Autism spectrum disorders: early detection sets the course

The Greek word autós means oneself , and autism denotes a disorder due to which people live a lot with and in themselves and seem to need and initiate less contact with other people.

In 1943 the “early childhood autism” was recognized and described for the first time by Leo Kanner, in 1944 by Franz Asperger the “Asperger syndrome ” named after him .

Only in the last thirty years has the frequency of peculiarities and peculiarities assigned to autism spectrum disorders (ASD) been recognized, whereby the numbers have increased dramatically: In 1975 the prevalence of ASD was given as 1: 5,000. In 1985 the incidence increased to 1: 2,500, in 2001 to 1: 250, in 2007 to 1: 110. Since 2014, it has been certain that every 88th child is born with autism (CDC 2015).

Have autism spectrum disorders really become more common or are they just better recognized? – Both are correct. The causes are varied.

What do parents, educators, early supporters, doctors and pedagogues need to know about ASD, about symptoms, early detection, therapeutic options and acceptance, including the self-image of those affected? In the following, essential aspects are shown and references to more detailed literature are given.

 * In this article, both the female and the male form apply.

ASD – the spectrum is wide

In medical classifications, early childhood autism, atypical autism and Asperger’s syndrome are among the “pervasive developmental disorders”. Although they are grouped together as ASD, they could be clearly delineated disorders. However, it is also assumed that it is a matter of different manifestations of a basic disorder, i.e. a continuous spectrum.

People with severe brain dysfunction (e.g. brain malformations and after injuries) remain or become autistic , with few or no skills that are necessary for well-founded social contacts. These diseases are not included under the term ASA.

In early childhood autism, there are initially no recognizable such – anatomical – reasons. Intelligence can be normal or impaired. Some children are also highly intelligent.

People with Asperger’s Syndrome – just like all neurotypical (commonly referred to as “normal”) people – have an intelligence that lies within the normal range. Symptoms appear later than in early childhood autism and are less easily noticeable. Some have high IQs with aptitude in certain specialties. What they have in common is the more or less severely restricted ability to socialize.

Causes: genetics and / or the environment?
Diseases, disorders, peculiarities, characteristics always arise from the interaction of genetically determined constitution and environmental factors: This also applies to ASA. The disposition to develop ASD is determined in some by new mutations; then it is a matter of sporadic individual cases. There are also familial clusters that must be based on the inheritance of genetic traits. The male to female ratio is four to one. Identical male twins are almost always both affected, girls only 80%. In families with two or more affected children, the risk of having additional children is almost 50% for boys and approx. 20% for girls.

Environmental factors that are reasonably suspected or known that they can trigger the development of ASD in sensitive, susceptible, genetically predisposed people are: Problematic delivery / childbirth; Influences that become active in early pregnancy, which become active in certain time frames and then probably in very low doses: malnutrition (e.g. folic acid deficiency), obesity, fever, some chemical products (e.g. so-called endocrine disruptors), fever, valproic acid (a remedy against Convulsions), polluted outside air. Such factors can influence epigenetic processes (which switch existing genes on or off).

A lot still needs to be researched in more detail, some things will be known much better in ten years’ time – and then perhaps we will be able to try to apply preventive measures .

Diagnosis: how do you recognize people with ASD?
According to the ICD 10 medical classification key, ASA is “characterized by qualitative deviations in mutual social interactions and communication patterns and by a restricted, stereotypical, repetitive repertoire of interests and activities.”

Early childhood autism
For parents and other carers more helpful than this dry definition is the descriptive characterization of toddlers with autism in the book “AUT IST IN”, which is partly taken from the textbook “Autism” by Prof. Dr. Inge Kamp-Becker and Prof. Dr. Sven Bölte quotes. After diagnosing early childhood autism, parents often recognize that traits and peculiarities of this kind already existed in infancy and early childhood. If such peculiarities are observed – not individual, but several in the same child – then increased attention is required and further diagnostics are indicated.

The fact that children with Asperger’s Syndrome often only become noticeable at the age of 3-4 is also related to the fact that they leave their parents’ home. There the special features of the children are somehow noticed and planned, which intuitively prevents conflicts. Other children and educators, on the other hand, treat them like everyone else, without consideration, and problems can then arise.

