Why is it that with the same diagnosis of autism, each child's performance is very different?
According to the DSM-5 diagnostic criteria, a child with social interaction and communication disorders is diagnosed with autism spectrum disorder as long as they meet the criteria for social interaction and communication disorders, accompanied by narrow interests, stereotypes, and paresthesias. Autism spectrum disorder is not a single disorder, but a general term for a group of disorders.
To the extent, doctors can diagnose severe, moderate and mild autism spectrum disorders respectively; from the causes, appearance, and behavioral characteristics, they can distinguish classic autism and symptomatic autism; in addition, each child's intelligence, movement, emotions, and sleep will be disturbed by various complications...
Differences in behavioral performance are not only prone to "misdiagnosis", but also easy to grasp the wrong focus and direction during intervention.
Today we have given some examples of behavioral manifestations that are not limited to social communication disorders and stereotyped behaviors in the autism spectrum category, and I hope that you will understand this to help children get targeted treatment.
Rare diseases
The low probability of occurrence has serious consequences
01
Disintegrating mental disorder (CDD) in children
CDD is mainly manifested in the rapid degradation of the acquired self-care ability, social function and language function, and even loss, and it is difficult to re-learn, leaving behind serious mental retardation.
Patients generally develop normally before the age of two years, onset of illness at 3 to 4 years of age, no obvious gender differences, and symptoms are very significant within half a year.
70% of CDD patients will continue to have nervousness, fear, restlessness, gibberish and other strange behaviors similar to schizophrenia for a period of time before their ability is degraded.
Within a few months of illness, the skills acquired in on-onset gradually disintegrate, and in addition to the severe degradation of language, there is also the degradation of play skills, social skills, and even self-harm behavior in some children.
Professor Zou Xiaobing introduced in "Walking with You" that this disease, also known as degenerative autism, has a poor prognosis, and most children will leave serious mental retardation.
(See: A high fever, the child's fever "degenerated"!) ）
02
Rett syndrome (LTL syndrome)
LTECH syndrome is a dominant genetic disease of the X chromosome, which is a serious abnormal disease of nervous system development, and the incidence is more common in girls, with an incidence of about 1 in 10,000.
Patients usually develop normally early and begin at half to two years of age.
LTECH children will have obvious and multi-faceted functional regression in the early stage of the disease, such as gradual loss of hand function and gradual loss of language.
Then the overall function began to stabilize, and the development of various capabilities began again, and there were many obstacles in development.
(See: My daughter suffers from the most horrific subtype of autism, and her parents recorded the family's daily routine for more than 700 days with 200 videos!) ）
Many children with LTECH syndrome are easily misdiagnosed as classic autism at first, but LTECH syndrome is mainly caused by mutations or deletions in the MECP2 gene, so it can be screened and identified by genetic testing.
But as of now, there is no cure for LTECH syndrome or a definitive medical solution.
03
Acquired epileptic aphasia
Acquired epileptic aphasia, also known as Landau-Kleffner syndrome, is a specific epileptic syndrome characterized by acquired aphasia, EEG abnormalities, and seizures.
During the onset of the disease, the patient's language function is significantly degraded. Parents can only watch their children degenerate from being able to speak to being unable to speak and understand language.
In this group, two-thirds of children have seizures. This proportion is much higher than the proportion of seizures in the typical autistic population.
04
Angel syndrome
Angel syndrome, also known as angelic syndrome, happy puppet syndrome, and Angermann syndrome, is a neurodevelopmental disorder caused by abnormal expression or functional defects in the expression of the UBE3A gene in the q11-13 region on chromosome 15. The incidence is 1/40,000 to 1/10,000.
Clinical manifestations are mental retardation and overall developmental delay, especially delayed language development, microcephaly, hyperactivity, there are ataxia, broad basal gait and limb tremor and other movement disorders, often have frequent unprovoked, incompatible with the surrounding environment bursts of laughter or smile, happy expression, clap hands and other happy behaviors.
There is no cure for the disease, but symptoms can decrease with age.
05
Genetically defective diseases
Some diseases caused by gene deletions also have autism-related symptoms. (See: A mom gave birth to 4 autistic children, their genetic reports showed-)
Common disorders
The high probability of occurrence has a great impact
The 10 most common physical and psychiatric disorders in the typical autistic population are as follows:
Intellectual disability
Although autism often co-exists with intellectual disability, there are many differences between simple intellectual disability and autism.
The most prominent thing is that children with simple intellectual disabilities are basically normal in social life. Although children with intellectual disabilities may have a slightly sluggish eye contact and call-up response, these responses are present.
The core symptom of autistic children is social impairment, and even without intellectual disability, it is difficult for autistic children to respond directly to social interaction.
language barrier
Many parents of children with autism will make their child's open mouth talking as the primary goal of intervention.
It seems that as long as the child can talk, autism is fine.
Many institutions also put language training at the heart of their interventions, but autism does not equate to a language barrier.
Language disorders include deafness due to hearing impairment, dysarthria, idiopathic delayed language development, and stuttering.
Although children with language disorders have no language or very little language, they are completely normal in terms of social interactions such as emotions, eyes, expressions, and movements, and even better than ordinary children.
Gastrointestinal disorders and eating problems
The study found that 42 percent of children with autism spectrum disorder develop gastrointestinal symptoms, compared with just 12 percent of the average child.
At the same time, children with autism have more food refusal than the average child, and the types of foods they are willing to eat are more limited.
Children with autism are prone to stereotyped diets, which can lead to inadequate fiber intake, which can lead to symptoms such as constipation.
For many children with severe picky eating autism, parents can change their children's dietary preferences by pairing them with reinforcements.
