Autism Spectrum Disorder ASD
The autism spectrum disorder (ASD) is a neurodevelopmental disorder characterised by difficulties in the development of communication and social interaction, together with restricted patterns of behaviour, interests and activities, and other clinical manifestations that can vary greatly from person to person.
The current prevalence of this disorder is already as high as 1%, i.e. one out of every 100 births has the disorder. TEA, and in the province of Malaga There are already some 16,000 people diagnosed, hence the importance of raising the profile of this wide-ranging syndrome.
Symptoms of Autistic Spectrum Disorder ASD
Although children and adults with autistic spectrum disorder ASDThe fact that, to a greater or lesser extent, they present certain common characteristics that define the disorder is often referred to as a spectrum since, within the diagnosed cases, the manifestations of this disorder vary enormously from one individual to another.
Thus, at one end of the autistic spectrum we could find people in whom the autistic condition is accompanied by intellectual disability and marked delay, or even absence of language (severe autism), while at the other end of the spectrum we would find those people who present good intellectual capacities (even above average) and linguistic capacities in accordance with their chronological age (asperger).
Persistent, age- and intellectually inappropriate deficits in maintaining communication and reciprocal social interaction, with limitations observed for:
- Understand, take an interest in or respond to the verbal and non-verbal social communications of others
- Understand and express the integration of verbal and non-verbal components such as eye contact, gestures, facial expressions and body language.
- Understand the use of language in the appropriate social context and the ability to hold reciprocal conversations.
- Understand jokes, jokes, double meanings or metaphors, as their language, if it exists, is very literal.
- Establish and maintain relationships with peers
- Understanding different social contexts
- Difficulty in putting oneself in another person's place and responding to the feelings, emotional states and attitudes of others
- Sharing interests (in younger children, for example, they do not usually point to what catches their attention to share with others).
Restrictive, repetitive and inflexible patterns of behaviour and interests, or activities that are clearly atypical or excessive for the individual's age, gender and socio-cultural context. Observed:
- Difficulty of the person to adapt to new circumstances, causing some stress that may be caused by even minor changes in the family environment or in the face of unanticipated events.
- Inflexibility or adherence to following certain routines
- Excessive adherence to rules and excessive patterns of rituals
- Hypersensitivity to sensory stimuli such as sounds, lights, textures, smells, tastes, heat, cold or pain
- Persistent preoccupation with one or more special interests, parts of objects, types of stimuli or unusually strong attachment to particular objects
- Absence of symbolic play (feeding dolls, making kitchenettes, playing with cars as if they were real cars).
- Repetitive and stereotyped movement patterns (called stereotypies), such as unusual hand and finger movements, swaying, tiptoeing, unusual postures, etc.
Capacities of persons with ASD
The defining characteristics of the TEA not only result in difficulties, but also present a number of capacities, which are as follows:
- Curiosity for very specific topics
- Expertise on topics of interest to you
- Meticulousness
- Sincerity
- Honesty
- Respect for and compliance with established rules
- Attention to detail
- Good adaptation and follow-up of routines
- Good skills in mechanical and repetitive tasks
- Ability to listen without prejudice
Why is early detection of ASD so important?
Detection is understood as the moment when professionals recognise a difficulty or disorder in the child, and therefore begin to work with him/her. The approach required for this type of disorder is multidisciplinary, including paediatricians, child psychiatrists, psychologists, educational teams and, of course, the family, as it is often the parents who are the first to detect the peculiarities and differences in their child's development.
There is no doubt about the importance of early detection of any warning signs that may raise suspicion of the presence of an autistic spectrum disorder, as it is essential for the improvement of the overall prognosis of these children. Therefore, the advantages of early detection of ASD are as follows:
- Early initiation of treatment and targeted interventions in ASD.
- Educational planning according to their specific needs
- Specialised medical care, neuroimaging and genetic diagnostic tests
- Genetic counselling for family planning
- Provides access to resources, supports and services
- Prevent or rectify misdiagnosis
- Reduces uncertainty and stress for parents
- Helps identify family support needs
- Helping others understand ASD
- Supports coping skills of the child and the family
- It contributes to the development of the child's social adaptation in the future.
How to treat ASD Autism Spectrum Disorder?
