Autism in children: signs of the disease and causes. Signs, symptoms and treatment of autism in children Intellectual disorders

There are more and more children diagnosed with autism every day. This prevalence of the disease is primarily due to improved diagnosis. Talented and gifted children in Russia often miss the diagnosis of autism. Such children require special attention and must be socialized in society.

What it is?

In simple words, “autism” is a mental disorder or disease characterized by mental changes, loss of social adaptation in society and altered behavior. Typically, the child experiences a persistent disruption of interaction within society.

Often autism is not diagnosed for a long time, since parents attribute changes in behavior to the child’s character traits.

The disease can indeed be mild. In this case, identifying the first characteristic signs and recognizing the disease is a very difficult task not only for parents, but also for doctors.

In Europe and the USA, the diagnosis of autism is much more common. This is due to the presence of excellent diagnostic criteria, which allow a commission of doctors to accurately make a diagnosis even in mild cases of illness or in complex clinical cases.

In autistic children, various changes occur in the cerebral cortex. They appear immediately after birth. However, they can appear much later, after many years. The disease occurs without periods of stable remission. With a long course of the disease and the use of various psychotherapeutic techniques that can improve the behavior of an autistic child, parents may see some improvements.

To date, no specific treatment has been developed. This means that a complete cure for the disease is, unfortunately, impossible.

Prevalence

Statistics on the incidence of autism in the USA and Europe differ markedly from Russian data. This is primarily due to the high detection rate of sick children abroad. Foreign doctors and psychologists use numerous questionnaires and diagnostic behavioral tests, which allow them to accurately diagnose children of any age.

In Russia, the statistics are completely different. Often, not all children show the first symptoms of the disease on time and at an early age. Russian children who suffer from autism often remain just withdrawn kids.

Symptoms of the disease are “attributed” to the child’s character and temperament, which leads to serious consequences. Such children subsequently integrate poorly into society, cannot find themselves in a profession, or they fail to create a good and happy family.

The prevalence of the disease is no more than 3%. Boys are most often affected by autism. Typically this ratio is 4:1. Girls from families where there are many cases of autism in relatives may also suffer from this mental illness.

Most often, the first clear symptoms of the disease are revealed only by the age of three. The disease, as a rule, manifests itself at an even earlier age, but remains unrecognized in most cases until 3-5 years of age.

Why are children born with autism spectrum disorder?

To date, scientists have not yet reached a consensus on this issue. In the development of autism, many experts believe that several genes are to blame, which cause disruption in the functioning of certain parts of the cerebral cortex. Often when analyzing cases of the disease it becomes obvious strongly expressed heredity.

Another theory of the disease is mutation. Scientists believe that the cause of the disease can be various mutations and breakdowns in the genetic apparatus of a particular individual.

Various factors can lead to this:

• exposure to ionizing radiation on the fetus during the mother's pregnancy;
• infection with bacterial or viral infections of the fetus during intrauterine development;
• exposure to hazardous chemicals that have a teratogenic effect on the unborn child;
• chronic diseases of the nervous system in the mother, for which she took various symptomatic psychotropic drugs for a long time.

According to American experts, such mutagenic effects quite often led to various disorders characteristic of autism.

This effect on the fetus is especially dangerous during the first 8-10 weeks from the moment of conception. At this time, the formation of all vital organs occurs, including the formation of the areas of the cerebral cortex responsible for behavior.

Genetic or mutational disorders that underlie the disease ultimately lead to specific damage to individual areas of the central nervous system. As a result, the coordinated work between the various neurons responsible for social integration is disrupted.

There is also a change in the functions of the mirror cells of the brain, which leads to the appearance of specific symptoms of autism, when the baby can repeatedly perform the same type of action and pronounce individual phrases several times.

Kinds

Currently, many different classifications of the disease are used. All of them are divided according to the variants of the course of the disease, the severity of manifestations, and also taking into account the stage of the disease.

There is no single working classification that would be used in Russia. In our country, specific criteria for the disease are currently being developed and streamlined, which will form the basis for diagnosing the disease.

Autism can usually occur in several forms or variations:

1. Typical. With this option, the signs of the disease appear quite clearly in childhood. Children are characterized by more withdrawn behavior, lack of involvement in games with other children, and have poor contacts even with close relatives and parents. To improve social integration, it is imperative to carry out a whole range of various psychotherapeutic procedures and the help of a child psychologist who is well versed in this problem.
2. Atypical. This atypical variant of the disease occurs at a much later age. As a rule, after 3-4 years. This form of the disease is characterized by the manifestation of not all specific signs of autism, but only some. Atypical autism is diagnosed quite late. Often, failure to diagnose in time and delay in making a diagnosis leads to the development of more persistent symptoms in the child, which are much more difficult to treat.
3. Hidden. There are no exact statistics on the number of children with this diagnosis. With this form of the disease, the manifestation of the main clinical symptoms is extremely rare. Very often, children are considered simply overly withdrawn or introverted. Such children practically do not allow strangers into their own inner world. Establishing communication with a child diagnosed with autism is very difficult.

How does the mild form differ from the severe form?

Autism can occur in several forms depending on severity. The mildest form occurs in most cases. It is characterized by violations of social adaptation, when the baby does not want to establish contacts or communicate with other people.

It is important to understand that he does this not because of modesty or excessive isolation, but simply due to the manifestations of the disease. Such children, as a rule, start speaking late.

Violations of one's personality in mild forms of the disease practically do not occur. Kids can make contact with the people closest to them. Usually the child chooses several family members who, in his opinion, treat him with more care and attention. Autistic children do not perceive physical contact well. Usually the child tries to shy away from hugs or does not like kisses.

Babies with more severe illness They try in every possible way to avoid contact with other people. Even touching or hugging from close relatives can cause them severe mental trauma. Only the closest people, according to the child, can touch him. This is a very important clinical sign of the disease. A child with autism is very sensitive to any interference in his personal space from a very young age.

Some severe variants of the disease are characterized by mental tendencies to cause harm to themselves. Such babies may even bite themselves or attempt to inflict various injuries at an older age.

This manifestation is rare, but requires urgent consultation with a psychiatrist and the prescription of special medications that reduce manifestations of aggression towards one’s own personality.

The mild form of the disease often goes undiagnosed, especially in Russia. Manifestations of the disease are simply attributed to the developmental characteristics of the child or the uniqueness of his character. Such children can grow up and carry the disease into adulthood. The course of the disease may change at different ages. However, the classic violation of social integration is observed almost constantly, without remission.

Severe forms of the disease, which often manifest as complete forced isolation of the baby from the outside world, are much easier to identify.

The behavior of a child with severe autism is manifested by a pronounced reluctance to communicate with any people. Such kids are more willing to be alone. This brings them peace of mind and does not disrupt their usual way of life.

Failure to provide therapeutic psychotherapy can lead to deterioration of the child’s condition and complete social maladjustment.

Symptoms and first signs

Manifestations of the disease can be checked already in the first years of a child’s life. With a thorough and attentive analysis of the baby’s behavior, even at a very young age, the first characteristic signs of autism syndrome can be identified. There are special psychological traits and characteristics for this disease.

The main characteristics of the disease can be divided into several main categories:

• Reluctance to create new social contacts.
• Disturbed interests or use of special games.
• Repeating typical actions many times.
• Speech behavior disorder.
• Changes in intelligence and different levels of mental development.
• Changing your own sense of personality.
• Psychomotor dysfunction.

The reluctance to create new social contacts is evident in children from birth. At first, children are reluctant to respond to any touch from those closest to them. Even hugs or kisses from parents do not evoke positive emotions in children with autism. From the outside, such children seem overly calm and even “cold.”

Babies practically do not respond to smiles and do not notice the “grimas” that their parents or close relatives make to them. They often fix their gaze on some object that is of great interest to them.

Newborn babies with autism syndrome They can stare at a toy for hours or stare at one point.

Children practically do not experience any expressed joy from new gifts. Children of the first year of life can be absolutely neutral towards any new toys. Most often, it is difficult to even get a smile from such kids in response to a gift. In the best case, an autistic child will simply twirl the toy in his hands for a few minutes, and then put it aside indefinitely.

Children older than one year are very selective in choosing people close to them. They usually choose no more than two people. This is due to the reluctance to create close contacts, as this leads to severe discomfort for the baby.

They usually choose one of their parents as their “friend.” This could be either dad or mom. In some cases - grandmother or grandfather.

Autistic children have virtually no contact with their peers or children of a different age. Any attempt to disturb their own comfortable world can bring such children significant discomfort.

They try in every possible way to avoid any situation that is traumatic for their psyche. Autistic children have practically no friends. They experience difficulties making new friends throughout their lives.

The first serious problems in such children appear at the age of 2-3 years. Usually at this time children are sent to kindergarten. As a rule, this is where the disease is detected, since it becomes simply impossible not to notice the characteristic manifestations of the disease.

When visiting kindergarten, the behavior of autistic children stands out sharply. They seem more withdrawn than other children, they can stay aloof, and play with the same toy for hours, performing some stereotypical repetitive movements.

Children with autism exhibit more withdrawn behavior. Most kids ask for almost nothing. If they need something, they prefer to take it themselves without outside help.

Children under three years of age may have difficulty potty training.

If you ask a child to give you a toy or some object, most often he will not give it to you, but will simply throw it on the floor. This is a manifestation of impaired perception of any communication.

Autistic children are not always completely passive in a new, unfamiliar group. Often, when trying to introduce a sick child into a new society, he may experience vivid negative outbursts of anger or aggression towards others. This is a manifestation of a violation or invasion of the boundaries of one’s own and such a cozy, and most importantly, safe inner world for children with autism. Expansion of any contacts can lead to severe outbursts of aggression and deterioration of mental well-being.

Disturbed interests or use of special games

Very often, children with autism remain indifferent to any active recreational activities. They seem to be in their own inner world. Entry into this personal space is usually closed to other people. Any attempts to teach a child to play very often lead to the complete failure of this idea.

Children with autism choose 1-2 favorite toys, with whom they spend a huge amount of time. Even with a large selection of different toys, they remain completely indifferent to them.

If you carefully observe the play of a child with autism, you will notice a strict repetition of the sequence of actions that he performs. If a boy plays with boats, then very often he lines up all the ships he has in one line. A child can sort them by size, color, or some characteristics that are special to him. He performs this action every time before the game.

Strict orderliness often manifests itself in everything in children with autism. This is a manifestation of a world that is comfortable for them, in which all objects are in their place and there is no chaos.

All new objects that appear in the life of an autistic child cause him severe mental trauma. Even rearranging furniture or toys can cause a strong attack of aggression in a child or, conversely, put the child into a state of complete apathy. It is better that all items remain in their places at all times. In this case, the baby will feel more comfortable and calm.

Girls with autism also experience changes in the form of play. Notice how the little girl plays with her doll. During such a lesson, every day she will perform all movements and actions according to the established algorithm. For example, she will first comb her hair, then wash the doll, then change her clothes. And never vice versa! Everything is in a strictly established sequence.

Such systematic actions in children with autism are due to the peculiarity of disturbed mental behavior, and not to character. If you try to ask your child why he does the same actions every time, you will not get an answer. The child simply does not notice what actions he performs. For the perception of his own psyche, this is absolutely normal.

Repeating typical actions multiple times

The behavior of a child with autism is not always very different from the communication style of a healthy child. From the outside, such children look absolutely normal, since the appearance of the children practically does not change.

Children with autism often do not lag behind in physical development and are not at all different in appearance from their peers. However, with more careful observation of the child's behavior, it is possible to identify actions that differ slightly from usual behavior.

Often, children with autism may repeat various words or combinations of several letters or syllables. Such disorders can occur in both boys and girls.

This symptom can manifest itself in different ways:

• Repetition of counting or sequential naming of numbers. Autistic children often count repeatedly throughout the day. This activity brings comfort and even positive emotions to the child.
• Repeating words previously spoken by someone. For example, after the question “how old are you?”, a child can repeat “I’m 5 years old, 5 years old, 5 years old” several dozen times. Very often, such kids repeat one phrase or word at least 10-20 times.

In other cases, children with autism may perform the same activity for a long time. For example, they turn lights off and on repeatedly. Some kids often open or close water taps.

Another feature may be constant wringing of fingers or the same type of movements with legs and arms. Such typical actions, repeated many times, bring peace and tranquility to children.

In more rare cases, babies may perform other similar actions, for example, sniffing various objects. Many scientists attribute this to the fact that disturbances occur in those areas of the cerebral cortex that are active in the perception of odors. Smell, touch, vision and taste - these areas of sensory perception in a child with autism are also often damaged, and various manifestations appear.

Speech behavior disorders

Speech disorders occur quite often in children with autism. The severity of manifestations varies. In milder forms of the disease, as a rule, speech disturbances are mild. In more severe cases, there may be a complete delay in speech development and the acquisition of persistent defects.

The disease can manifest itself in different ways. Children with autism often start talking late. As a rule, after the child says the first few words, he may remain silent for a long time. A baby's vocabulary consists of only a few words. He often repeats them many times throughout the day.

Children with autism have difficulty expanding their vocabulary. Even when memorizing words, they try not to use a large number of different combinations in their speech.

A peculiarity of speech behavior in a child over two years old is the mention of objects in the third person. Most often, the child will call himself by name or say, for example, “girl Olya.” The pronoun “I” is almost never heard from a child with autism.

If you ask a baby if he wants to swim, the child may answer “he wants to swim” or call himself by name “Kostya wants to swim.”

Very often, children with autism do not answer direct questions that are addressed to them. They may remain silent or avoid answering, move the conversation to other topics, or simply ignore. This behavior is associated with a painful perception of new contacts and an attempt to invade personal space.

If a child is pestered with questions or asked too many questions in a short time, the child may even react quite violently, showing aggression.

The speech of older children often includes many interesting combinations and phrases. They perfectly remember various fairy tales and proverbs.

A child suffering from autism can easily recite an excerpt from Pushkin’s poem by heart at the age of five or recite a complex poem.

Such children often have a tendency to rhyme. At a younger age, children get great pleasure from repeating various rhymes over and over again.

The combination of words may seem completely meaningless, and in some cases even crazy. However, for children with autism, repeating such rhymes brings joy and positive emotions.

Changes in intelligence and different levels of mental development

It has long been believed that children with autism are mentally retarded. But this is a huge misconception! A large number of autistic children have the highest IQ levels.

With proper communication with a child, you can notice that he has a high level of intelligence. However, he will not show it to everyone.

The peculiarity of the mental development of an autistic person is that it is very difficult for him to concentrate and be purposeful in achieving specific goals.

The memory of such children has the property of selectivity. The child will not remember all events with equal ease, but only those that, according to his personal perception, will be closer to his inner world.

Some children have defects in logical perception. They perform poorly on tasks to construct an associative series.

The baby perceives ordinary abstract events well, can easily repeat a sequence or chain of events even after a long time. Long-term memory impairments are not observed in children with autism.

Children with a higher level of intelligence integrate very poorly at school. Often such a child becomes an “outcast” or a “black sheep.”

The impaired ability to socialize contributes to the fact that autistic children become even more distant from the outside world. As a rule, such kids have a penchant for various sciences. They can become real geniuses if the right approach is applied to the child.

Different variants of the disease may progress differently. In some cases, children experience a decrease in intellectual abilities. They do poorly in school, do not answer teachers' questions, and do not solve difficult geometric tasks that require good spatial and logical abilities.

Very often, such children require special training using special pedagogical programs that are designed specifically for children with autism.

It is important to note that any deterioration in the child’s condition can occur suddenly when exposed to any provoking cause. Often these can be severe stress or attacks from peers.

Children with autism have a very difficult time with such triggering events. This can even lead to severe apathy or, conversely, cause violent aggression.

Watch the following video about teaching children with autism spectrum disorder.

Changing your sense of self

When any contact with other people is disrupted, autistic people often project any negative events onto themselves. This is called self-aggression. This manifestation of the disease in varying degrees of severity occurs quite often. Almost every third child with autism suffers from this unfavorable manifestation of the disease.

Psychotherapists believe that this negative symptom arises as a result of a disrupted perception of the boundaries of one’s own inner world. Any threat to personal safety is perceived excessively by a sick child. Children can cause various injuries to themselves: biting themselves or even cutting themselves on purpose.

Even in childhood, the child’s sense of limited space is disturbed. Such babies often fall out of the playpen after swaying violently. Some children may unfasten from the stroller and fall to the ground.

Usually such a negative and painful experience will force a healthy baby not to do such actions in the future. A child with autism, even despite the resulting pain syndrome, will still repeat this action over and over again.

It is quite rare for a child to show aggression towards others. In 99% of cases, the manifestation of such a reaction is self-defense. As a rule, kids are very sensitive to any attempts to invade their personal world.

Inept actions towards a child with autism or even a simple desire to make contact can cause an attack of aggression in the child, which provokes internal fear.

Psychomotor dysfunction

Quite often, children with autism experience an altered gait. They try to walk on tiptoes. Some children may bounce when walking. This symptom occurs every day.

All attempts to make comments to the baby that he is walking incorrectly and needs to walk differently do not evoke a response from him. The child remains faithful to his gait for quite a long time.

Children with autism do not notice the changes that appear in their everyday life. Older children try to choose routes that are familiar to him. A child with autism will almost always choose the same path to school, without changing his own habits.

Kids often remain true to their taste preferences. Such children should not be taught a certain diet. All the same, a child with autism will have his own idea and even a whole system in his head about what and when it is best for him to eat.

It will be almost impossible to force your baby to eat an unfamiliar product. They remain true to their taste preferences throughout their lives.

Basic characteristics by age

Up to a year

Children with symptoms of autism react poorly to any attempts to address them, especially by name. Children do not babble or utter their first words for a long time.

The child's emotions are quite impoverished. Gesticulation is also significantly reduced. A baby with autism gives the impression of a very calm child who cries little and practically does not ask to be held. Any contacts with parents and even mother do not give the child strong positive emotions.

Newborn babies and infants practically do not express various emotions on their faces. Such children even seem somewhat renounced. Often, when trying to make a child smile, he does not change his face or perceives this attempt rather coldly. Such children love to look at various objects. Their gaze stops on some object for a very long time.

Kids often try to choose one or a couple of toys with which they can spend almost the entire day. They absolutely do not need any outsiders to play. They feel great alone with themselves. Sometimes attempts to intrude on their play can cause an attack of panic or aggression.

Children in their first year of life with autism practically do not call adults for help. If they need something, they try to take the item themselves.

As a rule, there are no intellectual impairments at this age. Most children do not lag behind their peers in terms of physical or mental development.

Up to 3 years

Before the age of 3 years, symptoms of limited personal space begin to manifest themselves to a greater extent.

When playing outside, children categorically refuse to play in the same sandbox with other children. All objects and toys that belong to a child with autism belong only to him.

From the outside, such children seem very closed and “on their own.” Most often, by the age of one and a half years, they can only utter a few words. However, this does not happen to all babies. They often repeat various verbal combinations that do not carry much meaning.

After the child utters the first word, he may suddenly become silent and practically not speak for quite a long time.

Children with autism almost never answer questions asked of them. Only with the people closest to them can they utter a few words or answer in the third person a question addressed to them.

Very often such children try to avert their eyes and do not look at the interlocutor. Even if the child answers the question, he will never use the word “I”. Children with autism identify themselves as “he” or “she.” Many children simply call themselves by name.

Some children are characterized by manifestations of stereotypical actions. They may sway violently in their chair. Parents' comments that doing this is wrong or ugly do not evoke any response from the child. This is not due to the desire to demonstrate one’s character, but simply to a violation of the perception of one’s own behavior. The baby really does not notice and does not see anything wrong in his action.

Some babies may have problems with fine motor skills. When trying to take any small objects from the table or floor, the child does it very clumsily.

Often babies cannot clench their hands well. Such a violation of fine motor skills necessarily requires special classes that are aimed at improving this skill.

If correction is not carried out in a timely manner, the child may develop writing impairments, as well as the appearance of gestures that are unusual for an ordinary baby.

Autistic children love to play with water taps or switches. They also really enjoy opening and closing doors. Any similar movements evoke excellent emotions in the child. He can perform such actions for as long as he likes until his parents intervene. When performing these movements, the baby absolutely does not notice that he is performing them repeatedly.

Autistic children eat only those foods that they like, play independently and practically do not get to know other children. Many people around them mistakenly consider such kids to be too spoiled. This is a huge misconception!

A child with autism, under the age of three, sees absolutely no differences in his behavior relative to the behavior of others. He simply tries to limit the boundaries of his inner world from any outside interference.

It used to be that children with autism had certain facial features. Often such features were called aristocratic forms. Autistic people were believed to have thinner and longer noses. However, this is not at all true.

To date, the connection between facial structural features and the presence of autism in a child has not been reliably established. Such judgments are just speculation and lack scientific evidence.

From 3 to 6 years

The incidence of autism peaks at this age. Children begin to be sent to kindergarten, where disturbances in social adaptation become noticeable.

Children with autism perceive morning trips to preschool educational institutions without expressed delight. They would rather stay at home than leave their familiar safe home.

A child with autism practically does not meet new friends. At best, he makes one new acquaintance who becomes his best friend.

A sick child will never accept a large number of people into his inner world. Very often, such children try to close themselves off even more, to escape from the traumatic situation.

The child tries to come up with some kind of magical story or fairy tale that explains why he should go to this kindergarten. Then he becomes the main character of this action. However, visiting kindergarten does not give the child any pleasure. He doesn't get along well with his peers and practically doesn't listen to his teachers.

All things in the baby’s personal locker are usually folded strictly in order. This becomes clearly visible from the outside. Such children cannot stand any chaos or scattered things. Any violation of the ordering of the structure can cause them to have an attack of apathy, and in some cases, aggressive behavior.

Trying to force a child to meet new kids in a group can cause him extreme stress.

Children with autism should not be scolded for doing the same type of behavior over a long period of time. You just need to find the “key” to such a child.

Often, kindergarten teachers simply cannot cope with a “special” child. Many features of disrupted behavior are perceived by teaching staff as excessive spoilage and character traits. In these cases, the mandatory work of a medical psychologist is required, who will work daily with the child in a preschool institution.

Over 6 years old

Children with autism in Russia attend regular schools. In our country there are no specialized educational programs for such children. Typically, children with autism do well in school. They have a penchant for various disciplines. Many guys even show the highest level of mastery of the subject.

Such children often focus on one subject. In other disciplines that do not resonate in the child’s inner world, they may have very mediocre performance.

Children with autism have difficulty concentrating and are also characterized by insufficient concentration on several objects at the same time.

Often in such children, if the disease was detected at an early stage and there were no severe defects in fine motor skills, brilliant abilities for music or creativity are discovered.

Kids can play various musical instruments for hours. Some children even compose various works on their own.

Children, as a rule, try to lead a rather secluded lifestyle. They have few friends. They practically do not attend various entertainment events, which can be attended by a huge number of people. Being at home is more comfortable for them.

Very often, children have a commitment to certain foods. In most cases, it occurs in early childhood. Children with autism eat at specific times according to their own schedule. All meals are accompanied by the performance of a specific ritual.

They often eat only from plates that are familiar to them and try to avoid dishes of new colors. All cutlery is usually laid out by the child on the table in a strictly defined sequence.

Children with autism can graduate from school very successfully, showing excellent knowledge in one discipline.

In only 30% of cases, children suffering from this disease fall behind the school curriculum and have poor academic performance. As a rule, in such children the diagnosis of autism was made quite late or a good rehabilitation program was not carried out to reduce the unfavorable symptoms of the disease and improve social adaptation.

Problems

Very often, children with autism experience not only behavioral disorders, but also various pathological manifestations of internal organs.

Gastrointestinal disorders

They manifest themselves in the form of possible diarrhea or constipation, which are practically independent of the food that the child receives. Children with autism have special taste preferences. To normalize adverse manifestations and stool disorders, a gluten-free diet is effectively used. Such a diet, which contains a limited amount of gluten, promotes the smooth functioning of the gastrointestinal tract and reduces the negative symptoms of indigestion.

You can learn more about the diet for autism by watching the following video.

Sleep disorders

Babies are almost equally active during the day and at night. It is very difficult to put such children to sleep. Even if they fall asleep, they may only sleep for a few hours. Very often babies wake up very early in the morning. During the daytime, they may refuse to sleep. In some cases, when exposed to strong psychologically traumatic situations, insomnia may worsen or nightmares may appear, which further contribute to the disruption of the child’s general well-being.

When is a consultation with a psychiatrist necessary?

You should seek the help of a doctor immediately if parents suspect the first signs of illness in their baby. Only a psychiatrist can accurately establish a diagnosis and recommend the necessary therapeutic treatment.

As a rule, all children diagnosed with autism should be seen periodically by a doctor. Don't be afraid of this doctor! This does not mean that the child has severe mental disorders. Such observation is important primarily for preventing the development of unwanted long-term symptoms of the disease.

In our country, children diagnosed with autism practically do not undergo any specialized rehabilitation programs. European specialists and doctors from the United States use a whole range of different psychotherapeutic techniques that can greatly improve the quality of life of a child suffering from autism.

Medical psychologists, professional physical therapy instructors, defectologists and speech therapists work with children from a very early age. Throughout his life, such a patient must be observed by a psychiatrist.

At what age is the disease most often diagnosed?

According to statistics, The largest number of cases of newly registered disease occurs at the age of 3-4 years. It is at this time that the symptoms of the child’s social maladjustment begin to clearly manifest themselves.

There is scientific evidence that suggests that with the development of better diagnostic criteria, it will be much easier to identify cases of autism in children at an earlier age.

Determining the first manifestations of the disease in newborns is a very difficult task even for an experienced pediatrician. To conduct a full examination and establish a diagnosis, it is necessary to organize a full-fledged medical examination, which usually involves at least 5-6 different specialists with skills and knowledge in the treatment of autism in children.

Diagnostics

Diagnosing the disease is quite difficult. In Russia, the diagnosis of “autism” will most often be given upon detection of the following psychological disorders:

• social maladjustment of the child in the environment;
• pronounced difficulties in establishing new communications and contacts with other people;
• repeated repetition of typical actions or words over a long period of time.

If the course of the disease occurs in a typical or classic form, then the above symptoms occur in 100% of cases. Such children require mandatory consultation with a psychiatrist, and, if necessary, an extensive consultation with the involvement of specialists in related specialties who work with autistic children.

During a more detailed examination, doctors try to determine the presence or absence of not only the main signs, but also additional ones. To do this, they use several classifications of diseases.

For autism use:

• ICD-X is the main working document for Russian specialists.
• The DSM-5 rubricator or Diagnostic Statistical Manual of Mental Disorders is used by psychiatrists around the world, including in Europe and the United States.

According to these medical reference books, a child with autism must exhibit at least six of the symptoms listed. To determine them, doctors resort to various questionnaires, using which they assess the baby’s condition in a playful way. Such research is carried out in the most gentle way possible, so as not to traumatize the disturbed child’s psyche.

An interview with parents is also required. This study allows us to clarify the presence and nature of violations in the child’s behavior that cause them concern.

Parents are interviewed by several psychiatrists, as well as a medical psychologist. Such diagnostic methods are mainly used only in Europe and the USA. In Russia, unfortunately, the diagnosis of autism is in an extremely deplorable state.

Children with this disease remain unexamined for a long time.

Over time, their negative manifestations of social maladaptation intensify; apathy and inability to establish contacts with people around them may increase. In our country, working diagnostic criteria have not yet been developed that would easily establish such a diagnosis. In this regard, there are quite a few cases of establishing a correct and timely diagnosis.

Is testing at home possible?

It is almost impossible to conduct a full inspection of the house. During such testing, you can only get an approximate answer. The diagnosis of autism can only be made by a psychiatrist. To do this, he uses several different tests that are used to diagnose the disease, as well as various other techniques to clarify the extent and level of damage.

