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Among neurodevelopmental disorders, autism is one of the most severe, but early diagnosis gives a chance to improve the quality of life of the affected person. What are the symptoms of autism and how to alleviate its effects, explains Dr. Michał Wroniszewski, psychiatrist, director of the SYNAPSIS center for children and adults with autism, co-founder and president of the board of the SYNAPSIS foundation.

Even a slight degree of disorder causes a person affected by autism very serious social and life problems. Whenautismis detected early, its effects can be mitigated - but only to a certain extent. What is autism, explains Dr. Michał Wroniszewski, psychiatrist, director of the SYNAPSIS center for children and adults with autism, co-founder and president of the board of the SYNAPSIS foundation.

  • How to recognize the first symptoms of autism?

Dr. Michał Woniszewski : They appear in the second half of a child's life and these are two symptoms. The first is the lack or weakening of eye contact with the creation of a common field of attention, i.e. the ability to communicate by eyes.

The second is disturbed auditory reactions, in particular the lack or a weakened, delayed reaction to calling a name, i.e. turning to the person who calls the child.

These are strong indicators of the existence of the risk of autism, obviously after excluding other causes, such as visual and hearing impairment. Some autistic children have hearing problems, but most of them can even hear too well (hypersensitivity to sounds), which may cause, for example, cutting off stimuli.

  • Are psychomotor development disorders an early symptom of autism?

M.W.:No, mere psychomotor retardation is not a symptom of autism. But in these children, the risk of developing PFSA is significantly increased.

Therefore, their development should be monitored as risk groups. We do not always notice any abnormalities in motor development, including the reception of stimuli.

In children under the age of 1, they may be particularly concerned with the sense of balance and the integration of sensory stimuli from deep sensation and sight.

We then observe a delayed achievement of the ability to crawl, crawl, sit, stand and walk. They are not caused bymuscles (such as in cerebral palsy) but coordination problems.

Check: Early Childhood Autism

  • What is the communication of an autistic child?
  • M.W.:This is a complex, multi-faceted problem. A child with autism may have problems with the reception of sensory stimuli, including visual and auditory stimuli, and their central coherence, i.e. the overall reception of signals addressed to them as significant visual (gestures and facial expressions) and auditory (words) messages.

    This significantly limits development opportunities - it's as if you are visually impaired and hard of hearing at the same time. The fact that a child with autism does not understand or understands the function of feedback with a long delay is probably due to another deficit in understanding the intentionality of the other person, i.e. understanding that the other person is the same as me.

    Most autistic children develop one-way communication, usually they can demand - by shouting or gesturing. They have difficulty going through the stage of changing the situation from an infant who, paradoxically, actually rules the environment - "I scream and demand, and you find out what I mean at this moment", to a small child who is subordinate to his parents and other people around him.

  • How is this communication shaped in older children?
  • M.W.:Children in the 2nd and 3rd year of life, typically developing after a period of contrariness, trying what they are allowed to, trying to establish that they rule here, usually recognize real and emotionally satisfying dependence on adults.

    On the other hand, in those who communicate in a limited way and poorly understand the intentions of other people, it is very difficult to pass this process positively. Such children tend to maintain an infantile pattern of "despotic" governance, and the environment often conforms to their behavior.

    In this way, a specific authoritarianism is perpetuated, which additionally hinders social adaptation. It must be remembered that an autistic child is not realistic and adequate in relationships, which, if it extends into the pre-school and school periods, makes social adaptation more difficult for him.

  • What is the role of parents in therapy?
  • M.W.:Parents should try to diagnose their child as early as possible in case of disturbing symptoms. Active emotional, physical and playful contact with the toddler is important.

    A small autistic person needs the same as another child of his age, but due to the weakness and reduction of stimuli fromthe environment, messages addressed to him should be as clear and simple as possible, calm, but very expressive (conveyed quite loud and slowly).

    If the child is older and has not developed some skills, it is worth playing with him appropriate for an earlier age, e.g. sensory-motor, early relational (e.g. "a cuckoo" type) programmed by a specialist as part of the development process further competences, educational play exercises, thanks to which the child acquires understanding of the so-called representation, i.e. that one thing can pretend to be another.

    Parents should try to feel if and how their child likes being rocked (oversensitive or insensitive), which gives them pleasure and de-stresses them (this helps in development).

