form. It is distinguished not by a single symptom but by a triad of typical symptoms: a disorder in social interaction; interruption in communication; and limiting repetitive interests and behaviors. Other aspects, such as atypical eating, are also common but are not essential for diagnosis. Individual symptoms of autism occur in the general population and appear to be unrelated to the high, no sharp line that separates pathologically severe from common traits.
Social development
The social deficit distinguishes autism and related autism spectrum disorders (ASD, see Classification) from other developmental disorders. People with autism have social disorders and often lack intuition about others that many people consider ordinary. It is noted that Temple Grandin's autism illustrates his inability to understand neurotypical social communication, or people with normal neurological development, for leaving his feelings "like an anthropologist on Mars".
Unusual social developments become apparent early in childhood. Autistic infants pay little attention to social stimuli, smile and less often see others, and less respond to their own names. Different children with autism are more prominent than social norms; for example, they have less eye contact and take-turn, and do not have the ability to use simple movements to express themselves, such as pointing at things. Children aged three to five with autism tend to show no social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they form an attachment for their primary caregiver. Most children with autism show a slight resemblance to clinging rather than neurotypical children, although these differences disappear in children with higher mental development or less severe ASD. Older children and adults with ASD behave worse in face recognition and emotional tests although this may be partly due to lower ability to define one's emotions.
Children with high functioning autism suffer from more intense loneliness and are often compared to non-autistic counterparts, despite the common belief that children with autism prefer to be alone. Creating and maintaining friendships often proves difficult for those with autism. For them, the quality of friendship, not the number of friends, predicted how lonely their feelings were. Functional friendships, such as those that produce invitations to the party, can affect the quality of life more deeply.
There are many anecdotal reports, but few systematic studies, about aggression and violence in individuals with ASD. Limited data show that, in children with intellectual disabilities, autism is associated with aggression, property destruction, and tantrums.
Communications
About one-third to one-half of individuals with autism do not develop enough natural speech to meet their daily communication needs. Differences in communication can occur from the first year of life, and may include delayed babbling, unusual movements, reduced responses, and vocal patterns that are not synchronized with the caregiver. In the second and third years, children with autism have a combination of less frequent and less diverse words, consonants, words and words; their movements are less often integrated with words. Children with autism tend not to make requests or share experiences, and are more likely to just repeat the words of others (echolalia) or pronouns. Shared attention seems to be necessary for functional speech, and deficits in mutual concern seem to distinguish babies with ASD: for example, they may look at hand pointing instead of pointed objects, and they consistently fail to point objects in order to comment or share experiences. Children with autism may have difficulty with imaginative play and by developing symbols into the language.
In a pair of studies, high-functioning children with autism aged 8-15 perform equally well, and as adults better than, individually tailored controls on basic language tasks involving vocabulary and spelling. Both autistic groups perform worse than controls on complex language tasks such as figurative language, understanding and inference. Because people often start measuring their basic language skills, this study shows that people who speak to autistic individuals are more likely to exaggerate what their viewers understand.
Repeat behavior
Autistic individuals can display many repetitive or limited forms of behavior, which are revised Behavioral-Scale Behavior (RBS-R) as follows.
- Stereotypical behavior: Repetitive movements, such as flapping hands, turning heads, or wobbles.
- Compulsive behavior: A time-consuming behavior intended to reduce anxiety that a person feels he must perform repeatedly or according to a rigid rule, such as placing objects in a specific order, checking something, or washing a hand.
- Equality: Resilience to change; for example, insist that furniture is not moved or refused to be disturbed.
- Ritualistic behavior: Unusual patterns of daily activity, such as unchanging menus or dress rituals. This is closely related to the similarity and independent validation has suggested combining two factors.
- Limited interest: Abnormal interest or fixation in theme or focus intensity, such as preoccupation with a television program, toy, or game.
- Self-injury: Behavior like punching eyes, lifting skin, biting hands, and banging heads.
There is no self-repetitive or self-injurious behavior that seems specific to autism, but autism seems to have a high pattern of occurrence and severity of this behavior.
Other symptoms
Autistic individuals may have symptoms that are independent of the diagnosis, but may affect individuals or families. It is estimated that 0.5% to 10% of individuals with ASD exhibit unusual abilities, ranging from splinter skills such as memorizing trivial matters to extraordinary rare talents of outstanding autistic scholars. Many individuals with ASD exhibit superior skills in perception and attention, relative to the general population. Sensory abnormalities are found in more than 90% of those with autism, and are considered to be core features by some, although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders. The bigger difference is to be less responsive (eg, walking to things) than over-responsivity (eg, distress from loud noise) or to seek sensations (eg, rhythmic movements). It is estimated that 60% -80% of people with autism have motor signs that include poor muscle tone, poor motor planning, and walking; deficits in motor coordination spread throughout ASD and are greater in proper autism.
Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it was once a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food rejection also occur; this does not seem to produce malnutrition. Although some children with autism also have gastrointestinal symptoms, there is a lack of strictly published data to support the theory that children with autism have more or more gastrointestinal symptoms than usual; studies report conflicting results, and the relationship between gastrointestinal and ASD problems is unclear.
Parents of children with ASD have higher levels of stress. Brothers of children with ASD report greater admiration and less conflict with affected siblings than siblings of unaffected children and similar to siblings of children with Down syndrome in aspects of your relationship. However, they reported lower levels of closeness and intimacy than relatives of children with Down syndrome; brothers and sisters of individuals with ASD have a greater risk of poor welfare relations and poor relation as adults.
Maps Autism
Cause
It has long been assumed that there are common causes at the genetic, cognitive, and nerve levels for triads of symptoms of autism characteristics. However, there is an increased suspicion that autism is not a complex disorder whose core aspect has different causes that often occur together.
Autism has a strong genetic basis, although the genesis of autism is complex and it is unclear whether ASD is explained more by rare mutations with major effects, or by rare multigene interactions of common genetic variants. Complexity arises because of interactions among many genes, environments, and epigenetic factors that do not alter the DNA sequence but are inherited and affect the expression of genes. Many genes have been associated with autism through genome sequencing of affected individuals and their parents.
Studies on twins show that heritability is 0.7 for autism and as high as 0.9 for ASD, and brothers of those with autism are about 25 times more likely to be autistic than the general population. However, most mutations that increase the risk of autism have not been identified. Usually, autism can not be traced to Mendelian mutations (single genes) or to a single chromosomal abnormality, and no genetic syndrome associated with ASD has been shown to cause selective ASD. Many candidate genes have been discovered, with few effects caused by specific genes. Most loci individually explain less than 1% of cases of autism. The large number of autistic individuals with unaffected family members can occur due to spontaneous structural variation - such as removal, duplication or inversion in the genetic material during meiosis. Therefore, most cases of autism can be traced to genetically inherited but unheralded genetic causes: that is, mutations that cause autism do not exist in the parent genome.
Several lines of evidence indicate synaptic dysfunction as a cause of autism. Some rare mutations can cause autism by disrupting some synaptic pathways, such as those involved with cell adhesion. The study of gene substitutes in mice suggests that autistic symptoms are closely related to subsequent developmental steps that depend on activity in synapses and activity-dependent changes. All known teratogens (agents causing birth defects) associated with autism risk seem to act during the first eight weeks of conception, and although this does not exclude the possibility that autism can be started or affected later, there is strong evidence that autism appears very early in development.
Exposure to air pollution during pregnancy, especially heavy metals and particulates, may increase the risk of autism. Environmental factors that have been claimed without evidence to contribute or exacerbate autism include certain foods, infectious diseases, solvents, PCBs, phthalates and phenols used in plastic products, pesticides, brominated flame retardants, alcohol, smoking, illegal drugs, vaccines, and prenatal. emphasize. Some such as the MMR vaccine have been completely unproven.
Parents may first be aware of the autistic symptoms in their child around the time of routine vaccination. This leads to unsupported theories blaming "overloaded" vaccines, vaccine preservatives, or MMR vaccines to cause autism. The latter theory is supported by litigation-funded research that has since proven to be "elaborate fraud". Although these theories lack convincing scientific and biologically unreasonable evidence, parental concerns about potential vaccine relationships with autism have led to lower rates of childhood immunization, previously controlled childhood disease outbreaks in some countries, and deaths can be prevented from some children.
Mechanism
Autism symptoms result from changes associated with maturation in various brain systems. How autism happens is not well understood. The mechanism can be divided into two areas: the pathophysiology of brain structures and processes associated with autism, and neuropsychological relationships between brain structure and behavior. Behavior seems to have some pathophysiology.
Pathophysiology
Unlike many other brain disorders, such as Parkinson's, autism does not have a clear unifying mechanism at either the molecular, cellular, or system level; it is unknown whether autism is some disorder caused by mutations that converge on some common molecular path, or (like intellectual disability) a large number of disorders with diverse mechanisms. Autism seems to be the result of developmental factors that affect many or all of the functional brain systems, and interfere with the development time of the brain over the final product. Neuroanatomical studies and associations with teratogens strongly suggest that the mechanisms of autism include changes in brain development soon after conception. This anomaly appears to initiate a cascade of pathological events in the brain that are significantly influenced by environmental factors. After birth, the brains of children with autism tend to grow faster than normal, followed by normal or relatively slower growth in childhood. It is not known whether early early growth occurs in all children with autism. It seems that the most prominent in the area of ​​the brain underlying the development of higher cognitive specialization. Hypotheses for cellular and molecular basis of early pathological growth include the following:
- Excess neurons that cause local overconnections in the main brain region.