When testing at home, parents can often get a false result. Very often, the information system automatically analyzes the answers without applying differentiated treatment to a specific child.

To make a diagnosis, a multi-stage medical examination is required to determine whether the child has autism.

How to treat?

Currently, no specific treatment for autism has been developed. Unfortunately, there is no special pill or magic vaccine that would reliably protect the baby from the possible development of the disease. A single cause of the disease has not been established.

Lack of understanding about the original source of the disease does not allow scientists to create a unique medicine that would completely cure children with autism.

Treatment of this mental illness is carried out comprehensively, taking into account the symptoms that arise. Such psychotropic drugs are prescribed only by a psychiatrist. They are written out on special prescription forms and issued according to strict records in pharmacies. Such medications are prescribed in courses or for the entire period of deterioration.

All treatment methods can be divided into several groups:

• Drug treatment. In this case, various medications are prescribed to eliminate the adverse symptoms that occur in various stages of the disease. Such drugs are prescribed by a doctor only after examining the baby and possibly conducting additional examinations.
• Psychological consultations. A child medical psychologist must work with a child suffering from autism. Using various psychological techniques, the specialist will help the child cope with emerging outbursts of anger and auto-aggression, as well as improve the internal feeling when integrating into a new team.
• General restorative health procedures. Playing sports is not at all contraindicated for children with autism. However, they must study in special groups with professional instructors or trainers who are trained in the elements of working with “special” children. Such children can show excellent results and achieve good sporting achievements. Success is only possible by applying the right pedagogical approach.
• Speech therapy classes. A speech therapist must conduct classes with a child under 3 years of age. At such lessons, children learn to speak correctly and refuse to use repeated repetitions of words. Speech therapy classes allow you to improve your child’s vocabulary and add even more words to his vocabulary. Such educational games help children adapt better to new groups and improve their social adaptation.

Drug treatment

Prescription of various medications on an ongoing basis is not required for children with autism. Such drugs are used only to eliminate the negative manifestations of the disease. In this case, untimely treatment can lead to the development of various adverse consequences and even worsen the baby’s condition.

The following medications are most often prescribed to children with autism.

Psychotropic drugs and neuroleptics

Used to treat attacks of aggressive behavior. They can be prescribed as a course of treatment or once to eliminate a violent outbreak of auto-aggression. Psychiatrists choose various medications that can eliminate the negative symptoms of the disease. For example, the antipsychotic drugs Rispolept and Seroquel can cope with acute attacks of severe aggression and calm the baby.

It is important to note that the prescription of antipsychotic drugs on an ongoing basis is carried out only in severe cases of the disease. In this case, the severity of symptoms is excessively high.

Long-term use of any antipsychotic drugs can cause addiction and various side effects. In order to prevent this, doctors resort to prescribing a course of treatment.

To eliminate panic attacks or improve mood, the doctor may prescribe special medications that affect the level of endorphins. These drugs also have a number of contraindications. They are used only in cases where various psychological methods for correcting behavior were carried out, but they were not successful and did not lead to an improvement in the child’s well-being.

Probiotics for the treatment of dysbiosis

In children with autism, in 90% of cases, doctors register persistent irritable bowel syndrome or dysbiosis. In this case, the microflora in the gastrointestinal tract is disrupted. It contains practically no beneficial lactobacilli and bifidobacteria, but microorganisms of pathogenic flora reproduce well. Very often, such children also exhibit increased yeast growth.

To eliminate these unfavorable symptoms, doctors resort to prescribing various medications enriched with lacto- and bifidobacteria. Children are prescribed: “Bifidobacterin”, “Acipol”, “Linex”, “Enterol” and many others. The prescription of these funds is carried out after additional research - stool culture and a test for dysbacteriosis. The drugs are prescribed as a course of treatment. It is usually designed for 1-3 months of daily use.

In addition to medications, the diet of a child with dysbacteriosis must include fresh fermented milk products with a high content of microorganisms beneficial to the intestines.

You can also make them at home. In this case, the beneficial properties of the product are not lost, and you can safely give it to your baby.

The effect of using fermented milk products usually occurs by the end of the first week.

Vitamin therapy

Children with autism have a pronounced and almost constant deficiency of a number of vitamins: B1, B6, B12, PP. To eliminate this condition, the prescription of a complex of biologically active substances is required. Such vitamin and mineral preparations can eliminate the deficiency of any vitamins, as well as normalize the microelement composition within the body.

Since children with autism are very committed to some type of food, their diet is often very monotonous. This leads to insufficient supply of vitamins and microelements from the outside.

In order to improve this condition, daily addition of various vegetables and fruits to the diet is required, especially in the summer. These products contain a high content of various vitamins and microelements, which are vital for the baby.

Sedatives

Used to eliminate anxiety. Very often, when exposed to a strong traumatic situation, a sick child may experience a severe state of panic. In this case, psychiatrists prescribe psychotropic drugs that can effectively eliminate this manifestation. A course of such medications is not required. Only a single dose is enough.

Children with autism often have trouble sleeping. They have difficulty falling asleep. The duration of sleep can be no more than 6-7 hours a day.

For a small child this is not enough. To improve night sleep, as well as normalize the circadian rhythm, doctors recommend using mild medications that calm the nervous system and promote rapid sleep.

It is safe for children to use various herbs that have a sedative effect. Such natural medicines practically do not cause side effects and do not have numerous contraindications. To normalize sleep, decoctions of lemon balm or mint are used. You can give these herbs to your baby in the form of tea. It is better to drink such a sedative medicine no later than 2-3 hours before bedtime.

The prescription of sedative medications is allowed only for severe sleep disturbances. Typically, such drugs are prescribed for quite a long time. It is not advisable to use these drugs in milder forms of the disease, since they can have a pronounced tranquilizing effect or be addictive. The prescription of medications is made by a psychotherapist after a preliminary examination.

Help from a psychologist

The use of various psychological techniques is an important element of therapy for children suffering from autism. American experts who conduct classes with sick children every day recommend conducting such classes at least 2-3 times a week.

It is better for the psychologist to also have a medical education. In this case, it can quickly help him or her when the condition worsens and send the child for consultation with a psychiatrist.

The psychologist does not prescribe medications. He treats only with words. Usually, for children with autism, the first meeting with a specialist is very important. It is at this time that you can understand whether such classes will be successful and whether the child will find a common language with the psychologist.

In order to penetrate into the inner world of a child suffering from autism, the psychologist must very delicately make friends with him. Only in this case will the baby make contact.

Often, treatment may not bring a pronounced positive effect in the absence of primary contact between the autistic child and the psychologist.

All classes are conducted in a specially equipped room. Often, to work with children with autism, all lessons are held in only one room. This helps create a calmer and more comfortable atmosphere for the child.

Psychologists try not to move or rearrange toys without reason, as this can bring severe mental discomfort to the baby.

Usually, game forms of conducting classes are chosen. During such games, children are as “open” as possible and can demonstrate real emotions. Each lesson usually lasts no more than an hour.

With longer communication, the baby may become very tired and reluctant to make contact with a specialist.

Working with children who suffer from autism usually continues throughout the child's life. At the same time, only the types and forms of psychological techniques change.

Very often, psychologists become real family members or very close friends. In America, several cases of families turning to psychologists have been recorded. In this case, not only the child, but also one of the parents suffered from autism.

It is important to note that family activities also have a good therapeutic effect.

Classes with a psychologist for children under 3-5 years old are often carried out together with one of the parents. Usually the parent with whom the baby has a closer relationship is chosen. The psychologist, in a playful way, creates various everyday situations that can occur in everyday life. During such a game, he teaches the baby how to react correctly to new people. Children learn to communicate better with other kids, and also acquire new useful skills that can be useful to them every day.

Classes

To improve the integration into society of a child suffering from autism, additional activities are required to help him with this. Typically, such a complex of various activities is compiled together with a child psychologist or on the recommendation of a psychiatrist.

Usually, before choosing any hobby that will be interesting to the child, a good analysis of his abilities and a qualitative assessment of the level of health and physical development are required. Not all children with autism will perform the same tasks with the same interest. The correct choice of activities greatly improves the prognosis of treatment and has a beneficial effect on the mental and psychological development of the baby.

Typically, children with autism are recommended various correctional activities that can improve the child’s social integration in society. Sports are recommended for children. However, not all sports training can be selected. For autistic children, calm sports are more suitable: learning to swim, playing chess or checkers, golf. It is worth choosing those sports that require concentration on one subject.

Sports that require high speed or a high risk of injury are best left aside. Children with autism should not engage in running, jumping, boxing and various types of strength wrestling.

Team games are also not suitable. It is better to give preference to calmer sports that will help improve the baby’s health and have a positive effect on his nervous system.

Children with autism are very warm towards various animals. In such children, doctors often even note a certain “cult” of animals. An autistic child may have a whole collection of cats or dogs. Direct contact and touching of pets can evoke strong positive emotions in the baby and even improve the prognosis of treatment.

Children with autism benefit from spending time interacting with a variety of animals. Doctors recommend hippotherapy or dolphin therapy sessions. Such contacts with animals will bring great joy to the baby and will have a positive impact on his development.

When a baby touches any living creature, special endorphin molecules begin to be produced in the cerebral cortex, which evoke a sea of ​​positive emotions in him.

If possible, such exercises with animals should be carried out as often as possible. It is better that the child has the opportunity to constantly observe living beings and communicate with them. While communicating with a dog or cat, the baby learns to contact the environment. This has a positive effect on his ability to make new contacts and improves social adaptation in society.

What toys should I buy?

Parents often rack their brains over what gift to give to their baby, who has been diagnosed with autism by doctors. It seems that every new toy brings virtually no joy to the child. However, this is not quite true. Every child with autism has their own personal preference for a particular type of toy.

Often boys choose different planes or ships, and girls choose different animals or dolls. It is important to note that autistic children can be delighted with donated animals. The main thing is to determine which specific animal your child likes. Usually this does not pose any difficulty: an autistic child will never let go of the animal toy he likes.

If a plush dog once presented is the child’s favorite, then any other dogs will also cause great delight.

Children diagnosed with autism are not at all prone to hoarding. They only need 2-3 different toys to feel comfortable and happy. A huge number of different gifts can even scare them!

Children under three years old should choose toys that improve fine motor skills of their fingers. Typically, children with autism are quite poor at performing any tasks related to drawing or modeling.

You can try to interest your baby in putting together various puzzles consisting of large and bright parts. Construction sets are perfect, from the elements of which you can build numerous combinations of figures.

For children aged 1.5-2 years, rugs that consist of several large parts are perfect. The upper surface of such products has small elevations or irregularities. This is necessary so that your legs are massaged while walking. This effect has a beneficial effect on the entire musculoskeletal system of the child. You should choose a rug in more neutral colors, avoiding overly bright colors.

For older children and those especially prone to aggression, you can choose a spinner. This fashionable toy normalizes the functioning of the nervous system and even helps fight the effects of stress. Kids often like to spin the spinner, as any repeated action brings them calm and even positive emotions.

In adolescence, it is better not to buy computer games for your child. Most of these toys can cause a spontaneous attack of aggression in a child or, on the contrary, increase an apathetic state.

Very often, children with autism love to play computer games, since it does not require any real contact with the outside world. However, the consequences can be very negative.

Can autistic people have healthy children in the future?

Scientists note a pronounced genetic pattern in the possibility of inheriting the disease. There are also theories about the presence of special genes that are responsible for the development of the disease in children in whose families cases of autism have previously been established.

Autistic people can have healthy children. Inheritance of genes occurs at the stage of intrauterine development. If a baby was born into a family where only one of the parents has autism, then he may well turn out to be healthy.

If both parents have autism, the chance of having an affected child is 25%, and the chance of having a child who is a carrier of this gene is 50%. This disease is inherited in an autosomal recessive manner.

If more than one baby is born in such families, then the risk of having sick babies may increase. It also increases when exposed to various provoking factors on the unborn child during intrauterine development in the body of a pregnant mother.

To determine hidden autism in newborns, the “heel” method is used. It suggests the presence of this mental illness in the baby. It is usually carried out in autistic parents or in cases where there is a suspicion that the child may develop the disease.

Is the child given a disability?

In Russia, the diagnosis of autism requires the establishment of a disability group. However, it is not shown to all children. In our country, special medical and social criteria are used that take into account various factors.

The decision to establish a group is made strictly collectively. This involves specialists from several specialties: psychiatrist, psychologist, rehabilitation specialist.

In order for a child to have a disability group established, all necessary medical documentation must be provided to the medical and social examination authorities. The child’s child’s record must contain the conclusions of the psychiatrist and child psychologist who observed him. In this case, expert doctors can have a more informative picture about the duration of the disease.

Before undergoing a medical and social examination, the baby is often prescribed additional tests and examinations. This can be either various laboratory tests or specialized brain studies that make it possible to clarify the nature and extent of disorders. Usually in our country an EEG or electroencephalography of the brain is prescribed.

Using this method, it is possible to establish various disorders of the conduction of nerve impulses in the cerebral cortex. The method is quite informative and is quite often used in child psychiatric and neurological practice.

The test results allow doctors to determine the nature and extent of impairments resulting from the disease.

Not all forms of autism can be assigned a disability group. As a rule, it is determined in the presence of persistent disorders of nervous activity, which lead to pronounced maladaptation of the baby.

The level of mental development and intelligence also significantly influence the prognosis of the course of the disease and the establishment of a group.

Often, disability is established after three years. Cases of establishing a group at an earlier age in Russia practically do not occur and are episodic in nature.

Autism is a disease that in most cases occurs without persistent periods of remission. This leads to the fact that the disability group is usually set for life.

Children with mental disabilities must undergo a whole range of rehabilitation measures. Speech therapists, psychologists, and rehabilitation doctors work with such children. The rehabilitation course is usually designed for a fairly long period, since the treatment of the disease is carried out throughout the life of a person suffering from autism.

Parents who are faced with establishing a disability group for their child often note some difficulties when conducting a medical and social examination. They most often note: a huge amount of pre-prepared medical documentation and long queues for examination. The disability group was not always determined upon initial treatment. Often, only on the second or third attempt did expert doctors make a positive decision about the presence of disabling signs in the child.

Establishing a group is a highly complex and often controversial task. However, for children with autism, this step is often forced, but truly necessary. To conduct full-fledged classes with a child, quite large financial costs are required: training with a psychologist, consultations with a speech therapist, hippotherapy courses, the use of special psychotropic medications. All this without a disability group becomes very difficult and financially burdensome for many families.

For parents raising autistic children, the main thing is to understand that this disease will remain with the child for life. Unfortunately, there is currently no cure for autism.

With the right approach, autistic children develop well and, from the outside, do not even differ at all from their peers. Only a few strangers may notice that the baby is a little different from the others. However, they often believe that such a child is simply overly spoiled or has a bad character.

In order to improve your baby’s quality of life and help him with social adaptation, use the following tips:

• Try to communicate correctly with your child. Autistic children categorically do not accept raised voices or swearing. It is better to communicate with such children in the same calm tone, without using curse words. If your child does something wrong, try not to react too violently and aggressively, but simply explain to your child how to do this action correctly. You can also show this as a kind of game.
• Both parents should be involved in raising a child. Even though, as a rule, the baby chooses to communicate with dad or mom, they both must participate in his life. In this case, the child feels more comfortable and gets a correct idea of ​​the family organization. In the future, when creating his own life, he will largely be guided by the principles laid down in childhood.
• Potty training children with autism can be quite difficult. Child psychologists usually help with this. In a playful way, they create a similar everyday situation and work through the correct sequence of actions with the baby. For independent training at home, remember that you should potty train your child gradually and consistently. Never raise your voice or punish your child if he has done something wrong. In the case of an autistic child, this measure will not lead to a positive result.
• You can teach a child with autism to read only with daily lessons. Try to choose educational books without overly bright pictures. A huge number of different colors can alarm and even frighten a child. Choose publications without colorful pictures. Training is best done in a playful way. So the baby will perceive this process as a normal game.
• During a severe hysteria, the baby needs to be carefully calmed. It would be better to do this by the family member with whom the child has closer contact. If your child is overly aggressive, try to quickly take him to the nursery. A familiar environment will help your baby calm down more easily. Never raise your voice at a child, trying to shout to him! This won't lead to anything good. Explain to your baby that he has nothing to be afraid of and that you are nearby. Try to switch your attention to another event or object.
• Try to establish contact with your autistic child. The child communicates calmly only with the people closest to him. To do this, never ask your baby a million questions. Frequent hugs will also not lead to establishing contact. Try to spend more time with your baby, just watching his games. After some time, the child will perceive you as part of his game and will make contact more easily.
• Teach your child to the correct daily routine. Typically, autistic children respond well to a clearly organized routine. This gives them a feeling of complete comfort and security. Try to have your child fall asleep and wake up at the same time. Be sure to follow the feeding schedule. Even on weekends, maintain your baby's usual daily routine.
• Be sure to undergo regular examination and observation by a child psychotherapist and psychologist. Such consultations are very important for assessing the prognosis of the disease and establishing the dynamics of the child’s condition. Typically, young patients with autism should see a therapist at least twice a year. If your health worsens, more often.
• Provide proper nutrition for your baby. Considering the characteristics of the disturbed microflora, all children with autism need to eat fermented milk products. They must be as fresh as possible. It is in this case that the concentration of beneficial lactobacilli and bifidobacteria will be sufficient. Only such products will be beneficial for the child and improve his digestion.
• From the very first days of your child’s birth, try to show him care and affection more often. Autistic children react very poorly to various physical manifestations of love and tenderness. However, this does not mean at all that this should not be done. Doctors advise hugging and kissing your child more often. This must be done without causing him mental pressure. If the baby is not in the mood, it is better to postpone hugs for a while.
• Give your baby a new friend. Most autistic children love pets. Communication with furry animals not only brings positive emotions to the baby and has a beneficial effect on the course of his illness, but also has a real therapeutic effect on tactile sensitivity. A cat or dog will become real friends for your baby and will help him more easily establish contacts not only with animals, but also with new people.
• Don't scold your child! A child suffering from autism perceives any raising of his voice very painfully. The reaction can be the most unpredictable. Some kids fall into severe apathy and become more indifferent to everything that happens in everyday life. Other children may experience excessive aggression that may even require medication.
• Try to choose an interesting hobby for your child. Very often, children with autism are excellent at drawing or playing musical instruments. Studying in a specialized art school will help your child achieve high professional success. Often such children become real geniuses. Be sure to monitor the load that falls on the baby. Excessive enthusiasm can lead to severe fatigue and impaired attention.
• Do not move furniture in the children's room or throughout the apartment. Try to keep all toys and objects that belong to the child in their place. Strong changes can cause real panic attacks and excessive aggression in a child suffering from autism. Purchase new items carefully, without attracting much attention to it.
• Don't limit your child to just being at home! Children with autism should not be confined to four walls all the time. This will only exacerbate your inability to make new friends and connections. Gradually expand the conditions where the baby spends a lot of time. Try to motivate him to go for a walk, visit close relatives. However, this should be done gradually, without psychological pressure. The baby should be very comfortable in new conditions.

Autism is not a death sentence. This is just a disease that requires increased and special attention to a child who is sick with this mental illness.

The right approach to organizing life and establishing personal contact helps such children feel more protected and improves the prognosis of the course and development of the disease.

Moms and dads should remember that a child diagnosed with autism requires your attention and care every day throughout his life. Such children are often called “special” because you need to build a unique approach with them.

Children with autism, with good rehabilitation, integrate quite well into society and are quite successful in later life.

Useful videos

Yana Summ (ex-wife of Konstantin Meladze) in the next video from my own experience talks about what you should pay attention to in order to suspect a child has autism.

You will learn a lot of nuances about autism by watching the programs of Dr. Komarovsky and “Live Healthy.”

When preparing the article, materials from the website “autism-test.rf” were used.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is autism?

Autism statistics

Today in the United States of America this pathology is diagnosed in every 88 children. If we compare the situation in America with what it was in 2000, the number of autism has increased by 78 percent.

There are no reliable data on the prevalence of this disease in the Russian Federation. According to existing information in Russia, one child out of 200,000 children suffers from autism, and, obviously, this statistics is far from reality. The lack of objective information about patients with this disorder suggests that there is a large percentage of children in whom it is not diagnosed.

Representatives of the World Health Organization state that autism is a disease whose prevalence does not depend on gender, race, social status and material well-being. Despite this, according to existing data in the Russian Federation, about 80 percent of autistic people live in families with a low level of income. This is explained by the fact that treatment and support of a child with autism requires large financial costs. Also, raising such a family member requires a lot of free time, so most often one of the parents is forced to give up work, which negatively affects the level of income.

Many patients with autistic disorder are raised in single-parent families. Large expenditures of money and physical effort, emotional distress and anxiety - all these factors cause a large number of divorces in families raising a child with autism.

Causes of autism

Theories of the development of autism are:

• biological;
• genetic;
• post-vaccination;
• theory of metabolism;
• opioid;
• neurochemical.

Biological theory of autism

Functional features of the brain
Brain dysfunction is confirmed by an electroencephalogram (a test that records the electrical activity of the brain).

Features of the electrical activity of the brain in autistic children are:

• a decrease in the seizure threshold, and sometimes foci of epileptiform activity in the associative parts of the brain;
• increased slow-wave forms of activity (mainly the theta rhythm), which is a characteristic of depletion of the cortical system;
• increasing the functional activity of underlying structures;
• delay in EEG pattern maturation;
• weak alpha rhythm;
• the presence of residual organic centers, most often in the right hemisphere.

Morphofunctional changes in the brain in autism are:

• decreased metabolism in the temporal and parietal lobes of the brain;
• increased metabolism in the left frontal lobe and left hippocampus (brain structures).

Genetic theory of autism

Close relatives of a child with autism were also studied. Thus, concordance among the patient's siblings ranges from 2 to 3 percent. This means that a brother or sister of a child with autism has a 50 times higher risk of developing the disease than other children. All these studies are supported by another study conducted by Lacson in 1986. It included 122 children with autism spectrum disorder who were subject to genetic analysis. It turned out that 19 percent of the children examined were carriers of the fragile X chromosome. Fragile (or fragile) X syndrome is a genetic abnormality in which one of the ends of the chromosome is narrowed. This is due to the expansion of some single nucleotides, which in turn leads to insufficiency of the FMR1 protein. Since this protein is necessary for the full development of the nervous system, its deficiency is accompanied by various pathologies of mental development.

The hypothesis that the development of autism is caused by a genetic abnormality was also confirmed by a multicenter international study in 2012. It included 400 children with autism spectrum disorder who underwent DNA (deoxyribonucleic acid) genotyping. The study revealed a high frequency of mutations and a high degree of gene polymorphism in children. Thus, numerous chromosomal aberrations were discovered - deletions, duplications and translocations.

Post-vaccination theory of autism

At the same time, despite the fact that all previous studies deny the relationship between vaccines and autism, parents of sick children note that the first signs of the disease are observed after vaccination. Perhaps the reason for this is the age of the child when vaccination is carried out. The MMR vaccine is given at one year, which coincides with the appearance of the first signs of autism. This suggests that vaccination in this case acts as a stress factor triggering pathological development.

Metabolism theory

Opioid theory of autism

Neurochemical theory of autism

Autism Research

According to the researchers, the vaccine not only relieves symptoms (which affect more than 90 percent of children with autism), but can also control the development of the disease. The vaccine was tested in laboratory conditions, and according to Canadian scientists, it stimulates the production of specific antibodies. The same scientists published a report on the effects of various toxins on the intestinal mucosa. Canadian scientists have concluded that the high prevalence of autism in recent decades is due to the effects of bacterial toxins on the gastrointestinal tract. Also, toxins and metabolites of these bacteria can determine the severity of autism symptoms and control its development.

Another interesting study was conducted jointly by American and Swiss scientists. This study looks at the likelihood of developing autism in both sexes. According to statistics, the number of boys with autism is 4 times higher than the number of girls suffering from this disease. This fact was the basis for the theory of gender injustice regarding autism. The researchers concluded that the female body has a more reliable defense system against mild mutations. Therefore, men are 50 percent more likely to develop intellectual and mental disabilities than women.

Development of autism

Variants of the development of autism are:

• Malignant development of autism– characterized by the fact that symptoms appear in early childhood. The clinical picture is characterized by rapid and early collapse of mental functions. The degree of social disintegration increases with age, and some autism spectrum disorders can develop into schizophrenia.
• The undulating course of autism– characterized by periodic exacerbations, which are often seasonal. The severity of these exacerbations can be different each time.
• Regressive course of autism– characterized by gradual improvement of symptoms. Despite the rapid onset of the disease, the symptoms of autism gradually regress. However, signs of mental dysontogenesis persist.

Factors influencing the course of autism are:

• speech development before 6 years of age is a sign of a favorable course of autism;
• visiting special educational institutions is a favorable factor and plays an important role in the child’s adaptation;
• mastering a “craft” allows you to realize yourself professionally in the future - according to research, every fifth autistic child is capable of mastering a profession, but does not do so;
• attending speech therapy classes or kindergartens with a speech therapy profile has a positive effect on the further development of the child, because according to statistics, half of adults with autism do not speak.

Symptoms of Autism

Symptoms of autism are:

• speech pathology;
• features of intelligence development;

• pathology of behavior;
• hyperactive syndrome;
• disturbances in the emotional sphere.

Speech in autism

Very often, a child stops speaking after speech has been formed. Although a child's vocabulary may expand with age, speech is rarely used for communication. Children can conduct dialogues, monologues, declare poetry, but do not use words for communication.

Characteristics of speech in autistic children are:

• echolalia – repetitions;
• whispering or, conversely, loud speech;
• metaphorical language;
• pun;
• neologisms;
• unusual intonation;
• reversal of pronouns;
• violation of facial expression;
• lack of response to the speech of others.

The core disorder in autism is the problem of understanding spoken speech. Even with preserved intelligence, children have difficulty responding to speech addressed to them.
In addition to problems understanding speech and difficulty using it, autistic children often have speech defects. These may be dysarthria, dyslalia and other speech development disorders. Children often draw out words, put stress on the last syllables, while maintaining a babbling intonation. Therefore, speech therapy classes are a very important point in the rehabilitation of such children.

Intelligence in autism

The ability to abstract is also limited. The decline in school performance is largely due to behavioral anomalies. Children have difficulty concentrating and often exhibit hyperactive behavior. It is especially difficult where spatial concepts and flexibility of thinking are needed. However, 3 to 5 percent of children with autism spectrum disorder demonstrate one or two “special skills.” This could be exceptional mathematical abilities, recreating complex geometric shapes, or virtuoso playing a musical instrument. Children may also have an exceptional memory for numbers, dates, and names. Such children are also called “autistic geniuses.” Despite the presence of one or two such abilities, all other signs of autism remain. First of all, social isolation, impaired communication, and difficulties in adaptation dominate. An example of such a case is the film “Rain Man,” which tells the story of an already adult autistic genius.

The degree of intellectual delay depends on the type of autism. Thus, with Asperger syndrome, intelligence is preserved, which is a favorable factor for social integration. Children in this case are able to graduate from school and receive an education.
However, in more than half of cases, autism is accompanied by a decrease in intelligence. The level of reduction can vary from deep to mild delay. More often (60 percent) moderate forms of retardation are observed, in 20 percent - mild, in 17 percent - normal intelligence, and in 3 percent of cases - above average intelligence.

Autism behavior

Characteristics of the behavior of children with autism are:

• auto-aggression and hetero-aggression;
• commitment to consistency;
• stereotypies – motor, sensory, vocal;
• rituals.

The greatest difficulty in raising an autistic child is going to a public place. Even if a child does not show any signs of autistic behavior at home, “going out in public” is a stress factor that provokes inappropriate behavior. At the same time, children can commit inappropriate actions - throw themselves on the floor, hit and bite themselves, and scream. It is extremely rare (almost in exceptional cases) that autistic children react calmly to change. Therefore, before going to a new place, parents are recommended to familiarize their child with the upcoming route. Any change of environment must be carried out in stages. This primarily concerns integration into a kindergarten or school. First, the child must become familiar with the route, then with the place where he will spend time. Adaptation in kindergarten is carried out starting from two hours a day, gradually increasing the hours.

