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Autism - Early Child abuse

Autistic Disorder

DSM-IV and ICD-10 defined under the heading of Pervasive Developmental Disorders, a series of clinical conditions which typically had been diagnosed as psychotic children. Autistic disorder would be the most characteristic.

The name "infantile psychotic episodes" when applied to these syndromes is unrealistic. In fact for a clinical diagnosis as psychosis or schizophrenia should be a delusional or hallucinatory box with very specific criteria (including: delusions, hallucinations, loss of the ability of associations, catatonic) which is rare in childhood. Before 3 years of psychosis are much like children with autism, and only later onset are more similar to adult schizophrenia. The evolution with the emergence of delusional or hallucinatory symptoms, we will make a difference.

Of all However, some psychiatric professionals like to use the terminology of "psychotic children, or children with" psychotic personality structures. " Our choice has been clear in the sense of adopting the terminology of the DSM and ICD classification and therefore exclude the name of psychosis in this section.

The autistic disorder was first described by Leo Kanner in 1943, based on his observation of 11 children at the John Hopkins Children's Psychiatric Clinic. The initial report placed emphasis on the inability to develop interactions with others, emotional isolation, insistence on routine activities (With more or less compulsive demand of the invariance of the environment) and the presence of some specific skills that could be paradoxical in children with disabilities. At the same time Hans Asperger in Vienna University Pediatric Clinic, was preparing his doctoral thesis on the same phenomenon, also using the term "autism." In fact, the name belonged to the classical psychopathology and was used to define some characteristics of schizophrenic patients.

Kanner's case most often invoked (Donald) came to be a prototype diagnosis as the paradigm of many of the classic fallacies about autism, for example, the "normal intelligence" of autism, or "tend to have special skills." Donald, for example, at 2 years and sang sang melodies by ear.

From there appeared abundant descriptions, along with discussions to define what would be the defining features of the disorder. Rutter (1966) and Rutter and Lockyer (1967), through a research program for this purpose, identify three main areas of involvement, which, broadly speaking, have been repeated in various publications that are practically psychopathology and which at Over the years, includes in its criteria DSM-IV:

1. Profound and global failure of the social relationship characterized by ignoring the feelings of others, abnormal for support in stressful circumstances (eg not request help from hurting), difficulty (or inability) to imitate gestures and actions, anomaly ( or lack thereof) in social games, deficit in the ability to make friends.

2. Delayed acquisition of language, lack of acquisition and / or changes in its implementation. The accompanying symptoms are: abnormal communication extraverbal (absence of gesture, gaze, expression ...), no imaginative, serious anomalies in speech production (changes of volume, pitch, rate, rhythm, intonation), repetitive and stereotyped use of language, pronoun reversal ("you" instead of "I"), impaired ability to maintain or develop a conversation.

3. Ritualistic and compulsive behaviors that reflect a broad disorder of interests and activities, stereotyped body movements, preoccupation with details and forms (ie sniffing objects repeatedly examine the texture of an object or one of its details), links to unusual objects (for example, to always carry a piece of string), obsession for the stability of the environment with upset of small changes, insistence on following routines, restrictions on the set of interests with excessive preoccupation with certain specific purposes and illogical, self-injurious behavior.

In the event that some symptoms are present only in one or two of these areas, the DSM-IV recommends diagnose the case as "developmental disorder not otherwise specified," recognizing that this type of case "is not complete "are more common than autistic disorder itself. From a practical standpoint, to conduct examinations are the same and, in the treatment can be considered as mild cases of autism.

Often parents report about a perfectly normal child until a certain time (usually within 30 months), although sometimes referred to start 4-5 years. It is very difficult to assess retrospectively the actual start, unless we provide objective information about developments relating to language, socialization and games. It is likely that some parents (of children only, for example) they ignore the initial symptoms (or not want to see.) In such cases the clinical picture is evident when the child begins to attend school and can be compared with other children their same age. Remember our discussion Chapter 1 on the Kellog & Kellog experiment on the comparison between a child and a monkey during the first months of life: the monkey advanced in the human infant maturity until 13-14 months of life. If the spouses Kellogg, noting carefully the data were not being objective differences (other than physical appearance, as expected) between the development of your child and the primate, much more subject to error must be the criterion of parents of children Autistic firmly assert that their children were normal during the first year of life.