- Neural migration is impaired during early pregnancy.
- The inhibitory network of excitations is out of balance.
- The formation of abnormal synapses and dendritic spines, for example, by modulation of the neuroligin neuron-adhesion system, or by the synaptic synthesis of disordered proteins. Disrupted synaptic development may also contribute to epilepsy, which may explain why both conditions are related.
The immune system is thought to play an important role in autism. Children with autism have been found by researchers to have peripheral and central immune system inflammation as shown by elevated levels of pro-inflammatory cytokines and significant activation of microglia. Biomarkers of abnormal immune function have also been associated with an increase in disorders in behavior that are characteristic of core features of autism such as deficits in social interactions and communication. The interactions between the immune system and the nervous system start early during the life embryo stage, and successful neuronal development depends on a balanced immune response. It is thought that activation of the immune system of pregnant women such as from toxins or environmental infections may contribute to causing autism through causing brain development disorders. This is supported by a recent study that found that infections during pregnancy were associated with an increased risk of autism.
Neurochemical relationship with autism is not well understood; some have been investigated, with the most evidence for the role of serotonin and genetic differences in transport. The role of the metabotropic group I glutamate receptor (mGluR) in the pathogenesis of fragile X syndrome, the most commonly identified cause of genetic autism, has led to an interest in the possible implications for future autism research into this pathway. Some data suggest neuronal overgrowth that is potentially associated with an increase in some growth hormone or regulatory disorders of growth factor receptors. Also, some congenital metabolic errors are associated with autism, but may account for less than 5% of cases.
The theory of a mirror neuron system (MNS) autism theory hypothesizes that distortions in MNS development impair imitation and lead to the core features of autism from social disturbance and communication difficulties. The MNS operates when an animal performs an action or observes another animal performing the same action. MNS can contribute to an individual's understanding of others by enabling the modeling of their behavior through simulations embodied in their actions, intentions, and emotions. Several studies have tested this hypothesis by showing structural abnormalities in individual MNS areas with ASD, delay in activation in the core circuit for impersonation in individuals with Asperger syndrome, and a correlation between decreased MNS activity and severity of syndrome in children with ASD.. However, individuals with autism also have abnormal brain activation in many circuits outside MNS and MNS theory does not explain the normal performance of children with autism in artificial tasks involving objectives or objects.
ASD patterns associated with low function and deviant activation in the brain differ depending on whether the brain performs a social or non-social task. In autism there is evidence to reduce the functional connectivity of the default network, large-scale brain tissue involved in social and emotional processing, with intact connectivity from the positive-task network, used in sustained attention and goal-directed thinking. In people with autism two tissues are not negatively correlated in time, indicating an imbalance in switching between two tissues, possibly reflecting a self-referential thinking disorder.
The underconnectivity of autism theory hypothesizes that autism is characterized by underfunctioning of connections and high-level nerve synchronization, along with low-level excess processing. Evidence for this theory has been found in the study of functional neuroimaging in autistic individuals and by brainwave studies suggesting that adults with ASD have local overconnections in the cortex and weak functional connections between the frontal lobe and the rest of the cortex. Other evidence suggests a major disruption in each cortical hemisphere and that autism is a disorder of the association cortex.
From studies based on event-related potential, temporary changes to the electrical activity of the brain in response to stimuli, there is considerable evidence for differences in autistic individuals with respect to attention, orientation to auditory and visual stimuli, novel detection, language and facial processing, and information storage ; several studies have found a preference for nonsocial stimuli. For example, studies of magnetoencephalography have found evidence in children with delayed autism response in brain hearing signal processing.
In the genetic area, a relation is found between autism and schizophrenia based on duplication and chromosomal deletion; research has shown that schizophrenia and autism are significantly more common in combination with 1q21.1 removal syndrome. Research on the relationship of autism/schizophrenia to chromosome 15 (15q13.3), chromosome 16 (16p13.1) and chromosome 17 (17p12) can not be concluded.
The study of functional connectivity has found both hypo and hyper-connectivity in people's brains with autism. Hypo-connectivity seems to dominate, especially for interhemispheric and cortico-cortical functional connectivity.
Neuropsychology
Two main categories of cognitive theory have been proposed about the relationship between the autistic brain and behavior.
The first category focuses on the deficit in social cognition. Simon Baron-Cohen's reasoned-systemization theory postulates that autistic individuals can systemize - that is, they can develop internal operating rules to deal with events in the brain - but are less effective at empathizing with handling events generated by other agents. An extension, extreme male brain theory, hypothesizes that autism is an extreme case of the male brain, defined psychometrically as an individual in which the systemation is better than empathizing. These theories are somewhat related to previous Baron-Cohen mind-theory approaches, which hypothesize that autistic behavior arises from the inability to perceive mental states for oneself and others. The mind-theory hypothesis is supported by atypical responses of children with autism to the Sally-Anne test for reasoning about other people's motivations, and the theory of the autism mirror neuron system described in Pathophysiology mapped well to the hypothesis. However, most studies have found no evidence of impairment in the ability of autistic individuals to understand the basic objectives or targets of others; on the contrary, the data suggest that disorders are found in understanding more complex social emotions or in considering the viewpoints of others.