Rituals in the behavior of autistic children
This commitment to consistency applies not only to the environment, but also to other aspects - food, clothing, play. Changing dishes can be a stressful factor. So, if a child is used to eating porridge for breakfast, then suddenly serving an omelet can provoke an attack of aggression. Eating, putting on clothes, playing and any other activity is often accompanied by peculiar rituals. The ritual may consist of a certain order of serving dishes, washing hands, and getting up from the table. Rituals can be completely incomprehensible and inexplicable. For example, touch the stove before sitting down at the table, jumping before going to bed, going onto the porch of a store while walking, and so on.

Stereotypes in the behavior of autistic children
The behavior of autistic children, regardless of the form of the disease, is stereotypical. There are motor stereotypies in the form of swaying, circling around its axis, jumping, nodding, and finger movements. Most autistic people are characterized by athetosis-like movements of the fingers in the form of fingering, flexion and extension, and folding. No less characteristic are such movements as shaking, bouncing, pushing off from the tips of the fingers, and walking on tiptoe. Most motor stereotypies disappear with age and are rarely observed in adolescents. Voice stereotypies are manifested in the repetition of words in response to a question (echolalia), in the declaration of poems. There is a stereotypical account.

Hyperactivity syndrome in autism

Emotional disturbances in autism

The lack of an emotional response is largely due to the child’s social isolation. Since it is impossible to experience emotional experiences in life, it is also impossible for a child to further comprehend these emotions.
Emotional disorders are also expressed in a lack of perception of the surrounding world. Thus, it is difficult for a child to imagine his room, even knowing by heart all the objects that are in it. Having no idea about his own room, the child also cannot imagine the inner world of another person.

Features of the development of children with autism

The assimilation of gestures is also delayed - there is practically no pointing gesture, difficulties in greeting-farewell, affirmation-denial. The facial expressions of children with autism are characterized by inactivity and poverty. Often there are serious faces with drawn features (“the face of a prince” according to Kanner).

Disability in autism

Benefits for children with autism who have been certified as disabled are:

• free visits to specialized educational institutions;
• registration in a speech therapy garden or speech therapy group;
• tax deductions for treatment;
• benefits for sanatorium-resort treatment;
• the opportunity to study according to an individual program;
• assistance in psychological, social and professional rehabilitation.

Types of autism

• early childhood autism;
• atypical autism;
• Rett syndrome;
• Asperger's syndrome.

Early childhood autism

Signs of early childhood autism can begin to appear from the first days of a baby's life. In such children, mothers note impaired response to auditory stimuli and inhibited response to various visual contacts. In the first years of life, children have difficulty understanding speech. They also have a delay in speech development. By the age of five, a child with early childhood autism has difficulties with social relationships and persistent behavioral disturbances.

The main manifestations of early childhood autism are:

• autism itself;
• the presence of fears and phobias;
• lack of a stable sense of self-preservation;
• stereotypes;
• special speech;
• impaired cognitive and intellectual abilities;
• special game;
• features of motor functions.

The appearance of a new person can cause pronounced negative emotions - anxiety, fear, aggression. Communication with other children is very difficult and is accompanied by negative impulse actions (resistance, flight). But sometimes a child just completely ignores anyone who is near him. Reaction and response to verbal treatment is also absent or severely inhibited. The child may not even respond to his name.

Presence of fears and phobias
In more than 80 percent of cases, early childhood autism is accompanied by the presence of various fears and phobias.

Main types of fears and phobias in early childhood autism

Stereotypes
With early childhood autism, more than 65 percent of patients develop various stereotypes - frequent repetitions of certain movements and manipulations.

Stereotypes of early childhood autism

Impaired cognitive and intellectual abilities
In early childhood autism, cognitive and intellectual abilities are delayed or accelerated in development. In approximately 15 percent of patients, these abilities develop within normal limits.

Impaired cognitive and intellectual abilities

Special game
Some children with early autism completely ignore toys and there is no play at all. For others, play is limited to simple, similar manipulations with the same toy. Often, the game involves foreign objects that are not toys. At the same time, the functional properties of these items are not used in any way. Games usually take place in a secluded place alone.

Features of motor functions
More than half of patients with early childhood autism experience hyperexcitability (increased motor activity). Various external stimuli can provoke pronounced motor activity - the child begins to stomp his feet, wave his arms, and fight back. Waking up is often accompanied by crying, screaming or chaotic movements. In 40 percent of sick children, the opposite manifestations are observed. Reduced muscle tone is accompanied by low mobility. The babies suckle sluggishly. Children react poorly to physical discomfort (cold, moisture, hunger). External stimuli are not capable of causing adequate reactions.

Atypical autism

Characteristic groups of symptoms of atypical autism are:

• speech disorders;
• signs of emotional insufficiency;
• signs of social maladaptation and failure;
• thought disorder;
• irritability.

Signs of Emotional Insufficiency
Another important symptom of atypical autism is the inability to express one's emotions. Even when the patient has internal experiences, he is not able to explain and express what he feels. It may seem to others that he is simply indifferent and unemotional.

Signs of social maladaptation and failure
In each individual case, the signs of social maladaptation and failure have varying degrees of severity and their own special character.

The main signs of social maladaptation and failure include:

• tendency to loneliness;
• avoiding any contact;
• lack of communication;
• difficulties in establishing contact with strangers;
• inability to make friends;
• Difficulty making eye contact with your opponent.

Irritability
In atypical autism, the nervous system is more sensitive to various external stimuli. From bright light or loud music, the patient becomes nervous, irritable and even aggressive.

Rett syndrome

The first signs of the disease begin to appear 6 to 18 months after the birth of the child. Until this time, the growth and development of the baby does not differ in any way from the norm. Psychoneurological disorders develop through four stages of the disease.

Stages of Rett syndrome

Asperger's syndrome

The main characteristics of Asperger's syndrome are:

• social disorders;
• features of intellectual development;
• sensory (sensitivity) and motor impairments.

When interacting with peers, children with Asperger's syndrome try to impose their own rules, not accepting other people's ideas and not wanting to compromise. In response, those around them no longer want to come into contact with such children, exacerbating their social isolation. This leads to depression, suicidal tendencies and various types of addiction in adolescence.

Features of intellectual development
Asperger's syndrome is characterized by relative preservation of intelligence. It is not characterized by severe developmental delays. Children with Asperger syndrome are able to graduate from educational institutions.

Features of the intellectual development of children with Asperger syndrome include:

• normal or above average intelligence;
• excellent memory;
• lack of abstract thinking;
• precocious speech.

Another feature of intellectual development in Asperger syndrome is rapid speech development. By the age of 5–6 years, the child’s speech is already well developed and grammatically correct. Speech rate is slow or accelerated. The child speaks monotonously and with an unnatural timbre of voice, using many speech patterns in a bookish style. A story about a subject of interest can be long and very detailed, regardless of the reaction of the interlocutor. But children with Asperger syndrome cannot support a conversation on any topic outside their area of ​​interest.

Motor and sensory disorders
Sensory impairment in Asperger syndrome includes increased sensitivity to sounds, visual stimuli, and tactile stimuli. Children avoid other people's touches, loud street sounds, and bright lights. They develop obsessive fears of the elements (snow, wind, rain).

The main motor impairments in children with Asperger syndrome include:

• lack of coordination;
• clumsy gait;
• difficulty tying shoelaces and fastening buttons;
• sloppy handwriting;
• motor stereotypes.

Autism syndrome

Autism in schizophrenia

Autism in schizophrenia, first of all, manifests itself in the behavioral characteristics of the patient. This is expressed in adaptation difficulties, in isolation, in being “in your own world.” In children, autism can manifest itself in the form of “oversociality” syndrome. Parents note that the child was always quiet, obedient, and never bothered his parents. Often such children are considered “exemplary”. At the same time, they practically do not respond to comments. Their exemplary behavior cannot be changed; children do not show flexibility. They are closed and completely absorbed in the experiences of their own world. It is rarely possible to interest them in something, to involve them in some kind of game. According to Kretschmer, such exemplary behavior is an autistic barrier from the outside world.

Differences between autism and schizophrenia

A key criterion for schizophrenia is impaired thinking and perception. The former manifest themselves in the form of fragmentation and inconsistency, the latter - in the form of hallucinations and delusions.

Basic symptoms of schizophrenia and autism

Autism in adults

Personal life
Relationships with the opposite sex are an area that causes great difficulties for autistic people. Romantic courtship is unusual for autistic people, as they do not see the point in it. They perceive kisses as useless movements, and hugs as an attempt to limit movement. At the same time, they may experience sexual desire, but most often they are left alone with their feelings, since they are not mutual.
Without friends, autistic adults get a lot of their information about romantic relationships from movies. Men, having watched enough pornographic films, try to put such knowledge into practice, which frightens and repels their partners. Women with autistic disorders are informed more by TV series and, due to their naivety, often become victims of sexual violence.

According to statistics, people with autism spectrum disorders are much less likely than others to create full-fledged families. It should be noted that recently the opportunities for an autistic adult to arrange his personal life have increased significantly. With the development of the Internet, various specialized forums began to appear where a person diagnosed with autism can find a partner with a similar disorder. Information technologies that make it possible to establish contact through correspondence are helping many autistic people meet and develop friendships or personal relationships with others like themselves.

Professional activity
The development of computer technology has significantly increased the opportunities for professional self-realization of autistic people. One solution that is popular is remote work. Many patients with this disease have an intelligence level that allows them to cope with tasks of a high degree of complexity. Not having to leave their comfort zone and interact face-to-face with work colleagues allows autistic adults not only to work, but also to develop professionally.

If skills or circumstances do not allow remote work via the Internet, then standard forms of activity (work in an office, store, factory) cause great difficulties for an autistic person. Most often, their professional success is significantly lower than their real abilities. Such people achieve the greatest success in those areas where increased attention to detail is required.

Life conditions
Depending on the form of the disease, some autistic adults can live independently in their own apartment or house. If the patient underwent appropriate correctional therapy in childhood, then as an adult he can cope with everyday tasks without assistance. But most often, autistic adults need the support they receive from their relatives, loved ones, and medical or social service workers. Depending on the form of the disease, an autistic person may receive financial benefits, information about which should be obtained from the relevant authority.

In many economically developed countries there are homes for autistic people, where special conditions have been created for their comfortable living. In most cases, such houses are not only housing, but also a place of work. For example, in Luxembourg, residents of such houses make postcards and souvenirs and grow vegetables.

Social communities
Many autistic adults are of the opinion that autism is not a disease, but a unique life concept and therefore does not require treatment. To protect their rights and improve their quality of life, autistic people unite in various social groups. In 1996, an online community was formed called NIAS (Independent Living on the Autism Spectrum). The main goal of the organization was to provide emotional support and practical assistance to autistic adults. Participants shared stories and life advice, and for many this information was very valuable. Today there are a large number of similar communities on the Internet.

Specialty: Practicing psychiatrist of the 2nd category.

AUTISM is a mental disorder characterized by a deficit in social interaction. Autistic children exhibit lifelong developmental disabilities that affect their perception and understanding of the world around them.

At what age does autism appear?

Childhood autism today occurs in 2–4 cases per 100,000 children. In combination with mental retardation ( atypical autism) the figure increases to 20 cases per 100,000. The ratio of boys to girls with this pathology is 4 to 1.

Autism can occur at any age. Depending on age, the clinical picture of the disease also changes. Conventionally, early childhood autism is distinguished ( up to 3 years), childhood autism ( from 3 years to 10 – 11 years) and adolescent autism ( in children over 11 years old).

Controversy over the standard classifications of autism continues to this day. According to the international statistical classification of diseases, including mental ones, there are childhood autism, atypical autism, Rett syndrome and Asperger syndrome. According to the latest version of the American classification of mental illnesses, only autism spectrum disorders are distinguished. These disorders include both early childhood and atypical autism.

As a rule, the diagnosis of childhood autism is made at the age of 2.5 – 3 years. It is during this period that speech disorders, limited social communication and isolation are most clearly manifested. However, the first signs of autistic behavior appear in the first year of life. If the child is the first in the family, then parents, as a rule, later notice his “difference” from his peers. Most often this becomes obvious when the child goes to kindergarten, that is, when trying to integrate into society. However, if there is already a child in the family, then, as a rule, the mother notices the first symptoms of an autistic child in the first months of life. Compared to an older brother or sister, the child behaves differently, which immediately catches the eye of his parents.

Autism may also appear later. The debut of autism can be observed after 5 years. The IQ in this case is higher than that of children whose autism debuted before the age of 3 years. In these cases, basic communication skills are preserved, but isolation from the world still dominates. These children have cognitive impairment ( deterioration of memory, mental activity, etc.) are not so pronounced. Very often they have a high IQ.

Elements of autism may be present in Rett syndrome. It is diagnosed between the ages of one and two years. Cognitive-sparing autism, called Asperger's syndrome ( or mild autism), occurs between 4 and 11 years.

It is worth noting that there is a certain period between the first manifestations of autism and the moment of diagnosis. There are certain characteristic features of the child that parents do not attach importance to. However, if you focus the mother’s attention on this, then she really recognizes “something like that” with her child.

Thus, the parents of a child who was always obedient and did not create problems recall that in childhood the child practically did not cry, could spend hours looking at a spot on the wall, and so on. That is, certain character traits exist in a child initially. It cannot be said that the disease appears like a bolt from the blue. However, with age, when the need for socialization increases ( kindergarten, school) these symptoms are accompanied by others. It is during this period that parents seek advice from a specialist for the first time.

What is special about the behavior of a child with autism?

Despite the fact that the symptoms of this disease are very diverse and depend on age, there are nevertheless certain behavioral traits that are common to all autistic children.

Characteristics of the behavior of a child with autism are:

• disruption of social contacts and interactions;
• limited interests and characteristics of the game;
• tendency to engage in repetitive behavior stereotypies);
• verbal communication disorders;
• intellectual disorders;
• impaired sense of self-preservation;
• features of gait and movements.

Violation of social contacts and interactions

It is the main characteristic of the behavior of children with autism and occurs in 100 percent. Autistic children live in their own world, and the predominance of this inner life is accompanied by a withdrawal from the outside world. They are uncommunicative and actively avoid their peers.

The first thing that may seem strange to a mother is that the child practically does not ask to be held. Infants ( children under one year old) are characterized by inertia and inactivity. They do not react as animatedly as other children to a new toy. They have a weak reaction to light and sound, and they may also rarely smile. The animation complex, which is inherent in all young children, is absent or poorly developed in autistic people. Babies do not respond to their name, do not respond to sounds and other stimuli, which often imitates deafness. As a rule, at this age parents first turn to an audiologist ( hearing specialist).

The child reacts differently to an attempt to make contact. Attacks of aggression may occur and fears may develop. One of the most well-known symptoms of autism is lack of eye contact. However, it does not manifest itself in all children, but occurs in more severe forms, so the child ignores this aspect of social life. Sometimes a child can look as if through a person.
It is generally accepted that all autistic children are unable to show emotions. However, it is not. Indeed, many of them have a very poor emotional sphere - they rarely smile, and their facial expressions are the same. But there are also children with very rich, varied, and sometimes not entirely adequate facial expressions.

As the child grows, he can go deeper into his own world. The first thing that attracts attention is the inability to contact family members. The child rarely asks for help and begins to look after himself early. An autistic child practically does not use the words “give” and “take.” He does not make physical contact - when asked to give up this or that object, he does not give it in his hands, but throws it away. Thus, he limits his interaction with people around him. Most children also cannot tolerate hugs or other physical contact.

Problems most clearly make themselves felt when the child is taken to kindergarten. Here, when trying to introduce the baby to other children ( for example, seat them at the same common table or involve them in the same game) it can give various affective reactions. Ignoring the environment can be passive or active. In the first case, children simply do not show interest in the children around them or in their games. In the second case, they run away, hide, or act aggressively towards other children.

Limited interests and game features

One fifth of autistic children ignore toys and all types of play activities. If a child shows interest, it is, as a rule, in one toy or one television program. The child does not play at all or plays monotonously.

Infants can fix their gaze on a toy for a long time, but do not reach for it. Older children can spend hours watching the sun on the wall, the movement of cars outside the window, or watching the same film dozens of times. At the same time, children’s absorption in this activity can be alarming. They do not lose interest in their occupation, sometimes giving the impression of detachment. When trying to tear them away from classes, they express dissatisfaction.

Games that require fantasy and imagination rarely attract such children. If a girl has a doll, she will not change her clothes, seat her at the table and introduce her to others. Her play will be limited to monotonous actions, for example, combing this doll's hair. She can perform this action dozens of times a day. Even if a child does several actions with his toy, it is always in the same sequence. For example, an autistic girl can brush, bathe and change her doll, but always in the same order, and not in any other way. However, as a rule, children do not play with their toys, but rather sort them. A child can arrange and sort his toys according to various criteria - color, shape, size.

Autistic children also differ from normal children in the specifics of play. So, they are not occupied by ordinary toys. The attention of an autistic person is more attracted to household items, for example, keys, a piece of material. Typically, these objects make their favorite sound or have their favorite color. Typically, such children are attached to the selected object and do not change it. Any attempt to separate a child from his “toy” ( because sometimes they can be dangerous, for example, when it comes to a fork) is accompanied by protest reactions. They can be expressed in pronounced psychomotor agitation or, conversely, withdrawal.

A child’s interest may come down to folding and arranging toys in a certain sequence, or counting cars in a parking lot. Sometimes autistic children may even have different hobbies. For example, collecting stamps, robots, a passion for statistics. What makes all of these interests different is the lack of social content. Children are not interested in the people depicted on the stamps or the countries from which they are sent. They are not interested in the game, but they may be attracted to various statistics.

Children do not let anyone into their hobbies, even those who are autistic like them. Sometimes children's attention is attracted not even by games, but by certain actions. For example, they can turn the faucet on and off at regular intervals to watch the water flow, or turn on the gas to watch the flames.

Much less often in the games of autistic children, pathological fantasizing with transformation into animals and inanimate objects is observed.

Tendency to engage in repetitive actions ( stereotypies)

Repetitive behavior or stereotypy occurs in 80 percent of children with autism. In this case, stereotypies are observed both in behavior and in speech. Most often, these are motor stereotypies, which boil down to monotonous turns of the head, twitching of the shoulders, and bending of the fingers. In Rett syndrome, stereotypical finger wringing and hand washing are observed.

Common stereotypic behaviors in autism:

• turning lights on and off;
• pouring sand, mosaics, cereals;
• door swinging;
• stereotypical account;
• kneading or tearing paper;
• tension and relaxation of the limbs.

Stereotypes observed in speech are called echolalia. This can be manipulations with sounds, words, phrases. In this case, children repeat words heard from their parents, on TV or from other sources without realizing their meaning. For example, when asked “will you have juice?”, the child repeats “will you have juice, will you have juice, will you have juice.”

Or the child may ask the same question, for example:
Child- "Where we are going?"
Mother- “To the store.”
Child- "Where we are going?"
Mother- “To the store for milk.”
Child- "Where we are going?"

These repetitions are unconscious and sometimes stop only after interrupting the child with a similar phrase. For example, to the question “Where are we going?”, Mom answers “Where are we going?” and then the child stops.

Stereotypes in food, clothing, and walking routes are often observed. They take on the character of rituals. For example, a child always follows the same path, prefers the same food and clothes. Autistic children constantly tap out the same rhythm, spin a wheel in their hands, sway in a chair to a certain beat, and quickly turn the pages of books.

Stereotypes also affect other senses. For example, taste stereotypies are characterized by periodic licking of objects; olfactory - constant sniffing of objects.

There are many theories about the possible reasons for this behavior. Proponents of one of them consider stereotypies as a type of self-stimulating behavior. According to this theory, the body of an autistic child is hyposensitive and therefore it exhibits self-stimulation in order to excite the nervous system.
Proponents of another, opposite concept, believe that the environment is hyperexcitable for the child. In order to calm the body and eliminate the influence of the surrounding world, the child uses stereotypical behavior.

Verbal communication disorders

Speech impairment, to one degree or another, occurs in all forms of autism. Speech may develop delayed or not develop at all.

Speech disorders are most pronounced in early childhood autism. In this case, even the phenomenon of mutism may be observed ( complete lack of speech). Many parents note that after the child begins to speak normally, he becomes silent for a certain time ( a year or more). Sometimes, even at the initial stages, a child is ahead of his peers in his speech development. Then, from 15 to 18 months, regression is observed - the child stops talking to others, but at the same time fully speaks to himself or in his sleep. In Asperger's syndrome, speech and cognitive functions are partially preserved.

In early childhood, there may be no humming or babbling, which, of course, will immediately alert the mother. There is also a rare use of gestures in children. As the child develops, expressive language impairments are common. Children use pronouns and addresses incorrectly. Most often they refer to themselves in the second or third person. For example, instead of “I want to eat,” the child says “he wants to eat” or “do you want to eat.” He also refers to himself in the third person, for example, “Anton needs a pen.” Often children can use excerpts from conversations they have heard from adults or on television. In society, a child may not use speech at all and not answer questions. However, alone with himself, he can comment on his actions and declare poetry.

Sometimes a child’s speech becomes pretentious. It is replete with quotes, neologisms, unusual words, and commands. Their speech is dominated by autodialogue and a tendency to rhyme. Their speech is often monotonous, without intonation, and is dominated by commentary phrases.

Also, the speech of autistic people is often characterized by a peculiar intonation with a predominance of high tones at the end of the sentence. Vocal tics and phonetic disorders are often observed.

Delayed speech development is often the reason why the child’s parents turn to speech therapists and speech pathologists. In order to understand the cause of speech disorders, it is necessary to determine whether speech is used in this case for communication. The cause of speech disorders in autism is a reluctance to interact with the outside world, including through conversation. Anomalies of speech development in this case reflect a violation of the social contact of children.

Intellectual disorders

In 75 percent of cases, various intellectual disorders are observed. This may be mental retardation or uneven mental development. Most often, these are various degrees of mental retardation. An autistic child has difficulty concentrating and being goal-oriented. He also has a rapid loss of interest and attention disorder. Commonly accepted associations and generalizations are rarely available. An autistic child usually performs well on tests of manipulation and visual skills. However, tests that require symbolic and abstract thinking, as well as logic, perform poorly.

Sometimes children show interest in certain disciplines and the formation of certain aspects of intelligence. For example, they have unique spatial memory, hearing or perception. In 10 percent of cases, initially accelerated intellectual development is complicated by the decay of intelligence. With Asperger's syndrome, intelligence remains within the age norm or even higher.

According to various data, a decrease in intelligence within the range of mild and moderate mental retardation is observed in more than half of children. Thus, half of them have an IQ below 50. A third of children have borderline intelligence ( IQ 70). However, the decline in intelligence is not total and rarely reaches the level of deep mental retardation. The lower a child’s IQ, the more difficult his social adaptation. Other children with a high IQ have non-standard thinking, which also very often limits their social behavior.

Despite the decline in intellectual functions, many children learn basic school skills on their own. Some of them independently learn to read and acquire mathematical skills. Many people can retain musical, mechanical and mathematical abilities for a long time.

Intellectual disorders are characterized by irregularity, namely, periodic improvements and deteriorations. Thus, against the background of situational stress and illness, episodes of regression may occur.

Impaired sense of self-preservation

A violation of the sense of self-preservation, which manifests itself as auto-aggression, occurs in one third of autistic children. Aggression is one of the forms of response to various not entirely favorable life relationships. But since there is no social contact in autism, negative energy is projected onto oneself. Autistic children are characterized by hitting themselves and biting themselves. Very often they lack a “sense of edge.” This is observed even in early childhood, when the baby hangs over the side of the stroller and climbs over the playpen. Older children may jump onto the road or jump from a height. Many of them do not consolidate negative experiences after falls, burns, or cuts. So, an ordinary child, having fallen or cut himself once, will avoid this in the future. An autistic child can do the same action dozens of times, hurting himself, but not stopping.

The nature of this behavior has been little studied. Many experts suggest that this behavior is due to a decrease in the threshold of pain sensitivity. This is confirmed by the absence of crying when the baby hits or falls.

In addition to self-aggression, aggressive behavior directed at someone can be observed. The reason for this behavior may be a defensive reaction. Very often it is observed if an adult tries to disrupt the child’s usual way of life. However, an attempt to resist change can also manifest itself in self-aggression. A child, especially if he suffers from a severe form of autism, may bite himself, hit himself, or deliberately hit himself. These actions stop as soon as the interference in his world stops. Thus, in this case, such behavior is a form of communication with the outside world.

Features of gait and movements

Autistic children often have a specific gait. Most often, they imitate a butterfly, walking on tiptoes and balancing with their hands. Some people skip and jump. A peculiarity of the movements of an autistic child is a certain awkwardness and angularity. The running of such children may seem ridiculous, because during it they swing their arms and spread their legs wide.

Also, children with autism may walk with a side step, sway while walking, or walk along a strictly defined special route.

What do children with autism look like?

Children under one year old

The appearance of the baby is distinguished by the absence of a smile, facial expressions and other bright emotions.
Compared to other children, he is not as active and does not attract attention. His gaze is often fixed on some ( always the same) subject.

The baby does not reach out into his arms, he does not have a revival complex. He does not copy emotions - if you smile at him, he does not respond with a smile, which is completely uncharacteristic for small children. He does not gesticulate or point to objects that he needs. The baby does not babble like other one-year-old children, does not gurgle, and does not respond to his name. An autistic infant does not create problems and gives the impression of being a “very calm child.” For many hours he plays by himself without crying, without showing interest in others.

It is extremely rare for children to experience delays in growth and development. At the same time, with atypical autism ( autism with mental retardation) concomitant diseases are very often observed. Most often, this is a convulsive syndrome or even epilepsy. In this case, there is a delay in neuropsychic development - the child begins to sit late, takes his first steps late, and lags behind in weight and height.

Children from one to 3 years old

Children continue to be closed off and unemotional. They speak poorly, but most often they don’t speak at all. At 15–18 months, children may stop speaking altogether. A distant gaze is noticed; the child does not look the interlocutor in the eyes. Very early, such children begin to take care of themselves, thereby providing themselves with increasing independence from the world around them. When they do start speaking, those around them notice that they refer to themselves in the second or third person. For example, “Oleg is thirsty” or “Are you thirsty?” To the question: “Are you thirsty?” they answer: “He is thirsty.” A speech disorder seen in young children is echolalia. They repeat passages of phrases or phrases heard from the mouths of other people. Vocal tics are often observed, which manifest themselves in the involuntary pronunciation of sounds and words.

Children begin to walk, and their parents' attention is attracted by their gait. Walking on tiptoes, with arms flailing, is often observed ( as if imitating a butterfly). Psychomotor-wise, children with autism may be hyperactive or hypoactive. The first option is more common. Children are in constant motion, but their movements are stereotypical. They sway on a chair and make rhythmic movements with their torsos. Their movements are monotonous and mechanical. When studying a new object ( for example, if mom bought a new toy) they carefully sniff it, feel it, shake it, trying to extract some sounds. Gestures observed in autistic children can be very eccentric, unusual and forced.

The child develops unusual activities and hobbies. He often plays with water, turning the faucet on and off, or with the light switch. The attention of relatives is attracted by the fact that the baby very rarely cries, even when hit very hard. Rarely asks for anything or whines. An autistic child actively avoids the company of other children. At children's birthdays and matinees, he sits alone or runs away. Sometimes autistic children can become aggressive in the company of other children. Their aggression is usually directed at themselves, but can also be projected onto others.

