Foreword: If adults have the habit of reading the weather forecast every day, no one will feel strange. But if a 3-year-old child only loves to watch the weather forecast when watching TV, it is not so normal, and Xiaohang is such a child. At first, Xiao Hang's special hobby of watching the weather forecast did not attract the attention of his mother, until the skills he had originally learned gradually disappeared, such as the original will wave goodbye, but now it will not, even the father will not call, there is a phenomenon of development regression, Xiao Hang's mother only took the child to the hospital for treatment, did not expect to be diagnosed with autism. For children with autism, how to achieve early detection, early intervention, and early treatment? In this regard, we invited Jie Xiaosu, deputy director of the Department of Child Rehabilitation of Henan Provincial Hospital of Traditional Chinese Medicine, to be a guest of the Health Great Henan Studio to explain to us the knowledge about children's autism!
In this issue:
Question one: Earlier we mentioned that Xiaohang loves to read the weather forecast, and there is a phenomenon of development regression, in fact, this is the manifestation of autism, why does autism cause children to have this special hobby?
A: The basic features of autism are persistent impairment of interactive social communication and social interaction (Diagnostic Criterion A) and restricted, repetitive patterns of behavior, interest, or activity (Diagnostic Criterion B). And these characteristics can answer the questions in the question. Autistic children have difficulty understanding the characteristics of social cues, usually children like cartoons, television, movies are run through by social interaction between people, for autistic children these are not "watchable"; Autistic children have weaker language skills and relatively strong image thinking skills, while weather forecasts and advertisements obviously provide them with more appropriate opportunities to play this ability. Of course, the situation of different individual children with autism is not the same.
Question two: For diseases, we all hope to achieve early detection, so that we can control them as soon as possible, so what are the typical symptoms of autistic children?
A: 1. Social interaction disorders
Lack of/lack of social interaction interest and motivation
Avoidance of eyes
Difficulty communicating and interacting emotionally
Difficulty adjusting behavior to social context
Lack of proper body language such as nodding, shaking, waving, socializing, etc
Difficult to get along with, do not listen to instructions, I do my own thing
2. Communication disorders
Speech developmental delay/aphasia
Difficulty initiating and continuing conversations
The intonation rate is abnormal
Imitate language, stereotypically repeat language
Dress-up or social imitation games are difficult
3. Narrow and repetitive behavior, interests or activities
Behavior is stereotypically repetitive
Language is repetitive
Focus on non-primary features of the object
Compulsive behavior, ritual behavior
Question three: In addition to loving to read the weather forecast, what are some less typical symptoms that parents tend to ignore?
A: Have social motivation, have language skills, but inappropriate use of objects, inappropriate feelings or perceptions. It is manifested as improper manner, improper language, improper behavior, and improper emotion. For example, some autistic children also want to play with children, but do not know how to start communicating, will push, hug, there is no game rules.
Question four: when Xiaohang was 3 years old, he was found to have a phenomenon of development regression, thus diagnosing autism, is there any test, even if the child does not have a slow development phenomenon, you can also screen the child for autism.
A: Early warning signs of autism:
6 months can not be laughed at, the eyes rarely look at people,
10 months of normal hearing, no response to the name,
12 months of no response to verbal instructions, no babbling language, no sign language, no eye following, no interest in imitating movements,
16 months do not say any words, react less to language, do not understand what others say,
18 months can not use fingers or eyes to follow the fingers of others, no giving behavior,
No spontaneous two-word words for 24 months
Regression in language function or social skills at any age
Screening for Infant and Young Child Autism Screening Scale (CHAT), Revised Infant Autism Screening Scale (M-CHAT), CHAT-23, Gram Scale, ABC Scale, and Social Communication Questionnaire Screening.
Question 5: It is understood that in the diagnosis, it is easy to mistake severe ADHD for autism, why are these two easily misdiagnosed? Is there anything in common?
A: The main clinical features of ADHD are hyperactivity, attention deficits and impulsivity, and autism can also have behaviors such as inattention and hyperactivity. Children with ADHD do not have impairments in the nature of social interaction, stereotyped behaviors, and narrow interests. For example, children with ADHD are in kindergarten, have good friends, and interact with children.
Question Six: When it comes to autistic children, I believe that many people first think of loneliness and silence, hiding in a corner and playing alone without a word. Are there children who are at the other extreme, such as being irritable and irritable? In this case, in daily life, how should parents take care of children with such symptoms?
