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Ministry of Health of Ukraine Bukovynian State Medical University




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Ministry of Health of Ukraine

Bukovynian State Medical University


“Approved”

on the methodical meeting

of the Department of neurology, psychiatry

and medical psychology nm. S.M.Savenko

“____” ___________ 2009 (Report № __).

Chief of the Department

_______________________

Professor V.M. Pashkovsky


Methodical INSTRUCTION

for 4-th year students of medical faculty №2

(the speciality “medical affair”)

for independent work during preparing to practical class


Theme 29: Early child’s autism. Etiology and epidemiology. Clinical displays. Diagnostics. Treatment. Prophylaxis. Question of examination and rehabilitation. Children and teenagers hyperkinetic disorders. Etiology. Pathogenesis. Clinical displays. Disorders of social conduct. Clinic, ran across, prophylaxis. Principles of medical-pedagogic correction and social rehabilitation.


^ MODULE 2. SPECIAL (NOSOLOGY) PSYCHIATRY


Topical module 6. Disorders of adult personality and behaviour. Mental retardation. Disorders of psychological development. Behavioural and emotional disorders with onset usually occurring in childhood and adolescence.


Сhernivtsi, 2009


^ 1. Actuality of theme:

Autism is a brain development disorder characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. The autism spectrum disorders (ASD) also include related conditions such as Asperger syndrome that have milder signs and symptoms.

Autism has a strong genetic basis, although the genetics of autism are complex and it is unclear whether ASD is explained more by multigene interactions or by rare mutations. In rare cases, autism is strongly associated with agents that cause birth defects. Other proposed causes, such as childhood vaccines, are controversial, and the vaccine hypotheses lack any convincing scientific evidence. The prevalence of ASD is about 6 per 1,000 people, with about four times as many males as females. The number of people known to have autism has increased dramatically since the 1980s, partly due to changes in diagnostic practice; the question of whether actual prevalence has increased is unresolved.

Autism affects many parts of the brain; how this occurs is not understood. Parents usually notice signs in the first two years of their child’s life. Although early behavioral or cognitive intervention can help children gain self-care, social, and communication skills, there is no known cure. Not many children with autism live independently after reaching adulthood, though some become successful, and an autistic culture has developed, with some seeking a cure and others believing that autism is a condition rather than a disorder.

^ Attention-deficit/hyperactivity disorder (AD/HD or ADHD) is a neurobehavioral developmental disorder. It affects about 3 to 5% of children with symptoms starting before seven years of age. Global prevalence for children is approximately 5%, with wide variability dependent on research methodologies utilized in studies. It is characterized by a persistent pattern of impulsiveness and inattention, with or without a component of hyperactivity. ADHD is twice as common in boys as in girls, though studies suggest this discrepancy may be due to subjective bias. ADHD is generally a chronic disorder with 30 to 50% of individuals diagnosed in childhood continuing to have symptoms into adulthood. As they mature, adolescents and adults with ADHD are likely to develop coping mechanisms to compensate for their impairment.


2. Duration of practical classes - 2 hours.


3. ^ EDUCATIONAL PURPOSE


3.1. To know:

  1. Etiology and pathogenesis of child’s autism and hyperkinetic disorders.

  2. Clinical picture of child’s autism.

  3. Clinical picture of hyperkinetic disorders.

  4. Clinical picture of disorders of social conduct.

  5. Diagnostic of child’s autism and hyperkinetic disorders.

  6. Treatment of patients with child’s autism and hyperkinetic disorders.

  7. Prophylactic of child’s autism and hyperkinetic disorders.

  8. Principles of medical-pedagogic correction and social rehabilitation.


3.2. Able:

  1. To diagnose child’s autism, hyperkinetic disorders and disorders of social conduct.

3.To conduct differential diagnosis.

4.To conduct measures of prophylactic of child’s autism and hyperkinetic disorders.


3.3. To capture practical skills:

  1. To collect anamnesis in patients with child’s autism and hyperkinetic disorders.

  2. Clinical psychological examination of children with child’s autism and hyperkinetic disorders.

  3. To conduct psychoprophylactic measures of child’s autism and hyperkinetic disorders.



  1. ^ INTERSUBJECT INTEGRATION (base level of preparation).




Names of previous disciplines

Skills are got

1. Medical genetic.


2. Normal and pathologic physiology.


3. Anatomy

4. Medical psychology

1.To possess of methods reaviling genetic diseases of human.

2. To know functions of brain, physiology and pathological physiology HNA.

3. To know structure of brain

4. To know psychology of personality.



5. Advices to students.


5.1. ^ CONTENTS OF THEME.

Autism is a highly variable brain development disorder that first appears during infancy or childhood, and generally follows a steady course without remission. Symptoms tend to continue through adulthood, although often in more muted form. It is distinguished not by a single symptom, but by a characteristic triad of symptoms: impairments in social interaction; impairments in communication; and restricted interests and repetitive behavior. Other aspects, such as atypical eating, are also common but are not essential for diagnosis. Autism is one of three related autism spectrum disorders. Its individual symptoms occur in the general population and appear not to associate highly, without a sharp line separating pathologically severe from common traits.

Social development

Social deficits distinguish ASD from other developmental disorders. People with autism have social impairments and often lack the intuition about others that many people take for granted. Noted autistic Temple Grandin described her inability to understand the social communication of neurotypicals, or people with normal neural development, as leaving her feeling "like an anthropologist on Mars".

Unusual social development becomes apparent early in childhood. Autistic infants show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Autistic toddlers have more striking social deviance; for example, they have less eye contact and anticipatory postures and are more likely to communicate by manipulating another person's hand. Three- to five-year-old autistic children are less likely to exhibit social understanding, approach others spontaneously, imitate and respond to emotions, communicate nonverbally, and take turns with others. However, they do form attachments to their primary caregivers. They display moderately less attachment security than usual, although this feature disappears in children with higher mental development or less severe ASD. Older children and adults with ASD perform worse on tests of face and emotion recognition.

