Atypical autism is a developmental disorder belonging to the autism spectrum, the symptoms of which can be observed after the child turns 3 years of age. The development of this type of autism is often accompanied by severe genetic defects and mental retardation. We talk to Dr. Joanna Ławicka, president of the Prodeste Foundation, about how to recognize atypical autism and where to seek help in its diagnosis and therapy.
Atypical autismgives symptoms similar to those of childhood autism, but differs in their severity and duration. It is often diagnosed in children in whom autism produces non-specific, less characteristic symptoms and is associated with the occurrence of serious genetic disorders.
How to distinguish childhood autism from atypical? What is the treatment of a child with atypical autism and what is the importance of parents' participation in it? These and other questions are answered by Dr. Joanna Ławicka, special educator, co-founder and president of the Prodeste foundation dealing with diagnosis, therapy and education in the field of autism spectrum disorders.
- What is the difference between atypical autism and childhood autism?
Dr. Joanna Ławicka: Atypical autism is a unit defined in ICD-10, although very poorly elaborated - admit the authors of this classification themselves. It was probably created to be able to diagnose children or people who, for various reasons, "failed" the criteria for childhood autism. Currently, this diagnosis is used very rarely or incorrectly.
According to the ICD-10, we can diagnose atypical autism in a child who developed properly until the age of three or in a child who has clear symptoms in the so-called the diagnostic triad does not have them in the amount indicated by the ICD-10 for childhood autism. Unfortunately, the diagnosis of "atypical autism" is used most often in the case of diagnostic errors. Personally, I have encountered situations when, when asking specialists why they diagnosed atypical autism in a child with the classic form of childhood autism, I received the answer that they were not sure of the diagnosis, did not want to "stigmatize" the child, did not want to scare the parents, and wanted to give hope that it was not such "typical" autism.
- What factors influence the development of atypical autism later in life? Can a 5-year-old child, who has been perfectly he althy so far, suddenly show symptoms of autism?
J. Ł .: Situations in which a child with autism develops properly up to the age of 3 are extremely rare and generally concern serious metabolic defects that produce late developmental effects and in the course of which we can find symptoms typical of autism. According to world standards, in the case of coexistence of metabolic defects and autism, both should be diagnosed. In this case, the category of "atypical autism" is justified, the more so as the frequently progressing loss of communicative and social competences is the first signal that worries parents. It is worth emphasizing, however, that if such a person is reported for diagnosis - it absolutely must not stop at the symptomatic diagnosis of atypical autism. The child should be immediately referred to a specialist center for in-depth research into genetic and metabolic defects.
- What symptoms of atypical autism should worry parents? Are there any symptoms that are particularly characteristic of this disease?
J. Ł.: Let's start with the fact that none of the classified forms of autism spectrum disorders is a disease. From a therapeutic point of view, these are developmental disorders. The difference is fundamental. Illness is a static condition, curable or not. A developmental disorder is nothing less than a situation in which human development takes place in a different way from the usual way - from the earliest days of life to death. Autism cannot be cured, not because it is an incurable disease, but because it is not a disease at all. You can help people with a spectrum disorder to function better in the world, understand themselves and their surroundings, and develop their competences. Learn to live with autism. Just like blind people learn to live without their eyesight.
Atypical autism has no specific symptoms. The only characteristic pattern will be when a child is developing properly until the age of 3. In all other cases, we observe developmental problems typical of the autism spectrum in the sphere of communication, building social relationships and developing patterns of activity.
Parents should always be disturbed by signals such as delayed speech development, the lack of pointing with the hand to various things in order to arouse the interest of other people or to focus their attention more on objects, events, situations than on people in the environment. A typically developing infant, from the earliest stage of life, is more interested in people than in objects. The lack of following the objects indicated to the child or the lack of eye tracking of the direction should not be underestimated eitherseeing the other person.
It is not worth believing stereotypes. Children with autism are often happy to hug each other, not all of them have glaring difficulties with making eye contact, many are very open-minded and embrace people - unfortunately, suffering failures due to difficulties in assessing the needs of other people.
- Autism: causes, types, symptoms, therapy
- Types of Autism and Autism Spectrum Disorder
- Early childhood autism: causes, symptoms, therapy
- Autism in adults. Life as an adult autistic
- Where should parents direct their first steps if they suspect atypical autism in their child? Which facilities will help in making a diagnosis?
J. Ł .: It is definitely worth choosing specialist facilities. As with the entire autism spectrum, diagnosis is complex, requiring experience and the use of an international standard. It is impossible to correctly and responsibly diagnose anyone in the office, one-person, seeing a child for several minutes.
- How is Atypical Autism Diagnosed?
J. Ł .: The same as in the case of other autism spectrum disorders. The first step is a detailed diagnostic interview, the second step is to analyze the child's documentation and possible recordings from the child's environment, and the next step is a directed observation, the course of which is recorded by a diagnostic team consisting of at least three specialists.
The next step is a medical examination conducted by a specialist psychiatrist. Finally, the entire diagnostic team, all the people who participated in the process, collect the data from the diagnosis, relate it to the ICD-10 classification and make the diagnosis. As I mentioned - when we are talking about a situation where symptoms do appear after the age of three, the role of the doctor in the team is invaluable. It is he who has to decide where to refer the child for further diagnostics, so as not to overlook a metabolic or genetic defect that could potentially threaten he alth or even life.
- What are the consequences of a late diagnosis of autism?
J. Ł.: Nowadays, an early diagnosis is a diagnosis made no later than 36 months of age. This changes a lot in the therapeutic approach and in development forecasts. In the case of early developmental doubts - a correct diagnosis usually allows the child to avoid serious consequences, of which the lowering of intellectual potential comes to the fore.
