Autism intervention is a long road, many parents intervene for a period of time without seeing progress, began to wonder, am I going in the wrong direction? Or is it time to change institutions? Is it that the optimal intervention time has not worked...
Parents don't panic, this time we have collected everyone's concerns, and visited Professor Zou Xiaobing, director of the Child Behavior Development Center of Zhongshan Third Hospital.
Text/Zou Xiaobing
General Consultant of R&D for Rice and Xiaomi
Director of the Center for Child Development and Behavior of Zhongshan Third Hospital
01
Is there really an optimal time for autism?
Rice and millet: Is there an optimal time for autism?
Zou Xiaobing: Of course, the earlier the autism intervention, the better, in general, the intervention effect is relatively better for those under 6 years old. Children with severe autism are more desirable to start the intervention before the age of 3.
But it is not after the age of 6 that the intervention has no effect.
The degree of each child is different, and it is difficult to define at what age it must be found and at what age to intervene.
Many mild autism may be diagnosed at the age of 7 or 8, or even 10 or 20, and some children can be diagnosed even before the age of one, so as soon as symptoms are found, they can start to intervene.
02
Symptoms of autism vary in severity
Rice and millet: Autism symptoms are different in severity, what is severe and what is mild?
Zou Xiaobing: Autism has two main symptoms, one is the defect of social interaction and communication, and the other is narrow interest and repetitive stereotypes. The latter now also contain paresthesias, i.e. hypersensitivity or excessive dullness.
When these two symptoms manifest themselves in specific behaviors, there is a difference in severity.
Like what:
The same is the social communication barrier.
Severe children may manifest themselves as not seeing, listening, pointing, not speaking, and behaving inappropriately. Children with a lesser degree may only behave as not looking at people's eyes when communicating with people, answering questions that are not asked, and repeatedly asking questions.
A severe child may be very old and completely unspoken, and a mild child may have language, but his language is one-way, self-centered, and when communicating, he only cares about what he says, whether others are interested or not.
Narrow interests and repetitive stereotypes can also be mild and heavy.
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the eleventh edition of the World Health Organization's Manual of Diagnostics of Diseases (ICD-11) both list relevant symptoms in the diagnostic criteria for autism.
ICD-11
03
The cause of the increased prevalence of autism
Rice and millet: The prevalence of autism is increasing year by year, what are the reasons for this?
Zou Xiaobing:
1. Scholars believe that the diagnostic criteria for autism have changed.
In the past, only severe symptoms such as complete absence of language and significantly backward development were diagnosed with autism. But according to the current diagnostic criteria (DSM-5), some children who have no speech barriers and who talk endlessly also have social communication disorders and can also be diagnosed with autism.
2. The improvement of the doctor's diagnostic level leads to the replacement of the diagnosis. Children who have been diagnosed with intellectual disabilities, developmental delays, hyperactivity or other problems in the past have been consulted by professional doctors and found that their core problem is actually social communication disorders, which should be diagnosed with autism.
3. Increase the level of public awareness. In the past 20 years, the popularization of autism science has become more and more, many people know the early manifestations of autism and autism, and will seek medical treatment in time after finding relevant symptoms, and the number of children who come to the hospital for treatment has increased significantly.
4. Some scholars believe that the absolute number of autistic people has increased, before 1980, the global autism incidence rate was between 20,000 and 4/10,000, which is a rare disease, after 1980, the United States, Europe, and even the world's autistic children are more and more, last year's U.S. statistics have reached 1/54.
However, the exact prevalence of autism is still unknown, the data in the United States has been changing even if it is a statistical two-year, and whether the absolute number of autistic people is really increasing needs further study.
Most scholars agree on the revision of diagnostic standards, the improvement of doctors' diagnostic standards, and the increase in public awareness.
Rice and millet: What about the causes of autism, is there any new progress?