A: Autistic children are prone to impatience and irritability, and there are two common situations: one is that autistic children use improper language or poor language ability, cannot express their own ideas, and are prone to impatience and irritability when the family does not understand the child's expression. In this case, parents should observe in detail, communicate patiently with their children, and give their children more care. One is that autistic children are prone to feeling both extremes, or too sensitive, or too dull. For example, autistic children in a noisy environment, hear the whistle, easy to be impatient. In this case, parents should promptly let their children get rid of this feeling.
Question Seven: Every parent wants their child to be healthy and healthy, for autism, is there any drug or treatment that can be cured?
A: At present, there is no drug or treatment method that can cure autism, but early recognition, early diagnosis, early reasonable system intervention training, most autistic children have different degrees of improvement, and some autistic children can get basic life and learning.
Question Eight: I believe that every parent is like this, even if they know that the possibility is unlikely, but they are not willing to give up hope, eager to try all possible therapies, we have also noticed that many non-public medical institutions, there will be some therapies, such as stem cell treatment for autism, biological protein implantation in children's acupuncture points, ketogenic diet therapy, etc., can you tell us specifically what these therapies are all about, is it reliable?
A: Stem cell therapy for autism is the intravenous injection of human umbilical cord tissue mesenchymal stem cells into autistic children, and the latest research results suggest that the therapy has a good improvement in the core symptoms of some autistic children. At present, this therapy is not yet available in the clinical trial phase.
Biological protein implantation in children's acupuncture points is an unproven medically proven therapy, most likely pseudoscience.
The ketogenic diet refers to a diet with a very low carbohydrate content, moderate protein content, and high fat content, and is mostly used in the treatment of refractory epilepsy.
Question nine: It seems that for autism, parents still need to find out and intervene as soon as possible. So what are the current interventions?
A: At present, there are many mainstream early intervention methods used internationally
Structured Training (TEACCH)
Early Denver Intervention Model (ESDM)
Preschool Autism Communication Intervention (PACT)
Critical Response Training (PRT)
Interactive Imitation Training (PIT)
Common Attention Training (JA)
Non-mainstream interventions: transcranial magnetism, earpiece training, sensory system training, music therapy, acupuncture, tuina
Question 10: Which of these interventions can parents cooperate with? What are some that parents can do independently?
A: The skills learned in the intervention training of autistic children need to be generalized, and for the content of generalization, parents need to cooperate with rehabilitation therapists in the rehabilitation center to complete it, and usually complete it independently at home and when going out. For example, eating alone with a spoon and going to the toilet alone.
Question 11: Many parents can't believe that their children have autism in the early stages, so they have been taking their children to do various tests, missing the golden time of early intervention, is there any value in the later intervention? What are the measures for later intervention?
A: The best treatment window for children with autism is 2-3 years old, and the later intervention is still valuable, and the later intervention is applied behavioral analysis (ABA).
Question 12: In your medical career, have you ever encountered a child with severe autism whose condition has improved well through later intervention? Tell us about it.
A: Yes. Li Baobao, male, 2 and a half years old came to the doctor, to "find that the eye contact is poor for half a year" as the main complaint was admitted to the hospital, the child's name is unresponsive, and the language development is delayed.
Admission Assessment:
PEP-3 Cognition: Moderate Delay, Language Expression: Severe Delay, Language Comprehension: Severe Delay, Small Muscle: Moderate, Imitation: Moderate, Emotional Expression: Moderate, Social Interaction: Moderate, Problem Behavior: Severe, Personal Self-Care: Moderate, Adaptive Behavior: Severe.
ABC Scale: 82 cars score: 35 (moderate)
GESELL: Adaptability 62, Big Movement 90, Fine Motor 72, Language 55, Personal-Social 60
After 3 months of rehabilitation training (individual training + group lessons, sensory system, music, acupuncture, tuina)
Discharge assessment: PEP-3 cognition: mild, language comprehension and language expression are moderate, and other items have improved to varying degrees
ABC scale 50 points, CARS score 30 points,
GESELL: Adaptability 67, Big Movement 92, Fine Motor 76, Language 65, Personal-Social 65
After rehabilitation, eye contact is possible and simple communication can be made
Question 13: Some netizens asked: Her daughter found autism at the age of two and a half, should she be handed over to the rehabilitation center for treatment? Or quit your job to lead intervention in your child's treatment? Do you have any good advice for this situation?