    It is also important to stimulate better reception of stimuli through massages and compressions, which improve the so-called deep feeling.

    All babies in the first year of life should have a sufficient amount of a variety of sensory stimuli, especially related to contact with harder surfaces.

    Those hidden in soft bedding and little movement develop more slowly than those with a playpen with a blanket and a floor - a harder surface gives a lot of sensation and promotes activity.

  • What are the possibilities of rehabilitation started as soon as possible?
  • M.W.:It helps to reduce the various effects of damage to the central nervous system (brain) and its functional developmental disorders. Some deficits are due to damage - this could potentially be more permanent.

    Others are functional, which means that the child did not exceed a certain developmental threshold due to the fact that he did not acquire the skills to use the expected receiving and executive functions, characteristic for a given development period.

    In many children it is related to speech development - if the toddler is in the 12-15. month of life does not use the first, even "conventional", poorly articulated but meaningful words, it requires attention. The later the autism is detected and, consequently, the later the communication skills are shaped, the weaker the results of the therapy.

    Formerly about 50 percent autistic children did not speak at all. Now, this percentage is lower, which is due to starting treatment earlier, when the chances of getting speech are higher, and identifying less severe cases.

    • What is the central coherence that characterizes people with autism?

    M.W.:It is based on the tendency to perceive a specific object as a whole with all our senses. We see a human face with all of itsdetails that our brain puts together.

    Children with autism perceive everything broken down into individual elements: the sense of sight registers one eye, the other eye, nose, mouth and other details, e.g. glasses or tingles, the sense of hearing separately registers the voice of a given person. But all of these pieces of information don't connect with each other.

    Therefore, deeply disturbed children with autism can distinguish between people, especially from the distant environment, mainly by the mustache, beard, warts on the face, etc. Such perception makes it difficult or impossible to receive and understand the emotional and social message - what is expressed by the face of another people.

    "Neurotypical", non-autistic people find it difficult to get into their situation, because this is a completely different organization of receiving sensory impressions and the image of the surrounding world.

    • What are the causes of disorders of the development of central coherence in a child with autism?

    M.W .:They are not yet established. One of the theories relates them to disturbances in the maturation of the functions of the cerebellum, which is responsible for coordination - initially it was thought that only motor functions, but it turned out that also the function of receiving sensory stimuli from all senses.

    It is now known that the root causes of these disorders in each child may be different, as well as co-occurring: both possible genetic susceptibility and harmful factors during pregnancy and childbirth - infections, hypoxia, premature birth and others.

    • What are disturbances in social contacts?

    M.W.:In autism, disturbances in the development of the innate cognitive module, or "theory of mind" of another person, most likely result from a disturbance or delay in the development of neurophysiological functions, determining the abilities of the innate bipogic (unintentional) compassion.

    This results in qualitative disturbances in social interactions, communication and imagination. The system responsible for recognizing and inferring about the states of mind of other people by analogy to their own states does not reach the appropriate maturity.

    The hypothesis that the "theory of mind" of another person depends on the functioning of the system of the so-called mirror neurons responsible for sensing another person's state of mind. It works on the principle of "mirroring" the sensory reception, not the intellectual one.

    If, for example, a person is bent, his shoulders and mouth corners are lowered, he moves well, then another person looking at him "feels as if he or she has this attitude and appearance, that is, has the feeling of feeling the despondency of that person,even if she's fine herself.


    Is diet also important in autism?

    There has been disagreement over this for decades. Practitioners have long recognized the frequent occurrence of disorders of the immune and digestive systems in children and adults with autism. In 2010, recommendations of the US Academy of Pediatrics on he alth problems, in particular gastroenterological, of children with autism were published. Somatic problems, especially of the immune system (immunodeficiency or allergies), and / or digestive tract disorders, allergic and non-allergic intolerances disturb the child's internal environment and indirectly adversely affect the functioning of his nervous system, which can aggravate autism. They should be carefully examined in this regard, possibly carried out on trial diets for the most disturbing factors, especially casein and gluten. They are not intended to cure autism, but to diagnose what may be harmful to your child. For example, unrecognized milk intolerance can increase a baby's excitability, disturb sleep, and secondary disturbances in the digestive tract worsen his development.

    Worth reading:

    Atypical Autism

    Autism in adults

    High-Functioning Autism

    Asperger's Syndrome

    monthly "Zdrowie"

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