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Autism Autism (AW-tiz-um) is a brain disorder that affects a person's ability to communicate with and relate to other people and limits the person's interests and activities. KEYWORDS for searching the Internet and other reference sources Behavior Brain disorders Pervasive Development Disorder Psychology A World of His Own Like many children with autism, Jamie was concerned with order. Even as a young child, he kept his toys in the exact same spot on his shelves and would become very angry if anything was moved. He might throw toys, break dishes, or even kick his mother. Most of the time, though, Jamie ignored other people. He seemed to live inside his own head. When things became noisy or confusing in the real world, Jamie would bite himself until he bled. When Jamie started school, he was put in a special class where things were calm and his activities were carefully planned. By the time he was 14, Jamie seemed more relaxed. He would talk to others if they talked to him first. He was also taking medicines that helped him control his anger. However, he still liked everything to be orderly. What Is Autism? Autism is a brain disorder that seems to isolate people in worlds of their own. It can lead to a wide range of unusual behavior. People with autism have trouble communicating with and relating to others. They are Many people with autism repeat the same actions, such as rocking or twirling their hair, over and over. Some hurt themselves by banging their heads or biting their arms. Others seem painfully sensitive to touch, sound, taste, or smell. They may strongly dislike any form of physical contact. Children with autism may refer to themselves by name instead of "I" or "me." Some speak in a singsong voice. What Causes Autism? Studies suggest that autism may result from problems before birth that keep the brain from developing normally. The brain of an unborn baby starts out with just a few cells that grow and divide until the brain contains billions of special nerve cells, called neurons (NOOR-ons). Each neuron sends out long fibers that connect with other neurons to pass signals from one part of the brain to another or from the brain to the rest of the body. When a neuron receives a signal, it releases chemicals called neurotransmitters, which send the signal to the next neuron. Studies of people with autism have found that some of their neurons are smaller than normal. They also have short nerve fibers, which may affect signaling. In addition, studies suggest that people with autism may have an unusually high amount of the neurotransmitter called serotonin (ser-o-TO-nin). Scientists are studying the effect of such differences. Who Gets Autism? Autism occurs in people all over the world of every race and background. Estimates are that two to ten out of every 10,000 people have autism. If the milder forms of autism (see PDD sidebar) are included, this number can go as high as twenty in 10,000. Males are three to four times more likely than females to have the disorder. However, girls with autism tend to have more severe symptoms and lower intelligence. Genes * may play a role in autism. Families who already have one child with autism have a greater risk of having a second child with the disorder. However, autism does not seem to be caused by one particular gene. Some scientists think that autism may be due to a cluster of faulty genes. In most cases, these genes cause only mild symptoms, such as reading problems, but under certain conditions, full-blown autism may result. Pervasive Development Disorder (PDD) Recently, it has been recognized that there is a range for autism—from severe to relatively mild. The term "pervasive developmental" refers to milder cases that do not have all the signs of autism. People with PDD all have some degree of delayed or abnormal language, difficulty with social interaction, and some unusual behaviors or perseverations (overfocus) on ideas or actions. * genes are chemicals in the body that help detemine a person's characteristics, such as hair or eye color. They are inherited from a person's parents and are contained in the chromosomes found in the cells of the body. What Other Disorders May Occur? Other disorders often go along with autism: - Mental retardation. Many people with autism are mentally retarded to some degree, which means that their intelligence is well below average. - Seizures. A seizure is a sudden burst of uncontrolled electrical activity in the brain that can result in brief blackouts to convulsions (intense, uncontrolled muscle spasms throughout the body). About one third of children with autism have seizures, which can be controlled with medicine. - Fragile X syndrome. This disorder is associated with a faulty X chromosome * . About one out often people with autism, mostly males, have fragile X syndrome, which causes mental retardation. - Asperger's syndrome. Children with Asperger's syndrome, considered a mild form of autism, have a consuming interest in, or obsession with, one subject—often something unusual for their age. They generally have average or above-average intelligence and impressive verbal skills but lack nonverbal and social skills. What Are the Symptoms of Autism? The symptoms of autism can range from mild to severe. In some children, hints of future problems are apparent at birth and become more noticeable as the child's development lags behind that of other children. In others, everything seems fine at first, but between eighteen months and three years of age, the child starts to reject others and may seem to slip backward in development. Communication Healthy babies look at other people's faces and react to sounds. Babies with autism avoid eye contact and seem unable to hear. They may start making speech sounds, then suddenly stop. About half of people with autism are never able to speak; others may start talking as late as age five to eight years. Those who do speak often use language in unusual ways. For example, they may say the same thing over and over or speak only in single words. Some children with autism have echolalia (ek-o-LA-lee-a) and only parrot back what they hear. Some speak in a singsong or robot-like voice. People with autism also have trouble communicating with body language. Most people smile when talking about things they like or shrug when they cannot answer a question. People with autism often do not use their faces and bodies in this way, and their tone of voice may not indicate their true feelings. Relationships Usually, babies smile at familiar faces, and past the age of 7 to 9 months they show signs of fear around strangers. Babies with autism act as if they are unaware of the comings and goings of other people. They may seem impossible to reach. Some resist hugs and cuddling. Others accept physical contact but do not hug back. Older children with autism rarely seem to seek love and comfort from others. Children with autism also have trouble understanding what other people are thinking or feeling, and they are unable to see things from someone else's point of view. * X chromosome (X KRO-mo-som). A chromosome is a