Contrary to common beliefs, autistic children do not prefer being alone. Making and maintaining friendships often proves to be difficult for those with autism. For them, the quality of friendships, not the number of friends, predicts how lonely they feel.

Communication


About a third to a half of individuals with autism do not develop enough natural speech to meet their daily communication needs. Differences in communication may be present from the first year of life, and may include delayed onset of babbling, unusual gestures, diminished responsiveness, and vocal patterns that are not synchronized with the caregiver. In the second and third years, autistic children have less frequent and less diverse babbling, consonants, words, and word combinations; their gestures are less often integrated with words. Autistic children are less likely to make requests or share experiences, and are more likely to simply repeat others' words (echolalia) or reverse pronouns. Joint attention seems to be necessary for functional speech, and deficits in joint attention seem to distinguish infants with ASD: for example, they may look at a pointing hand instead of the pointed-at object, and they consistently fail to point at objects in order to comment on or share an experience. Autistic children may have difficulty with imaginative play and with developing symbols into language.

In a pair of studies, high-functioning autistic children aged 8–15 performed equally well, and adults better than individually matched controls at basic language tasks involving vocabulary and spelling. Both autistic groups performed worse than controls at complex language tasks such as figurative language, comprehension and inference. As people are often sized up initially from their basic language skills, these studies suggest that people speaking to autistic individuals are more likely to overestimate what their audience comprehends.
^

Repetitive behavior


  • Stereotypy is apparently purposeless movement, such as hand flapping, making sounds, head rolling, or body rocking.

  • Compulsive behavior is intended and appears to follow rules, such as arranging objects in a certain way.

  • Sameness is resistance to change; for example, insisting that the furniture not be moved or refusing to be interrupted.

  • Ritualistic behavior involves the performance of daily activities the same way each time, such as an unvarying menu or dressing ritual. This is closely associated with sameness and an independent validation has suggested combining the two factors.

  • Restricted behavior is limited in focus, interest, or activity, such as preoccupation with a single television program or toy.

  • Self-injury includes movements that injure or can injure the person, such as biting oneself. A 2007 study reported that self-injury at some point affected about 30% of children with ASD.
^

Other symptoms


Autistic individuals may have symptoms that are independent of the diagnosis, but that can affect the individual or the family. An estimated 0.5% to 10% of individuals with ASD show unusual abilities, ranging from splinter skills such as the memorization of trivia to the extraordinarily rare talents of prodigious autistic savants.Unusual responses to sensory stimuli are more common and prominent in autistic children, although there is no good evidence that sensory symptoms differentiate autism from other developmental disorders. Differences are greater for under-responsivity (for example, walking into things) than for over-responsivity (for example, distress from loud noises) or for sensation seeking (for example, rhythmic movements). Several studies have reported associated motor problems that include poor muscle tone, poor motor planning, and toe walking; ASD is not associated with severe motor disturbances.

Unusual eating behavior occurs in about three-quarters of children with ASD, to the extent that it was formerly a diagnostic indicator. Selectivity is the most common problem, although eating rituals and food refusal also occur; this does not appear to result in malnutrition. Although some children with autism also have gastrointestinal (GI) symptoms, there is a lack of published rigorous data to support the theory that autistic children have more or different GI symptoms than usual; studies report conflicting results, and the relationship between GI problems and ASD is unclear.

Sleep problems are known to be more common in children with developmental disabilities, and there is some evidence that children with ASD are more likely to have even more sleep problems than those with other developmental disabilities; autistic children may experience problems including difficulty in falling asleep, frequent nocturnal awakenings, and early morning awakenings.

Classification

Autism is one of the five pervasive developmental disorders (PDD), which are characterized by widespread abnormalities of social interactions and communication, and severely restricted interests and highly repetitive behavior. These symptoms do not imply sickness, fragility, or emotional disturbance. Leo Kanner introduced the label early infantile autism in 1943.

Of the five PDD forms, Asperger syndrome is closest to autism in signs and likely causes; Rett syndrome and childhood disintegrative disorder share several signs with autism, but may have unrelated causes; PDD not otherwise specified (PDD-NOS; also called atypical autism) is diagnosed when the criteria are not met for a more specific disorder. Unlike autism, Asperger's has no substantial delay in language development.The terminology of autism can be bewildering, with autism, Asperger's and PDD-NOS often called the autism spectrum disorders (ASD) or sometimes the autistic disorders, whereas autism itself is often called autistic disorder, childhood autism, or infantile autism. In this article, autism refers to the classic autistic disorder; in clinical practice, though, autism, ASD, and PDD are often used interchangeably. ASD, in turn, is a subset of the broader autism phenotype (BAP), which describes individuals who may not have ASD but do have autistic-like traits, such as avoiding eye contact.

The manifestations of autism cover a wide spectrum, ranging from individuals with severe impairments—who may be silent, mentally disabled, and locked into hand flapping and rocking—to high functioning individuals who may have active but distinctly odd social approaches, narrowly focused interests, and verbose, pedantic communication. Sometimes the syndrome is divided into low-, medium- and high-functioning autism (LFA, MFA, and HFA), based on IQ thresholds, or on how much support the individual requires in daily life; these subdivisions are not standardized and are controversial. Autism can also be divided into syndromal and non-syndromal autism, where the former is associated with severe or profound mental retardation or a congenital syndrome with physical symptoms, such as tuberous sclerosis. Although individuals with Asperger's tend to perform better cognitively than those with autism, the extent of the overlap between Asperger's, HFA, and non-syndromal autism is unclear.
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