Often such children give the impression of being spoiled. They are selective in food, do not get along with other children, and develop many fears. Most often, this is a fear of darkness, noise ( vacuum cleaner, doorbell), a certain type of transport. In severe cases, children are afraid of everything - leaving the house, leaving their room, being alone. Even in the absence of certain formed fears, autistic children are always fearful. Their fearfulness is projected onto the world around them, since it is unknown to them. Fear of this unknown world is the main emotion of a child. To counter the change in situation and limit their fears, they often throw tantrums.

Outwardly, autistic children look very diverse. It is generally accepted that children with autism have fine, defined facial features that rarely show emotion ( prince's face). However, this is not always the case. Children at an early age may exhibit very active facial expressions and an awkward, sweeping gait. Some researchers say that the facial geometry of autistic children and other children is still different - their eyes are wider apart, the lower part of the face is relatively short.

Preschool children ( from 3 to 6 years)

In children of this age group, difficulties with social adaptation come to the fore. These difficulties are most pronounced when the child goes to kindergarten or preparatory group. The child does not show interest in his peers, he does not like the new environment. He reacts to such changes in his life with violent psychomotor agitation. The child’s main efforts are aimed at creating a kind of “shell” in which he hides, avoiding the outside world.

Your toys ( if there are any) the baby begins to arrange them in a certain order, most often by color or size. People around them notice that, compared to other children, there is always a certain structure and order in the room of an autistic child. Things are laid out in their places and grouped according to a certain principle ( color, material type). The habit of always finding everything in its place gives the child a feeling of comfort and security.

If a child of this age group has not been consulted by a specialist, then he withdraws even more into himself. Speech disorders progress. It becomes increasingly difficult to disrupt an autistic person’s usual way of life. An attempt to take a child outside is accompanied by violent aggression. Fearfulness and fears can crystallize into obsessive behavior and rituals. This could be periodic hand washing, certain sequences in food, or in play.

More often than other children, autistic children exhibit hyperactive behavior. Psychomotorally, they are disinhibited and disorganized. Such children are in constant motion and can hardly stay in one place. They have difficulty controlling their movements ( dyspraxia). Autistic people also often exhibit compulsive behavior—they deliberately perform their actions according to certain rules, even if these rules go against social norms.

Much less often, children may exhibit hypoactive movement. At the same time, their fine motor skills may suffer, which will cause difficulties in some movements. For example, a child may have difficulty tying shoelaces or holding a pencil in his hand.

Children over 6 years old

Autistic students can attend both specialized educational institutions and general schools. If a child does not have disorders in the intellectual sphere and copes with learning, then selectivity of his favorite subjects is observed. As a rule, this is a hobby for drawing, music, and mathematics. However, even with borderline or average intelligence, children have attention deficits. They have difficulty concentrating on tasks, but at the same time they are extremely focused on their studies. Autistic people are more likely to have reading difficulties than others ( dyslexia).

At the same time, in one tenth of cases, children with autism demonstrate unusual intellectual abilities. These could be talents in music, art, or a unique memory. In one percent of autistic cases, savant syndrome is observed, in which outstanding abilities are noted in several areas of knowledge.

Children who show a decrease in intelligence or significant withdrawal into themselves are engaged in specialized programs. In the first place at this age are speech disorders and social maladjustment. A child can resort to speech only in case of urgent need in order to communicate his needs. However, he tries to avoid this too, starting to serve himself very early. The less developed the language of communication is in children, the more often they show aggression.

Deviations in eating behavior can become serious disorders, including refusal to eat. In mild cases, meals are accompanied by rituals - eating food in a certain order, at certain hours. The selectivity of individual dishes is not based on taste, but on the color or shape of the dish. For autistic children, what food looks like matters a lot.

If the diagnosis is made early and treatment measures taken, many children can adapt well. Some of them graduate from general education institutions and master professions. Children with minimal speech and intellectual disorders adapt best.

What tests can help identify autism in a child at home?

The purpose of using tests is to identify a child's risk of autism. Test results are not the basis for making a diagnosis, but are a reason to contact specialists. When assessing the characteristics of child development, one should take into account the child’s age and use tests recommended for his age.

Tests for diagnosing autism in children are:

• assessment of child behavior based on general development indicators - from birth to 16 months;
• M-CHAT test ( modified autism screening test) – recommended for children from 16 to 30 months;
• CARS Autism Scale ( Autism Rating Scale for Children) – from 2 to 4 years;
• ASSQ screening test – intended for children from 6 to 16 years old.

Testing a child for autism from birth

Child health institutes advise parents to monitor their baby’s behavior from the moment of birth and, if any discrepancies are identified, to contact pediatric specialists.

Deviations in child development from birth to one and a half years of age are the absence of the following behavioral factors:

• smiling or trying to express happy emotions;
• response to smiles, facial expressions, sounds of adults;
• attempts to establish eye contact with the mother during feeding, or with people around the child;
• reaction to one's own name or to a familiar voice;
• gesturing, waving arms;
• using fingers to point to objects of interest to the child;
• attempts to start talking ( walk, coo);
• please take him in your arms;
• the joy of being held in your arms.

If even one of the above abnormalities is detected, parents should consult a doctor. One of the signs of this disease is an extremely strong attachment to one of the family members, most often the mother. Outwardly, the child does not demonstrate his adoration. But if there is a threat of interruption of communication, children may refuse to eat, vomit, or develop a fever.

M-CHAT test for examining children from 16 to 30 months

The results of this test, as well as other childhood screening tools ( examinations), are not 100% reliable, but are a basis for undergoing a diagnostic examination by specialists. You must answer “Yes” or “No” to the M-CHAT test items. If the phenomenon indicated in the question occurred no more than twice during observations of the child, this fact is not counted.

The M-CHAT test questions are:

• №1 – Does the child enjoy being rocked ( on hands, knees)?
• №2 – Does the child become interested in other children?
• № 3 – Does the child like to use objects as steps and climb up them?
• № 4 – Does the child enjoy a game like hide and seek?
• № 5 – Does the child imitate any actions during the game ( talking on an imaginary phone, rocking a non-existent doll)?
• № 6 – Does the child use his index finger when he feels the need for something?
• № 7 – Does the child use his index finger to emphasize his interest in some object, person or action?
• № 8 – Does the child use his toys for their intended purpose ( builds forts from blocks, dresses dolls, rolls cars on the floor)?
• № 9 – Has the child ever focused his attention on objects that interested him, bringing them and showing them to his parents?
• № 10 – Can a child maintain eye contact with adults for more than 1–2 seconds?
• № 11 – Has the child ever shown signs of hypersensitivity to acoustic stimuli ( did he cover his ears during loud music, did he ask to turn off the vacuum cleaner?)?
• № 12 – Does the child have a response to a smile?
• № 13 – Does the child repeat after adults their movements, facial expressions, intonation;
• № 14 – Does the child respond to his name?
• № 15 – Point your finger at a toy or other object in the room. Will the child look at him?
• № 16 – Is the child walking?
• № 17 - Look at some object. Will your child repeat your actions?
• № 18 – Has the child been observed making unusual finger gestures near his face?
• № 19 – Does the child make attempts to attract attention to himself and to what he is doing?
• № 20 – Does the child give reason to think that he has hearing problems?
• № 21 – Does the child understand what the people around him say?
• № 22 – Has it ever happened that a child wandered around or did something without a goal, giving the impression of complete absence?
• № 23 – When meeting unfamiliar people or phenomena, does the child look his parents in the face in order to check his reaction?

Decoding M-CHAT test answers
To determine whether the child passed this test or not, you should compare the answers received with those given in the interpretation of the test. If three normal or two critical points coincide, the child must be examined by a doctor.

The M-CHAT test interpretation points are:

• № 1 - No;
• № 2 - No ( critical point);
• № 3, № 4, № 5, № 6 - No;
• № 7 - No ( critical point);
• № 8 - No;
• № 9 - No ( critical point);
• № 10 - No;
• № 11 - Yes;
• № 12 - No;
• № 13, № 14, № 15 - No ( critical points);
• № 16, № 17 - No;
• № 18 - Yes;
• № 19 - No;
• № 20 - Yes;
• № 21 - No;
• № 22 - Yes;
• № 23 - No.

CARS scale for determining autism in children from 2 to 6 years old

The CARS is one of the most used tests for identifying autism symptoms. The study can be conducted by parents on the basis of observations of the child during his stay at home, among relatives and peers. Information received from educators and educators should also be included. The scale includes 15 categories that describe all areas that are relevant for diagnosis.
When identifying correspondence with the proposed options, you should use the score indicated opposite the answer. When calculating test values, you can also take into account intermediate values ​​( 1.5, 2.5, 3.5 ) in cases where the child’s behavior is assessed as average between the descriptions of the answers.

The CARS rating scale items are:

1. Relationships with people:

• no difficulties- the child’s behavior meets all the necessary criteria for his age. Shyness or fussiness may occur in cases where the situation is unfamiliar - 1 point;
• mild difficulties- the child shows anxiety, tries to avoid direct gaze or suppress conversations in cases where attention or communication is intrusive and does not come on his initiative. Problems can also manifest themselves in the form of embarrassment or excessive dependence on adults in comparison with children of the same age - 2 points;
• moderate difficulties— deviations of this type are expressed in a demonstration of detachment and ignoring adults. In some cases, perseverance is required to gain children's attention. The child very rarely makes contact of his own accord - 3 points;
• serious relationship problems- the child rarely answers and never shows interest in what those around him are doing - 4 points.

2. Imitation and imitation skills:

• abilities correspond to age- the child can easily reproduce sounds, body movements, words - 1 point;
• imitation skills are slightly impaired- the child repeats simple sounds and movements without difficulty. More complex imitations are carried out with the help of adults - 2 points;
• average level of violations- to reproduce sounds and movements, the child needs outside support and significant effort - 3 points;
• serious problems with imitation- the child does not make attempts to imitate acoustic phenomena or physical actions, even with the help of adults - 4 points.

3. Emotional background:

• emotional response is normal— the child’s emotional reaction corresponds to the situation. Facial expression, posture and behavior change depending on the events taking place - 1 point;
• there are minor violations- sometimes the manifestation of children's emotions is not connected with reality - 2 points;
• emotional background is subject to moderate disturbances- a child’s reaction to a situation may be delayed in time, expressed too brightly or, conversely, restrained. In some cases, the child may laugh for no reason or not express any emotions corresponding to the events taking place - 3 points;
• the child is experiencing serious emotional difficulties- children's answers in most cases do not correspond to the situation. The child’s mood remains unchanged for a long time. The opposite situations may occur - the child begins to laugh, cry or express other emotions for no apparent reason - 4 points.

4. Body control:

• skills are age appropriate- the child moves well and freely, movements are precise and well-coordinated - 1 point;
• disorders in a mild stage- the child may experience some awkwardness, some of his movements are unusual - 2 points;
• average deviation level- the child's behavior may include such things as tiptoeing, pinching the body, unusual finger movements, pretentious poses - 3 points;
• the child experiences significant difficulties with control of his body- in children's behavior, strange movements are often observed, unusual for their age and situation, which do not stop even when trying to impose a ban on them - 4 points.

5. Toys and other household items:

• norm- the child plays with toys and uses other objects in accordance with their purpose - 1 point;
• slight deviations- strangeness may occur when playing or interacting with other things ( for example, a child can taste toys) – 2 points;
• moderate problems- the child may have difficulty determining the purpose of toys or objects. He may also pay increased attention to individual parts of a doll or car, become very interested in details and use toys in an unusual way - 3 points;
• serious violations- it is difficult to distract a child from playing or, conversely, to encourage him to do this activity. Toys are increasingly used in strange, inappropriate ways - 4 points.

6. Adaptability to change:

• the child's reaction is appropriate to the age and situation- when changing conditions, the child does not experience much excitement - 1 point;
• there are minor difficulties— the child has some difficulties with adaptation. So, when the conditions of the problem being solved change, the child can continue searching for a solution using the original criteria - 2 points;
• average level deviations- when the situation changes, the child begins to actively resist it and experiences negative emotions - 3 points;
• the response to changes does not fully correspond to the norm- the child perceives any changes negatively, hysterics may occur - 4 points.

7. Visual assessment of the situation:

• normal indicators- the child makes full use of vision to meet and analyze new people and objects - 1 point;
• mild disorders- such moments as “looking into nowhere”, avoidance of eye contact, increased interest in mirrors, light sources can be identified – 2 points;
• moderate problems- the child may experience discomfort and avoid direct gaze, use an unusual viewing angle, or bring objects too close to the eyes. In order for a child to look at an object, you need to remind him about it several times - 3 points;
• significant problems using vision- the child makes every effort to avoid eye contact. In most cases, vision is used in an unusual way - 4 points.

8. Sound reaction to reality:

• compliance with the norm- the child’s reaction to sound stimuli and speech corresponds to age and situation - 1 point;
• there are minor disorders- the child may not answer some questions, or respond to them with a delay. In some cases, increased sound sensitivity may be detected - 2 points;
• average level deviations- a child’s reaction may be different to the same sound phenomena. Sometimes there is no response even after several repetitions. The child may react excitedly to some ordinary sounds ( cover your ears, show displeasure) – 3 points;
• the sound response does not fully meet the norm- in most cases, the child’s reaction to sounds is impaired ( insufficient or excessive) – 4 points.

9. Using the senses of smell, touch and taste:

• norm- in exploring new objects and phenomena, the child uses all senses in accordance with age. When experiencing pain, it exhibits a reaction that corresponds to the level of pain - 1 point;
• small deviations- sometimes a child may have difficulty knowing which senses to use ( for example, tasting inedible objects). When experiencing pain, a child may express or exaggerate its meaning - 2 points;
• moderate problems- the child can be seen smelling, touching, tasting people and animals. The reaction to pain is not true - 3 points;
• serious violations— getting to know and studying subjects mostly occurs in unusual ways. The child tastes toys, smells clothes, touches people. When painful sensations arise, he ignores them. In some cases, an exaggerated reaction to minor discomfort may be detected - 4 points.

10. Fears and reactions to stress:

• natural response to stress and fears- the child’s behavioral model corresponds to his age and current events - 1 point;
• unexpressed disorders- sometimes a child may become scared or nervous more than usual compared to the behavior of other children in similar situations - 2 points;
• moderate impairment- children's reaction in most cases does not correspond to reality - 3 points;
• strong deviations— the level of fear does not decrease, even after the child experiences similar situations several times, and it is quite difficult to calm the baby down. You may also notice a complete lack of worry under circumstances that cause other children to worry - 4 points.

11. Communication skills:

• norm- the child communicates with the environment in accordance with the capabilities characteristic of his age - 1 point;
• slight deviation- A slight speech delay may be detected. Sometimes pronouns are changed, unusual words are used - 2 points;
• mid-level disorders- the child asks a large number of questions and may express concern about certain topics. Sometimes speech may be absent or contain meaningless expressions - 3 points;
• severe impairment of verbal communication— speech with meaning is almost absent. Often in communication the child uses strange sounds, imitates animals, imitates transport - 4 points.

12. Nonverbal communication skills:

• norm- the child makes full use of all the possibilities of nonverbal communication - 1 point;
• minor violations- in some cases, the child may have difficulty indicating his desires or needs with gestures - 2 points;
• moderate deviations- basically, it is difficult to explain to a child without words what he wants - 3 points;
• serious disorders- It is difficult for a child to understand the gestures and facial expressions of other people. In his gestures, he uses only unusual movements that have no obvious meaning - 4 points.

13. Physical activity:

• norm- the child behaves in the same way as his peers - 1 point;
• slight deviations from the norm- children's activity may be slightly higher or lower than normal, which causes some difficulties in the child's activities - 2 points;
• average degree of violation- the child’s behavior does not correspond to the situation. For example, when going to bed, he is characterized by increased activity, and during the day he remains in a sleepy state - 3 points;
• abnormal activity- the child is rarely in a normal state, in most cases showing excessive passivity or activity - 4 points.

14. Intelligence:

• child development is normal- child development is balanced and does not differ in unusual skills - 1 point;
• mild impairment- the child has standard skills, in some situations his intelligence is lower than that of his peers - 2 points;
• deviations of average type- in most cases the child is not so smart, but in some areas his skills are normal - 3 points;
• serious problems in intellectual development- children's intelligence is below generally accepted values, but there are areas in which the child understands much better than his peers - 4 points.

15. General impression:

• norm- outwardly the child does not show signs of illness - 1 point;
• mild manifestation of autism- under some circumstances the child shows symptoms of the disease - 2 points;
• average level- the child exhibits a number of signs of autism - 3 points;
• severe autism- the child shows an extensive list of manifestations of this pathology - 4 points.

Calculation of results
By placing a rating in front of each subsection that corresponds to the child’s behavior, the points should be summed up.

The criteria for determining the child’s condition are:

• number of points from 15 to 30– no autism;
• number of points from 30 to 36– the manifestation of the disease is likely to be mild to moderate ( Asperger's syndrome);
• number of points from 36 to 60– there is a risk that the child has severe autism.

ASSQ test for diagnosing children from 6 to 16 years old

This testing method is intended to determine a tendency towards autism and can be used by parents at home.
Each question in the test has three answer options - “no”, “somewhat” and “yes”. The first answer option is marked with a zero value, the answer “somewhat” implies 1 point, the answer “yes” - 2 points.

The ASSQ test questions are:

• Is it okay to use expressions such as “old-fashioned” or “smart beyond his years” to describe a child?
• Do your child's peers call you a "nutty or eccentric professor"?
• Can we say about a child that he is in his own world with unusual rules and interests?
• Collects ( or remembers) Does the child have data and facts on certain topics without understanding them enough or not at all?
• Has there been a literal perception of phrases spoken in a figurative sense?
• Does the child use an unusual communication style ( old-fashioned, pretentious, ornate)?
• Has the child been observed making up his own expressions and words?
• Can a child's voice be called unusual?
• Does the child use such techniques as squealing, grunting, sniffling, or screaming in verbal communication?
• Was the child markedly successful in some areas and significantly underperforming in other areas?
• Is it possible to say about a child that he uses speech well, but at the same time does not take into account the interests of other people and the rules of being in society?
• Is it true that the child has difficulty understanding other people's emotions?
• Is it common for a child to make naive statements and remarks that confuse other people?
• Is the type of eye contact abnormal?
• Does your child feel the desire, but cannot build relationships with peers?
• Is being with other children possible only on his terms?
• Child doesn't have a best friend?
• Can we say that the child’s actions lack common sense?
• Are there any difficulties when playing in a team?
• Were awkward movements and clumsy gestures noted?
• Has the child experienced involuntary movements of the body or face?
• Do you experience any difficulties in performing daily duties due to obsessive thoughts that visit your child?
• Does the child have a commitment to order according to special rules?
• Does the child have a special attachment to objects?
• Is a child exposed to weed from peers?
• Does the child use unusual facial movements?
• Has your child noticed any strange movements with his hands or other parts of his body?

Interpretation of the data obtained
If the total score does not exceed 19, the test result is considered normal. With a value that varies from 19 to 22, the likelihood of autism is increased; above 22, it is high.

When is it necessary to see a child psychiatrist?

You should consult a doctor at the first suspicion of elements of autism in a child. Before testing the child, the specialist observes his behavior. Often the diagnosis of autism is not difficult ( stereotypies are present, there is no contact with the environment). At the same time, making a diagnosis requires careful collection of the child’s medical history. The doctor is attracted to details about how the child grew and developed in the first months of life, when the mother’s first concerns appeared and what they are connected with.

Most often, before coming to a child psychiatrist or psychologist, parents had already visited doctors, suspecting the child to be deaf or dumb. The doctor clarifies when the child stopped speaking and what caused it. The difference between mutism ( lack of speech) in autism from another pathology is that in autism the child initially begins to speak. Some children begin to speak even earlier than their peers. Next, the doctor asks about the child’s behavior at home and in kindergarten, and about his contacts with other children.

At the same time, the patient is monitored - how the child behaves at the doctor’s appointment, how he orients himself in a conversation, whether he makes eye contact. A lack of contact may be indicated by the fact that the child does not give objects into his hands, but throws them on the floor. Hyperactive, stereotypical behavior speaks in favor of autism. If a child speaks, then attention is paid to his speech - is there any repetition of words in it ( echolalia), whether monotony predominates or, conversely, pretentiousness.

Ways to identify symptoms consistent with autism include:

• observation of a child in society;
• analysis of nonverbal and verbal communication skills;
• studying the interests of the child, the characteristics of his behavior;
• carrying out tests and analyzing the results obtained.

Deviations in behavior change with age, so the age factor should be taken into account when analyzing child behavior and the characteristics of its development.

The child's relationship with the outside world

Social impairments in children with autism may appear from the first months of life. From the outside, autistic people look calmer, undemanding and withdrawn compared to their peers. Being in the company of strangers or unfamiliar people, they experience severe discomfort, which, as they grow older, ceases to be anxiety. If a person from the outside tries to impose his communication or attention, the child may run away and cry.

Signs that can be used to determine the presence of this disease in a child from birth to three years are:

• lack of desire to make contact with the mother and other close people;
• strong ( primitive) attachment to one of the family members ( the child does not show adoration, but when separated, he may become hysterical and have a fever);
• reluctance to be held by the mother;
• lack of an anticipatory posture when the mother approaches;
• expression of discomfort when trying to establish eye contact with the child;
• lack of interest in events happening around;
• demonstration of resistance when trying to caress the child.

Problems with building relationships with the outside world remain even at a later age. The inability to understand the motives and actions of other people makes autistic people poor communicators. In order to reduce the level of their worries about this, such children prefer solitude.

Symptoms that indicate autism in children aged 3 to 15 years include:

• inability to form friendships;
• demonstration of detachment from others ( which can sometimes be replaced by the emergence of a strong attachment to one person or a narrow circle of people);
• lack of desire to make contact on one’s own initiative;
• difficulty understanding the emotions and actions of other people;
• difficult relationships with peers ( bullying by other children, using offensive nicknames towards the child);
• inability to take part in team games.

Verbal and nonverbal communication skills in autism

Children with this disease begin to speak much later than their peers. Subsequently, the speech of such patients is characterized by a reduced number of consonants and is replete with mechanical repetition of the same phrases that are not related to the conversation.

Deviations of speech and non-speech communication in children aged 1 month to 3 years with these diseases are:

• lack of attempts to interact with the outside world using gestures and facial expressions;
• absence of babbling before the age of one year;
• non-use of single words in conversation for up to one and a half years;
• inability to construct full-fledged meaningful sentences under the age of 2 years;
• lack of a pointing gesture;
• weak gestures;
• inability to express one’s desires without words.

Communication disorders that may indicate autism in a child over 3 years of age include:

• speech pathology ( inappropriate use of metaphors, reversal of pronouns);
• use of squealing, screaming in conversation;
• the use of words and phrases that are inappropriate in meaning;
• strange facial expressions or its complete absence;
• absent, directed to “nowhere” look;
• poor understanding of metaphors and speech expressions spoken in a figurative sense;
• inventing your own words;
• unusual gestures that have no obvious meaning.

Interests, habits, behavioral characteristics of a child with autism

Children with autism have difficulty understanding the rules of playing with toys that are understandable to their peers, such as a car or a doll. So, an autistic person may not roll a toy car, but spin its wheel. It is difficult for a sick child to replace some objects with others or use fictitious images in play, since poorly developed abstract thinking and imagination are one of the symptoms of this disease. A distinctive feature of this disease is disturbances in the use of the organs of vision, hearing, and taste.

Deviations in the behavior of a child under 3 years of age that indicate the disease are:

• concentration when playing not on the toy, but on its individual parts;
• difficulties in determining the purpose of objects;
• poor coordination of movements;
• increased sensitivity to sound stimuli ( severe crying due to the sound of the TV playing);
• lack of response to calling by name, requests from parents ( sometimes it seems that the child has hearing problems);
• studying objects in an unusual way - using the senses for purposes other than their intended purpose ( the child can smell or taste the toys);
• using an unusual viewing angle ( the child brings objects close to his eyes or looks at them with his head tilted to the side);
• stereotypical movements ( swinging your arms, swaying your body, turning your head);
• non-standard ( insufficient or excessive) response to stress, pain;
• sleep problems.

Children with autism at an older age retain the symptoms characteristic of this disease, and also show other signs as they develop and mature. One of the characteristics of autistic children is the need for a certain system. For example, a child may insist on walking along the route he has drawn up and not change it for several years. When trying to make changes to the rules he has established, an autistic person may actively express dissatisfaction and show aggression.

Symptoms of autism in patients whose age ranges from 3 to 15 years are:

• resistance to change, tendency to monotony;
• inability to switch from one type of activity to another;
• aggression towards oneself ( According to one study, about 30 percent of children with autism bite, pinch, or cause other types of pain.);
• poor concentration;
• increased selectivity in choosing dishes ( which causes digestive problems in two thirds of cases);
• narrowly defined skills ( memorization of irrelevant facts, passion for topics and activities that are unusual for age);
• poorly developed imagination.

Tests to determine autism and analysis of their results

Depending on the age, parents can use special tests that will help determine whether the child has this pathology.

Tests to determine autism are:

• M-CHAT test for children aged 16 to 30 months;
• CARS Autism Rating Scale for children 2 to 4 years of age;
• ASSQ test for children from 6 to 16 years old.

The results of any of the above tests are not the basis for making a final diagnosis, but are a valid reason to consult a specialist.

Decoding M-CHAT results
To pass this test, parents are asked to answer 23 questions. Answers obtained from observations of the child should be compared with options that support autism. If three matches are identified, it is necessary to show the baby to the doctor. Particular attention should be paid to critical points. If the child’s behavior meets two of them, consultation with a specialist in this disease is required.

Interpretation of the CARS Autism Scale
The CARS autism scale is a voluminous study that consists of 15 sections affecting all areas of a child’s life and development. Each item requires 4 answers with corresponding points. If parents cannot choose the proposed options with firm confidence, they can choose an intermediate value. To complete the picture, observations provided by those people who surround the child outside the home are necessary ( educators, teachers, neighbors). Having summed up the points for each item, you should compare the total amount with the data given in the test.

Rules for determining the final diagnostic result on a scale CARS are:

• if the total score varies from 15 to 30 points, the child does not suffer from autism;
• the number of points ranges from 30 to 36 – there is a possibility that the child is sick ( mild to moderate autism);
• If the score exceeds 36, there is a high risk that the child has severe autism.

ASSQ Test Results
The ASSQ screening test consists of 27 questions, each of which has 3 answer types ( “no”, “sometimes”, “yes”) with a corresponding award of 0, 1 and 2 points. If the test results do not exceed 19, there is no cause for concern. With a score of 19 to 22, parents should consult a doctor, as there is an average likelihood of illness. When the test result exceeds 22 points, the risk of the disease is considered high.

Professional help from a doctor does not only include drug correction of behavioral disorders. First of all, these are special educational programs for autistic children. The most popular programs in the world are the ABA program and Floor Time ( game time). ABA includes many other programs that are aimed at gradually mastering the world. It is believed that learning results are felt if the learning time is at least 40 hours per week. The second program uses the child's interests to establish contact with him. In this case, even “pathological” hobbies are taken into account, for example, pouring sand or mosaics. The advantage of this program is that any parent can master it.

Treatment of autism also comes down to visits to a speech therapist, speech pathologist and psychologist. Behavioral disorders, stereotypies, and fears are corrected by a psychiatrist and psychotherapist. In general, treatment for autism is multifaceted and targets areas of development that are affected. The sooner you consult a doctor, the more effective the treatment will be. It is believed that treatment is most effective before 3 years of age.

