Prof. Dr. Vagif Rakhmanov, Director of Research Institute of Children’s and Family Psychiatry, Psychotherapy, Psychology, Medical and Psychosocial Rehabilitation, Ukraine
Despite numerous and longstanding scientific research, the problem of medical and social rehabilitation of patients suffering Autism (A) and Autistic Sphere of Disorders (ASD) is still unsolved.
According to the data of various authors, Childhood A occurs with from 2-4 up to 6-15 children in 10000 people. Two thirds of children suffering Early Childhood Autism (ECA) are diagnosed with mental retardation. At the same time 1 of 10 children with mental retardation suffer A. If we combine A with mental retardation, this number increases up to 20 cases in 10000 people.
Still there are inconsistencies in the views on pathologic nature, structure, taxonomy of A and ASD. In practice, it is impossible to define reasons of A and ASD with 30-40% of children. After thorough interrogation of mothers, we can observe consistent correlation with psychogenic factors during perinatal and postnatal periods in aetiopathogenesis of these disorders.
In order to evaluate the relevance of aetiopathogenetic factors, including acute and chronic psyco-traumatic factors that affect psycosensorial, psychomotor, psychoverbal development of children, and to develop new methods of psychosocial rehabilitation, we have examined 350 children aged from 2 to 17.
Basing on diagnostic results, we conducted complex statistical data analysis concerning 121 children (96 boys and 25 girls). Besides principal diagnosis (enuresis, encopresis, habit spasm, stuttering, and sensorineural hearing loss) after the examination there were diagnosed cases of verbal retardation: dyslalia, dysarthria, dyslexia, dysphagy, expressive language disorder, impressive language disorder, incoherence, iteration etc.
Provided classification of variants of clinical manifestation of autism (A) is grounded upon one or several leading pathopsychological symptoms (syndroms), their expressiveness, breach of relations in micro- and macroenvironement.
1. Hyperactive form is characterized by hyperactive behavior in micro- and macroenvironement. We distinguish a) hyperactivity with attention deficit, nervousness, mood swing, impulsion, motor stereotypy, unformed intellectual activity (moderate or profound mental retardation), psychomotor and psychoverbal delay, uncontrolled behavior; b) hyperactivity with fairly moderate affectability and mood swing, impulsion, easy cognitive activity of mild mental retardation, psychomotor and psychoverbal delay and relatively controlled behavior.
We should differentiate hyperactivity in the family environment and hyperactivity in society (in public places, in particular, at school).
Manifestations of hyperactivity at school are more indicative. Behavioral disorders, associated with excessive mobility that take place mostly at home, are less specific. They can testify about the child suffering oppositional defiant disorder.
2. Aloofness (dispassionateness, detachment) is characterized by detachment from real life and out-of-body experience, breach of communication skills, dispassionateness towards the environment, dysontogenesis retardation and delay with following cognitive retardation, psychomotor, psychoverbal, psychosensor delay. Underdeveloped imitation.
Aloofness is more profound than detachment and is characterized by social and emotional withdrawal. The difference between these two conditions is defined according to the levels of non-attachment to sensible objects.
Herewith among clinical manifestations, we can observe emotional aloofness, communicative (social aloofness), and combined form. Aloofness comes gradually as the last stage of detachment.
3. Obnubilation is characterized by disorder of consciousness with mild black vision. There are observed difficulties in getting around, lack of understanding the world, threshold shift of all external (sensor) irritants, difficulties in psychic behavior often with psychomotor, psychoverbal, psychosensor retardation, less often with disinhibition. Absence of imitation.
4. Apathetic form is characterized either by lowered emotions, indifference to oneself, superinhibition towards environment, or by short-termed psychic activity in order to satisfy physiological needs, or by strong outer motivation (demonstration of favorite toy, meal). Such children retain nonverbal communication and imitation.
5. Sensitive form is characterized by tearfulness, crying, monotonous crying etc., and increased sensitivity towards environment, occurring events, in combination with anxiety about new environment, new people, events, actions, nyctophobia, monophobia (often “symbiosis” with mother).
6. Mixed form: hyperactive-aloof; hyperactive-obnubilated; hyperactive-obnubilated-aloof; sensitively hyperactive; apathetic-sensitive.
7. Constitutionally (genetically) caused form is observed in the frame of family and relatives.
8. Autism. Normotonic form in clinical practice comprehends psychic activity, social behavior, affection. It is characteristic for the children undergone appropriate treatment and rehabilitation measures and staying in friendly social and living conditions. They have behavior that is more congruent, glance, nonverbal, verbal communication, and retained developed imitation, formal social and emotional perception. These conditions are unstable. After stopping treatment and rehabilitation measures and in case of negligible psycho-traumatic situation child's state can worsen and exacerbate.
9. Atypic form (AA) is characterized by idiopathic appearance in families with friendly social and living conditions (in past medical history there are organic reasons, CNS and chromosomal pathologies, derangement of metabolism, traumas). AA constitutes 50% cases of ASD. The difference between AA and ECA is that the former arises with physiologic crisis periods, increases and acts as an impulse in manifestation of different forms of A, plays not only pathogenic role, but also is accompanied by manifestation of A in their structure. Herewith sufficiently distinct manifestation of psychopathologic symptoms (breach of communication in micro- and macroenvironement, limited stereotypies) are absent.
Offered classification will be instrumental in more selective and effective medical and psychosocial rehabilitation of children suffering A and ASD.
Literature
1. Rakhmanov Vagif: Psychophysical Rehabilitation of Children Suffering Autism and Autistic Sphere of Disorders (Method Guidelines). Dnepropetrovsk, RIA “Dnepr-VAL”, 2012.
2. Rakhmanov Vagif: Significance of Psychotraumatic Factors of Mothers in the Manifestation of Autism and Autistic Sphere of Disorders with Their Children. Their Modern Classification. Materials (Poster Presentation) of the 1st International Developmental Pediatrics Congress. Istanbul, Turkey, December 2-5 2015.
3. Rakhmanov Vagif: Optimization Model of Complex Medical-Social Rehabilitation: Theoretical Aspects and Principles of Applying. Materials of the 10th International Research-to-Practice Conference “Topical Questions in Modern Science – 2014”, Sophia, Bulgary, April 17-25 2014.