The second category focuses on nonsocial or general processing: executive functions such as working memory, planning, inhibition. In his review, Kenworthy states that "claims of executive dysfunction as a contributing factor to autism are controversial", however, "it is clear that executive dysfunction plays a role in the social and cognitive deficits observed in individuals with autism". Executives core process tests such as eye movement tasks show improvement from childhood through adolescence, but performance never reaches a typical adult level. The power of theory predicts stereotypical behavior and narrow interests; two drawbacks are that executive function is difficult to quantify and that executive function deficits have not been found in children with autism.
The weak central coherence theory hypothesized that limited ability to see the big picture underlies the central disorder in autism. One of the strengths of this theory is predicting special talent and peak performance in autistic people. A related theory - improving perceptual functioning - focuses more on the superiority of locally oriented and perceptual operations in autistic individuals. Yet others, monotropism, argue that autism comes from different cognitive styles, tend to concentrate (or processing resources) intensely, leaving aside other stimuli. These theories mapped out well from the theory of autism underconnectivity.
Not one category satisfies itself; the theory of social cognition cares less about the rigid and repetitive behavior of autism, while nonsocial theory has difficulty explaining social disorders and communication difficulties. A combined theory based on some deficits may prove more useful.
Diagnosis
Diagnosis is based on behavior, not cause or mechanism. Under DSM-5, autism is characterized by persistent deficits in social communication and interaction across multiple contexts, as well as restricted, repetitive patterns of behavior, interests, or activities. This deficit is present in early childhood, usually before the age of three, and leads to clinically significant functional impairment. Examples of symptoms include lack of social or emotional reciprocity, stereotypes and repetitive use of idiosyncratic languages ​​or languages, and constant preoccupation with unusual objects. This disorder should not be better accounted for by Rett syndrome, intellectual disability or global developmental delays. ICD-10 basically uses the same definition.
Several diagnostic instruments are available. Two are commonly used in autism research: Autism Diagnostic Interview-Revised (ADI-R) is a semi-structured parent interview, and the Autism Diagnostic Observation Schedule (ADOS) uses observation and interaction with children. The Childhood Autism Rating Scale (CARS) is used extensively in clinical settings to assess the severity of autism based on children's observations. Interviews Diagnostics for social and communication disorders (DISCO) can also be used.
Pediatricians usually conduct a preliminary investigation by taking historical developments and physically examining the child. If justified, the diagnosis and evaluation is done with the assistance of an ASD specialist, observing and assessing cognitive, communication, family, and other factors using standard tools, and taking into account the associated medical conditions. A pediatric neuropsychologist is often asked to assess cognitive behavior and skills, both to aid diagnosis and to help recommend educational interventions. The differential diagnosis for ASD at this stage may also consider intellectual disability, hearing loss, and certain language disorders such as Landau-Kleffner syndrome. The presence of autism can make it more difficult to diagnose common psychiatric disorders such as depression.
Evaluation of clinical genetics is often done after ASD is diagnosed, especially when other symptoms have already shown genetic causes. Although genetic technology allows clinical geneticists to connect about 40% of cases with genetic causes, consensus guidelines in the US and UK are limited to high-resolution chromosomes and fragile X testing. The first genotype diagnostic model has been proposed, which will routinely assess the variation of the genomic number of copies. When new genetic tests are developed, some ethical, legal, and social issues will arise. The availability of commercial tests may precede an adequate understanding of how to use the test results, given the complexity of genetic autism. Metabolic and neuroimaging tests are sometimes helpful, but not routine.
ASD can sometimes be diagnosed at the age of 14 months, although the diagnosis becomes more stable during the first three years of life: for example, a one-year-old child who meets the diagnostic criteria for ASD is less likely than a three-year-old to continue to do so several years later. In the UK, the National Children's Autism Plan recommends at most 30 weeks of first concern to complete diagnosis and assessment, although some cases are dealt with promptly in practice. Although symptoms of autism and ASD begin early in childhood, they are sometimes missed; Years later, adults can look for diagnoses to help them or their friends and family understand themselves, to help their employers make adjustments, or in some locations to claim disability benefits or other benefits. Girls are often diagnosed more slowly than boys.