MINISTRY OF EDUCATION AND SCIENCE OF THE RUSSIAN FEDERATION

STATE EDUCATIONAL INSTITUTION

HIGHER PROFESSIONAL EDUCATION

TYUMEN STATE UNIVERSITY

INSTITUTE OF PEDAGOGY, PSYCHOLOGY AND MANAGEMENT

DEPARTMENT OF AGE AND PEDAGOGICAL PSYCHOLOGY

Course work

Features of the development of an autistic child

Tyumen, 2006

Introduction………………………………………………………………………………….3

Chapter 1. Childhood autism and its features

1.1. Psychological theories of autism………...……………..……….……..5

1.2. Forms of manifestation of autism………………...………………...…….….10

Chapter 2. Psychological support for children with autism

2.1. Causes and factors of autism…………...…..………...16

2.2. Psychological assistance to children with autism………………...………..19

Conclusion………………………………………………………………………………...24

List of used literature……………………………………………………..26

Introduction

Nowadays, autistic people often suffer from a wide range of problems: food allergies, depression, obsessive disorders, hyperactivity with lack of attention and concentration. But, as researchers believe, the main defect is difficulty in recognizing the fact that the thoughts, desires and needs of other people are different from your own. Typically, children come to this at the age of four, but autistic children, so to speak, have a blind consciousness: they believe that what they think about is on the minds of others, and what they feel is felt by others. They do not know how to imitate adults, but imitation in the early years serves as the most important learning tool. By imitating, children begin to recognize what certain gestures and facial expressions mean. Autistic people have great difficulty reading the internal state of their partner, the implicit signals with which normal people easily understand each other. At the same time, it is wrong to believe that autistic people are cold and indifferent to those around them.

It is not yet clear whether autism begins in one part of the brain and then affects others, or whether it is initially a problem for the brain as a whole, a problem that becomes more pronounced as the problems that need to be solved become more complex. But whether one or the other point of view is correct, one thing is clear: the brains of autistic children are different from the brains of ordinary children, both at the microscopic and at the macroscopic level.

It is ironic that autistic disorders that specifically affect children offer some hope. Because the neural pathways in a child's brain are strengthened through experience, properly targeted mental exercises can have beneficial effects. Although only a quarter of children with pronounced autism benefit from them, but three quarters do not, and it is not clear why.

Be that as it may, scientists are testing all the assumptions, and they believe that more effective forms of therapeutic intervention will certainly be found in the next decade.

The study examined the literature on the characteristics of childhood autism, its forms, the causes of autism and methods of psychological assistance. This information is useful for society in that when faced with such a child, a person will know how to behave with him and how to help, if possible.

Subject research: developmental features of an autistic child.

Object research is the developmental process of an autistic child.

Subject research is the features of the occurrence of autism in children.

Target: selection of methods of psychological assistance for autistic children.

Tasks research:

1. Familiarize yourself with and compare theories of autism;

2. Identify criteria for autism;

3. Study the forms of manifestation of childhood autism;

4. Reveal the causes and factors contributing to the occurrence of autism;

5. Analyze methods of psychological assistance to autistic children.

When starting our research, we proceed from hypotheses that methods of psychological assistance for children with autism syndrome will be more effective if they are based on the specific development of an autistic child.

CHAPTER 1. CHILDHOOD AUTISM AND ITS FEATURES

1.1. Psychological theories of autism

According to the “Handbook of Psychology and Psychiatry of Childhood and Adolescence”, edited by S.Yu. Tsirkina:

Autism is a “withdrawal” from reality with a fixation on the inner world of affective complexes and experiences. As a psychopathological phenomenon, it differs from introversion as a personal dimension or is considered as a painful variant of introversion.

Asperger's syndrome (autistic psychopathy) is a constitutional pathology of the character of the autistic type. The condition, as in early childhood autism, is determined by communication disorders, underestimation of reality, a limited and unique, stereotypical range of interests that distinguish such children from their peers.

Early childhood autism (Kanner syndrome) – a special disorder defined by manifestations of dissociative dysontogenesis, i.e. unevenly impaired development of the child’s mental, speech, motor, emotional spheres of activity with impaired social communication.

In the early 40s of the last century, autism was described by Leo Kanner and the Austrian pediatrician Hans Asperger. Kanner applied this term to socially withdrawn children prone to patterned behavior; being often intellectually gifted, they had difficulty mastering speech, which led to suspicion of mental retardation. Asperger, in turn, was referring to children who had difficulty communicating, exhibited bizarre thoughts, but were also very talkative and apparently quite intelligent. He also noted that such violations often pass from father to son in a family. (Kanner, however, also pointed to the role of heredity in the occurrence of autism). Subsequently, research took a different direction. The prevailing opinion has become that children are not born autistic, but become so because parents, especially mothers, treat them coldly and insufficiently caringly.

However, in 1981, an article by British psychiatrist Lorna Wing appeared, which revived interest in Asperger's work. She showed that the disorders described by this scientist are a type of Kannerian autism. Current researchers believe that Asperger and Kanner were describing two faces of a very complex and diverse disorder, the source of which is generally encoded in the human genome. It has also been established that severe forms of autism are not always accompanied by intellectual giftedness, but, on the contrary, are often characterized by mental retardation.

Genes are related to a person's susceptibility to autism. The suspects are primarily genes responsible for brain development, as well as cholesterol and immune system functions.

First described by Leo Kanner in 1943, autism continues to generate great interest to this day. Many psychological theories have been developed trying to explain its nature. Some of them place the main emphasis on emotional disturbances, attributing to them a leading role in the development of autistic manifestations.

Within the framework of psychoanalysis, autism is considered as a result of early psychogenic influence caused by an indifferent, cold attitude on the part of the mother. Early psychological stress, a specific pathology of parent-child relationships, according to the authors of this concept, lead to pathological personality development. However, the results of numerous studies of patients with autism, indicating its connection with organic and genetic factors, as well as studies of the interaction of mothers with children suffering from autism, made it possible to refute the assertion that the personal characteristics of mothers and their negative attitude towards the child are the cause of the development of the disease.

Other concepts that focus on affective disorders can be divided into 2 groups. According to the theories of the first group, the cause of all manifestations of autism is emotional disturbances. According to the authors of the concepts of the second group, affective disorders also determine interaction with the world in patients with autism, however, they themselves are derived from specific cognitive impairments.

The most consistent and detailed concept belonging to the first group is considered to be the theory of V.V. Lebedinsky, O.S. Nikolskaya. According to this concept, biological deficiency creates special pathological conditions to which the autistic child is forced to adapt. From the moment of birth, a typical combination of two pathogenic factors is observed:

Impaired ability to actively interact with the environment, which manifests itself in decreased vitality;

A decrease in the threshold of affective discomfort in contacts with the world, manifested in painful reactions to ordinary stimuli and increased vulnerability when contacting another person.

Both of these factors act in the same direction, preventing the development of active interaction with the environment and creating the prerequisites for strengthening self-defense. Autism, according to the authors, develops not only because the child is vulnerable and has little emotional endurance. Many manifestations of autism are interpreted as the result of the inclusion of protective and compensatory mechanisms that allow the child to establish relatively stable, albeit pathological, relationships with the world. Within the framework of this concept, distortion of the development of cognitive functions is a consequence of disturbances in the affective sphere. Features of the formation of motor processes, perception, speech and thinking are directly associated with early onset gross emotional disorders.

Childhood autism: introduction to the problem

Autism in a broad sense usually refers to obvious unsociability, the desire to avoid contacts, to live in one’s own world. Non-contact, however, can manifest itself in different forms and for different reasons. Sometimes it turns out to be simply a characterological trait of the child, but it can also be caused by insufficient vision or hearing, profound intellectual underdevelopment and speech difficulties, neurotic disorders or severe hospitalism (a chronic lack of communication generated by the social isolation of the child in infancy). In most of these very different cases, communication disorders turn out to be a direct and understandable consequence of the underlying deficiency: low need for communication, difficulties in perceiving information and understanding the situation, painful neurotic experience, chronic lack of communication in early childhood, inability to use speech.

There is, however, a communication disorder in which all these difficulties are connected into one special and strange knot, where it is difficult to separate the root causes and consequences and understand: the child does not want or cannot communicate; and if it can’t, then why. This disorder may be associated with early childhood autism syndrome.

Parents are most often concerned about the following behavioral features of such children: the desire to withdraw from communication, limiting contacts even with close people, the inability to play with other children, the lack of active, keen interest in the world around them, stereotypical behavior, fears, aggression, self-injury. There may also be a delay in speech and intellectual development that increases with age, and learning difficulties. Difficulties in mastering everyday and social skills are typical.

At the same time, loved ones, as a rule, have no doubt that the baby needs their attention and affection even when they cannot calm and console him. They do not believe that their child is emotionally cold and unattached to them: it happens that he gives them moments of amazing mutual understanding.

In most cases, parents do not consider their children to be mentally retarded. An excellent memory, dexterity and ingenuity demonstrated at certain moments, a complex phrase suddenly pronounced, extraordinary knowledge in certain areas, sensitivity to music, poetry, natural phenomena, and finally just a serious, intelligent facial expression - all this gives parents hope that the child is really “It can do anything” and, according to one of the mothers, “it just needs a little tweaking.”

However, although such a child can really understand a lot on his own, it can be extremely difficult to attract his attention and teach him anything. When he is left alone, he is content and calm, but most often he does not fulfill requests made to him, does not even respond to his own name, and is difficult to draw him into the game. And the more they bother him, the more they try to deal with him, checking again and again whether he can really speak, whether his (from time to time) intelligence really exists, the more he refuses contact, the more fierce his strange stereotypical actions, self-injury. Why do all his abilities appear only by chance? Why doesn't he want to use them in real life? What and how should he be helped if his parents do not feel able to calm him down, protect him from fear, if he does not want to accept affection and help? What to do if efforts to organize a child’s life and teach him only end up embittering adults and himself, destroying the few forms of contact that already exist? Parents, educators and teachers of such children inevitably face similar questions.

There are different views on the origin and causes of the development of early childhood autism. Next, we will try to outline these views, as well as highlight possible approaches to correcting mental disorders observed in autistic children.

The type of strange, self-absorbed person, perhaps commanding respect for his special abilities, but helpless and naive in social life, unadapted in everyday life, is quite well known in human culture. The mystery of such people often arouses special interest in them; the idea of ​​eccentrics, saints, and people of God is often associated with them. As you know, in Russian culture a special, honorable place is occupied by the image of the holy fool, a fool, capable of seeing what the smart ones do not see, and telling the truth where the socially adjusted are cunning.

Individual professional descriptions of both children with autistic mental development disorders and attempts at medical and pedagogical work with them began to appear in the last century. Thus, judging by a number of signs, the famous Victor, the “wild boy” found at the beginning of the last century near the French city of Aveyron, was an autistic child. From the attempt of his socialization, correctional training undertaken by Dr. E.M. Itard (E. M. Itard), and, in fact, the development of modern special pedagogy began.

In 1943 American clinician L. Kanner, summarizing observations of 11 cases, was the first to conclude that there is a special clinical syndrome with a typical mental development disorder, calling it “early childhood autism syndrome.” Dr. Kanner not only described the syndrome itself, but also identified the most characteristic features of its clinical picture. Modern criteria for this syndrome, which later received a second name - “Kanner syndrome,” are mainly based on this study. The need to identify this syndrome, apparently, is so ripe that, independently of L. Kanner, similar clinical cases were described by the Austrian scientist H. Asperger in 1944 and by the domestic researcher S.S. Mnukhin in 1947.

The most striking external manifestations of childhood autism syndrome, summarized in clinical criteria, are:

– autism as such, that is, the extreme, “extreme” loneliness of the child, a decrease in the ability to establish emotional contact, communication and social development. Characterized by difficulties in establishing eye contact, interaction with gaze, facial expressions, gestures, and intonation. It is common for children to have difficulty expressing their emotional states and understanding the states of other people. Difficulties in contact and establishing emotional connections manifest themselves even in relationships with loved ones, but to the greatest extent autism disrupts the development of relationships with peers;

– stereotypical behavior, associated with an intense desire to maintain constant, familiar living conditions; resistance to the slightest changes in the situation, the order of life, fear of them; absorption in monotonous actions - motor and speech: rocking, shaking and waving arms, jumping, repeating the same sounds, words, phrases; addiction to the same objects, the same manipulations with them: shaking, tapping, tearing, spinning; capture by stereotypical interests, the same game, the same topic in drawing, conversation;

– special characteristic delay and disorder of speech development, first of all – its communicative function. In one third, and according to some data even in half of cases, this can manifest itself as mutism (lack of purposeful use of speech for communication, in which the possibility of accidentally pronouncing individual words and even phrases remains). When stable speech forms develop, they are also not used for communication: for example, a child can enthusiastically recite the same poems, but not turn to parents for help even in the most necessary cases. Characterized by echolalia (immediate or delayed repetition of heard words or phrases), a long-term lag in the ability to correctly use personal pronouns in speech: the child can call himself “you”, “he”, by name, indicate his needs with impersonal orders (“cover”, “ give me something to drink”, etc.). Even if such a child formally has well-developed speech with a large vocabulary and extensive “adult” phrases, then it also has the character of a cliched, “parrot-like”, “phonographic” character. He does not ask questions himself and may not respond to requests to him, that is, he avoids verbal interaction as such. It is characteristic that speech disorders appear in the context of more general communication disorders: the child practically does not use facial expressions and gestures. In addition, the unusual tempo, rhythm, melody, and intonation of speech attract attention;

– early manifestation of these disorders(at least until 2.5 years), which was already emphasized by Dr. Kanner. At the same time, according to experts, we are not talking about regression, but rather about a special early violation of the child’s mental development.

Many specialists of various profiles have been studying this syndrome and searching for opportunities for correctional work with autistic children. The prevalence of the syndrome, its place among other disorders, the first early manifestations, their development with age were determined, and diagnostic criteria were clarified. Long-term studies not only confirmed the accuracy of identifying the general features of the syndrome, but also introduced several important clarifications into the description of its picture. Thus, Dr. Kanner believed that childhood autism is associated with a special pathological nervous constitution of the child, in which he did not identify individual signs of organic damage to the nervous system. Over time, the development of diagnostic tools has made it possible to identify the accumulation of such symptoms in children with autism; in a third of the cases that Kanner himself described, epileptic seizures were observed in adolescence.

Kanner also believed that childhood autism was not caused by mental retardation. Some of his patients had a brilliant memory and musical talent; typical of them was a serious, intelligent expression on their faces (he called it “the face of a prince”). However, further research has shown that, although some autistic children do have high intellectual scores, in very many cases of childhood autism we cannot help but see profound mental retardation.

Modern researchers emphasize that childhood autism develops on the basis of a clear deficiency of the nervous system, and clarify that communication impairments and difficulties in socialization appear independently of the level of intellectual development, that is, both at low and high levels. The parents of the first children examined by Kanner were mostly educated, intellectual people with high social status. It has now been established that an autistic child can be born into any family. Perhaps the special status of the first families observed was due to the fact that it was easier for them to receive help from a famous doctor.

Studies have been conducted in a number of countries to determine the prevalence of childhood autism. It has been established that this syndrome occurs in approximately 3–6 cases per 10,000 children, being found in boys 3–4 times more often than in girls.

Recently, it has increasingly been emphasized that multiple cases of similar disorders in the development of communication and social adaptation are grouped around this “pure” clinical syndrome. Although they do not fit exactly into the picture of the clinical syndrome of childhood autism, they nevertheless require a similar corrective approach. The organization of assistance to all such children should be preceded by their identification using a single educational diagnosis, which makes it possible to distinguish children in need of specific pedagogical influence. The frequency of disorders of this kind, determined by pedagogical diagnostic methods, according to many authors, increases to an impressive figure: on average, 15–20 out of 10,000 children have them.

Research shows that although formally the early development of such children may fall within the parameters of the norm, it is unusual from their very birth. After the first year of life, this becomes especially obvious: it is difficult to organize interaction, to attract the child’s attention, and there is a noticeable delay in his speech development. The most difficult period, burdened by a maximum of behavioral problems - self-isolation, excessive stereotypical behavior, fears, aggression and self-injury - is noted from 3 to 5-6 years. Then, affective difficulties may gradually smooth out, the child may be more drawn to people, but mental retardation, disorientation, misunderstanding of the situation, awkwardness, inflexibility, and social naivety come to the fore. With age, inability to adapt to everyday life and lack of socialization become more and more obvious.

These data attracted attention to the study of the cognitive capabilities of such children and the identification of features of the formation of their mental functions. Along with islands of abilities, multiple problems were discovered in the development of sensorimotor and speech areas; Features of thinking were also identified that make it difficult to symbolize, generalize, correctly perceive subtext, and transfer skills from one situation to another.

As a result, in modern clinical classifications, childhood autism is included in the group of pervasive, i.e., pervasive disorders, manifested in impaired development of almost all aspects of the psyche: cognitive and affective spheres, sensory and motor skills, attention, memory, speech, thinking.

It is now becoming increasingly clear that childhood autism is not a problem of childhood alone. Difficulties in communication and socialization change shape, but do not go away over the years, and help and support should accompany a person with autism all his life.

Both our experience and the experience of other specialists shows that, despite the severity of the violations, in some cases (according to some sources, in a quarter, according to others - in a third) of cases, successful socialization of such people is possible - acquiring independent living skills and mastering quite complex professions . It is important to emphasize that even in the most difficult cases, persistent correctional work always gives positive dynamics: the child can become more adapted, sociable and independent in the circle of people close to him.

The search for reasons went in several directions. As mentioned, early studies of autistic children showed no evidence of damage to their nervous systems. In addition, Dr. Kanner noted some common features of their parents: a high intellectual level, a rational approach to parenting methods. As a result, in the early 50s of our century, a hypothesis arose about the psychogenic (arising as a result of mental trauma) origin of the deviation. Its most consistent guide was the Austrian psychotherapist Dr. B. Bettelheim, who founded a famous children's clinic in the USA. He associated the disruption of the development of emotional connections with people and activity in mastering the world around him with the incorrect, cold attitude of parents towards the child, the suppression of his personality. Thus, responsibility for disrupting the development of a “biologically complete” child was placed on the parents, which was often the cause of severe mental trauma for them.

Comparative studies of families with children suffering from early childhood autism and families with children with other developmental disorders have shown that autistic children have experienced no more traumatic situations than others, and parents of autistic children are often even more caring and devoted to them than parents of other children. "problem" children. Thus, the hypothesis about the psychogenic origin of early childhood autism has not been confirmed.

Moreover, modern research methods have revealed multiple signs of central nervous system deficiency in autistic children. Therefore, at present, most authors believe that early childhood autism is a consequence of a special pathology, which is based precisely on the failure of the central nervous system. A number of hypotheses have been put forward about the nature of this deficiency and its possible localization. Nowadays, intensive research is underway to test them, but there are no clear conclusions yet. It is only known that in autistic children signs of brain dysfunction are observed more often than usual, and they often exhibit disturbances in biochemical metabolism. This deficiency can be caused by a wide range of reasons: genetic factors, chromosomal abnormalities (in particular, the fragile X chromosome), and congenital metabolic disorders. It may also be the result of organic damage to the central nervous system as a result of the pathology of pregnancy and childbirth, a consequence of neuroinfection, or an early onset schizophrenic process. American researcher E. Ornitz has identified more than 30 different pathogenic factors that can lead to the formation of Kanner syndrome. Autism can manifest itself as a result of a variety of diseases, such as congenital rubella or tuberous sclerosis. Thus, experts point to the polyetiology (multiple causes of occurrence) of early childhood autism syndrome and its polynosology (manifestation within different pathologies).

Of course, the action of various pathological agents introduces individual features into the picture of the syndrome. In different cases, autism may be associated with mental development disorders of varying degrees, more or less severe speech underdevelopment; emotional disorders and communication problems can have different shades.

As we see, taking into account etiology is absolutely necessary for organizing medical and educational work. However, for children with early childhood autism syndrome of various etiologies, the main points of the clinical picture, the general structure of mental development disorders, as well as the problems facing their families remain common.

Sometimes autism can be confused with some other problems encountered in children.

First, almost every autistic child is suspected of having deafness or blindness. These suspicions are caused by the fact that he, as a rule, does not respond to his name, does not follow the instructions of an adult, and does not concentrate with his help. However, such suspicions are quickly dispelled, since parents know that the lack of response to social stimuli is often combined in their child with “over-fascination” with certain sound and visual impressions, caused, for example, by the perception of rustling, music, lamp light, shadows, the pattern of wallpaper on the wall - their special meaning for the child leaves no doubt in the minds of those close to him that he can see and hear.

Nevertheless, the attention to the peculiarities of such a child’s perception is quite understandable. Moreover, there are reasoned proposals to introduce an abnormal response to sensory stimuli into the main clinical criteria for childhood autism syndrome. Anomaly in this case is not just the absence of a reaction, but its unusualness: sensory vulnerability and ignoring the stimulus, paradoxical response or “over-fascination” with individual impressions.

It is also important to remember the characteristic differences in reactions to social and physical stimuli. For a normal child, social stimuli are extremely important. He primarily responds to what comes from another person. An autistic child, on the contrary, may ignore a loved one and respond sensitively to other stimuli.

On the other hand, the behavior of children with visual and hearing impairments may also include monotonous actions, such as rocking, irritating the eye or ear, or fiddling with their fingers in front of their eyes. Just as in cases of childhood autism, these actions serve the function of autostimulation, compensating for the lack of real contact with the world. However, we cannot talk about childhood autism until stereotypical behavior is combined with difficulties in establishing emotional contact with other people, of course, at a level accessible to the child, using the means available to him. It should also be noted that a real combination of childhood autism, or at least autistic tendencies, with visual and hearing impairments is possible. This happens, for example, with congenital rubella. In such cases, stereotypical behavior is combined with difficulties in communication even at the most primitive level. The combination of autism and sensory impairments makes intervention particularly difficult.

Secondly, there is often a need to correlate childhood autism and mental retardation. We have already mentioned that childhood autism can be associated with various, including very low, quantitative indicators of mental development. At least two-thirds of children with autism are assessed as mentally retarded on routine psychological assessment (and half of these two-thirds are assessed as severely mentally retarded). It is necessary, however, to understand that impaired intellectual development in childhood autism has qualitative specificity: with a quantitatively equal IQ, a child with autism, compared to an oligophrenic child, can show much greater intelligence in certain areas and significantly worse adaptation to life in general. His performance on individual tests will differ greatly from each other. The lower the IQ, the more pronounced the difference between the results in verbal and nonverbal tasks will be in favor of the latter.

In cases of deprivation in children with severe mental retardation, it is possible to develop special stereotypes of autostimulation, for example, rocking, as happens in the case of deprivation in children with sensory impairments. The solution to the question of whether we are dealing with childhood autism, as in the first case, will require checking: whether this manifestation of stereotyping in the child’s behavior is combined with the impossibility of establishing emotional contact with him at the simplest and seemingly accessible level.

Thirdly, in some cases it is necessary to distinguish speech difficulties in childhood autism from other speech development disorders. Often the first concerns arise among parents of autistic children precisely in connection with the unusualness of their speech. Strange intonation, cliches, rearrangement of pronouns, echolalia - all this manifests itself so clearly that problems of differentiation with other speech disorders, as a rule, do not arise. However, in some, namely the most severe and mildest cases of childhood autism, difficulties are still possible.

In the most severe case - the case of a mutic (not using speech and not responding to the speech of others) child, the question of motor and sensory alalia (lack of speech with normal hearing and mental development; motor alalia - inability to speak, sensory - inability to understand speech) may arise. A turbid child differs from a child suffering from motor alalia in that sometimes he can involuntarily pronounce not only words, but even complex phrases. It is more difficult to resolve the issue of sensory alalia. A deeply autistic child does not concentrate on the speech addressed to him; it is not an instrument for organizing his behavior. It is difficult to say whether he understands what is being said to him. Experience shows that even if he tries to concentrate on the instruction, he does not retain it entirely in his consciousness. In this he is similar to a child who has difficulty understanding speech. On the other hand, an autistic child can sometimes adequately perceive and take into account in behavior relatively complex information received from a speech message addressed to another person.

The most important identifying feature is a global communication disorder characteristic of a deeply autistic child: unlike a child with purely speech difficulties, he does not try to express his desires by vocalization, gaze, facial expressions or gestures.

In the mildest cases of childhood autism, when instead of a complete lack of communication there are only difficulties associated with it, manifestations of a variety of speech disorders are possible. In such cases, one can detect obvious problems with the perception of speech instructions, general blurriness and unclear pronunciation, hesitations, agrammatisms (violations of the grammatical structure of speech), and difficulties in constructing a phrase. All these problems arise precisely when the child tries to communicate and organize purposeful speech interaction. When the statements are autonomous, undirected, and cliched, then the speech can be purer, the phrase more correct. When differentiating in such cases, one should start from comparing the possibilities of understanding and using speech in situations of autostimulation and directed interaction.

The differential diagnosis must also consider more general behavioral characteristics. In attempts to communicate, an autistic child will show hyper-shyness, inhibition, and increased sensitivity to the gaze of another person, the tone of his conversation. He will strive to communicate in a familiar and ritualized form and will get lost in a new environment.

Fourthly, it is important for both professionals and parents distinguish between childhood autism and schizophrenia. Their confusion is associated with many not only professional problems, but also personal experiences in families of autistic children.

Western experts completely deny the connection between childhood autism and schizophrenia. It is known that schizophrenia is a hereditary disease. Studies have shown that there is no accumulation of cases of schizophrenia among relatives of autistic children. In Russia, until recently, childhood autism and childhood schizophrenia were in most cases simply equated, which was also confirmed by numerous clinical studies.

This contradiction will become clearer if we take into account the differences in the understanding of schizophrenia in different clinical schools. Most Western schools define it as a painful process accompanied by acute mental disorders, including hallucinations. The Russian psychiatric schools that dominated until recently attributed to schizophrenia also sluggish painful processes that disrupt the mental development of a child. With the first understanding, the connection with autism is really not visible, but with the second, childhood autism and schizophrenia can overlap.

A child suffering from schizophrenia (in the traditional Russian sense of the word) may not have difficulties specific to childhood autism syndrome. Here, differentiation will be helped by relying on the basic criteria of the syndrome. Distinguishing between “stable” and “current” forms within the childhood autism syndrome itself allows long-term observation of the child’s development. The presence of periods of exacerbation not caused externally (increasing problems of the child) may indicate in favor of schizophrenia.

A diagnosis in which autism is interpreted as a mental illness is perceived by parents, and often teachers, as a cruel verdict on the possibility of successful mental development and social adaptation of a child. With this understanding, the effectiveness of correctional work, training and education is called into question: “Is it worth working, what can we hope for, if the movement of the disease process constantly destroys the fruits of our efforts?” Our experience shows that the severity of a child’s problems and the prognosis of his development should not be made directly dependent on the medical diagnosis. We know of cases when working with a child is very difficult, despite the absence of exacerbations, and, conversely, there are cases of fairly rapid progress even with regular deterioration of the condition. During a difficult period, a child does not lose anything completely. He may temporarily stop using the acquired skills and move to a lower level of adaptation, but emotional contact and the support of loved ones allow him to quickly restore the previously achieved level, and then move on.

Finally, fifthly, it is necessary to dwell on the distinction between childhood autism syndrome and communication disorders caused by special living conditions and raising a child. Such disorders can occur if, at an early age, the child is deprived of the opportunity to establish emotional contact with a loved one, i.e. in cases of so-called pediatric hospitalism.

It is known that a lack of emotional contacts with people and a lack of impressions often cause serious mental retardation in children raised in orphanages. They may also develop special stereotypical activity, designed to compensate for the lack of contacts with the world. However, stereotypic actions are not as sophisticated in hospitalism as in childhood autism: it could be, say, just persistent rocking or thumb sucking. The main thing here is that a child with hospitalism, once in normal conditions, can compensate much faster than an autistic child, since he has no internal obstacles to emotional development.