Zou Xiaobing: At present, it is still an unsolved mystery, but two theories must be completely denied:
First, autism is caused by parental indifference. That is, the "refrigerator mother" theory, which has been proven wrong by many studies since 1970, autism is congenital and has nothing to do with the parenting of acquired parents.
Second, vaccine theory. In the late 1890s, a British scholar published an article in the authoritative medical journal The Lancet, saying that the increased incidence of autism was closely related to vaccination. But the paper is suspected of academic fraud, and subsequent studies have also proved that autism has nothing to do with vaccines.
There are also many environmental factors mentioned, environmental pollution, intestinal microbiota disorders, perinatal complications, nutritional problems, vitamin and mineral deficiencies, or pesticide use, premature low birth weight or maternal obesity, etc., scientists have studied and demonstrated, none of which can be determined to cause autism.
After 1980, scientists' research on the causes of autism focused on genes and heredity.
It is more certain that there is a genetic predisposition to autism, that is, autism is clustered in the family, if the first child in the family has autism, the second child is also autistic Probability may reach 10% to 20%.
Identical twins, one of whom has autism and the other is more than 80% more likely.
In addition, parents of autistic children and other members of the family can also find some autistic characteristics to a greater or lesser extent.
Some foreign scholars have proposed that children's behavior and parenting behavior affect each other to a certain extent, and parenting behavior of parents will affect children's development, and children's development will also affect the parenting behavior of parents. Under the premise of acknowledging genetic susceptibility, if parents can identify some of the early symptoms of autism and then help their children, it may affect the development of autism.
04
How to diagnose autism as early as possible
Rice and millet: how to do early detection and early diagnosis, what symptoms should parents focus on?
Zou Xiaobing: There are many early screening scales for autism, most of which are for children aged 1 or 1 and a half years. Most scholars believe that it is difficult or almost impossible to diagnose autism before the age of 1 year, but around the age of 1 and a half, experienced doctors can find clues to early autism.
The Child Development and Behavior Center of the Third Affiliated Hospital of Sun Yat-sen University also proposed a concise screening method, children around 1 and a half years old, if there are 5 "no' that do not see, should not, do not refer to, do not say, and do not do not, parents need to pay attention to whether the child has autism.
The child is not serious, but see less, less should, less finger, less language, the behavior problem is not big, or see, point, should, say a little bit, also need to pay attention to.
China is vast, there are many ethnic groups, the cultural differences and levels between parents are different, I recommend using "5 noes" to do early screening, parents are easy to operate and understand.
05
Difficulties and challenges in autism intervention
Rice and Millet: What do you think are the main difficulties and challenges of the current autism intervention?
Zou Xiaobing: The intervention of autism has basically formed a consensus in all countries in the world.
▲ Autism is a neurodevelopmental disorder that mainly affects children's social communication, and interventions must be socially centered.
▲ Interventions must be organized and planned, with personalized support tailored to each child's characteristics.
▲ Intervention is not just a matter for the institution, nor is it just a matter for a certain rehabilitator or a family member, and it requires everyone to work together and devote themselves wholeheartedly.
When parents intervene, they often encounter these difficulties:
1. Because the child lacks social communication instincts, the name should not be called, and the interaction and play with people are not, parents are easily helpless, and the patience is given up after repeated consumption.
2. As soon as the child is diagnosed, the parents have not yet acted, and they are frightened by the description of autism on the Internet that "this is a rare, untreatable, and serious mental disorder that occurs in infancy and childhood." People are broken, anxious, depressed, and families are in disorder.
3. Use various magical remedies as life-saving straws, and try what your child hears works. But these therapies are either harmful or ineffective, and ultimately delay the child's golden intervention time and prevent the child from getting the correct scientific intervention.
4. Children with a slight degree of autism, milder degrees, or children with a relatively severe degree in the early stages, but who have made greater progress after scientific intervention, can go to kindergarten, primary school, and even enter middle school, college, and society like ordinary children.
Although they still have autistic traits and some strange behaviors, if the environment is tolerant, understanding, and accepting, they can grow up healthy and happy, and slowly learn simple communication.