Underdiagnosis and overdiagnosis are problems in marginal cases, and much of the recent increase in the number of reported ASD cases is likely due to changes in diagnostic practice. The increasing popularity of treatment options and the expansion of benefits has provided incentives to service providers to diagnose ASD, which causes some overdiagnosis in children with uncertain symptoms. Conversely, the cost of screening and diagnosis as well as the challenge of getting paid can hinder or delay the diagnosis. It is very difficult to diagnose autism among people suffering from visual impairment, in part because some of its diagnostic criteria depend on vision, and partly because autistic symptoms overlap with the syndrome of blindness or blindness.
Classification
Autism is one of five pervasive developmental disorders (PDD), characterized by widespread abnormalities of social interaction and communication, and very limited repetitive interests and behaviors. These symptoms do not imply illness, frailty, or emotional distress.
Of the five forms of PDD, Asperger's Syndrome is closest to autism in signs and possible causes; Rett syndrome and disintegrative disorder of childhood share some signs with autism, but may have unrelated causes; Unspecified PDD (PDD-NOS, also called atypical autism) is diagnosed when the criteria are not met for a more specific disorder. Unlike autism, people with Asperger syndrome have no delay in language development. Autism terminology can be confusing, with autism, Asperger syndrome and PDD-NOS often called autism spectrum disorder (ASD) or sometimes autistic disorder, whereas autism itself is often called < i> autistic disorder , childhood autism , or infantile autism . In this article, autism refers to classical autistic disorder; in clinical practice, though, autism , ASD , and PDD are often used interchangeably. ASD, in turn, is part of a wider autism phenotype, depicting individuals who may not have ASD but have autistic characteristics such as avoiding eye contact.
The manifestations of autism cover a wide spectrum, ranging from individuals with severe disorders - who may be silent, developmental disabilities, and locked into flapping hands and rocking - to highly functioning individuals who may have an active but strangely active social approach with a narrow focus. interests, and verbose, verbose communication. Due to the continuous behavior spectrum, the boundaries between the diagnostic categories are certainly somewhat arbitrary. Sometimes the syndrome is divided into low, moderate or high functioning autism (LFA, MFA, and HFA), based on the IQ threshold, or how much support individual needs in daily life; This subdivision is not standardized and controversial. Autism can also be divided into syndromal and non-syndromal autism; Autism syndrome is associated with severe or severe intellectual disability or congenital syndrome with physical symptoms, such as tuberous sclerosis. Although individuals with Asperger syndrome tend to perform better cognitively than those with autism, the degree of overlap between Asperger's syndrome, HFA, and non-syndrome autism is unclear.
Several studies have reported the diagnosis of autism in children due to loss of language or social skills, compared with failure to make progress, usually from the age of 15 to 30 months. The validity of this difference is still controversial; It is possible that regressive autism is a specific subtype, or that there is a continuum of behavior between autism with and without regression.
Causal research has been hampered by the inability to identify subgroups that are biologically significant in autistic populations and by traditional boundaries between psychiatric, psychological, neurological and pediatric disciplines. New technologies such as fMRI and tensor imaging diffusion can help identify relevant biological phenotypes (observable properties) that can be seen in brain scans, to help further autism neurogenetic studies; one example is lowering activity in the fusiform facial area of ​​the brain, which is associated with a person's perception of the object. It has been proposed to classify autism using genetics as well as behavior.
Screening
About half of parents of children with ASD see their child's unusual behavior at 18 months of age, and about four-fifths notice by 24 months of age. According to an article, the failure to fulfill one of the following milestones "is an indispensable indication to proceed with further evaluation." The delay in reference to such testing may delay diagnosis and early treatment and influence long-term outcomes. "
- Not babble for 12 months.
- No cue (pointing, waving, etc.) for 12 months.
- There is not a word in 16 months.
- There are no two-word phrases (spontaneous, not just echolalic) for 24 months.
- Any loss of language or social skills, at any age.
The United States Preventive Services Task Force in 2016 found that it was not clear whether the examination was beneficial or dangerous among children with no concern. The Japanese practice is to screen all children for ASD at 18 and 24 months, using an autistic-specific formal screening test. In contrast, in the UK, children whose families or doctors recognize the possibility of signs of autism being screened. It is not known which approach is more effective. Screening tools including Modified Checklist for Autism in Toddlers (M-CHAT), Screening Initial Autisticity Questionnaire, and First Year Inventory; preliminary data on M-CHAT and its predecessor, Checklist for Autism in Toddlers (CHAT), in children aged 18-30 months indicates that it is best used in clinical settings and has low sensitivity (many false negatives) but good specificity ( some false-positive). It may be more accurate to precede this test with a broadband screener that does not distinguish ASD from other developmental disorders. Filtering tools designed for one cultural norm for behavior such as eye contact may not be appropriate for different cultures. Although genetic screening for autism is generally still impractical, it can be considered in some cases, such as children with neurological symptoms and dysmorphic features.