The problem appearswhen we are actually dealing with the loss of communicative and social competences after the age of 3. Then the early diagnosis will be a situation in which the diagnosis is made as soon as possible from the moment when doubts arise. Otherwise, the consequences of not diagnosing or being diagnosed too late can be truly dire. Many metabolic defects are defects that lead to death if left untreated. This possibility cannot be ignored or the late onset of symptoms should not be explained in a way that is not related to scientific facts.
I met a situation where the environment explained the worsening, regressive disorders of a child's development that appeared in the fifth year of life with … vaccination. You can't do that. There is no evidence of a link between autism and vaccines, and there are numerous and serious studies to prove that there is no link.
- Some of the symptoms of autism overlap with the symptoms of Asperger's syndrome. Can these two units be confused? Can such a mistake affect the course and progress of the therapy?
J. Ł .: Committing such a mistake proves a complete misunderstanding of the principles of differential diagnosis within pervasive developmental disorders. The basic criteria differentiating Asperger Syndrome with autism are the lack of delay in speech development and the correct level of intellectual development, allowing for life adaptation typical of age. If the child meets these two plus additional criteria - we will diagnose Asperger's Syndrome. If a child has delayed speech development, we must opt for a different form of pervasive developmental disorder. If we find that the child's development meets the criteria of childhood autism, we close the topic with this diagnosis.
In the descriptive part of ICD-10, we can find detailed guidelines from the authors of the classification to understand the essence of atypical autism. The first indication for such a diagnosis is the aforementioned occurrence of symptoms after the age of 3, with all the consequences of such a situation, which I have already discussed.
The second is a specific situation, when in a child with severe, multiple disabilities, most often including a serious burden on intellectual development, we also observe deficits in the diagnostic triad for pervasive development disorders. Then a serious diagnostic dilemma arises - to what extent do the observed difficulties of the child result from the general disability, and to what extent are they a direct manifestation of autism?
In this case, when the picture of development is not uniform, the symptoms in quantitative terms do not fully match the criteria of childhood autism, and they are qualitatively blurred by the generaldisability - we can also try to diagnose atypical autism. We are talking then about the atypical symptomatology. However - as it is easy to see - these are situations that make it impossible to confuse atypical autism with Asperger's syndrome.
It is worth adding that the ICD-10 also allows the diagnosis of highly functioning children who do not meet the criteria for childhood autism (quantitatively or qualitatively) or Asperger's syndrome (e.g. due to delayed speech development, which rapidly improved rapidly). Such a possibility is created by category F84.8 - Other pervasive developmental disorders.
- What is life like an adult autistic?
- High-functioning autism: causes, symptoms, therapy
- What is the treatment of a child diagnosed with atypical autism?
J. Ł .: As in the case of every child with an autism spectrum, the therapy must be very individualized and involve the whole family. We must say it clearly and clearly: it is impossible to help a child with autism by working with him in the office, at the table. In this way, yes, we can correct single, narrow developmental functions, but we will not help the child in the area of relationship development and communication in any way. This cannot be done in isolation from the child's immediate environment, because it is only there that the child learns to communicate and build real relationships.
Therapy should always be combined with a program for parents that will allow them to thoroughly understand the specificity of their child's development, accept them and understand their specific needs. It is not an easy task, but it can be done. The clinic at our Foundation responds to this difficult need with the formula of Family Therapeutic Meetings (RST). It is a comprehensive therapy program that allows both to work out the direction in which the child's development should be supported in its individual areas, as well as to provide effective support for the whole family - parents and siblings.
In the course of daily therapy, in addition to RST, the family should support the child's development of key competences related to building social relationships. We are talking here primarily about developing the Theory of Mind, looking for strategies to stimulate relational processes, introducing techniques of alternative and supporting communication and special educational strategies that allow the child to regain a sense of security and predictability. An important element will also be counteracting the effects of difficulties in the analysis and synthesis of sensory stimuli, but we must be aware that the mere support of a child in this regard does not prevent the worsening of social and communication difficulties.
In ourIn society, we all too often view the autism spectrum as a behavioral disorder. The therapeutic process is then aimed at the elimination of behaviors deviating from generally accepted norms. Meanwhile, this is not the way. The fact that a child has stopped waving his arms in excitement, for example, does not mean that he understands his emotions and knows that other people are curious about his emotional state and its causes. Thus, he cannot relate to the states of other people, and as a consequence - he still does not have the resources to build shared, satisfying relationships with the environment.
- Psychologists predict that in the new version of the ICD classification, the division into individual types of autism will disappear and they will be replaced by one disease entity - "autism spectrum disorder". Do you think such a solution is beneficial for patients?
J. Ł.: This is no longer a matter of predictions - this change will take place. Changes in the ICD are always correlated with changes in the American DSM classification, which in the latest version eliminated the division into clinical subcategories. The ICD is sure to follow this path, which means that we will soon be diagnosing simply Autism Spectrum Disorder (ASD). This is a very good procedure. It will certainly limit the number of diagnostic errors. I also hope that it will additionally increase the number of people diagnosed in the earliest childhood.
It is worth saying that in a therapeutic approach, not a medical one, we try to avoid the term "patient" because it suggests a medical approach and a disease state. A person with autism is not sick and therefore not a patient in this connection.
About the expertDr. Joanna ŁawickaHe is a doctor of social sciences, a special educator, co-founder and president of the board of the Prodeste Foundation from Opole. Author of numerous scientific, popularizing and computer educational games in cooperation with PWN. The author of the book "I'm not an alien. I have Asperger's syndrome ", which will appear on the publishing market in June 2016. Privately, a mother of three daughters.