If they are discriminated against, isolated, or bullied, they are vulnerable to severe anxiety, depression, or other mental illness. Especially in adolescence, setbacks and blows are likely to re-emerge serious obstacles for children who were recovering well, depriving them of the ability to live and work independently.
5. Autism has a genetic predisposition, and many parents have some autism traits, which may make it difficult for parents to achieve the enthusiasm and enthusiasm required for intervention.
06
Interventions are largely socially focused
Rice and Millet: Is there any research data to support social-centered interventions? What is its core goal?
Zou Xiaobing: The intervention is socially centered on the recognition of the academic community and the support of research data. The early interventions being done in the United States, as well as the main autism therapies – key competency training, applied behavioral analysis, etc. – are all socially focused.
Some parents say that social intervention does not bring children to their peers? Do you talk to your child?
Not exactly. We come up with the concept of social ladders and social elements. From birth, each age stage has a corresponding developmental milestone, we call it a social element, and each level of socialization is composed of a social element.
For example, a 1-year-old or 1.5-year-old child should have the social elements of seeing, pointing, responding, and saying (making sounds):
When the mother calls the child's name, he will respond; when the mother comes back from outside, the child will have a gaze; when the mother asks the child where the lamp is, he will point with his hand.
Children who are about to enter kindergarten, they should show off, show off, ask for help, but also know how to share, cooperate, compete, confrontation, take turns... Older, you should know good villains, honor and disgrace, closeness...
From birth to school, we can sort out 6 social ladders and summarize 100-200 social elements. Parents can target these social elements as interventions.
Children with autism inherently lack social motivation and social interest, but they do not lack physical and psychological needs such as eating, drinking, toys, and going out to play.
Parents can use their physical and psychological needs to induce him to appear social elements such as seeing, pointing, responding, and speaking.
What are the specific social elements, how to divide the ladder, how to intervene? You can see my previous article:
That's what we're going to do with socially-centric interventions, and the phased interventions we build on top of that are likely to be at the international level.
07
Social motivation in children with autism
Rice and Millet: Many children with autism have social motivations, but they can't translate social motivation into successful social interactions.
Zou Xiaobing: This involves different degrees of autism.
Severe children have almost no social motivation, but some mild to moderate children have social motivation, they want to socialize, but lack skills, do not know how to greet others, do not know how to ask for help, do not know how to follow the rules of the game...
How can I help children of varying degrees?
When a child is diagnosed with autism, the first thing to assess is whether his social motivation is completely absent or somewhat. Based on the results of the assessment, the intervention of personalized children is not necessary for every child to start from the first social ladder, and some children may start directly from the second and third levels.
For people with autism diagnosed late (eg, 7 years old, 8 years old, adolescence, adulthood), they can cope with early social interactions, but they do not understand the rules of socialization and unspoken rules, and it is difficult to cope with social situations when they grow up.
For this obvious "lack of heart eyes", we must slowly train them to grow heart eyes; for their tendons, we must let them learn to be flexible.
08
Promote the sinking and development of professional rehabilitation resources
Rice and Millet: Now, the entire industry has a great demand for rehabilitation, how do you think you can promote the sinking and development of professional rehabilitation resources?
Zou Xiaobing: I think I can walk on two legs.
One is top-down. Vigorously develop relevant university education at the national level, train speech therapists, behavioral therapists, occupational therapists, and special educators, and introduce more guaranteed policies and laws.
The other way is from the bottom up. Relying on the strength of parents, professionals, institutions, non-governmental public welfare organizations, and charitable organizations, we will continue to learn from the advanced experience of foreign developed countries, and then organize relevant academic activities and training, speak out to the society, and slowly expand our influence.
Doing these things well from the bottom up can help solve problems such as insufficient support and insufficient number of professional doctors and rehabilitation practitioners.
--END--
Edit | Chun Tao Dangdang Editor-in-Chief | Qin Yu
Like to reward the editor with a "" and "in the watch" ~