Another cause of a psychogenic communication disorder may be a child’s negative neurotic experience: trauma suffered, failure to interact with another person. Of course, any child with increased vulnerability can have such an experience. And yet this is not childhood autism, because the communication disorder here, as a rule, is selective and relates specifically to individual, difficult situations for the child. Even if the neurotic experience entailed selective mutism, i.e. mutism that manifests itself only in special circumstances (while answering in class, when communicating with other adults, etc.), then even then the child with psychogenic disorders has contact with loved ones, with children in a play situation, it is quite preserved. In the case of childhood autism, the ability to communicate is impaired in general, and the most difficult thing for such children is to organize non-obligatory play contacts with peers.

A specialist working with an autistic child must understand not only the clinical signs, not only the biological causes of childhood autism, but also the logic of the development of this strange disorder, the order in which problems appear, and the characteristics of the child’s behavior. It is the understanding of the psychological picture as a whole that allows a specialist to work not only on individual situational difficulties, but also on normalizing the very course of mental development.

It should be emphasized that although the “center” of the syndrome is autism as an inability to establish emotional connections, as difficulties in communication and socialization, no less characteristic of it is a violation of the development of all mental functions. That is why, as we have already mentioned, in modern classifications, childhood autism is included in the group of pervasive, i.e., all-pervasive disorders, manifested in the abnormal development of all areas of the psyche: intellectual and emotional spheres, sensory and motor skills, attention, memory, speech.

The disorder in question is not a mechanical sum of individual difficulties - here we can see a single pattern of dysontogenesis, covering the entire mental development of the child. The point is not only that the normal course of development is disrupted or delayed, it is clearly distorted, going “somewhere in the wrong direction.” Trying to comprehend it according to the laws of ordinary logic, we constantly face the incomprehensible paradox of its picture, which is expressed in the fact that with random manifestations of both the ability to perceive complex forms and dexterity in movements, as well as the ability to speak and understand a lot, such a child does not strive use their capabilities in real life, in interaction with adults and other children. These abilities and skills find their expression only in the sphere of strange stereotypical activities and specific interests of such a child.

As a result, early childhood autism has a reputation as one of the most mysterious developmental disorders. For many years, research has been ongoing to identify central mental deficiency, which may be the root cause of the emergence of a complex system of characteristic mental disorders. The first to appear was a seemingly natural assumption about a decrease in the need for communication in an autistic child. However, then it became clear that although such a decrease may disrupt the development of the emotional sphere, impoverish the forms of communication and socialization, they alone cannot explain the entire unique pattern of behavior, for example, stereotypy, of such children.

Moreover, the results of psychological research, family experience, and observations of professionals involved in correctional education indicate that the above assumption is not true at all. A person who has close contact with an autistic child rarely doubts that he not only wants to be with people, but can also become deeply attached to them.

There is experimental evidence indicating that the human face is just as emotionally significant for such a child as for any other, but he withstands eye contact for much less time than all others. That is why his gaze gives the impression of being intermittent, mysteriously elusive.

There is also no doubt that it is really difficult for such children to understand other people, to perceive information from them, to take into account their intentions and feelings, and it is difficult to interact with them. According to modern ideas, an autistic child is still more likely to be unable than unwilling to communicate. Work experience also shows that it is difficult for him to interact not only with people, but also with the environment as a whole. This is precisely what the multiple and varied problems of autistic children indicate: their eating behavior is disturbed, self-preservation reactions are weakened, and there is practically no research activity. There is total disadaptation in relations with the world.

Attempts to consider the pathology of one of the mental functions (sensorimotor, speech, intellectual, etc.) as the root cause of the development of childhood autism also did not lead to success. Violations of any one of these functions could explain only part of the manifestations of the syndrome, but did not allow us to understand its overall picture. Moreover, it turned out that it is always possible to find a typically autistic child who is characterized by other, but not these, difficulties.

It is becoming increasingly clear that we should not be talking about a violation of a single function, but about a pathological change in the entire style of interaction with the world, difficulties in organizing active adaptive behavior, in using knowledge and skills to interact with the environment and people. English researcher U. Frith believes that autistic children have a impaired understanding of the general meaning of what is happening, and associates this with some kind of central cognitive deficiency. We believe that this is due to a violation of the development of the system of affective organization of consciousness and behavior, its main mechanisms - experiences and meanings that determine a person’s view of the world and ways of interacting with it.

Let's try to trace why and how this violation occurs. Biological deficiency creates special pathological conditions, in which an autistic child lives, develops and is forced to adapt. From the day of his birth, a typical combination of two pathogenic factors appears:

– impairment of the ability to actively interact with the environment;

– lowering the threshold of affective discomfort in contacts with the world.

First factor makes itself felt both through a decrease in vitality and through difficulties in organizing active relationships with the world. At first, it may manifest itself as a general lethargy of a child who does not bother anyone, does not require attention, does not ask to eat or change the diaper. A little later, when the child begins to walk, the distribution of his activity turns out to be abnormal: he “now runs, then lies down.” Very early on, such children surprise with their lack of lively curiosity and interest in new things; they do not explore the environment; any obstacle, the slightest hindrance slows down their activity and forces them to abandon the implementation of their intention. However, such a child experiences the greatest discomfort when trying to purposefully focus his attention and arbitrarily organize his behavior.

Experimental data indicate that the special style of an autistic child’s relationship with the world manifests itself primarily in situations that require active selectivity on his part: selection, grouping, and processing of information turn out to be the most difficult task for him. He tends to perceive information, as if passively imprinting it into himself in whole blocks. The perceived blocks of information are stored unprocessed and are used in the same form, passively received from the outside. In particular, this is how the child learns ready-made verbal cliches and uses them in his speech. In the same way, he masters other skills, tightly linking them with one single situation in which they were perceived, and not applying them in another.

Second factor(reducing the threshold of discomfort in contacts with the world) manifests itself not only as a frequently observed painful reaction to ordinary sound, light, color or touch (this reaction is especially typical in infancy), but also as increased sensitivity and vulnerability when contacting another person. We have already mentioned that eye contact with an autistic child is only possible for a very short period of time; longer interactions, even with close people, cause him discomfort. In general, such a child usually has little endurance in communicating with the world, a quick and painfully experienced satiety even with pleasant contacts with the environment. It is important to note that most of these children are characterized not only by increased vulnerability, but also by a tendency to fixate on unpleasant impressions for a long time, to form strict negative selectivity in contacts, to create a whole system of fears, prohibitions, and all kinds of restrictions.

Both of these factors act in the same direction, preventing the development of active interaction with the environment and creating the prerequisites for strengthening self-defense.

With all of the above in mind, we can now come to an understanding of what the specific sources of both autism itself and stereotypical behavior in a child are.

Autism develops not only because the child is vulnerable and has little emotional endurance. The desire to limit interaction even with close people is due to the fact that they are the ones who require the greatest activity from the child, and it is precisely this requirement that he cannot fulfill.

Stereotyping is also caused by the need to take control of contacts with the world and protect oneself from uncomfortable impressions, from the scary. Another reason is the limited ability to actively and flexibly interact with the environment. In other words, the child relies on stereotypes because he can only adapt to stable forms of life.

In conditions of frequent discomfort and limited active positive contacts with the world, special pathological forms necessarily develop compensatory autostimulation, allowing such a child to raise his tone and drown out discomfort. The most striking example is monotonous movements and manipulations with objects, the purpose of which is to reproduce the same pleasant impression.

The emerging attitudes of autism, stereotypy, and hypercompensatory autostimulation cannot help but distort the entire course of the child’s mental development. It is impossible to separate the affective and cognitive components here: this is one set of problems. Distortion of the development of cognitive mental functions is a consequence of disorders in the affective sphere. These violations lead to deformation of the basic mechanisms of the affective organization of behavior - those mechanisms that allow every normal child to establish an optimal individual distance in relations with the world, determine their needs and habits, master the unknown, overcome obstacles, build an active and flexible dialogue with the environment, establish emotional contact with people and arbitrarily organize their behavior.

An autistic child suffers from the development of mechanisms that determine active interaction with the world, and at the same time the pathological development of defense mechanisms is accelerated:

– instead of establishing a flexible distance that allows both to come into contact with the environment and to avoid uncomfortable impressions, the reaction of avoiding influences directed at him is recorded;

– instead of developing positive selectivity, developing a rich and varied arsenal of life habits that meet the child’s needs, negative selectivity is formed and fixed, i.e. the focus of his attention is not what he loves, but what he does not like and does not accept, fears;

– instead of developing skills that allow one to actively influence the world, i.e., examine situations, overcome obstacles, perceive each of his mistakes not as a disaster, but as setting a new adaptive task, which actually opens the way to intellectual development, the child focuses on protecting constancy in the surrounding microcosm;

– instead of developing emotional contact with loved ones, giving them the opportunity to establish voluntary control over the child’s behavior, he builds a system of protection against the active interference of loved ones in his life. He establishes the maximum distance in contacts with them, strives to keep the relationship within the framework of stereotypes, using the loved one only as a condition of life, a means of autostimulation. A child’s connection with loved ones manifests itself primarily as the fear of losing them. A symbiotic relationship is fixed, but real emotional attachment does not develop, which is expressed in the ability to empathize, regret, give in, and sacrifice one’s interests.

Such severe disturbances in the affective sphere entail changes in the direction of the development of the child’s higher mental functions. They also become not so much a means of active adaptation to the world, but rather a tool used for protection and obtaining impressions necessary for autostimulation.

So, in motor development the formation of everyday adaptation skills and the development of ordinary, necessary for life, actions with objects are delayed. Instead, the arsenal of stereotypical movements is actively replenished, such manipulations with objects that allow one to receive the necessary stimulating impressions associated with contact, changing the position of the body in space, feeling one’s muscle ligaments, joints, etc. These can be waving the hands, freezing in certain strange positions, selective tension of individual muscles and joints, running in a circle or from wall to wall, jumping, spinning, swinging, climbing furniture, jumping from chair to chair, balancing; stereotypical actions with objects: a child can tirelessly shake a string, knock with a stick, tear paper, peel a piece of fabric into threads, move and twirl objects, etc.

Such a child is extremely awkward in any objective action performed “for benefit” - both in large movements of the whole body and in fine manual motor skills. He cannot imitate, grasping the desired pose; poorly controls the distribution of muscle tone: the body, arm, fingers may be too sluggish or too tense, movements are poorly coordinated, their time is not absorbed " I am consistency. At the same time, he can unexpectedly show exceptional dexterity in his strange actions: move like an acrobat from a window sill to a chair, maintain balance on the back of a sofa, spin a plate on the finger of an outstretched hand while running, lay out an ornament from small objects or matches...

IN development of perception In such a child, one can note disturbances in orientation in space, distortions of the holistic picture of the real objective world and a sophisticated isolation of individual, affectively significant sensations of his own body, as well as sounds, colors, and shapes of surrounding things. Stereotypical pressure on the ear or eye, sniffing, licking objects, fingering in front of the eyes, playing with highlights and shadows are common.

The presence of more complex forms of sensory autostimulation is also characteristic. Early interest in color and spatial forms can manifest itself in a passion for laying out ornamental rows, and this interest can even be reflected in the development of the child’s speech. His first words may not be the names of complex shades of colors and shapes most useful to an ordinary baby - for example, “pale golden” or “parallelepiped”. At the age of two, a child can look everywhere for the shape of a ball or the outlines of letters and numbers familiar to him. He can be absorbed in construction - he will fall asleep doing this activity, and when he wakes up, he will enthusiastically continue to connect all the same parts. Very often, before the age of one year, a passion for music manifests itself, and the child may develop an absolute ear for music. Sometimes he learns early to use a record player, unerringly, based on incomprehensible signs, selects the record he needs from the pile and listens to it again and again...

The sensations of light, color, shape, and one’s body acquire intrinsic value. Normally, they are primarily a means, a basis for organizing motor activity, but for autistic children they become an object of independent interest, a source of autostimulation. It is characteristic that even in autostimulation such a child does not enter into free, flexible relationships with the world, does not actively master it, does not experiment, does not look for novelty, but strives to constantly repeat, reproduce the same impression that once sunk into his soul.

Speech development the autistic child reflects a similar trend. With a general violation of the development of purposeful communicative speech, it is possible to become fascinated with certain speech forms, constantly playing with sounds, syllables and words, rhyming, singing, distorting words, reciting poetry, etc.

A child often cannot address another person in a directed manner, even just call his mother, ask her for something, express his needs, but, on the contrary, is able to absentmindedly repeat: “moon, moon, look out from behind the clouds,” or: “ how much is an onion”, clearly pronounce interesting-sounding words: “ochre”, “super-imperialism”, etc. Using only a meager set of speech cliches for business, he can simultaneously show acute sensitivity to speech forms, words as such, fall asleep and wake up with dictionary in hand.

Autistic children usually have a passion for rhymes, verses, and reciting them by heart “by the mile.” An ear for music and a good sense of speech form, attention to high poetry - this is what amazes everyone who comes into close contact with them in life.

Thus, what is normally the basis for the organization of speech interaction becomes an object of special attention, a source of autostimulation - and again we do not see active creativity, free play with speech forms. Just like motor skills, speech stereotypies (monotonous actions) also develop, allowing the child to reproduce the same impressions necessary for the child over and over again.

IN development of thinking Such children experience enormous difficulties in voluntary learning and in purposefully solving problems that actually arise. Experts point to difficulties in symbolization and transfer of skills from one situation to another, linking them with difficulties in generalization and with limitations in understanding the subtext of what is happening, the one-dimensionality, and literalness of its interpretations. It is difficult for such a child to understand the development of a situation over time, to distinguish causes and consequences in the sequence of events. This is very clearly manifested when retelling educational material and completing tasks related to plot pictures. Researchers note problems with understanding the logic of another person, taking into account his ideas and intentions.

It seems to us that in the case of childhood autism we should not talk about the absence of individual abilities, for example, the ability to generalize, to understand cause-and-effect relationships, or to plan. Within a stereotypical situation, many autistic children can generalize, use game symbols, and build a program of action. However, they are not able to actively process information, actively use their abilities in order to adapt to the constantly changing world and the impermanence of another person’s intentions.

For an autistic child, the separation of a symbol from the usual game is painful: this destroys the constancy he requires in the world around him. The need for constant flexible adjustment of his own program of action is also painful for him. The very assumption of the existence of a subtext that undermines the stable meaning of the situation causes fear in him. It is unacceptable for him that his partner has his own logic, which constantly jeopardizes the prospect of interaction he himself has outlined.

At the same time, in a situation of complete control over what is happening, such children may develop stereotypical play with separate mental operations - unfolding the same patterns, reproducing some kind of counting operations, chess compositions, etc. These intellectual games can be quite sophisticated, but They, too, are not active interaction with the environment, creative solutions to real problems, and only constantly reproduce the pleasant impression for the child of an easily accomplished mental action.

When faced with a real problem, the solution to which he does not know in advance, such a child most often turns out to be incompetent. Thus, a child who enjoys playing chess problems from a textbook, reproducing classical chess compositions, is baffled by the moves of the weakest, but real partner, acting according to his own, unknown in advance, logic.

And finally, we must consider the most striking manifestations of the syndrome in the form of the child’s immediate reactions to his own maladjustment. We are talking about so-called behavioral problems: violation of self-preservation, negativism, destructive behavior, fears, aggression, self-injury. They increase with an inadequate approach to the child (as well as autostimulation increases, fencing him off from real events) and, on the contrary, decrease with the choice of forms of interaction available to him.

In a tangle of behavioral problems, it is difficult to single out the most significant one. Let us therefore begin with the most obvious - with active negativism, which is understood as the child’s refusal to do anything with adults, withdrawal from the learning situation, arbitrary organization. Manifestations of negativism may be accompanied by increased autostimulation, physical resistance, screaming, aggression, and self-injury. Negativism is developed and consolidated as a result of a misunderstanding of the child’s difficulties and an incorrectly chosen level of interaction with him. Such mistakes in the absence of special experience are almost inevitable: those close to him are guided by his highest achievements, the abilities that he demonstrates in line with autostimulation - in the area in which he is dexterous and smart. A child cannot voluntarily repeat his achievements, but it is almost impossible for his loved ones to understand and accept this. Excessive demands give rise to fear of interaction and destroy existing forms of communication.

It is also difficult to understand and accept the need for a child to comply in detail with the stereotype of life he has mastered. Why, after all, can’t you rearrange the furniture, go to the house on a different, more convenient road, or listen to a new record? Why doesn't he stop shaking his hands? How long can you talk about the same thing, ask the same questions? Why is any new thing met with hostility? Why can’t an adult talk about certain topics or say certain words? Why is mom strictly forbidden to leave the house, be distracted by a conversation with a neighbor, and sometimes even close the door behind her? - these are the typical questions that constantly arise from his loved ones.

Paradoxically, it is precisely the decisive struggle against these absurdities, this slavery into which loved ones fall, that can make an adult a toy in the stereotypical autostimulation of such a child. After some time, an adult may have the feeling that he is being deliberately teased and provoked into outbursts of indignation. The child seems to like to do everything out of spite; he seems to consciously evoke angry reactions and refine the ways of provoking them. A painful vicious circle develops, and breaking out of this trap can be very difficult.

A huge problem is fears child. They may be incomprehensible to others, since they are directly related to the special sensory vulnerability of such children. When experiencing fear, they often do not know how to explain what exactly frightens them, but later, when establishing emotional contact and developing methods of communication, the child can tell, for example, that at the age of four his cries of horror and the inability to enter his own room were connected with an unbearably harsh ray of light falling from the window onto the baseboard. He may be frightened by objects that make sharp sounds: rumbling pipes in the bathroom, household electrical appliances; There may be special fears associated with tactile hypersensitivity, such as intolerance to the sensation of a hole in tights or the insecurity of bare legs sticking out from under the blanket.

Often fears arise from a child's tendency to overreact to situations in which there are signs of a real threat that are instinctively recognized by every person. This is how, for example, the fear of washing arises and is reinforced: an adult washes a child’s face for a long time and thoroughly, simultaneously grabbing his mouth and nose, which makes breathing difficult. The fear of getting dressed is of a similar origin: the head gets stuck in the collar of the sweater, which gives rise to an acute feeling of discomfort. In summer, such a child is frightened by butterflies, flies and birds because of their sudden oncoming movement; the elevator gives him a feeling of danger due to the tightness in a small confined space. And there is a total fear of novelty, of violations of the established stereotype of life, of unexpected developments in the situation, of one’s own helplessness in unusual conditions.

When such a child feels bad, he can become aggressive towards people, things and even himself. For the most part, his aggression is not directed at anything specifically. He simply shrugs off in horror the “attack” of the outside world on him, from interference in his life, from attempts to break his stereotypes. In the specialized literature, this is described using the term “generalized aggression” - that is, aggression against the whole world.

However, its unaddressed nature does not reduce its intensity - these can be explosions of despair of extreme destructive power, crushing everything around.

However, the extreme manifestation of despair and hopelessness is self-injury, which often poses a real physical danger to the child, since it can cause self-harm. We have already said that autostimulation is a powerful means of protection and shielding from traumatic impressions. The necessary impressions are most often achieved by irritating one’s own body: they drown out unpleasant impressions coming from the outside world. In a threatening situation, the intensity of autostimulation increases, it approaches the pain threshold and can go beyond it.

We can understand how and why this happens from our own experience. To drown out despair, we ourselves are sometimes ready to bang our heads against the wall - experiencing unbearable mental pain, we strive for physical pain, just so as not to think, feel, or understand. However, for us this is an extreme experience, and an autistic child can experience such moments every day - while swinging, he begins to hit his head on something; pressing on the eye, he does it so hard that he risks damaging it; Feeling danger, he begins to beat, scratch, and bite himself.

It must be said that, unlike the behavioral characteristics of other children, problems here can manifest themselves for years in the same, unchanged form. On the one hand, this makes it possible to predict the development of events and avoid a possible breakdown in the child’s behavior, on the other hand, it gives a special painful shade to the experiences of loved ones: they cannot break out of the vicious circle of the same problems, are included in a sequence of repeating events, constantly overcome all the same difficulties.

So, we see that an autistic child goes through a complex path of distorted development. However, in the overall picture, you need to learn to see not only its problems, but also opportunities and potential achievements. They may appear to us in a pathological form, but, nevertheless, we must recognize them and use them in corrective work. On the other hand, it is necessary to recognize the child’s defensive attitudes and habits that oppose our efforts and stand in the way of his possible development.

It is known that, despite the commonality of mental disorders, autistic children differ significantly in the depth of maladjustment, the severity of problems, and the prognosis of possible development. Mutism and adult speech that is not according to age, vulnerability, fears and lack of a sense of real danger, severe mental deficiency and highly intellectual interests, indiscriminateness towards loved ones and a tense symbiotic relationship with the mother, the elusive gaze of the child and his very open, extremely naive gaze directed at the face of an adult - all this coexists in a complex, paradoxical picture of childhood autism. Therefore, despite the general logic of developmental disorders, it is impossible to talk about working with an autistic child “in general”; The pressing problem has always been the development of an adequate classification and differentiation within the syndrome of childhood autism.

The first such attempts were clinical classifications, based on the etiology of the syndrome, distinguishing the forms of biological pathology that determine its development. These classifications play a significant role in the development of adequate approaches to providing medical care to such children.

Psychological and pedagogical tasks required other approaches that made it possible to specialize, depending on the specific case, the strategy and tactics of correctional work. First of all, there was a search for prognostic signs that would allow assessing the possibilities of mental and social development of such children. For these purposes, many authors have put forward criteria for assessing speech and intellectual development. Experience has shown that the appearance of speech before the age of five and a level of mental development exceeding 70 points on standard tests (on a 100-point scale) can be considered relatively favorable prognostic signs. At the same time, the possibility of verbal contact with a specialist and interaction with him during a psychological examination provides only indirect information about the depth of autism and the severity of the child’s autistic dysontogenesis.

There is also the idea of ​​classifying such children according to the nature of social maladjustment. English researcher Dr. L. Wing divided autistic children according to their ability to engage in social contact into “lonely” (not involved in communication), “passive” and “active-but-ridiculous”. She associates the best prognosis for social adaptation with “passive” children.

The classification proposed by L. Wing successfully connects the nature of a child’s social maladjustment with the prognosis of his further social development, however, the derivative manifestations of the disorder are still taken as a basis. It seems to us that there is a possibility of more accurate psychological differentiation of such children in accordance with the depth of their autism and the degree of distortion of mental development. In this case, the criteria for separation become the child’s availability of certain methods of interaction with the environment and people and the quality of the forms of protective overcompensation developed by him - autism, stereotypy, autostimulation.

When we look at the developmental histories of autistic children, we see that at an early age, activity disorders and vulnerability are present in unequal degrees in such children, and, accordingly, they face different problems. At the same time, different life tasks turn out to be a priority, as a result of which each child develops his own ways of interacting with the world and protecting himself from it.

What comes to the fore in the behavior of autistic children, of course, are the striking manifestations of pathological forms of compensatory defense. Autism itself can manifest itself in different forms: 1) as complete detachment from what is happening; 2) as active rejection; 3) as a preoccupation with autistic interests and, finally, simply 4) as an extreme difficulty in organizing communication and interaction.

Thus we distinguish four groups children with completely different types of behavior. It is important for us that these groups also represent different stages in the development of interaction with the environment and people. With successful correctional work, we see how the child climbs these steps, acquiring the ability to organize increasingly complex and active forms of interaction. And in the same way, as internal and external circumstances worsen, we can observe how these forms are simplified and transferred into passive form, how a transition occurs to more primitive ways of organizing life, to an even more deaf “defense” from it.

In order to prevent a child from being deprived of his achievements and help him take a step forward, it is important to understand the level of relationships available to him with the world. To this end, we will consider the listed groups in their sequence - from the heaviest to the lightest.

The main complaints with which the child’s family turns to specialists first group, is the absence of speech and the inability to organize the child: to catch the eye, to achieve a return smile, to hear a complaint, a request, to receive a response to a call, to draw his attention to instructions, to achieve the fulfillment of an order. Such children show the greatest discomfort and impaired activity at an early age. During the period of full-blown manifestations of the syndrome, obvious discomfort remains a thing of the past, since their compensatory defense from the world is built radically: not to have any points of active contact with it. The autism of such children is as deep as possible; it manifests itself as complete detachment from what is happening around them.

The children of this group make a mysterious impression with their detached and, nevertheless, often sly and intelligent facial expression, special dexterity, even grace in movements; the fact that they do not respond to requests and do not ask for anything themselves, often do not even react to pain, hunger and cold, and do not show fear in situations in which any other child would be afraid. They spend time moving aimlessly around the room, climbing, climbing over furniture, or standing in front of the window, contemplating the movement behind it, and then continue their own movement. When you try to stop them, hold them, get attention, force them to do something, discomfort may arise, and, as a reaction to it, screaming, self-injury; however, self-absorbed balance is restored as soon as the child is left alone.

Such children do not develop practically any forms of active selectivity in contacts with the world; purposefulness is not manifested in them either in motor action or in speech - they are muted. Moreover, they hardly use central vision, do not look purposefully, and do not look at anything specifically.

The behavior of a child in this group is predominantly field behavior. This means that it is determined not by active internal aspirations, not by the logic of interaction with another person, but by random external influences. In fact, his behavior is an echo of extraneous impressions: it is not the child who pays attention to the object, but the object itself, as it were, draws his attention to itself with its sensory texture, color, sound. It is not the child who goes somewhere in a direction, but the spatial organization of objects forces the child to move in a certain direction: the carpet takes him deep into the corridor, an open door pulls him into another room, a row of chairs provokes jumping from one to another, a sofa causes a series of jumps, a window for a long time captivates by the glimpses of the street. And the child moves passively, “drags” around the room, being attracted by one object or another, absentmindedly touches things, pushes a ball without looking, hits the xylophone, turns on the light... In essence, if you know what and how is placed in the room, the behavior of such the child can be almost accurately predicted.

Of course, field behavior is characteristic not only of childhood autism; its episodes are common for any small child who has not yet developed his own line of active behavior, and we, adults, in our absent-mindedness, sometimes also become the plaything of external forces. If we talk about abnormal manifestations, then pronounced field tendencies can manifest themselves for a long time in the behavior of a variety of children with developmental disorders. However, the field behavior of autistic children of the first group has a special, immediately recognizable character. Things do not provoke such children to even short-term, but active manipulations with them, as we see, say, in the case of a disinhibited, reactive child with organic damage to the central nervous system. In our case, satiety sets in almost before the very beginning of the action with an object that has attracted fleeting attention: the gaze that highlighted it immediately goes to the side, the outstretched hand falls even before it touches the object to which it was reaching, or takes it, but he immediately unclenches indifferently and drops it... Such a child seems to be drifting with the flow, pushing off from one object and colliding with another. Therefore, the line of his behavior is determined to a greater extent not so much by the things themselves and their properties, but by their relative location in space.

Children of the first group do not develop not only active means of contact with the world, but also active forms of autistic defense. Passive evasion and withdrawal create the most reliable, most total protection. Such children simply elude the movement directed in their direction, any attempt to organize their behavior. They establish and maintain the maximum possible distance in contacts with the world: they simply do not come into active contact with it. Persistent attempts to attract the attention of such a child, to achieve a response by word or action, are unsuccessful. In conditions when the child cannot evade, when trying to restrain him by force, a moment of short active resistance arises, which quickly turns into self-aggression. It is clear that such children, during psychological examinations, despite their intelligent look, give the lowest indicators of intellectual development. It is also clear that at home, by chance, they can demonstrate their potential abilities, but the child’s mental functions do not develop independently.

If we talk about the perception and motor development of such children, then in their aimless movement around the room they can show remarkable coordination of movements: climbing over, jumping over, fitting into narrow passages, they will never hurt themselves or miss. Parents say about such a child that he is smart in his own way. Indeed, he can show excellent visual-spatial thinking abilities: deftly get out of any obstacles, quickly fold a box with forms traditionally used in examinations, and easily sort objects according to similar characteristics. Relatives often tell stories, for example, about how, having left a pile of socks and threads prepared for darning, they find them neatly arranged by color. The tasks that such a child copes with surprisingly easily are similar in one thing: their solution is directly in the field of vision, and you can find it just by walking, with one movement - as they say, “poke and go.”