Asperger syndrome

Qualitative impairment of social interaction : Affected children and adolescents are conspicuous in their non-verbal behavior (gestures, facial expressions, eye contact) as well as incapable of establishing informal relationships with their peers or the elderly. In addition, they cannot react emotionally and share the joy or anger and anger of others.

Unusually pronounced and special interests and stereotypical behavioral patterns: This includes, for example, the monomaniacal occupation with special areas of knowledge that are usually not of general interest, e.g. special interest in melting points of metals, for dinosaurs, church towers, types of beer or washing machines. It is not only the interests as such that are exceptional, but also the extent to which those concerned devote themselves to them. Above all, you impress by the fact that you can hardly be dissuaded from these interests, that you burden your surroundings with them and / or that you don’t talk about anything else.

No delay in speech development or delay in cognitive development : In contrast to early childhood autism, Asperger’s syndrome lacks delayed speech development. Cognitive development is not restricted either. Rather, children with Asperger’s Syndrome learn to speak well and relatively early. They sometimes stand out due to their linguistically quite unusual expressions and their intelligence is in the middle to upper normal range. “

Why early detection is so important
Children with early childhood autism often become so noticeable around the age of three, i.e. during kindergarten, that the diagnosis is made. With careful observation, however, one can observe earlier in many children that, for example, they do not stretch their arms towards their mother in order to be lifted, that they make little or no eye contact and do not smile back. Feeding and sleeping problems are often part of it.

An early diagnosis is important and helpful for parents who blame themselves and who doubt their competence. So they can be relieved of this. It is also helpful for other carers, such as kindergarten teachers, if they know where they stand.

In autism centers and facilities that have special experiences with children with early childhood autism, behavioral therapy is generally used with the aim of reducing stereotypes, (auto) aggressiveness and other disruptive or disabling behavioral patterns. Language and communication promotion are also part of the therapy.

It is important to take care of the parents with the aim of relieving them of stress, strain and feelings of guilt and to help them develop strategies for dealing with their children’s particular behaviors.

The treatment goals should not be set too high, because radical improvements cannot always be achieved in early childhood (and also in atypical) autism. About 10–15% of people with early childhood autism can live independently in adulthood. Often lifelong care and sheltered accommodation are required.

For people with Asperger’s Syndrome , an early diagnosis is particularly important, because as they get older they learn to reasonably compensate for their difficulties in dealing with others, but the constant feeling of being “different”, doing nothing right and not expectations Being able to fulfill leads to high levels of suffering and later often to social isolation and depression.

Often the reason for behavioral problems, for peculiarities, for difficulties with social contacts is found far too late – if at all. For these people, it is almost always a great relief and relief to know why they are and react that way. The same applies to the family, schoolmates, work colleagues, friends and spouses: If you know that it is an Asperger’s syndrome, then you can understand and excuse “mistakes”, strange behavior, possibly hurtful peculiarities and also encourage special talents .

In early childhood, around four- and five-year-olds, good observation and some knowledge are required in order to correctly classify what is the basis of the abnormalities, because Asperger’s children are not intellectually or linguistically retarded.

If, however, solitary confinement and intensive, sustained preoccupation with special fields of knowledge are observed in a child who is conspicuous as “strange”, then further diagnostics should be initiated.

Understood? What has to be considered?
Children with early childhood autism require targeted support that starts as early as possible. Parents and caregivers need to be patient and empathetic and learn to be happy even with small advances. The parents must also be looked after and trained.

People with Asperger’s Syndrome are not “sick” or “disabled”. You shouldn’t be underestimated and you don’t want to be regretted. Many have exceptional skills, a high level of professional competence and also a high level of social intelligence. They have feelings like others, they just can’t express them that way. The perception is different. Your thoughts and actions are focused, you have a high level of concentration. The ability to interact socially suffers as a result.

These special features come in very different forms. The transition from “normal” to mild to very pronounced manifestations of Asperger’s Syndrome is fluid and dazzling.

And finally: who or what is normal anyway?

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