Prevention
While rubella infection during pregnancy causes less than 1% of cases of autism, vaccination against rubella can prevent many of these cases.
Management
The main goal when caring for children with autism is to reduce related deficits and family pressures, and to improve quality of life and functional independence. In general, a higher IQ correlates with a greater response to treatment and improved treatment outcomes. There is no single best treatment and treatment is usually tailored to the needs of the child. Family and education systems are the primary source of care. The study of intervention has a methodological problem that prevents definitive conclusions about efficacy, but the development of evidence-based interventions has advanced in recent years. Although many psychosocial interventions have some positive evidence, suggesting that some forms of treatment are better than no treatment, the methodological quality of systematic review of these studies is generally poor, their clinical outcome is largely tentative, and there is little evidence for the relative effectiveness of treatment options. Intensive and sustainable specialized education programs and early behavioral therapy can help children acquire self-care, social, and occupational skills, and often improve function and reduce the severity of maladaptive symptoms and behaviors; claims that intervention by about three years of age is very important is not proven. Available approaches include applied behavior analysis (ABA), developmental models, structured teaching, speech and language therapy, social skills therapy, and occupational therapy. Among these approaches, interventions either treat autistic features comprehensively, or focus treatment on specific areas of deficit. There is some evidence that early intensive behavioral intervention (EIBI), an initial ABA-based intervention model of 20 to 40 hours a week for several years, is an effective treatment for some children with ASD. The two theoretical frameworks outlined for early childhood intervention include applied behavioral analysis (ABA) and social development pragmatic models (DSP). One of the intervention strategies uses a parent training model, which teaches parents how to apply various ABA and DSP techniques, enabling parents to disseminate the intervention itself. Various DSP programs have been developed to explicitly provide an intervention system through home parent implementations. Despite recent developments in the parenting training model, these interventions have demonstrated effectiveness in many studies, evaluated as effective treatment possibilities.
Education
Educational interventions can be effective for various levels in most children: intensive care has demonstrated effectiveness in improving the global function of preschool and established children to improve the intellectual performance of children. Similarly, interventions implemented by teachers utilizing ABA in combination with a growing social pragmatic approach have been found to be well-established treatment in improving social communication skills in children, although there is little evidence in the treatment of global symptoms. Neuropsychological reports are often poorly communicated to educators, so there is a gap between what is recommended by the report and what education is provided. It is not known whether treatment programs for children lead to significant improvement after children grow up, and studies limited to the effectiveness of adult housing programs show mixed results. Accuracy including children with varying degrees of autism spectrum disorder in the general education population is the subject of current debates among educators and researchers.
Medication
Many drugs are used to treat ASD symptoms that interfere with integrating a child into a home or school when behavioral care fails. More than half of US children diagnosed with ASD are prescribed psychoactive or anticonvulsant drugs, with the most common classes of drugs being antidepressants, stimulants, and antipsychotics. Antipsychotics, such as risperidone and aripiprazole, have been found to be useful for treating irritation, repetitive behavior, and sleeplessness that often occur with autism, but side effects should be weighed against their potential benefits, and people with autism can respond atypically. There is little reliable research on the effectiveness or safety of drug treatments for adolescents and adults with ASD. There is no known drug that relieves the core symptoms of social disorder and autism communication. Experiments on mice have reversed or reduced some symptoms associated with autism by replacing or modulating gene function, suggesting possible targeting therapy for certain rare mutations known to cause autism.
Alternative medicine
Although many alternative therapies and interventions are available, little is supported by scientific research. The treatment approach has little empirical support in the context of quality of life, and many programs focus on measures of success that have no predictive validity and real-world relevance. Scientific evidence seems less important to service providers than to program marketing, availability of training, and parental demand. Some alternative treatments can put children at risk. A 2008 study found that compared to their counterparts, autistic boys had significantly thinner bones if on a casein-free diet; in 2005, chelation therapy failed to kill a five-year-old child with autism. There have been preliminary studies seeking hyperbaric treatments in children with autism.
Although popularly used as an alternative treatment for people with autism, there is no good evidence that a gluten-free diet is beneficial. In a subset of people who have gluten sensitivity there is limited evidence to suggest that a gluten-free diet can improve some autistic behaviors. There is tentative evidence that music therapy can enhance social interaction, verbal communication, and non-verbal communication skills.
Society and culture
The emergence of the autism rights movement has served as an attempt to encourage people to be more tolerant of those with autism. Through this movement, people hope to make others think autism as a difference, not a disease. The proponents of this movement want to seek "acceptance, not healing." There are also many events around the world that promote awareness of autism such as World Autism Awareness Day, Light It Up Blue, Autism Sunday, Autistic Pride Day, Autreat, and more. There are also many organizations dedicated to increasing awareness of autism and the impact of autism on one's life. These organizations include Autism Speaks, the Autism National Committee, the Autism Society of America, and many others. Social science scientists have increased their focus on studying them with autism in hopes of learning more about "autism as a culture, cross-cultural comparison... and research on social movements." The media has an influence on how people perceive people with autism. Rain Man , a film that won 4 Oscars including Best Picture, depicts characters with autism who have outstanding talents and abilities. While many autistic do not have this special ability, there are some autistic individuals who have succeeded in their field.
