How Do I Become an Autism Specialist?

Childhood autism is a subtype of generalized developmental disorder. It is more common in men and occurs in infants and young children. It is mainly manifested in different degrees of speech development disorders, interpersonal communication disorders, narrow interest and stereotypes. About three-quarters of the patients are accompanied by significant mental retardation, and some children have better abilities in certain aspects in the context of general mental retardation.

Basic Information

English name

Autistic disorder

Visiting department

Pediatrics, Psychology

Multiple groups

Male infant

Common causes

Genetic, perinatal, immune, environmental, etc.

Common symptoms

Language and social communication barriers, stereotypes, mental retardation, etc.

Causes of childhood autism

It is unclear and may be related to the following factors:

Heredity

The role of genetic factors in autism has become clear, but the specific genetic mode is still unknown.

2. Perinatal factors

The perinatal complications, such as birth injury and intrauterine asphyxia, were more than those of the normal control group.

3. Immune system abnormality

It was found that the number of T lymphocytes decreased, the number of helper T cells and B cells decreased, the lack of suppressor-induced T cells, and the decrease in natural killer cell activity.

4. Neuroendocrine and neurotransmitters

Related to a variety of neuroendocrine and neurotransmitter dysfunction. Studies have found that monoamine systems in patients with autism, such as serotonin (5-HT) and catecholamines, are immature, and the pineal gland-lower thalamus-pituitary-adrenal axis is abnormal, leading to increased 5-HT and endorphins and promoting adrenal Corticosteroid (ACTH) secretion is reduced.

Clinical manifestations of autism in children

Language barrier

Speech and communication disorders are important symptoms of autism and are the main reason for most children to see a doctor. Language and communication disorders can take many forms. Most children with autism have delayed or impaired language development. They usually do not speak at the age of two and three, or they experience language regression after normal language development. There was previously expressive language, which gradually decreased with age, or even completely lost, remained silent for life or used limited language in rare cases. There is a certain degree of obstacles to their language perception and expression ability.

2. Social Communication Barriers

Patients cannot establish normal interpersonal relationships with others. When he was young, he showed no eyesight with others, lacked expression, lacked the expression or gesture of expecting parents and others to hug and caress, and did not enjoy the happy expression of caress. He even refused to hug and caress his parents and others. . You can't distinguish between relatives and ties, and treat your loved ones with the same attitude as others. Cannot establish a normal attachment relationship with parents, and it is difficult for patients to establish a normal partnership with their peers. For example, they are lonely in kindergarten and do not like to play with their peers. When they see some children playing games together, they do not go Watch for interest or desire to participate.

3. Narrow scope of interest and rigid behavioral patterns

Patients are not interested in games and toys that normal children like, and they like to play with non-toy items, such as a bottle cap or watching a rotating electric fan, etc., and it can last for tens of minutes or even hours without Boredom. Not interested in the main features of toys, but very concerned about non-main features: Patients stubbornly require the routine of daily activities to be unchanged, such as the time to go to bed, the quilt covered, and the same route when going out, etc. . If these activities are stopped or behavioral patterns are changed, patients may show significant unpleasantness and anxiety, and even defiant behavior. Patients may have repetitive stereotypes, such as repeated claps, turns, lick the wall with their tongues, and stomp their feet.

4. Intellectual Disability

In children with autism, the level of intelligence is very inconsistent. A few patients are in the normal range, and most patients have different degrees of mental retardation. Studies at home and abroad have shown that conducting intelligence tests on children with autism found that about 50% of children with autism have moderate or higher intellectual impairment (IQ is less than 50), 25% have mild intellectual impairment (IQ of 50 to 69), 25 % Intelligence is normal (IQ is greater than 70), and normal intelligence is called high-function autism.

Childhood Autism Diagnosis

By collecting a comprehensive and detailed history of growth and development, medical history, and mental examination, if patients are found to have typical clinical manifestations such as speech development and social interaction disorders, narrow areas of interest, and stereotyped behavioral patterns before the age of 3, children with schizophrenia, Mental retardation, Asperger syndrome, Heller syndrome, and Rett syndrome and other extensive developmental disorders can make a diagnosis of childhood autism.

The clinical manifestations of a small number of patients are atypical and can only partially meet the criteria for autism symptoms, or the age of onset is not typical, for example, symptoms appear after 3 years of age. These patients can be diagnosed as atypical autism. Such patients should continue to observe and follow up, and finally make a correct diagnosis.

Childhood Autism Treatment

Training intervention method

Although there are many intervention methods for autism at present, most of them lack evidence of evidence-based medicine. There is no optimal treatment plan, and the best treatment method should be individualized treatment. Among them, education and training are the most effective and main treatment methods. The goal is to promote patient language development, improve social communication skills, and master basic life skills and learning skills. People with autism generally receive education and training in families, special education schools, and medical institutions because they cannot adapt to ordinary kindergarten life. After school age, patients' language and social skills will improve. Some patients can go to ordinary elementary schools to receive education with their children of the same age, and some patients may still stay in special education schools.

At present, the training intervention methods recommended and used by mainstream medicine in the world provide the direction for the standardized treatment of autism. These mainstream methods are mainly

(1) Application of Behavioral Analysis Therapy (ABA) advocates the promotion of various abilities of autistic children based on the principle of behaviorism and the use of behavioral shaping principles, with the emphasis on positive reinforcement. Training emphasizes high intensity, individualization and systematization.

(2) TEACCH training for children with autism and related disorders This course designs individualized training content based on the characteristics of autistic children's abilities and behaviors, and it can help children with language, communication, and sensory perception. Defects are targeted for education. The core is to improve the understanding and obedience of children with autism to the environment, education and training content.

(3) Interpersonal relationship training methods include floor time therapy and relationship development intervention (RDI).

The above treatment methods have been carried out in some autism rehabilitation institutions in China, and have achieved good treatment effects, but further research and demonstration are needed.

2. Drug treatment

At present, medication does not change the course of autism and lacks specific drugs to treat core symptoms. However, drugs can improve some emotional and behavioral symptoms of patients, such as emotional instability, attention deficit and hyperactivity, impulsive behavior, aggressive behavior, Suicidal and suicidal behaviors, tics and obsessive-compulsive symptoms, and psychotic symptoms are conducive to maintaining the safety of patients themselves or others, and the smooth implementation of educational training and psychological treatment. The commonly used drugs are as follows:

(1) Central stimulant drugs are suitable for those with combined attention deficit and hyperactivity symptoms. A commonly used drug is methylphenidate.

(2) Antipsychotic drugs should be used in small doses and short-term. Pay attention to the side effects of the drugs, especially the extrapyramidal side effects.

Risperidone is effective for emotional symptoms such as impulse, aggression, agitation, emotional instability, irritability and psychotic symptoms associated with autism. Haloperidol is effective for behavioral symptoms such as impulsivity, hyperactivity, and stereotypes, as well as for emotional symptoms such as emotional instability, irritability, and psychotic symptoms. It is also reported to improve social communication and language development disorders. Aripiprazole, quetiapine, olanzapine and other atypical antipsychotic drugs are also effective in controlling patients' impulsive, aggressive and psychotic symptoms.

(3) Antidepressants can reduce repetitive stereotypes, obsessive-compulsive symptoms, improve emotional problems, and improve social communication skills. It also has certain dyskinesias such as withdrawal, tardive dyskinesia, and tics that occur after using dopamine blockers. effect.

Selective 5-HT reuptake inhibitors (SSRIs) are effective for behavioral and emotional problems in patients with autism. Such as sertraline can be used in patients over 6 years of age.