Kanner suggested in his initial work that the IQ of autistic children was normal. Another falacia. Actualmente se considera que hasta un 80 % de niños autistas tienen un C.I. inferior a 70. De la misma forma, la situación es similar en modo recíproco: hasta el 84 % de niños afectos de retraso mental profundo son poseedores de rasgos autistas. Es posible que algunos autistas den el perfil del "débil mental oculto", con una cifra de C.I. normal o cuasi normal, a causa de un buen rendimiento en tareas mecánicas o de memoria, en tanto que con bajo rendimiento en pruebas que miden pensamiento abstracto, capacidad para formar conceptos, etc. En la película Rain Man, Dustin Hoffmann interpreta a un autista típico en cuanto a su contrariedad para comunicarse y para entender el mundo que le rodea, pero con una capacidad específica well developed: the skill to calculate mentally. The isolation of autism is well reflected in the film, masterfully played by Hoffmann, but the idea of \u200b\u200b"autistic gifted in depending on which" still not the real paradigm of this devastating disability.

Other syndromes associated

DSM-IV (provisoional edition) identifies three clinical conditions that were not present in previous editions:

1. Rett syndrome. Be characterized by normal development during the first 6 months (both psychomotor and estaturoponderal) but with the appearance between 5 and 48 months, the following symptoms: stunted growth arrest or cranial diameter, stereotypic hand movements, reduced capacity for social interaction, uncoordinated movements of the trunk and severe psychomotor retardation and language (receptive and expressive).

2. Child disintegrative disorder. The development will have been normal up to two years, including aspects of language. From this age displayed disorders own pervasive developmental delays, which are defined as follows:

Alterations in at least two of the following areas: a) expressive or receptive language, b) social skills or adaptive behavior, c) bowel or bladder control, games, motor.

criteria are also defined as qualitative abnormalities of social interaction (estraverbal communication, interpersonal relations, emotional expression, empathy and reciprocity), qualitative abnormalities in communication (arrest or non-appearance of speech, difficulty holding conversations, repeats , stereotypes, idiosyncratic language, impaired symbolic play or imitation).

Finally, the criteria related to behavior, interests, altered, altered motor activities (including stereotypies and mannerisms).

3. Asperger syndrome.

remember that Asperger defined autism (in Vienna) while Kanner, and their inclusion in U.S. policy manual seems a sort of relief. Not given a numerical code, but it's something. The description includes:

should appear qualitative disorders of social interaction: extraverbal misbehavior, low level of interpersonal relationships, difficulty expressing joy or participate in other difficult interaction. The existence of cognitive delay and delay language, complete the syndrome, which, to be diagnosed, requires a final criterion: did not meet the criteria that would diagnose as autism.

impact

Applying the strict criteria of Kanner autism appears in 4 of every 10,000 births (Frith, 1993), but if we use the broader current criteria, appears with the same repetition Down's syndrome: 1 to 2 cases per 1000 births. The ratio is 2 to 4 times more common in males.

What we know about the etiology?

No existe una certeza acerca de la etiología del autismo: anomalías en el ambiente familiar (padres fríos, alejados, poco receptivos a las primeras demandas del niño), trastornos neurológicos, trastornos bioquímicos en procesos del SNC, etc. han sido invocados por diversos autores, con pruebas más o menos sólidas.

Hoy en día parece poco consistente remitirnos a etiologías psicogenéticas, según las cuales la relación con unos padres fríos y alejados afectivamente (especialmente si es la madre) crea en el niño una sensación insalvable de rechazo y su "encierro" en una campana de cristal as a defense mechanism. This poetic description has helped to create resplendent guilt in mothers of autistic, but has no epidemiological support smaller, or, much less scientific. The pity is that the violent indictment of mothers and / or parents is a heinous neurotic price they pay in exchange for the unlikely hope that this false belief entails: the process is reversible if we can overcome the psychological defenses that the child is psychotic developed to protect their schizophrenogenic parents.

