Diagnosis and treatment of autism in children
Introduction to autism in children
Autism in children is a subtype of pervasive developmental disorder (PDD), which is prevalent in males and begins in infancy and early childhood, and manifests itself in varying degrees of impaired speech development, impaired interpersonal interactions, and a narrow range of interests and stereotyped behavior. About 3/4 of patients have significant mental retardation, and some children have better abilities in some area against a background of general intellectual backwardness.
The prevalence of the disorder is 3 to 4 per million. However, in recent years there has been a trend of increasing reports, according to the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH), the prevalence of autism in the United States in the 1?to 2? There is no national survey data on autism in China, and only some regions have reported on it, such as Guangdong, where the prevalence of autism was reported to be 0.67% in 2010, and Shenzhen, where the prevalence was as high as 1.32%.
Diagnosis
By taking a comprehensive and detailed growth and development history, medical history, and psychiatric examination, if the patient is found to have typical clinical manifestations such as impaired verbal development and social interactions, narrowed interests, and stereotyped and repetitive behavioral patterns that appear progressively before the age of 3 years, we can rule out childhood schizophrenia, mental retardation, The diagnosis of autism can be made by excluding other pervasive developmental disorders such as childhood schizophrenia, mental retardation, Asperger syndrome, Heller syndrome, and Rett syndrome.
A small number of patients have atypical clinical presentations that only partially fulfill the autism symptom criteria or have atypical age of onset of symptoms, for example, after 3 years of age. These patients may be diagnosed with atypical autism. These patients should be followed up to make the correct diagnosis.
Treatment
1. Training interventions
Although there are a number of interventions for autism, most of them lack evidence-based medicine. There is no optimal treatment plan yet, and the best treatment should be individualized. Among them, education and training are the most effective and primary treatments. The goal is to promote the patient's language development, improve social interaction ability, and master basic life skills and learning skills. Before school age, autistic patients usually receive education and training at home, special education schools, and medical institutions because they cannot adapt to ordinary kindergarten life. After school age, the patient's language ability and social skills will improve, and some patients can go to ordinary elementary school to receive education with children of the same age, and some patients may still stay in special education schools.
At present, the training and intervention methods recommended and used by mainstream medicine in the international arena provide a direction for the standardized treatment of autism, and these mainstream methods include
(1) Applied Behavioral Analysis (ABA) advocates the principle of behaviorism and the use of behavioral shaping principles, and promotes the development of various abilities of autistic children with positive reinforcement as the mainstay. The training emphasizes high intensity, individualization and systematization.
(2) Treatment and Education for Children with Autism and Related Disorders (TEACCH) training The course is designed according to the ability and behavioral characteristics of autistic children to design individualized training content, targeted education on the child's language, communication, and perceptual-motor deficiencies in various aspects of education, the core is to enhance the autistic child's understanding of and compliance with the environment, education and training content.
(3) interpersonal relationship training method, including Greenspan's floor time therapy and Gutstein's . Relationship Development Intervention (RDI) therapy.
The above treatments have been carried out in some autism rehabilitation organizations in China, obtaining better therapeutic effects, but further research is needed to demonstrate.
2. Medication
Currently, medication cannot change the course of autism, and there is a lack of specific medication for core symptoms, but medication can improve some emotional and behavioral symptoms, such as emotionally unstable, attention-deficit and hyperactivity, impulsive behaviors, aggressive behaviors, self-injurious and suicidal behaviors, tics and obsessive-compulsive symptoms, as well as psychotic symptoms, which can help to maintain the safety of patients or others. It is conducive to maintaining the patient's own safety or that of others, and the smooth implementation of educational training and psychotherapy. Commonly used drugs are as follows:
(1) central excitatory drugs for combined attention deficit and hyperactivity symptoms. Commonly used drugs are methylphenidate.
(2) antipsychotic drugs should be used in small doses and for a short period of time, and attention should be paid to the side effects of the drugs in the process of use, especially extrapyramidal side effects
① Risperidone is effective for the emotional symptoms such as impulsivity, aggression, agitation, emotional instability, irritability, and psychotic symptoms accompanying autism, as well as psychotic symptoms. ② Haloperidol is effective for behavioral symptoms such as impulsivity, hyperactivity, stereotypy, and affective symptoms such as emotional instability and irritability, as well as psychotic symptoms, and has been reported to improve social interaction and language development disorders. Atypical antipsychotics such as aripiprazole, quetiapine, and olanzapine are also effective in controlling impulsivity, aggression, and psychotic symptoms in patients.
(3) Antidepressants can reduce repetitive stereotyped behaviors, obsessive-compulsive symptoms, improve mood problems, improve social interaction skills, and also effective in motor disorders such as withdrawal, delayed dyskinesia, and tics that occur after the use of dopamine receptor blockers.
Selective 5-HT reuptake inhibitors (SSRIs) are effective for behavioral and emotional problems in autistic patients. For example, sertraline can be tried in patients over 6 years of age.
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