At the same time, such children cannot repeat their achievements at the request of an adult, and therefore even their loved ones have doubts whether they really distinguish colors and shapes. When trying to teach them to do something voluntarily, it is discovered that gross violations of muscle tone, lethargy and weakness appear in both large and “subtle” movements; For them, mastering and maintaining the required posture, coordinating the movements of the hand and eye (the child simply does not look at what he is doing), and reproducing the required sequence of actions turn out to be overwhelming tasks. A child can, in submission, passively take a pose or repeat a movement asked by an adult, but with great difficulty consolidates a motor skill, and practically cannot use it in life on his own, without external encouragement and dictation.

As already mentioned, these are non-speaking, mute children. It is important to note that language development disorders occur in the context of a more general communication disorder. The child not only does not use speech, he does not use gestures, facial expressions, or figurative movements. Even the humming and babbling of such children produces a strange impression: they also do not have an element of communication, the sounds are rather non-speech in nature - this can be a special muttering, chirping, whistling, creaking, often high-pitched intonation. Sometimes a special musical harmony can be heard in them.

In some cases, such children began to speak at an early age, pronounced complex words and even phrases clearly, but their speech was not aimed at communication; in other cases there was practically no attempt to speak. By the age of 2.5–3 years, all children in this group are mute: they do not use speech at all, but can sometimes pronounce individual words and even phrases quite clearly. Such words and phrases are a reflection, an echo of what children hear, something that at some point touched them with its sound or meaning (for example, “what happened to you, my dear”), or a commentary on what is happening around (“grandmother is cleaning”), i.e. they also turn out to be a manifestation of passive field behavior. Often those around them rejoice at such words and phrases, seeing in them the child’s achievement, but he may never repeat them again - they seem to float up and again sink to the bottom without a trace.

Despite the absence of external communicative speech, internal speech can apparently be maintained and even developed. This can be established only after long, careful observation. At first glance, it seems that the child does not understand the speech addressed to him, because he does not always follow verbal instructions. However, even in the absence of an immediate reaction to what was heard, the child’s subsequent behavior may reveal that the information received has been internalized to one degree or another. In addition, a lot depends on the situation: such a child often assimilates speech information that is not directed to him, received by chance, better than direct instructions. There are cases when, at an older age, such a child mastered reading - and communication with him was managed to be established through written speech.

We have already said that children in this group develop active forms of autistic defense to a small extent. Only moments of self-aggression are actively manifested - the most desperate form of defense in response to direct pressure from an adult. In many children, you can see the clear result of such self-aggression: the usual callus on the hand, scars from bites, etc.

Such children have the least active resistance to changes in the world around them. Clinicians have known this for a long time. Dr. B. Bettelheim pointed out that it is children with the most profound forms of autism who least of all defend the immutability of their life stereotype. However, if dependence on a constant environment may not be outwardly manifested, this does not mean that maintaining a constant way of life is not important for them. Often, regression of the speech of such children at an early age is associated precisely with the loss of their usual way of life as a result of moving or hospitalization.

Active forms of autostimulation do not develop in such children either; they have almost no fixed forms of even primitive motor stereotypies. The absence of their own self-stimulation stereotypes does not mean that they do not receive the same impressions over and over again that they need for self-regulation. For them, visual, vestibular sensations, related to bodily sensations, associated with their own movement (climbing, climbing, jumping), with the activity around them are important - for hours they can sit on the windowsill and contemplate the flickering on the street. Thus, to obtain the desired impressions, they widely use the possibilities of the environment. Stereotyping is manifested in them primarily in the monotony of field behavior.

In everyday life, they usually do not create much trouble, passively obeying their parents. They can use loved ones for active autostimulation: they often happily allow them to spin around and disturb themselves, but they strictly dose even these pleasant impressions, come and go on their own. However, despite the depth of autism in such children, it cannot be said that they are not attached to their loved ones. They do not address them and try to avoid attempts to organize interaction, but mostly stay close. Like other children, they suffer from separation from loved ones, and it is in their relationships with loved ones that they exhibit the most difficult behavior. If they need something, they can bring an adult to an object that interests them and put his hand on the object: this is an expression of their request, a form of the most active contact with the world.

Establishing and developing emotional connections with such a child will help increase his activity and allow him to develop the first, still common with adults, stable forms of behavior. Joint experience of what is happening around, the formation of common habits and activities can stimulate the emergence of the child’s own active selectivity, that is, the transition to a higher level of relations with the world.

We must remember that even such deep self-isolation can be overcome with patient work, that such a child, like any other, is capable of love, becoming attached to loved ones, that he will be happy when he begins to establish stable connections and master ways of interacting with the world and people. Belonging to a given group only means the correspondence of his problems to a certain initial level, indicates the forms of contact available to him, the direction of the next step that we must help him take.

Children second group initially they are somewhat more active and a little less vulnerable in contacts with the environment, and their autism itself is more active, it no longer manifests itself as detachment, but as a rejection of most of the world, of any contacts that are unacceptable for the child.

Parents most often come for the first time with complaints about the delay in the mental development of such children, and above all, the development of speech; they report all other difficulties later. These other difficulties in the parents' complaints fade into the background, because they have gotten used to and adapted to a lot - the child has already taught them to maintain the special living conditions he needs, and, first of all, to strictly adhere to the established life stereotype, which includes both the situation and habitual actions, and the entire daily routine, and ways of contacting loved ones. It is common to have particular selectivity in food and clothing, fixed walking routes, predilections for certain activities and objects, a special strict ritual in relationships with loved ones, numerous demands and prohibitions, failure to comply with which leads to disruptions in the child’s behavior.

At home, in familiar conditions, these problems do not manifest themselves in an acute form; difficulties arise when leaving the house and are especially pronounced in an unfamiliar environment, in particular at an appointment with a specialist. With age, when attempts to go beyond the boundaries of home life become more and more inevitable, this kind of difficulty becomes especially acute.

We will try to describe such children as they appear to us at the initial examination, in a new place, with new people - that is, not being protected by the usual routine of home life. Outwardly, these are the most suffering autistic children: their face is usually tense, distorted with a grimace of fear, and they are characterized by stiffness in their movements. They use telegraphically condensed speech patterns, typical echolalic responses, reversal of pronouns, and tensely chanted speech. Compared to children of other groups, they are more burdened by fears, are involved in motor and speech stereotypies, they may exhibit uncontrollable drives, impulsive actions, generalized aggression, and severe self-injury.

When assessing the state of such pronounced maladaptation of a child, we must remember that, despite the severity of the manifestations, these children are much more adapted to life than children of the first group. Despite all their difficulties, they come into contact with the world more actively, and this is what reveals the depth of their problems.

Their activity manifests itself primarily in the development of selective relations with the world. Of course, given their vulnerability, we can talk mainly about negative selectivity: everything unpleasant and scary is recorded, and multiple prohibitions are formed. At the same time, such a child already has habits and preferences that reflect his desires. Thus, he has a basis for developing life skills, there is a certain arsenal of simple behavioral stereotypes with the help of which the child gets what he wants. As a result, it becomes possible to create a holistic life stereotype within which he can feel confident and protected.

The main problem of a child in the second group is that his preferences are fixed very narrowly and rigidly; any attempt to expand their range causes him horror. Extreme selectivity in food may develop: for example, he agrees to eat only noodles and cookies, and only of a certain taste and a certain shape. The selectivity in clothes is similar, because of which he often cannot part with some thing even for a while - hence the great difficulties with seasonal changes of clothes, even with ordinary washing. This strict selectivity permeates all areas of his life: a walk must follow the same route, he is only satisfied with a certain place on the bus, he must get home only by a certain type of transport, etc.

The commitment to constancy is reinforced by the fact that social and everyday skills are acquired by him only as strictly tied to a specific situation in which they first developed, to the person who helped them develop. They are not used flexibly by the child, in isolation from the circumstances that formed them, and are not transferred to other situations to solve similar problems. For example, he dresses himself only at home in the presence of his grandmother; When you come to visit, you don’t always say hello, but only if it’s the apartment of specific neighbors. Progress is possible, but it is limited by the narrow corridors of life stereotypes accepted by the child.

At first glance, the motor development of such children appears to be much more impaired than that of children of the first group. There are no plastic movements, no peculiar dexterity in mastering space. On the contrary, the movements are tensely constrained, mechanical, the actions of the arms and legs are poorly coordinated. The children do not seem to move, but change positions; the space of the room is crossed by bending over and running, as if it were a dangerous place.

They develop everyday skills with difficulty, but still easier than those of children of the first group. They also cannot imitate the actions of other people, they are also very awkward, their hands do not obey them. The easiest way to teach such children something is by using their own hands, giving them a ready-made form of movement from the outside. However, they still learn it, fix it and get the opportunity to successfully use it in these specific circumstances. This is already a very big step forward, because in this way they can adapt to their usual home conditions, learn to take care of themselves, eat, dress, and wash themselves. The skill is acquired with difficulty, but firmly, and then the child can be quite dexterous within the boundaries of what has been learned (although he is not able to transform the skill or adapt it to new conditions).

Children in this group typically have an abundance of stereotypical motor movements, they are absorbed in them, and their motor stereotypies are of the most bizarre and sophisticated nature. This includes selective tension of individual muscle groups, joints, and jumping on tense straight legs, and waving of arms, turning the head, fiddling with fingers, shaking ropes and sticks. In such actions they show exceptional dexterity. It is important to note that this is the dexterity of a separate part of the body: the whole body is constrained, and, for example, the hand does something unimaginably skillful. And the saucer spins on your finger, a butterfly is removed from a blade of grass with a precise and careful movement, your favorite animal is drawn with one stroke, mosaic patterns are laid out from the smallest elements, your favorite record is skillfully played...

Often these children are gifted with a special perception of the world. For example, before they are even a year old, they may develop an extraordinary love for music. Very quickly they begin to pick out their favorite melodies, and already at an early age, without the simplest everyday skills, they selflessly finger the piano keys and learn to use radios, tape recorders and players.

They also surprise with their early special attention to colors and shapes. At two years old, they can already distinguish them well, not only the main ones, but also the rarer ones. In their first drawings they can show form and movement remarkably well; Such children are well versed in the routes of daily walks.

It is characteristic that they are always occupied by a separate impression: what is important is not the object with its useful everyday function, with its emotional and social meaning, but its individual sensory properties that are attractive to the child. Thus, when playing with a toy car, he most often does not carry, load or unload it, but deepens in contemplation of its rotating wheels. He does not develop a holistic idea of ​​the object, a holistic picture of the objective world, just as he does not develop a holistic perception of his own body as an instrument of purposeful action. For such a child, individual tactile and muscle sensations are primarily significant.

Of course, the sensory texture of the environment is important for any child, because it is from childhood that we take away the joy of smell, sound, taste, and color. But there is a significant difference: an autistic child does not develop exploratory behavior; he does not know free, joyful immersion in the world around him. An ordinary child experiments, seeks more and more new sensations, and thus actively masters the sensory environment. An autistic child recognizes and records only a narrow set of impressions that are pleasant to him, and then strives to receive them only in a form familiar to him. His amazing abilities are most often lost in attempts at arbitrary organization. During the examination, he may not even show the ability to distinguish colors and shapes, which seems to be his strong point.

As for the speech development of children in this group, it also represents a fundamental step forward compared to children of the first group. These are talking children, they can use speech to express their needs. At the same time, the development of speech here is also associated with difficulties generally characteristic of childhood autism syndrome. The same trend can be traced that we talked about when describing the features of the motor development of such children: speech skills are acquired, fixed in a ready-made, unchangeable form and are used only in the situation in which and for which they were developed. Thus, the child accumulates a set of speech cliches and commands that are strictly related to the situation. This tendency to assimilate ready-made cliches makes clear the tendency towards echolalia, chopped telegraphic style, a long delay in the use of first-person pronouns, requests in the infinitive (“give me a drink”, “for a walk”), in the third person (“Petya [or: he, boy] wants") and in the second (“Do you want some cheesecake”) - that is, in his addresses he simply reproduces the words of his loved ones.

It is possible to use in everyday life suitable quotes from books and cartoons that are attached to the situation: a request for food - “bake me a bun for me, grandma”, a call for contact - “guys, let’s live together”, etc. The person does not separate depending on the situation, and the child does not specifically address him. He simply casts a “spell,” “presses a button,” and waits for the situation to change in the right direction: a cheesecake will appear or he will be taken for a walk. This also happens with ordinary very young children who do not yet separate themselves either from their loved ones or from the whole situation as a whole.

The lack of appeals is also manifested in the fact that such children have not mastered either directional gestures or facial expressions aimed at communication. The intonation of their speech also does not serve as a means of influencing another person. It is often a simple echo of the intonation of a loved one, the tone in which they speak to the child. This is what often gives the intonation a special childish quality; it is characterized by a special rise towards the end of the phrase: this is how mothers with babies speak, and this is how the children themselves “return” this intonation to their mothers.

And with this poverty, cliched speech used “for business”, the inclinations of the child’s general linguistic talent, his sensitivity to the “flesh” of language, are often striking. In general, all children at a certain age become more sensitive to this kind of sensitivity (remember the examples given by K. Chukovsky in the book “From Two to Five”). Normally, however, this language game does not interfere with the rapid development of communicative speech. Here we see other trends.

The gap is striking: on the one hand, an agrammatic telegraphic phrase, the desire to use ready-made cliches and quotations, on the other, a love for good poetry, their long, selfless reading, special attention to the affective side of speech, the linguistic forms themselves. Playing with sounds is no longer carried out abstractly, as is typical for children of the first group; it is associated with certain life situations, with the child’s specific life experience. Word creation can be expressed, in particular, in curse words of one’s own composition. Example: “saber infection” - here, in addition to growling and threatening whistling sounds, one can hear “saber”, “infection”, and much more. Or: “rossolimstvo” - the same sounds are associated with the name of the street on which the hospital was located, where the child experienced separation from his loved ones, where he underwent a painful operation.

It is also possible to become fascinated by language constructions - and then a tongue-tied child with a small vocabulary of words learns to read on his own - but not in order to read children's books, but, for example, in order to enjoy searching through words in the Russian-Romanian dictionary. Again, a distortion: a special sense of language is used not to master it as a whole as a tool of communication and knowledge of the world, but to highlight individual pleasant impressions and their stereotypical reproduction: repetition of the same poems, affectively rich words and phrases, individual expressive phrases. Even in language play, these children do not feel free.

The mental development of such children occurs in a very unique way. It is also limited to the corridors of stereotypes and is not aimed at identifying general relationships and patterns, at understanding cause-and-effect relationships, processes, changes, transformations in the surrounding world. Limitedness, narrowness of understanding, rigidity and mechanicalness in the perception of relationships between events, literal thinking, difficulty in symbolizing in play, i.e. all those signs that are currently recognized as the most characteristic of early autism syndrome are manifested to the greatest extent in children of this age. groups.

When we talk about the difficulties of symbolization, we do not mean the situation when a child, while playing, easily imagines, for example, a package of pills as a typewriter, or, throwing a toy on the rug and jumping excitedly next to him, says: “swimming in the sea, floating.” Game symbolization is in many cases accessible to autistic children, but the game image that arises with its help usually cannot be freely developed in a plot game and is only constantly reproduced in a collapsed stereotypical form.

In class, such a child can easily grasp what “furniture” and “vegetables” are, and successfully solve the problem of identifying the “fourth extra,” but he does not apply the ability to generalize in life. Its symbols and generalizations are strictly tied to specific sensory circumstances of a game or activity and, like motor and speech skills, are not transferable from one situation to another. Literality is also supported by a special vulnerability: first of all, one, the most powerful, often unpleasant, meaning of what is happening is recognized and firmly fixed. Thus, a child may be frightened when he hears the expression “the clock is striking.”

Generalization can occur precisely based on the affective characteristics of the unpleasant. In certain situations, such a child utters a phrase that, in our opinion, is meaningless: for example, at a doctor’s appointment he begins to repeat: “the vase fell.” The phrase becomes clear if you know that this is how he refers to all the unpleasant moments of his life, summarizing them from the impression of fear in the situation when he broke a vase.

Psychological and pedagogical examinations of such children can give different results. A prepared child is able to answer standard questions quite satisfactorily; he performs his usual tasks without much stress. At the same time, he will be less successful in verbal tests: it is difficult for him to retell the text in detail, to compose a story from a picture - difficulties generally arise in situations where he needs to independently comprehend and actively organize the information received. In non-verbal tests, the greatest difficulty is caused by the task of putting in order the pictures depicting the sequential development of the plot.

If we talk about quantitative indicators of mental development, the results will, of course, be higher than those of children of the first group. However, despite individual successes (for example, in tasks where mechanical memory is important), overall results will most often remain within the boundaries of mental retardation. Failure will most clearly manifest itself in a less standard situation, even during normal conversation, when the child most likely will not be able to answer the simplest everyday questions.

However, with the constant help of a patient mother, such a child can complete high school. He is able to accumulate a large arsenal of formal knowledge in all subjects and, in a concise, condensed form, correctly answer questions in physics, chemistry and history. But, as one selfless mother noted with alarm, “it seems that this knowledge is stuffed into a big bag, and he himself will never be able to get it out of there, will not be able to use it.”

For children in this group, their understanding of the world is limited to a few situations known to them, mastered by the “corridors” in which they live. It is also important that the child of this group is not able to see phenomena in development, to clearly separate the present, past and future. Everything that happened to him before remains relevant in the present, and first of all, he pulls behind him a trail of fears and memories of troubles. He cannot wait, plan, the future is also strictly tied to the present: nothing can be postponed, everything promised and declared must be fulfilled immediately. This gives rise to numerous problems and provokes behavioral breakdowns.

This creates a very narrow and rigid life stereotype, in which nothing can be changed arbitrarily: the child is very dependent on it and strives to subordinate the lives of his loved ones to it. Not only he himself, but also everyone at home becomes, to one degree or another, slaves to this stereotype. The established order must be observed by everyone with absolute precision: one regime, one environment, the same actions. The child becomes increasingly better at maintaining consistency: not only should the furniture be in its usual places, but there may also be demands that cabinet doors not be opened, that the same radio program always be on, that loved ones always address each other with the same words etc. Outside of this order, the child does not know how to do anything and is afraid of everything.

Fears are most clearly manifested in children of this group. They are less vulnerable than the children of the first group, but they firmly and permanently fix their fear, which may be associated with an unpleasant sensory sensation (sharp sound, harsh light, bright color), with a violation of the regime. They are generally extremely sensitive to situations of real or perceived threat. As a result, ordinary home life turns out to be filled with terrible things: such a child often refuses to wash himself, sit on the potty, or even enter the bathroom and toilet, because the water is noisy there, the pipes are rumbling; he is afraid of buzzing electrical appliances, slamming elevator doors, changing screensavers on the TV screen, ventilation holes; often very afraid of birds, insects, and domestic animals. He has an experience of failures - often when asked to try something, he shouts in horror: “you can’t”, “you don’t want”; He also resists attempts to complicate interaction.

It is clear that he has something to protect and something to defend against. Constantly being in conditions of numerous fears, having life skills suitable only for a small set of everyday situations, such children strive to maintain stability in the environment and resist any innovation. This is no longer just an attempt to escape, this is a desperate defense of oneself, which can turn into generalized aggression, when the child scratches, bites, fights off with screams with his head, legs, arms and everything that comes to hand. However, if the situation remains hopeless, aggression here too easily turns on itself, becoming dangerous to the life and health of the baby. It is especially difficult that the reaction of self-aggression can be fixed and become habitual for the child. It is extremely difficult to distract, calm, and console him in these moments of despair.

Such children develop the most active and sophisticated methods of autostimulation. They are captured by motor and speech stereotypies, constantly busy with monotonous manipulations with objects, and the child’s activity in such manifestations increases with any violation of his life stereotype, with any “outside” intrusion into his established life: he actively drowns out unpleasant impressions with the help of autostimulation.

It is also characteristic that with selective attention to individual sensations of their body, children in this group begin to specifically highlight and use in autostimulation impressions associated with the sphere of innate drives. We can understand some of these drives, but much, apparently, is an echo of such ancient or so infantile aspirations that it is difficult for us to clarify their original affective meaning: attempts to grab the hair, the desire to cling to the legs, tearing the arm, masturbation, sniffing are possible , extracting a variety of oral sensations. Attractions are part of the behavioral problems of such children; they extremely confuse parents and become a source of conflict.

It cannot be said that the children of this group are not attached to their loved ones. Quite the contrary, they feel dependence on adults to the greatest extent. They perceive their loved one as a prerequisite for their life, its core, they strive to control his behavior in every possible way, try not to let him go from them, force him to act only in a certain, familiar way (we have already said that such a relationship is called symbiotic). On this basis, a situation of chronic conflict and anxiety is often formed, autostimulation, aggressive and self-injurious actions are provoked. Self-injury can take extremely severe forms.

When separated, such children demonstrate a catastrophic behavioral regression and can become detached and indifferent, like the children of the first group. At the same time, it is a loved one, working taking into account the existing life stereotype, who can help the child gradually smooth out the disproportion in the development of positive and negative selectivity and establish an emotional connection with him. On such a basis, the opportunity opens up to make the child’s relationship with the world more active and flexible.

Children third group It is also easiest to distinguish by external manifestations, primarily by methods of autistic defense. Such children no longer seem detached, no longer desperately rejecting their surroundings, but rather hyper-captivated by their own persistent interests, manifested in a stereotypical form.

In this case, parents are forced to seek help from specialists not because of a lag in speech or intellectual development, but due to difficulties in interacting with such a child, his extreme conflict, his inability to give in, to take into account the interests of another, preoccupation with the same things. activities and interests. For years, a child can talk on the same topic, draw or act out the same story. Parents are often worried that he likes to be scolded, he tries to do everything out of spite. The content of his interests and fantasies is often associated with terrible, unpleasant, asocial phenomena.

Outwardly, such children look very typical. The child’s face, as a rule, retains an expression of enthusiasm: sparkling eyes, a frozen smile. It seems that he is addressing his interlocutor, but he is an abstract interlocutor. The child looks at you intently, but in essence does not mean you; he speaks quickly, chokingly, not caring about being understood; his movements are uniformly impetuous and exalted. In general, this exaggerated animation is somewhat mechanical in nature, but during examination such children can make a good impression with their brilliant, emphatically “adult” speech, large vocabulary, complex phrases, and their interests can be highly intellectual.

Although children of this group create many problems for their loved ones and need constant help in adjusting their development, nevertheless, they initially have more " Greater opportunities for developing active relationships with the environment and people. They are no longer just selective in their contacts with the world, they can define a goal for themselves and develop a complex program of action to achieve it. The problem for such a child is that his program, with all its possible complexity, does not adapt flexibly to changing circumstances. This is an extended monologue - the child cannot adaptively take into account changes in the world around him and clarify his actions. This is especially noticeable in speech: the child does not take into account the presence of the interlocutor at all, does not know how to listen to him, does not strive to give him the necessary information, does not hear questions, and does not respond to messages. If the implementation of his plan to influence the environment and people is disrupted, this can lead to a destructive breakdown in behavior.

Perceptual and motor development are also impaired, but to a lesser extent compared to other groups. These are motorically awkward children: there are disturbances in the regulation of muscle tone, poor coordination of movements of the torso, arms and legs, a heavy gait, absurdly splayed arms; they can fly into objects, and in general they often do not fit well into free space. Difficulties manifest themselves in both “gross” and “fine” manual motor skills. These intelligent children, surprising with their knowledge, are striking in their inability to adapt to everyday life - even by the age of six or seven they may not have developed the simplest habits of self-care. They do not imitate anyone, and it is possible to teach them motor skills only by using their own hands, setting a ready-made form of the skill from the outside: posture, tempo, rhythm, coordination of movements, timing " yu sequence of actions.

They often refuse to learn and don’t even want to try something new. Their active negativism is associated with both a fear of difficulties and a reluctance to feel inadequate. But if in the second group, as a response to failure, we discovered a panicky fear of failure, even to the point of self-injury, here we encounter active negativism, which, as we grow older, can be “rationally” justified. The real goal here is to try to shift the responsibility for your reluctance to do something onto your loved ones.

Such children are much less focused on individual sensations of their body, on external sensory impressions - therefore, they have much less motor stereotypies, and do not have the dexterous and precise movements and skillful manipulations with objects that are characteristic of the second group, aimed at autostimulation.

The uniqueness of such children is especially evident in their speech. First of all, these are generally very “verbal” children. They gain a large vocabulary early and begin to speak in complex phrases. However, their speech gives the impression of being too adult, “bookish”; it is also absorbed with the help of quotations (albeit quite complex and extensive), widely used in a slightly modified form. An attentive person can always trace the bookish origin of the phrases they use or find corresponding prototypes in the speech of loved ones - it is because of this that children’s speech produces such an unnaturally adult impression. However, compared to the children of the groups described above, they are more active in mastering speech forms. This is expressed, for example, in the fact that, although with a delay, but earlier than children of the second group, they begin to correctly use the first person forms: “I”, “me”, “mine”, and coordinate verb forms with them.

However, this speech, so rich in possibilities, also serves little communication. The child is able to express his needs in one way or another, formulate intentions, convey impressions, and may even answer a separate question, but you cannot talk to him. The most important thing for him is to speak his monologue, and at the same time he completely does not take into account the real interlocutor.

Lack of focus on communication is also manifested in a peculiar intonation. The child speaks very unintelligibly. The regulation of tempo, rhythm, and pitch is impaired. He speaks without intonation pauses, monotonously, quickly, choking, swallowing sounds and even parts of words, the pace increasingly accelerates towards the end of the statement. Unintelligible speech becomes one of the important problems in a child’s socialization.

The child of the third group is less focused on the sensory texture of speech; he is not characterized by playing with words, sounds, rhymes, or being fascinated by speech forms. Perhaps one can only note the special pleasure with which such a child pronounces complex speech periods, exquisite introductory sentences, normally inherent in adult, and literary, speech. It is with the help of speech that the main methods of autostimulation are carried out. It is used to pronounce and live in verbal form the stereotypical plots of the child’s autistic fantasies.

The development of thinking in these seemingly intellectually gifted children (they can score very high on a standard examination) is impaired and, perhaps, most distorted. Living, active thinking aimed at mastering new things does not develop. A child can identify and understand individual complex patterns, but the trouble is that they are separated from everything else happening around him; it is difficult for him to let the entire unstable, changing world into his consciousness.

These smart children often show great limitations and lack of understanding of what is happening. Often they do not feel the subtext of the situation, show great social naivety, and experience a feeling of painful uncertainty when trying to simultaneously perceive several semantic lines in what is happening.

The ability to easily perform mental operations becomes for them a source of impressions for autostimulation. They find pleasure in the stereotypical reproduction of individual impressions associated with pronouncing logical and drawing spatial diagrams, mathematical calculations, playing chess compositions, collecting information from the field of astronomy, genealogy, other sciences and branches of abstract knowledge.

The autistic defense of such a child is also the defense of a stereotype. However, unlike the child of the second group, he is not so attentive to the detailed preservation of the constancy of the environment; for him it is more important to defend the inviolability of his behavior programs. He can even bring something new into his life if it happens under his complete control, but he is not able to accept something new if it is unexpected, if it comes from someone else. On this basis, most conflicts between loved ones and such children arise, and corresponding attitudes of negativism are formed. Aggression is also possible. Although in such a child it is most often verbal, the intensity of his aggressive experiences and the sophistication of his reasoning about what he will do to his enemies can be very difficult for his loved ones.

Autostimulation has a special character here. The child does not drown out unpleasant and frightening impressions, but, on the contrary, invigorates himself with them. It is with such impressions that his monologues and drawings of the same type are most often associated. He talks all the time about fires, bandits or garbage dumps, draws rats, pirates, high-voltage lines with the inscription: “Don’t get involved - he’ll kill you!” His intellectual interests, as a rule, are also initially associated with the fright he experienced. For example, an interest in electrical engineering often grows out of an interest in a dangerous and forbidden electrical outlet.