Rui Rui, a 5-year-old boy, was once completely unable to accept apples, but thanks to the efforts of Rui Rui's mother to use potato chips to continuously strengthen the pairing, he can now take the initiative to eat a whole apple.
Sleep disorders
If it is difficult to coax ordinary babies to sleep, then coaxing autistic babies to sleep is hellish difficulty.
The researchers found that 80.9% of children and adolescents with autism had sleep problems. There is a strong correlation between sleep problems and problem behaviors in children with autism.
Sleep problems in children with autism are mainly manifested in sleep anxiety, drowsiness, and chaotic circadian rhythms. For example, children with autism have difficulty falling asleep, often feel irritable before going to bed, and must be accompanied by adults to calm down.
More than 75% of sleep-deprived children have problems with attention span and social interaction. Sleep-deprived children with autism experience more stereotyped behaviors, hyperactivity, and anxiety.
But this is not an insoluble problem, severe autism boy mother Waring once suggested that everyone maintain a regular schedule, to create a comfortable sleeping environment, which can help children fall asleep.
(See: 6 years!) The autistic son couldn't sleep on his own and was cured by my laziness once! ）
epilepsy
The prevalence of epilepsy in children with autism is 30% and the prevalence of epilepsy in children is 2-3%.
The researchers found that seizures in people with autism were associated with intellectual disability. The more severe the degree of intellectual disability in a person with autism, the higher the incidence of epilepsy.
Seizures in children are typically characterized by stiff limbs, bruising, foaming at the mouth, and paroxysmal convulsions.
For patients with autism and epilepsy, they experience more gross fine motor problems, incontinence, social disturbances, and problem behaviors.
In addition, when autism is complicated by neurological damage (such as cerebral palsy), children are at higher risk of developing seizures.
06
Attention deficit hyperactivity disorder
Attention deficit hyperactivity disorder (ADHD) is one of the most commonly associated disorders with autism, accounting for 28.2% of autism.
Inability to concentrate, difficulty calming down to communicate with peers, sudden outbreaks of impulsive behavior, these core manifestations of ADHD are very similar to autism symptoms, which brings many challenges to clinical differential diagnosis.
07
Anxiety disorders
Among the various anxiety disorders, autism combined with social anxiety disorders has the highest proportion. Studies have shown that 29.2% of people with autism develop social anxiety disorder.
Many children do not understand the rules of social interaction, and social situations can easily trigger their anxiety and even accompany panic attacks.
For autistic children with social anxiety disorder, the most important thing is to change the child's social impairment symptoms and help them integrate into social situations.
In addition to social anxiety disorder, autism is accompanied by diseases such as generalized anxiety disorder and separation anxiety disorder.
08
Depressive disorders
Depressive disorders are also a type of disorder that is very likely to coexist with autism.
In the case of depression, the most common manifestations of depression include long-term low mood, decreased volitional behavior, and lack of interest.
The core symptoms of autism, which are social disturbances, stereotyped behaviors and narrow interests, are very different from depression.
If parents want to distinguish between autism and depressive disorders, they can pay attention to:
Has the child been depressed for the last two weeks and cannot be happy?
Is the child not interested in what he liked before, and no new interest is being generated?
Has the child become particularly "cocky" and doesn't want to move at all?
If the above 3 points are met, parents should take their children to a professional psychiatric department to see if there is any comorbidity.
09
Oppositional defiance disorder
The probability of antagonistic defiance disorder combined with autism is 28.1%.
The problem behavior of children with autism is very similar to that in opposing defiance disorder. Simply not understanding the rules can easily be misdiagnosed as autism.
But for individuals with oppositional defiance disorder alone, their emotional expression and social communication are basically normal.
For example, when a 6-year-old child is also hungry, the autistic child may not be able to communicate with the parents in words, and can only use crying to attract the attention of the parents; while the children with opposition defiance disorder can express their needs with language, but it is easy to disobey the parents' requests or orders.
10
Other obstacles
In the autistic group, another 24.7% suffer from Diseases such as Tourette's syndrome, obsessive-compulsive disorder, enuresis, chronic convulsions, etc.
A correct or comprehensive diagnosis is necessary. Many times, before finding the name of the disease, many of the symptoms in children seem to be labeled negatively, "You have a problem," or even unmanageable.
For autistic children with comorbidities or misdiagnosed, this not only increases the complexity of the child's condition, but also easily delays the child's timely diagnosis and treatment.
Only when a correct or comprehensive diagnosis is made in a timely manner can the child be treated more specifically.
Resources:
Lu Minghui, Miao Yu, Yang Guangxue. Research status and enlightenment of comorbidities in autism spectrum disorder[J]. Modern Special Education, 2015(2):7.
[2] DeFilippis M. Depression in children and adolescents with autism spectrum disorder[J]. Children, 2018, 5(9): 112.
[3] Goldman S E, McGrew S, Johnson K P, et al. Sleep is associated with problem behaviors in children and adolescents with autism spectrum disorders[J]. Research in Autism Spectrum Disorders, 2011, 5(3): 1223-1229.
[4] Mannion A, Leader G. Comorbidity in autism spectrum disorder: A literature review[J]. Research in Autism Spectrum Disorders, 2013, 7(12): 1595-1616.
[5] Simonoff E, Pickles A, Charman T, et al. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample[J]. Journal of the American Academy of Child & Adolescent Psychiatry, 2008, 47(8): 921-929.
[6] Wang L W, Tancredi D J, Thomas D W. The prevalence of gastrointestinal problems in children across the United States with autism spectrum disorders from families with multiple affected members[J]. Journal of Developmental & Behavioral Pediatrics, 2011, 32(5): 351-360.
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Finishing | Yuzu Summer Editor| Dangdang Editor-in-Chief | Qin Yu