(Jrt)
Autism
The infantile autism was first described in 1943 by Leo Kanner who has isolated within the psychoses of the child into a full-fledged disease. Today describes several forms of autism, and it is no longer considered a disease but a syndrome [ref. necessary], or a set of clinical signs which may be several causes and / or more pathological mechanisms.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) Autism is a pervasive developmental disorder (ASD) which is characterized by alterations serious development in the following three areas:
1. Communication verbal and nonverbal
2. Social Interactions
3. Behaviour, interests and activities are restricted and stereotyped (APA 1994)
This "triad autistic" appears before the age of 3 years. In most cases, the autistic syndrome accompanying mental retardation. Otherwise you are talking about High-Functioning Autism.
The term "pervasive developmental disorder" includes autism, Asperger syndrome, Rett syndrome, the disorder of childhood désintégratif and pervasive developmental disorder not specified.
Autism called "high-level" comes from the English term "high-functioning". The person catching up with its development at the cognitive level normal. A language disorder is present, and cognitive profile is uneven. Despite its level of functioning, the subject clearly presents symptoms of autism.
In Asperger syndrome, the emergence of language does not suffer any delay. Unlike autism high-level verbal IQ is often higher than IQ performance. There is often a certain clumsiness, deficits in communication and social interactions are less present than in autism high-level.
Epidemiology
The estimated prevalence on a french population is about 4 cases per 1000 children the same age.
In France, autism concerns over a hundred thousand people, children and adults alike. This figure, however, considers sub-reality.
Several publications have reported a prevalence rate of over 60 children on 10,000 affected by some form of autism is 1 child in 166.
This figure would have increased. This is evident in the recent epidemiological studies conducted in the USA since 2000 by the CDC (Center for Disease Control and Prevention), hundreds of thousands of children: the prevalence of autism now reach one child in 150, A boy on 94.
Diagnosis
The clinical picture of this disease was identified in 1943 by psychiatrist Leo Kanner, who took over the term autism (from the Greek auto, himself), created in 1911 by Eugen Bleuler to appoint the behaviour of self-qu 'he observed in some subjects in its studies on schizophrenia (early dementia).
Symptoms appear during the first three years of the child's life. They are diverse and vary from one patient to another, their intensity could change, especially with age:
* Indifference to others or bizarre reactions;
* Repetitive behaviors and activities stereotypical (shaking hands, rocking the body…);
* Lack of objects in its environment or use non-conventional and stereotyped;
* Silence or unusual language (for example echolalia: repetition echoing words or phrases heard);
* Afraid of change.
None of them individually is sufficient to establish a diagnosis. Similarly, the absence of a criterion does not necessarily disqualify a diagnosis of autism.
Thus, a child may be verbal and have an autistic behavior.
Diagnostic Criteria
The descriptive criteria diagnostic Manual of Psychiatric Diseases, 4th edition (DSM-IV) of the American Psychiatric Association are as follows (Diagnostic Criteria for Autistic Disorder 299.00).
* Criterion A
1. The qualitative alteration of reciprocal social interactions, severe and lasting;
2. Alteration of communication, marked and lasting, which affects the capacity verbal and non-verbal;
3. Character restricted, repetitive and stereotyped attitudes, interests and activities.
* Criterion B
1. Beginning before the age of 3 years.
* Criterion C
1. The disruption is not explained by better diagnosis of Rett syndrome or disorder désintégratif of childhood.
The use of international classifications allows all stakeholders (professionals and parents) better communication by using the same terminology.
Screening
The international classifications (ICD-10, DSM-IV) emphasize the failures relating to communication and social interactions in autism, and these anomalies are easily detected in the very young child.
In response to these difficulties screening, S. Baron-Cohen et al. in 1992 have developed a tool to identify early signs of TED among autistic children at risk from 18 months.
This test, composed of a series of nine questions to ask the parents and a series of seven observations to be carried out by a professional is fast and simple to administer. It may well be used by non-specialists in autism, such as general practitioners. It consists of observations that relate to two central points. Firstly, the concept of "pretend" in the normal development around the age of 12-15 months, and is disrupted in autism. Secondly, the conduct of joint attention, and is present in normal development around the age of 9-14 months, and who is absent or rare in autism. The validity of studies (16 000 subjects) revealed that children 18 months identified as high risk of diagnosis of autism have subsequently been diagnosed in 3 years.
The test CHAT [ref. necessary] helps detect tampering of child development in the following areas:
1. Thursday "pretend";
2. Pointing protodéclaratif (attracting the attention of the entourage to a focus on pointing the finger);
3. social interest;
4. Thursday social;
5. joint attention.
The diagnosis
The disorders are fairly stable at the age of three years so that we can make a reliable diagnosis. For a large majority of cases, the diagnosis can be made as early as two years. Before that age, the reliability of diagnosis is not guaranteed.
The diagnosis must be made on the basis of international classifications.
Intoxication with heavy metals
Many people associate the disease with vaccination (and mercury it contains) of their child then become autistic. This assumption is now not officially recognized. It may, however, noted that the Autism Research institute supports this thesis.
Anomalies and brain defects in the placenta
Scientists have discovered that the earliest indicators of autism so far, could be the presence of defective cells in the placenta. This discovery could lead to earlier diagnosis of the disorder of development that affects about one child in 200 and may result in learning difficulties, problems with speech and difficulty in interpersonal relationships.