This warp theory presents no empirical or scientific verification. This has led researchers to delve into the possible biological causes for damage of any brain structure. The data for are: Autism conjunction with some organic entities (maternal rubella, mental retardation due to chromosomal abnormalities like Down syndrome fragile X chromosome tuberosis sclerotic, perinatal brain damage and seizures). The same can be said about their increased incidence in identical twins and the possibility that autism is repeated in the same family members (50 to 100 times greater than expected by chance alone).

Kaplan and Sadock (1990) strongly believe that autism is a phenomenon organic, based on the accumulation of data above. Not have a specific location for the brain injury, although it would have implications for cortex, cerebellum, brainstem and vestibular system. Neuropsychological tests suggest an involvement very similar to those seen in patients with frontal lesions (deficit in planning, initiative and spontaneous production of new ideas). The EEG often shows no focal abnormalities. CT is abnormal in 25% of cases, whereas MRI evidence ventricular dilation often. Positron emission tomography (PET) revealed an increased glucose metabolism in the frontal lobe in a sample of autistic subjects. Some subgroups have abnormal levels of neurotransmitters or their metabolites in CSF.

Anyway, it seems most reasonable is likely to refer to the biochemical origin, given that theories psychogenetic, apart from blaming the parents, do not provide meaningful solutions for treatment. Uta Frith (1993), the Cognitive Development Unit of the Medical Research Council (England), argues that the core cognitive feature of autism is their inability to judge mental states, and to "think about thinking." An example: the autistic child is unable to understand a hoax, because for him things are so eminently practical that it is not possible to assess pros and cons, and the two sides of the coin. In one of his research, autistic children are a theatrical scene where a character hides a girl doll in a drawer, while the lady of the wrist, which had left her in bed, is absent. When asked the subjects about "where to look for its owner's wrist when he returns", sixteen of twenty-two autistic children with similar mental age to 9 years, answered that "in the box." They could not come up with the possibility that the owner of the doll would think something that was not true (this test is usually exceeds by the generality of normal children from 4 years).

Similar experiments in other laboratories fully confirm the inability of autistic people to understand mental states, representing a wide range of consequences for a large number of cognitive processes, it entails no ability of the mind to reflect itself (thinking about thinking). Frith concluded that the classic triad of autism (communication, imagination, socialization) is derived from a single cognitive mechanism is damaged, a fact which is more likely to endorse the biological basis of disorder.

Treatment

Treatment should be based on educational measures: stimulation techniques developed areas (social interaction, language, interests). Give better results that are based on behavior modification techniques. As we said when speaking of mental retardation, it is possible to perform such tasks in special schools for autistic or integrating children in a mainstream school. The characteristics of children and the chances of finding suitable schools in their immediate environment are the variables you manage to decide one way or another action. Specific pharmacological measures do not exist. Table 2.1. showcase the current possibilities. The psychological measures should be raised to support the special educational work. It is interesting to supportive therapy for parents of autistic children, while they taught lessons about training techniques to be employed in the education of their children.

Forecast

The prognosis of autism is highly variable. Depends on the degree of gravity (there are many more symptoms worse the prognosis) and the response to this the child stimulation. Autism, over life, can reach an adaptation considered acceptable. Can even maintain social contact, minimal but rewarding, well-structured environments, especially within the family if they learn to interact with them without rejection or reluctance. This adaptation depends in each case, their special features. Intellectually the brightest come to take bitterly aware of their limitations, and yet despite their efforts, rarely make themselves feel secure or arrive at broad social contacts. The less bright, and those with more behavioral problems, go to swell the grim list of chronic illnesses, like defectual schizophrenic, alternating phases of agitation and aggressiveness blunted affect others and extreme sedation caused by the unavoidable use of neuroleptics, and their frequent confinement in mental hospitals minimum care centers.

Source:

http://drromeu.net/autismo.htm
http://www.dailymotion.com/video/xeww5k_historia-del-autismo_school

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