Cost
Treatment is expensive; indirect costs are better. For someone born in 2000, a US study estimated the average lifetime cost of $ 4.2 million (net present value in 2017 dollars, adjusted for inflation from the 2003 estimate), with about 10% of medical care, 30% additional education and other care, and 60% loss of economic productivity. Publicly supported programs are often inadequate or inappropriate for a given child, and unpaid medical or medical expenses related to possible family financial problems; one US study in 2008 found a 14% average annual loss of income in families of children with ASD, and a related study found that ASD was associated with a higher probability that child-care issues would greatly affect the work of parents. US states increasingly require private health insurance to shut down autism services, shifting the costs of publicly funded education programs to privately funded health insurance. After childhood, major care issues include home care, job training and placement, sexuality, social skills, and housing planning.
Prognosis
There is no known cure. Children sometimes recover, so they lose the diagnosis of ASD; this sometimes happens after intensive care and sometimes not. It is not known how often recovery occurs; the reported rates in a sample of children with unselected ASD ranged from 3% to 25%. Most children with autism acquire a language at age five or younger, although some have developed communication skills in later years. (See also: nonverbal autism) Most children with autism have no social support, meaningful relationships, future employment opportunities or self-determination. Although major difficulties tend to persist, symptoms often become less severe with age.
Some high-quality research that deals with long-term prognosis. Some adults show a modest improvement in communication skills, but some decrease; no research has focused on autism after middle age. Obtaining a language before the age of six, having an IQ above 50, and having marketable skills all predicting better results; independent living is not possible with severe autism. Most people with autism face significant obstacles in the transition to adulthood.
Epidemiology
The latest review tends to estimate the prevalence of 1-2 per 1,000 for autism and nearly 6 per 1,000 for ASD, and 11 per 1,000 children in the United States for ASD in 2008; because of insufficient data, these numbers may underestimate the true level of ASD. Globally, autism affects about 24.8 million people by 2015, while Asperger syndrome affects 37.2 million further. In 2012, the NHS estimates that the overall prevalence of autism among adults over 18 years in the UK is 1.1%. The rate of PDD-NOS's has been estimated at 3.7 per 1,000, Asperger's Syndrome at about 0.6 per 1000, and disintegrative disruption of childhood at 0.02 per 1,000. The latest CDC estimate is that 1 out of every 68 children, or 14.7 per 1,000, has an ASD in 2010.
The number of reported cases of autism increased dramatically in the 1990s and early 2000s. This increase is largely due to changes in diagnostic practices, referral patterns, service availability, age at diagnosis, and public awareness, although unidentified environmental risk factors can not be ruled out. The available evidence does not rule out the possibility that the true prevalence of autism has increased; the real increase will suggest directing more attention and funding to changes in environmental factors rather than continuing to focus on genetics.
Boys are at higher risk for ASD than girls. The average gender ratio was 4.3: 1 and strongly modified by cognitive impairment: probably close to 2: 1 with intellectual disability and over 5.5: 1 without. Some theories of higher prevalence in men have been investigated, but the cause of the difference has not been confirmed; One theory is that women are under-diagnosed.
Although the evidence does not involve a single pregnancy-related risk factor as a cause of autism, the risk of autism is associated with old age in both parents, and with diabetes, bleeding, and the use of psychiatric medications in the mother during pregnancy. The risk is greater for older fathers than older mothers; two potential explanations are the increased burden of mutations known in older sperm, and the hypothesis that men marry later if they carry genetic responsibility and show some signs of autism. Most professionals believe that race, ethnicity, and socioeconomic background do not affect the occurrence of autism.
Some other conditions are common in children with autism. They include:
- Genetic disorders . Approximately 10-15% of cases of autism have Mendelian conditions (single gene), chromosomal abnormalities, or other genetic syndromes, and ASD is associated with some genetic disorders.
- The intellectual disability . The percentage of autistic individuals who also meet the criteria for intellectual disability has been reported anywhere from 25% to 70%, a wide variation that illustrates the difficulty of assessing individual intelligence on the autism spectrum. In comparison, for PDD-NOS the relationship with intellectual disabilities is much weaker, and by definition, Asperger's diagnosis does not include intellectual disability.
- Anxiety disorder is common in children with ASD; there is no definitive data, but studies have reported prevalence ranging from 11% to 84%. Many anxiety disorders have symptoms that are better explained by ASD itself, or are difficult to distinguish from ASD symptoms.