Brain abnormality
The magazine practitioner in April 1999 reported anomalies cytoarchitectonique the limbic system and cerebellum. There is an increased size of certain cells and a decrease of intercellular connections. "The absence of anomalies in other regions suggests that injuries occur before the 23rd week of gestation".
Failures placenta
Researchers at the School of Medicine at Yale revealed the presence of defective cells in the placenta of children developing with TED. These results could lead to early diagnosis of a developmental disorder that affects about one child in 200 and which has as a consequence of difficulties in communication, socialization and interaction with others. [Ref. necessary]
Kliman and his team examined under a microscope samples of tissue from the placenta recovered by various research hospitals. Thirteen samples came from children later diagnosed Asperger and sixty-one children were undiagnosed. The comparison of different tissues highlights the presence in the placentas of children who are in the autistic spectrum disorders, abnormal microscopic wells, three times more numerous than those in the control group.
The research could lead to routine analysis of the placenta of newborns at risk, especially those who have a brother or older sister who is developing with autism.
Genetic Causes
Autism include a genetic nearly 90%.
The elements for the genetic origin of autism are:
1. The proportion of girls to boys is the same in all countries, irrespective of the level sociocultural
2. The chance to grow with autism increases with proximity genetic:
* Less than 1% for the general population
* 3% (autism) and 10% (TED) among brothers and sisters of children with autism
* 60 to 90% among twins
3. The "consistency" of autism is higher among identical twins than in fraternal twins (about 3%)
4. Several genetic diseases, malformations or chromosomal infectious diseases are associated with autism so statistically significant.
Autism is seen in the following diseases which account for nearly 10% of autism:
* Syndrome fragile X;
* Rett Syndrome;
* Sotos Syndrome;
* Joubert Syndrome;
* Neurofibromatosis type I;
* Tuberous sclerosis Bourneville;
* Syndrome Prader-Willy;
* Angelman Syndrome.
In other cases, analysis of DNA collected from families where a member is autistic were carried out: there is a susceptibility region on chromosome 11, a higher frequency of deletions in an area of chromosome 16 And a lack of expression of a gene on chromosome 2.
Most cases of autism could be explained by genetic mutations spontaneous and not by a genetic predisposition transmitted over many generations.
Salaries
There is no cure for autism, which does not prevent people with autism can benefit from psychotherapeutic treatment in parallel with an institutional care, educational and pedagogical.
The scientific literature is, however, unanimous on this point: There must be educational intervention is early, massive and structured.
The best results are obtained when the child receives care and behavioral education since its 2 years: "Thirty years of research have shown the effectiveness of applied behavioral methods to reduce behavior problems and increase communication, learning and social behaviour appropriate ".
Behavioral Interventions
Any intervention begins with a good evaluation. Once the profile of developmental determined the child is developing an individualized project that the team followed and parents will apply within the structure and in the daily life of the child. Every year, it assesses the child development and on the draft réadapte personalized children at meetings synthesis.
The behavioral intervention is very effective in treating the behavioural disorders, which are very often present in autism. The intervention is usually to replace an inappropriate behaviour by another, adequate. They spoke on the conduct itself and / or on the causes of behavior.
There is evidence today that people with autism who has received a formal education are more independent, less medicated and more integrated into society than those who have been deprived.
Method PECS
When the child does not acquire verbal language, we need to propose ways of augmentative and alternative communication. In autism, these are all facets of communication that are affected.
Andrew Bondy and Lori Frost (Delaware U.S.) have developed a communication tool called PECS. The method PECS is for the child to give the caller the image of the object he wants in return.
Unlike the other methods of alternative communication, PECS allows a child to learn to introduce himself communication with others. The time required for learning is extremely short. Moreover, the cost is extremely low, given the possibility to create your own equipment, consisting of photos or icons, according to the understanding of the topic.
The PECS has been validated as soon as 18 months, and can be initiated at any age of life.
Programme A.B.A
The ABA (Applied Behavioral Analysis, or applied behavioral analysis) is an educational approach based on behaviourism and Ivar Lovaas created by the USA in 1960. It consists of an analysis of behavior, coupled with an intensive intervention aimed at achieving better integration into society by increasing behaviour deemed appropriate, and the decline in behaviour deemed inappropriate (see operant conditioning).
The results obtained initially by Lovaas, and then confirmed by other studies recount that 50% of children - who were under 3 years at the start - after the program for 2 to 3 years, could then continue their studies school without aid, with a functioning indistinguishable from the normal children.
For a programme ABA to be effective, its proponents give the following two conditions. First, it must be intensive at a rate of 30 to 40 hours per week. Then it must be conducted by an educational team (whose parents are an integral part) trained and involved in the same way, under an individualized program clearly defined. Moreover, the prognosis is even better than the ABA program is started early.
Such intervention is against a very binding. In addition to its modus operandi, it is a cost that families can not bear alone. In France, ABA is not recognized by Social Security. By cons, Holland or Canada (Ontario) this approach is supported by the state.
Opponents of ABA criticize this method because it takes its source in research on the packaging (Pavlov, Skinner). Its proponents contend, however, that packaging is part of all education and qu'ABA is an adaptation of this aspect for a population which has particular difficulty in learning. They insist on the results they achieve:
Some studies Krantz & McClannahan (1999) show a complete recovery between 42% and 67% of cases in the case of an intensive care before 4 years.
In the case of care later, even if the recovery is only partial, learned enable children to grow dramatically: language development, learning to read, etc. ... Capacities extremely important for an adult life as independent as possible.
Read also www.autism.org,Social Phobia
wikipedia