As in the early detection process, the multidisciplinary approach is also fundamental in the intervention process (educational, psychotherapeutic, pharmacological, family, etc.). A large part of the intervention in ASD focuses on the family, as this allows learning to be generalised and behavioural problems to be tackled in their natural developmental environments, adapting interventions with the child to the needs and strengths of the family.
The aim is always to seek improvement in the areas that are most affected in the child (communication/social and behavioural areas), but this work can be carried out in different ways, i.e. using different methodologies.
Some of the best known methodologies in early childhood are as follows:
- ABA (Applied Behavioural Analysis): An individual work programme is drawn up for each child according to his or her characteristics and is carried out by therapists, training parents to apply the procedures taught at home. In order to achieve the objectives, on the one hand, the tasks to be taught are broken down into parts, and on the other, specific behaviour modification techniques are used to promote the desirable ones and eliminate the undesirable ones. Within these strategies, what is fundamental is the reinforcementThe application of positive consequences for the child (praise, toys, activities...) to the desired responses with the aim of reinforcing them.
- Denver model: It is very similar to the ABA model, and focuses on working in play sessions with the child, in which short activities are used to maintain the child's attention. It works in the child's natural environment, where parents carry out the intervention together with the therapist, and its main technique is social reinforcement (praise, attention, etc.).
The choice of one or the other will be made according to the characteristics and needs of each child and family, but always bearing in mind the common elements that, according to scientific evidence, a good intervention programme should have, regardless of the methodology used.
In addition to the methodology used to advance the child's development as a whole, the family will be given certain guidelines that can be followed to improve certain times of the day, such as the following behaviours:
- Problem behaviours: These behaviours tend to occur with greater frequency and intensity due to the difficulties inherent to the disorder. The psychological current based on positive behavioural support advocates interventions to address behavioural problems in a positive way, with the main objective being to change the environment to make the problematic behaviour irrelevant, while the socially appropriate alternative behaviour becomes the most effective. A medical approach by child psychiatry will also be necessary to treat this type of disruptive behaviour and irritability.
- Social skills in everyday life: These are the set of behaviours that allow optimal interaction both in the immediate environment and with other people, establishing interpersonal relationships, and is one of the areas most affected in ASD children as they have many difficulties in putting themselves in the place of others, initiating and maintaining conversations, listening, keeping turns of speech, taking an interest in others. Therefore, in addition to individual work with the child, social skills groups are highly recommended to work on all these difficulties.
- More specific situations: There are situations in daily life that are necessary for optimal development in the life of the child and their family, and some of them often present difficulties for people with ASD that generate major problems, such as going to the doctor. Therefore, in addition to carrying out preparation strategies, such as anticipating this type of situation in advance, using a calendar to indicate the day of the appointment, providing specific information to the child regarding the specific situation, it is also advisable to teach them different relaxation techniques, one of the best known being Jacobson's progressive muscle relaxation.
What is the pharmacological treatment of children with ASD?
Alongside these core symptoms of autism, 70-90% of children with autism have significant additional psychiatric disorders that worsen their daily functioning and reduce the quality of life for them and their families. These commonly take the form of both emotional problems (e.g. anxiety or depressed mood) and behavioural problems (e.g. conduct problems, irritability, oppositional behaviour or hyperactivity) as well as other problems such as sleep-wake cycle disturbances or significant attentional difficulties. (Comorbid Attention Deficit Hyperactivity Disorder).
Pharmacological treatment focuses on minimising these symptoms and thereby improving their functioning at both school and family level.
There are currently promising studies of new drugs that are showing improvement in ASD symptomatology.
Due to the high frequency of additional psychiatric disturbances in these children, assessment by a child psychiatrist is recommended for appropriate and individualised pharmacological treatment if necessary.
At Cips Malaga We have an excellent multidisciplinary medical team with which we can evaluate, diagnose and carry out an individualised treatment tailored to each child to address their specific needs. Consult us about your case
References
Ibáñez López, P., & Mudarra, M.J. (2014). Early attention: diagnosis and psycho-pedagogical intervention. Publisher: UNED
Ojea, R.M. (2017). Autistic Spectrum Disorder. Editorial Pirámide
Palomo, R. (2017). Autism: current explanatory theories. Madrid: Alianza Editorial
Simonoff, E., Pickles, A., Charman, T., Chandler, S., Loucas, T., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child & Adolescent Psychiatry, 47(8), 921-929.
Wendy L, S., & Theresa, F. (2006) My child is autistic: A guide to the early detection and treatment of autism.