And the point here is not a strange perversity, paradoxicality of desires. In fact, this is also a very vulnerable child. The point is that he has already partially experienced this trouble, he is not so afraid of it and enjoys the feeling of some control over the danger. This is reminiscent of a kitten playing with a half-strangled mouse. A normal child also needs the feeling of victory over danger, liberation from fear, but he receives them in real achievements, in the process of mastering the world. An autistic child uses the same limited set of his half-experienced fears for autostimulation.

He can be very attached to his loved ones. For him they are guarantors of stability and security. However, relationships with them are usually difficult: the child is not capable of dialogue and strives to completely dominate the relationship, tightly control it, and dictate his will. This means that, although in general he may love his loved ones, he is often unable to respond to their immediate reaction, to give in to them, to feel sorry for them: such behavior would violate the typical script he has developed. At the same time, the loved one, having found a suitable role for himself in this scenario, becomes able to help the child work out the elements of dialogue and facilitate the organization of voluntary forms of behavior.

For children fourth group autism in its mildest form is inherent. What comes to the fore here is no longer protection, but increased vulnerability, inhibition in contacts (i.e. contact stops when the slightest obstacle or opposition is felt), underdevelopment of the forms of communication themselves, difficulties in concentrating and organizing the child. Autism, therefore, appears here no longer as a mysterious withdrawal from the world or its rejection, not as absorption in some special autistic interests. The fog clears, and the central problem is highlighted: the lack of opportunities to organize interaction with other people. Therefore, parents of such children come with complaints not about difficulties in emotional contact, but about delayed mental development in general.

These are physically fragile children who tire easily. Outwardly, they may resemble children of the second group. They also look stiff, but their movements are less tense and mechanical, rather they give the impression of angular awkwardness. They are characterized by lethargy, but it is easily replaced by overexcitation. Their faces often show an expression of anxiety, confusion, but not panic. Their facial expressions are more adequate to the circumstances, but are also “angular”: there are no shades, smoothness, or natural transitions; sometimes it resembles a change of masks. Their speech is slow, their intonation fades towards the end of the phrase - this is how they differ from children of other groups: for example, chanting is typical for the second group, and choking patter is typical for the third group.

A clear difference from other children with autism is their ability to make eye contact, through which they take the lead in communication. The gaze of the children of the first group smoothly escapes us; children of the second group, accidentally meeting someone’s gaze, turn away sharply, scream, and cover their faces with their hands; third - they often look into the face, but in reality their gaze is directed “through” the person. Children of the fourth group are clearly able to look into the face of their interlocutor, but contact with him is intermittent: they stay close, but can half-turn away, and their gaze often floats to the side, only to then return to the interlocutor again. In general, they are drawn to adults, although they come across as pathologically timid and shy.

Mental development here is distorted to the least extent, and its multiple disorders come to the fore. Difficulties in mastering motor skills are observed: the child gets lost, imitates without much success, and does not grasp movements. There are also problems with speech development: he clearly does not understand instructions, his speech is poor, slurred, and ungrammatical. His lack of understanding in the simplest social situations is also obvious. These children are clearly losing, they seem to be retarded not only in comparison with the children of the third group with their developed speech and intellectual interests, but also in comparison with the children of the second - with their individual abilities and skills, and even in comparison with the self-absorbed, smart children of the first group. The faces of children in the fourth group show, first of all, timidity and tense confusion.

However, we must always remember that they show ungrammaticality, awkwardness, and lack of understanding in attempts to enter into dialogue, into real interaction with other people, while others are primarily busy with defense and autostimulation. Thus, children of the fourth group experience difficulties when trying to establish contact with the world and organize complex relationships with it.

An idea of ​​their potential capabilities can be given by manifestations of their individual abilities, usually associated with the non-verbal sphere: music or design. It is important that these abilities manifest themselves in a less stereotypical, more creative form, for example, a child really actively masters the piano keyboard and begins to reproduce different melodies by ear. Hobbies remain constant, but within them the child is less stereotypical, which means he is more free and more involved in creativity.

Such children, if they are in normal conditions, do not develop special autistic defenses. Of course, they are also sensitive to changes in environment and feel better in stable conditions; their behavior is inflexible and monotonous. However, the stereotypical nature of their behavior is more natural and can be considered as a special pedantry, an increased passion for order. And the very order that the child strives for is more understandable to us. He tries to literally follow the rule he knows, to do everything as the adults close to him taught him. These are very “correct” children: it is impossible for them to talk or deceive in order to justify themselves. It is their over-correctness, over-orientation toward adults that is often perceived as stupidity. Such a child strives to build all his relationships with the world through an adult. With tension, he tries to read on our face: “What do you think is right?”, “What answer do you expect from me?”, “What should I do to be good?”

Forms of autostimulation have not been developed here - it is this feature that most clearly distinguishes children of the second and fourth groups. Motor stereotypies can only arise in a tense situation, but even in this case they will not be sophisticated. Tension is more likely to manifest itself in particular restlessness, fussiness of movements, and a decrease in the ability to concentrate. Calming and toning is achieved here in a more natural way - by turning to a loved one for support. Such children are extremely dependent on emotional support, constant confirmation that everything is okay. When separated from loved ones, they can develop forms of autostimulation characteristic of the second group.

Children of the fourth group can often be assessed as ordinary children with mental retardation. However, work aimed only at correcting their cognitive difficulties does not solve their problems, but, on the contrary, often fixes their difficulties. Here, special correctional efforts are needed, which should concentrate on the common core of affective and cognitive problems. The development of voluntary interaction must be combined with work to free the child from overdependence on the adult. Such assistance can give a powerful impetus to the mental development of the child, and if it is organized correctly, such children have the best prognosis for social development.

The syndrome of early childhood autism, as mentioned above, is formed as a result of a special violation of the mental development of the child and manifests itself in various variants, reflecting the depth of this disorder and the corresponding degree of adaptation of the child to the world around him.

Those problems that obviously confront parents of autistic children during the period when the syndrome is already evident and force them to turn to specialists do not arise suddenly. However, quite often the child’s relatives get the impression that in the first or second year of life he developed quite normally. And the point here is not that loved ones are not attentive enough. If we focus on the most well-known formal indicators of mental development, as is usually done not only by parents, but also by most pediatricians who regularly monitor a child at an early age, it turns out that in infancy in autistic children such indicators often actually fall within the normal range, and sometimes in some respects they exceed it. As a rule, anxiety occurs at the end of the second – beginning of the third year of a child’s life, when it turns out that he is making little progress in speech development, or, in the most severe cases, is gradually losing speech. Then it becomes noticeable that he does not respond sufficiently to requests, has difficulty engaging in interaction, does not imitate, and is not easily distracted from the activities that absorb him, which are not always clear to his parents, or switch to another activity. He begins to differ more and more from his peers, does not seek to interact with them, and if attempts at contact occur, they are increasingly unsuccessful.

Having analyzed numerous information about the first months of life of autistic children of various groups, we saw the presence of specific features that distinguish autistic development from normal development. Moreover, already in the early stages of an autistic child’s life, trends appear that are characteristic of the formation of one or another group of early childhood autism.

Below we will try to present the development stories typical for each of the four groups.

First group. Parents' memories of the first year of life of such children are usually the brightest. From an early age, they amazed those around them with their attentive, “smart” look, adult, very meaningful expression on their faces. Such a child was calm, “comfortable”, quite passively obeyed all the regime requirements, was plastic and pliable to his mother’s manipulations, and obediently took the desired position in her arms. He began to react early on to an adult’s face, to respond with a smile to his smile, but did not actively demand contact, and did not ask to be held.

Here are some typical descriptions of such children by loved ones in the early stages of their development: “radiant boy”, “radiant child”, “very sociable”, “real movie star”. These descriptions indicate that the child was easily infected from any smiling adult, from communication between adults, from lively conversation around him. This is a mandatory initial stage of normal emotional development (usually lasting up to three months), after which selectivity in communication, expectation of support, encouragement from an adult, and a clear distinction between friends and others should appear. Here, throughout the entire first year of life, there was no further development of the initial stage of infection: the child could calmly go into the arms of a stranger, he did not develop “fear of strangers,” and later such a baby could easily walk away hand in hand with a stranger.

Such a child, up to a year old, never put anything in his mouth; he could be left alone in a crib or playpen for quite a long time, knowing that he would not protest. He didn’t actively demand anything and was “very tactful.”

At the same time, according to the recollections of many parents, it was these children who, at a very early age, showed special sensitivity (sensitivity) to sensory stimuli of increased intensity, especially to sounds. The baby could be frightened by the buzz of a coffee grinder, an electric razor, the noise of a vacuum cleaner, or the crackling sound of a rattle. However, these impressions were not recorded for long. And already in the second or third year of life, he had paradoxical reactions to strong stimuli, for example, a lack of response to cold or pain. There is a known case when a girl pinched her finger very badly and did not let anyone know about it - the father realized what had happened only when he noticed that the finger had turned blue and swollen. Another child jumped out into the street naked in the winter at the dacha, could climb into icy water, and his parents did not have the feeling that he was ever cold. A pronounced reaction to a loud sound may also disappear (which is especially typical in the first months of life), so much so that the baby’s relatives sometimes suspect that his hearing is declining.

From an early age, such children looked like contemplators. They did not actively use toys; even before they were one year old, they showed a special interest in books and loved listening to good poetry and classical music. Parents often talk about their child’s “good taste”, their preference for talented poetic or musical creations, and exquisite illustrations. Early on, a special fascination with light and movement manifested itself: the child studied the glare, played with his shadow.

Parents' early concerns arose closer to two years of age. The first serious problems were discovered when the child began to move independently. Relatives often recall that, having stood firmly on his feet, he immediately ran. The previously passive, calm, peaceful baby became almost uncontrollable. He desperately climbed over furniture, climbed onto window sills, ran away in the street, without looking back and completely losing the sense of real danger.

With the normal development of a child, this age period is also critical: after the first year of life, any baby is strongly influenced by the surrounding sensory field (the entire complex of sensory impressions). It is at this age that he constantly pulls out and pushes drawers of a table or cabinet, cannot help but get into a puddle, smears food on the table, runs along the path, etc. It is quite difficult for an adult to control his behavior in such situations. However, previous experience of sharing common impressions helps. Using this experience, loved ones manage to switch the child’s attention to some other phenomenon that is significant for him: “Look at...”, “There’s a bird flying,” “Look, what a car,” etc. An autistic child has a similar experience does not accumulate. He does not react to adults’ calls, does not respond to names, does not follow the pointing gesture, does not look into his mother’s face, and he himself increasingly looks away. Gradually his behavior becomes predominantly field.

Second group. Even in infancy, children in this group have many more problems associated with caring for them. They are more active, more demanding in expressing their desires, more selective in their first contacts with the outside world, including with loved ones. If a child of the first group passively submits in the usual daily procedures of feeding, dressing, putting to bed, etc., then this child often dictates to the mother how he should be treated, even becoming a despot in his demands for a certain regime of self-care. Therefore, the first stereotypes of a child’s interaction with his immediate environment are formed very early and very rigidly.

Such a baby begins to distinguish his mother early, but the attachment that is formed in relation to her is in the nature of a primitive symbiotic relationship. The constant presence of his mother is necessary for him as the main condition of existence. Thus, a seven-month-old girl, when her mother left for several hours, vomited and had a fever, although she remained with her grandmother, who lived with them constantly. Of course, at this age, even an ordinary child acutely experiences even a short separation from a loved one, but he does not react so catastrophically - on a somatic level. With age, this tendency does not smooth out, but, on the contrary, sometimes intensifies. Often the mother cannot get out of the baby’s field of vision at all - to the point that it turns out to be impossible even to close the door to the toilet.

Commitment to constancy and stability in relationships with the environment is also characteristic of the first months of development of a normal child (it is known that at the age of two months the baby is very sensitive to adherence to the regime, is especially attached to the hands of the caregiver, and reacts heavily to changes), but gradually everything is adjusted greater flexibility in his relationship with his mother, and through her, with the outside world. This does not happen in an autistic child.

Early selective fixation of not only the necessary sensory impression, but also the method of obtaining it, is especially characteristic of a child in this group. This is how extreme stability of a limited set of its possible contacts with the environment is created and maintained over a long period of time. A pronounced tendency to maintain constancy in such a child is detected in almost all manifestations of his activity even before one year, and at the age of 2–3 years it already looks like a pathological symptom. By this time, a certain set of habitual actions has accumulated that make up the child’s every day, and which he does not allow to change: the same walking route, listening to the same record or book, eating the same food, using the same words, etc. Sometimes quite complex rituals are formed, which the child necessarily reproduces in certain situations, and they can look quite ridiculous and inadequate. For example, a two-year-old girl had to spin around in a certain place in a bookstore, holding a long cucumber or loaf of bread in her hands.

The child of this group is especially sensitive to compliance with the regime with all its smallest details. Thus, during a single attempt to replace breastfeeding with feeding with expressed milk, the baby not only refused to eat, but screamed during the hours coinciding with the time of this unsuccessful substitution, every day for two months. In infancy, every child prefers a certain form of pacifier, one, the most comfortable and familiar, sleeping position, a favorite rattle, etc. However, for an autistic child of this group, maintaining habits is the only acceptable way of existence, their violation is comparable to a threat to life. For example, the loss of a favorite pacifier (or the fact that it was chewed through) turns into a serious tragedy due to the fact that it was not possible to get a similar one; The inability to fit into a stroller - the only place in which a child slept from birth to three years - leads to serious disruption of the baby's sleep. In the future, the introduction of complementary foods often turns out to be a significant problem: these are children with the greatest selectivity in food.

From an early age, a child of this group shows special sensitivity to the sensory parameters of the surrounding world. Very often, already before the age of one year, there is increased attention to the color, shape, and texture of surrounding objects. At first, such subtlety of perception can give rise to a feeling among the child’s loved ones of his good intellectual development. Thus, parents often tell us how the child himself wonderfully arranges cubes, rings from pyramids, and pencils by color, although it seems that he was not specifically taught this; remembers well and shows letters, numbers, countries on the world map; demonstrates excellent musical memory, reproducing quite complex rhythms and melodies (such singing, or rather intonation, is possible in a child under one year old); remembers poetry perfectly and protests when any word is replaced in them. Before reaching two years of age, such children, for some reason, can accurately get their favorite book from a shelf, are well versed in the TV buttons, etc. Their sense of form is sometimes expressed to such an extent that a two-year-old child can, for example, distinguish in ordinary the objects surrounding him, the shape of a ball hidden in them; see geometric shapes everywhere, even on the fabric of my mother’s dress; everywhere, right down to the dandelion stem, look for the “tubes” that interest it.

At the same time, such sensitivity to sensory sensations already at an early age gives rise to quite complex and diverse forms of autostimulation in children of the second group. The earliest of these, which parents notice in the first year of life, are rocking, jumping and shaking the arms in front of the eyes. Then, a special concentration gradually increases on the sensations of tension in individual muscles and joints, freezing in a characteristic position upside down. At the same time, it begins to attract teeth grinding, masturbation, playing with the tongue, with saliva, licking, sniffing objects; the child searches for certain tactile sensations arising from the surface of the palm, from the texture of paper, fabric, from sorting or delaminating fibers, squeezing plastic bags, turning wheels, lids, saucers.

A certain period of normal development of an infant (up to 8-9 months) is characterized by repeated monotonous manipulations with objects, as if provoked by their sensory properties - primarily shaking and knocking. These are so-called circular reactions, aimed at repeating the once received sensory effect; with their help, the baby begins an active exploration of the world around him. Even before a year, they naturally begin to give way to more complex forms of examination, which already take into account the functional properties of toys and other objects. The autistic child of the second group is so captivated by certain sensory sensations that his circular reactions are fixed: for example, he does not try to carry or load the car, but continues for a number of years to turn the wheels or hold a wound up toy in his hands; does not build a tower of cubes, but stereotypically arranges them in a monotonous horizontal row.

With the same force as a positive one, such a child also fixes a negative impression once received. Therefore, the world around him is painted in very contrasting colors. Numerous fears arise extremely easily at an early age and remain relevant for a number of years. They are generated primarily by stimuli associated with an instinctive feeling of threat (caused, for example, by some sudden movement in the direction of the child, getting his head stuck or fixing his body when dressing, a feeling of pain, an unexpected “break” in space: a step of a staircase, a hatch opening, etc.) etc.), so the reaction of fear itself is quite natural. What is unusual here is the severity of this reaction and its irresistibility. Thus, one boy, even in infancy, was afraid of birds unexpectedly flying up from under his stroller, and this fear was recorded for many years.

The special sensitivity of such children to sensory stimulation is the reason that fears can be caused both by stimuli of increased intensity - a loud sound (rumbling of pipes, the sound of a jackhammer), bright colors, and unpleasant sensations, although of low intensity, but of that variety (for example, tactile ), to which sensitivity is especially high. One can imagine how uncomfortable the usual procedures for caring for a small child are under such conditions. Fears of the potty, washing hair, cutting nails, hair, etc. often arise early and become firmly established.

But the worst thing for him is to break the stereotype of daily behavior and perception. He perceives such a danger as vital (threatening his very life). This could be moving to the country, rearranging the furniture in the apartment, the mother going to work, hospitalization for some somatic indicators, or placement in a nursery. In such cases, a very severe reaction is common: sleep disturbance, loss of skills, regression of speech, increased self-stimulation that drowns out the experience, the appearance of self-injury (hitting oneself on the head, banging one’s head against the wall, etc.).

While the child is under the constant care of his mother, who supports the established set of possible ways of interaction for him, who knows his affections and fears, and understands his desires, he is sufficiently protected from threatening moments. His behavior is basically predictable - and just as every mother understands when to give the potty to a child who is not asking for it, so the mother of a child in this group knows when and how to prevent his possible affective breakdown. Therefore, it is no coincidence that relatives usually do not complain about problems at home: the main difficulties begin when the child finds himself in less stable and more difficult situations. The frequency of the latter inevitably increases in the child’s second year of life: going out on a visit, traveling by transport, colliding with other children on the playground, etc. All his negative experiences are firmly recorded in the child’s memory, while, on the one hand, inhibition and anxiety, on the other – negativism. Thus, by the age of 2–3 years, he is increasingly encapsulated within his limited set of stereotypes of interaction with the environment and is fenced off from the latter by an abundance of autostimulatory actions.

Third group. According to the recollections of the parents, the children of this group also showed quite obvious sensory vulnerability in the first year of life. Serious diathesis and a tendency to allergic reactions were often noted. In the first months of life, the child could be whiny, restless, have difficulty falling asleep, and could not be easily calmed down. He also felt uncomfortable in his mother’s arms: he was spinning or very tense (“like a column”). Increased muscle tone was often noted. The impetuosity, abruptness of movements, and motor restlessness of such a child could be combined with a lack of “sense of edge.” For example, one mother said that the baby had to be tied to the stroller, otherwise he would hang out of it and fall out. At the same time, the child was timid. Because of this, it was sometimes easier for a stranger to put him in order than for someone close to him: for example, the mother could not calm the baby down after an appointment at the children's clinic, but a passing nurse easily did it.

A child of the third group identifies loved ones early, and especially his mother, and unconditionally becomes attached to her. But it is precisely in the stories of children in this group that most often there are concerns and experiences of loved ones that there is not enough tangible emotional return from the baby. Usually his activity in emotional manifestations is expressed in the fact that he doses them himself. In some cases, by maintaining a distance in communication (such children are described by their parents as unaffectionate, cold: “he will never rest his head on his shoulder”); in others, dosing is carried out through limiting the time of contact (the child could be emotional, even passionate, give an adoring look, but then suddenly abruptly stop such communication, not reciprocating the mother’s attempts to support him).

Sometimes a paradoxical reaction was observed when the child seemed to be guided by the intensity of the influence, and not by its quality (for example, a five-month-old baby could burst into tears when his father laughed). When adults tried to actively influence the child and eliminate the existing distance in contacts, early aggression often arose. Thus, a child even before one year old could try to hit his mother when she took him in her arms.

When these children gain the opportunity to move independently, they are uncontrollably captured by field behavior. But if we can say about a child of the first group that he is fascinated by the sensory field as a whole, then a child of the third group is attracted by individual impressions, and special drives are recorded early in him. Such a child is impetuous, exalted, he does not see real obstacles to achieving what he wants. So, one boy, walking down the street at the age of two, ran from tree to tree, passionately hugged them and exclaimed: “My favorite oaks!” Another child at about the same age took his mother to each entrance to get into the elevator there. A typical desire is to touch every passing car.

When an adult tries to organize such a child, a violent reaction of protest, negativism, and acts of spite arises. Moreover, if the mother reacts to this quite sharply herself (gets angry, upset, shows that it hurts her), such behavior is reinforced. The child strives again and again to receive that acute sensation, fused with fear, which he experienced during the vivid reaction of an adult. Children in this group usually experience early speech development, and they actively use speech to enhance such autostimulation: they tease loved ones, utter “bad” words, and act out possible aggressive situations in speech. At the same time, such a child is characterized by accelerated intellectual development; he develops “adult” interests early – in encyclopedias, diagrams, counting operations, and verbal creativity.

Fourth group. In the most “prosperous” children of the fourth group, the early stages of development are as close as possible to the norm. However, in general, their development appears to be more delayed than that of children in the third group. First of all, this concerns motor skills and speech; A general decrease in tone and slight inhibition are also noticeable. A significant time gap between walking by the hand or with support (the child learns this in time) and moving independently is very typical.

Such children early identify their mother and, in general, the circle of people close to them. Fear of strangers appears in a timely manner (at the age of about seven months), and it can be very pronounced. A typical reaction of fear is to an inadequate or simply unusual expression on the face of an adult, or to the unexpected behavior of a peer.

Children of this group are affectionate and affectionate in their emotional contacts with their families. They, like the children of the second group, are in a very close connection with their mother, but this is no longer a physical symbiosis, but an emotional one, when you need not just the presence of a loved one, but also constant emotional toning with his help. There is no dosage of contact here, as in the third group; on the contrary, from an early age and then constantly, such a child demonstrates the need for expressed support and approval from parents. He is overly dependent on those close to him in adopting external manners and intonations of speech. Usually, an imprint of the mother’s manner of speaking is clearly visible - even boys can retain the use of the first person in the feminine gender in their speech for a long time.

However, despite such overdependence, a child of the fourth group, not even one year old, refuses the interference of loved ones in his activities; It is difficult to teach him anything; he prefers to figure out everything himself. The parents of one boy very accurately established that he can be calmed, but cannot be distracted. Here is a typical description of such a child under one year old: affectionate, affectionate, restless, fearful, inhibited, disgusted, conservative, stubborn.

In the second or third year, parents begin to worry about delayed speech development, motor awkwardness, slowness, and lack of tendency to imitate. When trying to purposefully interact with him, the child very quickly becomes fed up and tired. At the same time, he himself can engage in some of his own manipulations and games for a long time. Even at the age of one, such a child can fall asleep in front of a construction set, assembling his building until he is completely exhausted, or endlessly look out of the window at moving trains, or turn the lights on and off, or wind up the spinning top. Attempts by parents to more actively organize the child are met with stubbornness, increasing negativism, and refusal to interact. A negative assessment from a loved one only slows down his activity and can provoke manifestations of physical self-aggression. The fear of being incompetent, of experiencing disapproval from adults, of being rejected by other children contributes to the development of constant anxiety, mild inhibition, and the desire to live in stereotypical conditions.

In the previous sections, the reader became acquainted with the characteristics, problems and capabilities of autistic children; To conclude this part of the book, we would like to specifically focus on the difficulties of their parents.

First of all, it should be said that a specialist working with an autistic child should also be aware of the special vulnerability of his loved ones. The intensity of their experiences makes families of autistic children stand out even compared to families with children with other severe developmental disorders. And there are quite objective reasons for this. One of them is that awareness of the gravity of the child’s situation often comes suddenly. Even if alarms exist, specialists usually do not take them into account for a long time, assuring that nothing unusual is happening. The difficulties of establishing contact and developing interaction are balanced in the eyes of parents by calming impressions that evoke the child’s serious, intelligent look and his special abilities. Therefore, at the time of diagnosis, the family sometimes experiences severe stress: at three, four, sometimes even five years old, parents are informed that their child, who was until now considered healthy and gifted, is in fact “unteachable”; Often they are immediately offered to register for disability or be placed in a special boarding school.

The state of stress for a family that continues to “fight” for their child often becomes chronic from this point on. In our country, this is largely due to the absence of any system of assistance for autistic children, and the fact that children with unusual, complex behavior “do not fit in” in existing child care institutions. It is not easy to find a specialist who would undertake to work with such a child. Locally, as a rule, they do not undertake to help such a child - they not only have to travel far, but also wait for months until it is time for consultation.

Moreover, the family of an autistic child is often deprived of moral support from acquaintances and sometimes even close people. In most cases, those around them know nothing about the problem of childhood autism, and it can be difficult for parents to explain to them the reasons for the child’s disordered behavior, his whims, and to deflect reproaches for his spoiled behavior. Often, a family is faced with unhealthy interest from neighbors, hostility, and aggressive reactions from people in transport, in a store, on the street, and even in a child care facility.

But even in Western countries, where there is better support for such children and there is no problem with a lack of information about autism, families raising an autistic child also find themselves suffering more than families with a child with mental retardation. In special studies conducted by American psychologists, it was found that stress is most manifested in mothers of autistic children.

Not only do they experience excessive restrictions on personal freedom and time due to the overdependence of their children, but they also have very low self-esteem, believing that they are not fulfilling their role as mothers well enough.

This self-perception of the mother of an autistic child is quite understandable. From an early age, the child does not encourage her, does not reinforce her maternal behavior: does not smile at her, does not look into her eyes, does not like to be held; sometimes he doesn’t even single her out from other people, doesn’t give any visible preference in contact. Thus, the child does not bring her sufficient emotional response, the immediate joy of communication, which is usual for any other mother and more than covers all her hardships, all the fatigue associated with daily worries and anxieties. Therefore, her manifestations of depression, irritability, and emotional exhaustion are understandable.

Fathers tend to avoid the daily stress of raising an autistic child by spending more time at work. However, they also experience feelings of guilt and disappointment, although they do not talk about it as clearly as mothers. In addition, fathers are concerned about the severity of the stress that their wives experience; they face special financial burdens in providing care for a “difficult” child, which are felt even more acutely due to the fact that they promise to be long-term, in fact lifelong.

The brothers and sisters of such children grow up in a special situation: they also experience everyday difficulties, and parents are often forced to sacrifice their interests. At some point, they may feel deprived of attention and feel that their parents love them less. Sometimes, sharing the concerns of the family, they grow up early, and sometimes they “go into opposition”, forming special defensive personal attitudes, and then their alienation from the concerns of the family becomes an additional pain for their parents, which they rarely talk about, but which they feel acutely.

The vulnerability of a family with an autistic child increases during periods of age-related crises and at those moments when the family passes certain critical points in its development: the child enters a preschool institution, school, or reaches adolescence. The onset of adulthood, or rather, the events that mark it (receiving a passport, transferring to an adult doctor, etc.), sometimes causes the same stress for the family as making a diagnosis.

Attempts to provide professional psychological support to such families began to be made only recently, and so far they are sporadic. We are convinced that such support should develop primarily as help to the family in its main concerns: raising and introducing a child with autism into life. The main thing here is to give parents the opportunity to understand what is happening with their child, help establish emotional contact with him, feel their strength, learn to influence the situation, changing it for the better.

In addition, it is generally useful for such families to communicate with each other. They not only understand each other well, but each of them has their own unique experience of experiencing crises, overcoming difficulties and achieving success, mastering specific techniques for solving numerous everyday problems.