A: Two and a half years old is the best window period for autistic children to intervene in training, it is recommended to go to the rehabilitation center for treatment as soon as possible, increase the interaction and communication time with the child, strengthen the intervention content of the rehabilitation center, and generalize the learning skills. The intervention training of autistic children takes a long time, and autistic children need a warmer family atmosphere, which requires careful observation and patient guidance from parents. It is recommended that she not quit her job and assist professional rehabilitation therapists to perform standardized interventions.
Question 14: Does autism inherit? If the family of the child wants to have another child, what advanced means are there to guide the birth of a healthy baby?
A: Autism is likely to be inherited, most children gradually develop symptoms of autism after birth, and a small number of children experience 1-2 years of normal development after regression, just like Xiaohang, at the age of 3, it is found that there is a phenomenon of developmental regression. The causes of ASD are actually quite complex, involving a series of genetic and environmental risk factors, genetic factors account for up to 70%-90%, which is its main cause, so autism is likely to be inherited.
Therefore, it is recommended that children with loneliness spectrum disorder check the genetic causes through genetic testing, and according to the genetic diagnosis results, they can go to the reproductive specialist hospital for genetic counseling and guide the birth of healthy babies through advanced assisted reproductive technology.
Question 15: The incidence of autism is increasing year by year, what kind of parents are more likely to have autistic children?
A: Like some older fathers, or elderly mothers, young first-time mothers are more likely to have autism, and for example, your exposure to excessive radioactive substances during pregnancy, excessive amounts of harmful substances, such as drugs, alcohol, etc., as well as serious infections, will lead to a significant increase in the risk of children susceptible to autism
Question 16: How to reduce or avoid the occurrence of predisposition to autism?
A: First of all, it is recommended to conduct genetic examination for children, for children with the risk of autism, early autism-related genetic screening, early diagnosis, is conducive to the child's timely intervention, the improvement effect of long-term prognosis is obvious.
Question 17: How to understand autism, when it comes to children with autism, is it really just introverted, not talkative, withdrawn personality, like to play alone? Autism is called autism spectrum disorder, how to understand "spectrum disorder"?
A: As you said, autism, also known as autism spectrum disorder, ASD, autism spectrum disorder, is a neurodevelopmental disorder characterized by impaired social communication and repetitive limited interest behaviors. The so-called "spectrum disorder" is that the disease is not only a single system of pathogenesis, often co-existing other diseases, such as the more common ASD comorbidity of intellectual retardation, ASD comorbid epilepsy, ASD comorbid attention deficit disorder, ASD comorbid gastrointestinal diseases and so on. ASD with other systemic diseases, also known as syndromic autism, is often caused by single-gene genetic factors, and it is more meaningful to make a genetic diagnosis of this part of the child, clarify the cause, and improve its prognosis.
Question 18: Is there anything to remind parents about how to detect whether a child has autism-like manifestations at an early stage?
A: The social communication skills and some stereotyped behaviors of autistic children can appear at an early stage, and here is a "five noes" recipe, that is, 5 behavioral markers that are recognized early:
Not (less) to see: abnormal eye contact; No (less) should: mainly refers to the child's non-response to the name and can not attract common attention; No (less) refers to: lack of proper body movements, inability to make requests for something of interest; No (less) language: most children with ASD have delayed language development, and parents need more attention; Improper: Mainly refers to inappropriate use of objects and related feelings or perceptions. Remembering these 5 no's is important for early identification.
Speakers:
Jie Xiaosu, Deputy Chief Physician, Deputy Director of the Department of Pediatric Encephalopathy Rehabilitation, Henan Provincial Hospital of Traditional Chinese Medicine (The Second Affiliated Hospital of Henan University of Traditional Chinese Medicine). National Birth Defect Prevention and Control Division (Advanced), European Total Body Exercise Quality (GMs) Senior Assessor. He is a member of the Children's Rehabilitation Professional Group of the Rehabilitation Physicians Branch of the Henan Medical Doctor Association, a member of the Professional Committee for the Prevention and Rehabilitation of Childhood Cerebral Palsy of the Henan Preventive Medicine Association, and a member of the Rehabilitation Professional Committee of Integrated Traditional Chinese and Western Medicine of the Henan Association for the Disabled.
Specialty: 1. Early neurodevelopmental screening and early intervention of high-risk children such as preterm birth, hypoxic-ischemic encephalopathy, low birth weight; 2. Cerebral palsy, developmental delay, speech dysfunction (slurred speech, language backwardness); 3. Cortical blindness, torticollis, facial paralysis, tics, attention deficit hyperactivity disorder, autism.