- Epilepsy , with variations in the risk of epilepsy due to age, cognitive level, and type of language disorder.
- Some metabolic defects , such as phenylketonuria, are associated with autistic symptoms.
- Minor physical anomalies increase significantly in the autistic population.
- Diagnosis takes precedence . Although DSM-IV excludes a concurrent diagnosis of many other conditions along with autism, the complete criteria for Attention Deficit Hyperactivity Disorder (ADHD), Tourette syndrome, and others of this condition are often present and the diagnosis of comorbidity is increasingly accepted. li>
- Sleeping problems affect about two-thirds of individuals with ASD at some point in childhood. It most often includes symptoms of insomnia such as difficulty falling asleep, often waking up at night, and waking up early. Sleep problems are associated with difficult behavior and family pressure, and are often the focus of clinical attention above and above the primary diagnosis of ASD.
History
Some examples of autistic symptoms and treatments are described long before autism is named. The Table Talk Martin Luther, composed by his notetaker, Mathesius, contains the story of a 12-year-old boy who may have been very autistic. Luther was reported to have thought the boy was a collection of lifeless flesh owned by the devil, and declared that he would suffocate, though a critic later has cast doubt on the truth of this report. The earliest documented case of autism was the case of Hugh Blair of Borgue, as detailed in the 1747 court case in which his brother succeeded in petitioning to annul Blair's marriage to acquire Blair's legacy. The Wild Boy of Aveyron, a wild child caught in 1798, showed some signs of autism; medical student Jean Itard treated her with a behavioral program designed to help her form social bonds and encourage speech through imitation.
The New Latin word autismus was coined by the Swiss psychiatrist Eugen Bleuler in 1910 when he defined the symptoms of schizophrenia. He is derived from the Greek word autÃÆ'³s (?????, meaning "self"), and uses it to mean self-admiration, referring to "the patient's autism withdrawal from his fantasies, where external influences become a disorder that can not be tolerated ".
Clinical development and diagnosis
The word autism first took on a modern notion in 1938 when Hans Asperger of Vienna University Hospital adopted the Bleuler terminology of autistic psychopath in a lecture in Germany on child psychology. Asperger is investigating ASD now known as Asperger's Syndrome, although for many reasons it was not widely recognized as a separate diagnosis until 1981. Leo Kanner of Johns Hopkins Hospital first used autism in its modern sense in English. when he introduced the infantile autism infantile label in a 1943 report of 11 children with striking behavioral similarities. Almost all of the characteristics described in Kanner's papers on the subject, particularly "autistic interdependence" and "insistence on similarities", are still considered to be typical of the autistic spectrum of disorders. It is not known whether Kanner acquired an independent term from Asperger.
Donald Triplett was the first person diagnosed with autism. He was diagnosed by Kanner after being first examined in 1938, and labeled as "case 1". Triplett is renowned for his remarkable ability, mainly for being able to name music notes played on the piano and mentally multiply the numbers. His father, Oliver, described him as being socially attractive but interested in numerical patterns, musical notes, alphabet letters, and images of US presidents. At the age of 2 years, he has the ability to recite the 23rd Psalm and memorize 25 questions and answers from the Presbyterian catechism. He is also interested in creating musical chords.
Kanner reusing autism led to decades of confusing terminology such as infantile schizophrenia, and the child's psychiatric focus on maternal deprivation led to the misconception of autism as a baby's response to the "mother of the refrigerator". Beginning in the late 1960s autism was established as a separate syndrome.
Terminology and differences from schizophrenia
Until the mid-1970s there was little evidence of genetic roles in autism; while in 2007 it is believed to be one of the most heritable psychiatric conditions. Although the emergence of the parent organization and destigmatization of ASD children has influenced how ASD is perceived, parents continue to feel social stigma in situations where their child's autistic behavior is felt negatively, and many primary care physicians and medical specialists reveal some consistent beliefs that are outdated. research autism.
It took until 1980 for DSM-III to differentiate autism from childhood schizophrenia. In 1987, DSM-III-R provided a checklist to diagnose autism. In May 2013, the DSM-5 was released, updating the classification for pervasive developments. Groupings of disorders, including PDD-NOS, Autism, Asperger's Syndrome, Rett's Syndrome, and CDD, have been removed and replaced by the general term Autism Spectrum Disorder. The two categories are social and/or interaction, and the behavior is limited and/or repetitive.
The Internet has helped autistic individuals pass the nonverbal cues and emotional sharing that they find so hard to deal with, and has given them a way to form online communities and work remotely. The social and cultural aspects of autism have evolved: some in the community are looking for drugs, while others believe that autism is just another way.
References
External links
- Autism in Curlie (based on DMOZ)
- Pervasive portal developmental disorders
Source of the article : Wikipedia
0 Comments