Source 丨21 Healthnews21 original work
Author 丨 Tang Weike
Editor 丨Xu Xu
Picture 丨 Figure worm
On 2 April, World Autism Awareness Day, the United Nations encourages governments and relevant organizations to hold events on this day to raise awareness of autism and to promote the importance of early diagnosis and intervention in the treatment of autism.
Autism, also known as autism, is a serious disorder of mental development. Symptoms of autism generally manifest themselves before the age of 3 years, and are characterized by disregard for emotions, refusal to communicate, language retardation, repetitive stereotypes of behavior, and significant limitations in the range of activities and interests.
The erudite Raymond Babbitt in "Rain Man" and the "Sherber" in "The Big Bang Theory" are the general impression of autistic people. Because children with autism are like stars in the sky, twinkling alone in the night sky, they are also called "children from the stars".
According to the World Health Organization, the prevalence of autism spectrum disorders is about 1-2%. Autism is the world's fastest-growing serious condition, and the number of children diagnosed with autism will exceed the number of children diagnosed with diabetes, cancer and AIDS combined. There are currently 67 million people with autism worldwide, four times as many as girls in boys.
Catherine Lord has said that although biological research has not brought advances in autism treatment, effective, evidence-based psychosocial interventions for autism have been established. Professor Zou Xiaobing, director of the Center for Child Development and Behavior of the Third Affiliated Hospital of Sun Yat-sen University, told the 21st Century Business Herald that in the family and natural scenes, parents or caregivers can carry out natural development behavior interventions that conform to the laws of child development under professional guidance.
Autism requires early detection and early intervention
At present, the cause of autism is still inconclusive in the medical community, mainly including more than 10 views and hypotheses such as nervous system damage, low function of specific parts of the brain, heredity, viral infections and immunodeficiency. Therefore, the diagnosis of autism and other diseases is different, not by taking a film, doing a test can get the diagnosis results, the doctor needs to observe the child's performance according to clinical experience and other ways, and finally confirm the diagnosis.
Experts who can diagnose autism include: psychologists, psychiatrists, speech therapists, pediatricians, etc. In countries with a perfect diagnosis of autism, diagnosing autism generally requires more than two expert-level diagnoses. The diagnostic process typically includes parent interviews, clinical observations, questionnaires, adjunctive assessment tests, follow-up visits, etc.
The clinical manifestations of autism usually include social communication disorders, verbal and non-verbal communication disorders, narrow interests and repetitive stereotyped behaviors, so if parents find that their children have "five noes": "do not see" (the gaze is always not looking at people), "do not listen" (no response to the name), "do not refer" (lack of appropriate body movements, can not use fingers), "no speech" (will not be babbling), "inappropriate behavior" (often repeated actions), need to take the child to the doctor in time, early detection, early treatment, can be diagnosed early.
At present, experts generally believe that 2 to 6 years old is the best time to treat autism, and early diagnosis and treatment can achieve significant results in terms of language and IQ.
In general, the weight of the brain at birth is only 25% of the weight of an adult, twice as much as at birth at 6 months, and 3 times as much at the age of 2. It can be seen that the development of the brain in the first 2 years of birth is a critical period of development, infants and young children before the age of 2-3 years of the brain has the strongest plasticity, but also the early detection of autism, early intervention training effect of the best stage, can significantly affect the prognosis effect of autistic children.
Generally speaking, for children with severe autism, if they are diagnosed around the age of 2 years old and implement early intervention, they will have good results. Interventions in moderately autistic children before the age of 6 years will be effective to varying degrees. If autistic children miss the critical period of training, the child's intelligence and behavior can only stay in the early childhood period, and the lack of basic self-care ability will affect the physical and mental health, social interaction, learning and employment of a lifetime.
Autism can co-occur many diseases, such as anxiety, ADHD, tics, mood disorders, sleep disorders, epilepsy and other diseases, and many gastrointestinal and immune problems. Usually 13% of these children are accompanied by more than 3 other psychological or physical diseases at the same time, so it is necessary to pay attention to the treatment of autism comorbidities at the same time.
Treatment requires educational and behavioural pathway interventions
Early diagnosis of autism, the importance of early intervention, and the development of interventions specific to young children have contributed to the emergence of a large number of similar, evidence-based autism interventions that also represent a convergence of applied behavioral and developmental science.
Although modern medical methods cannot fundamentally cure autism, and there is currently no drug that can completely cure autism, it has become a consensus that educational guidance and intervention training of behavioral pathways are effective ways to improve the developmental disorders of autistic children. Even if the golden time for early intervention is missed, there is still a possibility of improvement through active intervention training.
The treatment of autism is usually a "combination of medicine and education", before treatment, it is necessary to make a systematic and scientific assessment, understand the child's abilities in various fields, personalize the short-term treatment goals according to the assessment results, based on applied behavioral analysis (ABA), using structured teaching intensive training, sensory integration training, speech training, guided education, multi-sensory therapy, etc. Educational intervention for autism can improve the child's ability in all aspects as a whole, so that the child has the ability of social interaction and language communication, and can integrate into society, which is also the ultimate goal of treatment.
Zou Xiaobing said, "At present, the international mainstream advocates the method of natural development behavior intervention, which is a natural development behavior intervention model that can be carried out by parents or caregivers under the guidance of professionals or semi-professionals in family and natural situations. ”
It is reported that this method follows more of the normal order of development of children, emphasizing children's play, social interaction and active communication, as well as natural results contrary to rewards (such as food). These treatments are usually performed one-on-one with the child by an adult teacher or therapist, using learning rules to teach the child to develop skills such as language, imitation, or cognitive tasks (such as matching or sorting), usually more intense, 15-20 hours per week or more.
Zou Xiaobing said that the structured social behavior intervention model (BSR) is a natural development behavior intervention model that has been effectively tested in China. The BSR model takes behavioral therapy (B) as the main means of training intervention, flexibly uses intrinsic, spontaneous motivations, interests and activities, appropriate and positive rewards for good behavior, "seven noes" for problem behavior (no hitting, no swearing, no nagging, no deception, no threat, no unfavorable inducement and no confrontation) and mild "eight punishments" (natural results, logical results, reaction costs, neglect, etc.). The BSR model takes the structured education model (S) as the basic framework for training, and Zou Xiaobing emphasizes the combination of "organized and planned" training and random training.
Among them, social disorders are the core symptoms of autism, but also the root of many problem behaviors, so social interaction (R), emotional regulation is the core content of BSR model training intervention, intervention should aim at social development and social elements, follow the children's social and its development ladder targeted intervention, the ideal intervention is to let the child in one-on-one, face-to-face, happy, intensive interactive games, learning and activities.
Family interventions remain the most important means of intervention, and hospital or institutional interventions can be used as a complement to family interventions. Zou Xiaobing said, "The intervention model of the development behavior of simulating the natural scenario of the family is worth recommending, and some institutional intervention models or hospital biological treatment lack a correct basis and are not recommended to parents." ”
Liu Li, director of the Health Center of Beijing Children's Hospital, said that the treatment of autism is a long process, parents need to be psychologically prepared, and the most important thing in treatment is to obtain long-term support from parents and families. In the face of children's abnormal behavior, parents should repeatedly guide education, and cannot often show disappointment, despair and other emotions. Parents can spend more time with their children, put their children in one-on-one interactions, and strengthen the density of interventions through daily parent-child games.