WHAT IS AUTISM?
It is a developmental disorder characterized by decreased quality of speech, initiating and maintaining social communication, and repetitive movements.
It is accepted that autism is a developmental disorder that starts in infancy and continues in childhood, adolescence and adulthood.
Incidence Frequency
It is 8/10000
in the studies conducted in previous years, and 20/10000 in recent years.
The incidence in boys is 4-5 times higher than in girls.
WHAT ARE THE CAUSES OF AUTISM?
Autism is a disease of structural biological origin.
It is known that it develops due to disorders in the metabolism of both structural and biochemical substances in some centers of the brain.
However, it is not known exactly in which centers and in which areas of the brain there is a problem.
Autism is a genetically inherited disease.
If a sibling has autism, the probability of having autism in the other sibling increases 60 times.
If the first child has autism, the probability of having autism in the second child is 10-15% higher than normal children.
Identical twins are more likely to be seen than fraternal twins.
Do problems in pregnancy cause autism? (Diseases, drugs, alcohol, etc.)
Exposure of the baby to infections, toxins and lack of oxygen during birth can lead to autism-like diseases.
It is known that the mother’s use of alcohol and drugs during pregnancy causes autism-like diseases as well as other diseases.
Does Parental Attitude Cause Autism?
Autism is a structural disease.
No parental attitude causes autism.
However, autism-like symptoms may be seen in some children, especially in early infancy, who could not communicate well with the mother or the attachment figure that could be substituted for the mother, or who were neglected by the mother or caregiver, which is called reactive attachment disorder.
Does Watching Too Much Tv Cause Autism?
Autistic children may show excessive interest in certain visual and audio materials on the TV screen and may want to stay in front of the screen for hours.
Watching TV alone does not cause autism, but autism-like symptoms can be seen in children who are left in front of the TV for a long time.
For this reason, these children should be cut off from TV.
CLINICAL FEATURES:
What are the Symptoms Before 1 Year of Autism?
These babies are idiosyncratic, have little social smiles, little or no eye contact, dislike being cuddled, prefer to be alone, do not react to strangers, do not show much interest in human voices, do not look when their name is called (8-12 It is expected to develop between months).
What are the symptoms seen in autism between 1-2 years old?
Significant deterioration in social smiling, emotional responsiveness, and joint attention continues.
Their visual viewing is unusual, staring at objects for a long time.
There is some retardation in gross and fine motor skills and strange motor behaviors.
Their games are limited and repetitive, they cannot do imitation games.
Expressions of positive emotions decreased.
There are peculiarities in understanding language, communicating verbally, using the body for communication, that is, in gestures and facial expressions.
Eye contact limitation continues.
In general, in this period, there is a retardation in all areas of development, especially in cognitive development.
What are the symptoms seen in autism between 2-3 years old?
Symptoms continue between 1-2 years of age
Insensitivity to pain,
Hypersensitivity to flavors begins.
Motor stereotypes (repetitive bodily movements) are added.
Most cases do not acquire language development, and in cases where language development begins, language is specific to autism.
What are the Symptoms of Autism between the ages of 3-6?
They cannot establish age-appropriate relationships with their peers.
They cannot play games with rich imaginary content.
They are unique in human relations with limited gestures and facial expressions.
30% learn to speak at this age, but the language acquired is unique.
Echolalia (repetitive speech), reverse use of pronouns and verb tenses, reluctance to use language socially begins.
What are the Symptoms Seen in Primary School Age in Autism?
In some, complete distance from the relationship, repetitive behaviors, and limited interests continue in this period as well.
On the other hand, some groups want to establish a relationship, but cannot initiate it actively, they do not know how to establish a relationship.
Social use of language has increased, even if language is echolic (repetitive speech).
Autistic children without language have more behavioral problems.
What are the Symptoms of Autism in Adolescence?
30-40% of them have not learned the language yet.
Difficulty in anger control, difficulty in controlling impulses and controlling sexual behaviors.
Harmful behaviors to self and others may increase.
If mental retardation is accompanied, the problems may increase more in this period.
DIAGNOSIS PROCESS
Diagnosis should be made by a child and adolescent mental health specialist.
According to the diagnostic criteria, it is said that autism can be diagnosed from the age of 3 years.
Only an experienced child and adolescent psychiatrist can evaluate the diagnosis of autism at the age of 2 years.
If there are autistic symptoms from the first year of age, it is necessary to accept these children as risky children and direct them to treatment.
The sooner treatment interventions begin, the better the response.
Diagnosis is made according to psychiatric examination, clinical features, developmental features and family history.
In addition, tests that screen the symptoms of autism and measure its severity can be used during follow-up. Developmental tests and intelligence tests may be requested.
Blood tests, imaging tests (MRI, CT), EEG may be requested in terms of differential diagnosis.
If there is concomitant mental retardation and other anomalies, genetics, if epilepsy is accompanied, neurology consultation is requested.
TREATMENT
The most effective way of treatment is education.
A drug that treats autism has not been developed yet.
There are some medications that work well in reducing various symptoms, but they do not completely eliminate autism.
80% of autistic children use medication.
Medicines are used to control anger, reduce irritability, irritability, repetitive behaviors, and obsessions.
What are the Drug Groups Used in Autism?
Atypical antipsychotics
Antidepressants
Attention deficit drugs
When to Start Education in Autism?
Education should begin as soon as the diagnosis is made. In fact, if there are deficiencies in development before the full diagnosis is made, and if he is evaluated as a risky child, it is necessary to start education immediately.
Education is education to replace what is missing.
Is the Education Provided in the Education Institution Sufficient?
In some countries, programs of 20-30-40 hours per week are carried out only in educational institutions.
In our country, in addition to 2-3 hours of training per week, we recommend that families carry out a training program that they can apply at home, and if they cannot implement it themselves, they should bring an experienced person to home who will implement the home training program.
Can Children with Autism Diagnosis Go to Regular School?
The high-functioning group of children with autism with normal intelligence can be included in the mainstreaming system in the regular school after gaining a certain level of social skills.
What are Inappropriate (Alternative) Approaches in Treatment?
Neuro feedback
Diet
Heavy metal removal
Methods such as Hyperbaric Oxygen have no scientific evidence and are not recommended for treatment.
Which Methods Are Effective in the Treatment of Autism?
Educational therapies are the most effective way.
Behavior analysis techniques are the most useful among them. (20-40 hours per week applied)
Social skills programs have been added to these programs recently.
The continuity of the program and its applicability in all environments are important.
What is the Role of the Family in Treatment?
Family is the most important part of treatment.
The remaining part of the education outside the educational institution should be conducted at home.
All family members have certain duties.
Can Autism Be Cured?
It is said that 20-25% of those diagnosed with autism have lost their diagnosis of autism with the developing education programs today.
There is a 30% group with autism who have good general adaptation. These are also called the well-functioning autistic group.
How Much Improvement Can We Expect in Autism?
According to recent data, complete recovery in autism is between 3% and 25%.
Studies dealing with only the first 2 age groups show that 18-37% of these children lose this diagnosis when they reach the age of 4.
This shows the benefit of early education programs.
Exp. Dr. Birsen Şentürk Pilan
Child and Adolescent Psychiatry Specialist