structure inside the body's cells containing DNA, the genetic material that helps determine characteristics, such as whether a person has brown hair or blue eyes. The X chromosome carries many different genes. Females have two X chromosomes, while males have only one. Interests Babies are fascinated by the world around them. They reach for objects and play with toys, constantly moving from one thing to another. Babies with autism often seem stuck on one activity. They may repeat one movement, such as rocking back and forth or flicking their fingers. Children with autism may also become obsessed with certain objects. For example, a child who is obsessed with watches might grab strangers' arms to look at their wrists. Senses Many people with autism seem painfully sensitive to touch, sound, taste, or smell. They might cover their ears and scream at the sound of a vacuum cleaner. Other senses may be extremely dull. Some children with autism do not seem to notice extreme cold or pain, to the point where they might break an arm and never cry. Talents Some people with autism have remarkable talents. For example, at an early age, when other children are drawing lines and scribbles, some children with autism can draw detailed, realistic pictures. Other children learn to read before they even start to speak. Still others can play a song on the piano after hearing it once. A few people with autism can even memorize whole television programs or pages of the phone book. How Is Autism Diagnosed? Since the symptoms of autism vary so widely, it can be hard to diagnose. Parents are usually the first ones to notice that something is wrong. A doctor can rule out problems such as hearing loss, speech problems, mental retardation, and other brain disorders. If autism is suspected, the child can see a specialist. There is no single test for autism. The doctor will closely note the child's language and actions around other people and ask the parents about the child's symptoms and development. Autism Is Not Schizophrenia The term "autism" was introduced by the psychiatrist Eugen Bleuler in 1911 to refer to a group of symptoms observed in people with schizophrenia. Bleuler described the symptoms as "detachment from reality," with a "predominance of inner life" withdrawn from the external world. The Johns Hopkins psychiatrist Leo Kanner (1894—1981), founder of child psychiatry as a medical specialty, first identified autism as a disorder distinct from schizophrenia. Kanner believed that people with autism had not withdrawn from participation in the external world, but that autism was a fundamental inability to relate, from the beginning of life. In 1944 he designated the condition as "early infantile autism." Thinking in Pictures Temple Grandin is a gifted animal scientist who has earned a Ph.D. Today she invents equipment for handling livestock, writes books, and gives lectures. Yet as a child, Grandin had many of the signs of full-blown autism. As a baby, she would stiffen when picked up and struggle to be put down. By age two, she was sometimes overpowered by her ultra-sharp senses. She screamed, flew into rages, and threw things. At other times, she found that focusing intently on one thing, such as an apple or her hand, made herfeel calmer and safer. Grandin's mother put her in a special class with strict routines designed for children with speech problems. By age four, Grandin had started to speak, and by age five, she could go to regular school. As an adult, she recalled her experiences in a book called Thinking in Pictures. The book begins: "I think in pictures. Words are like a second language to me." Today Grandin uses the way her brain works to imagine how the parts of the complicated equipment she invents will fit together. How Is Autism Treated? There is no cure for autism, but there is reason for hope. Behavioral treatments Some treatments focus on using rewards to teach new skills, then using the new skills to replace problem behaviors. Others build on the special interests, skills, and needs of the particular child. Studies have shown that such treatments are most likely to work if they involve a regular routine and planned activities and teach tasks as a series of simple steps. It also helps if the parents are involved, and with training, parents can continue the treatment at home. Medicines No medicine can fix the brain problems that seem to cause autism. However, doctors may prescribe medications to reduce symptoms such as head banging or violent outbursts. Some medications also decrease seizures and lessen problems related to paying attention. Most such drugs affect the amount of signaling chemicals, such as serotonin in the brain. Special education Special education classes can help a child with autism learn as much as possible. For some, this means mastering simple skills such as dressing and handling money. For others, this means learning to read, write, and do math. Many people with autism finish high school, and a few even earn college degrees. The sooner a child gets help, the greater the chance for learning. Can Autism Be Outgrown? People do not outgrow autism. In general, those with milder forms (PDD) do better in their day-today lives. Over time and with help, however, the symptoms of autism may get better. Although most adults with autism need lifelong training and help taking care of themselves, some go on to lead nearly normal lives. The Real "Rain Man" In the movie Rain Man, actor Dustin Hoffman portrays a man with autism who is a savant, or a person with mental deficiencies who is exceptionally gifted in one area. To prepare for the role, Hoffman studied real-life "rain man" Joe Sullivan. Like Sullivan, Hoffman's character insists on eating cheese puffs with toothpicks and mutters the same things over and over to himself. Also like Sullivan, the character can do complicated math in his head and name the day of the week for any date past or future. When the movie came out in 1988, Sullivan was a high school graduate who held a job shelving books at a library. Resources Book Grandin, Temple. Thinking in Pictures, and Other Reports from My Life with Autism. New York: Vintage Books, 1995. Organizations Autism Research Institute, 4182 Adams Avenue, San Diego, CA 92116. group that studies autism. http://www.autism.com/ari Autism Society of America, 7910 Woodmont Avenue, Suite 300, Bethesda, MD A group for people with autism and their families. aTelephone 800-3AUTISM http://www.autism-society.org The National Institutes of Health posts information about autism on its website at: http://www.nimh.nih.gov/publicat/autism.htm U.S. National Institute of Mental Health (NIMH), NIMH Public Inquiries, 5600 Fishers Lane, Room 7C-02, MSC 8030, Bethesda, MD 20892-8030. NIMH publishes a pamphlet called Autism. http://www.nimh.nih.gov The U.S. Centers for Disease Control, located in Atlanta, Georgia, posts information about autism on its website at: http://www.cdc.gov/nceh/programs/CDDH/
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Autizam kod djece – kako ga prepoznati, uzroci i liječenje Autizam je u skupini težih smetnji u razvoju koje se javljaju u ranom djetinjstvu, obično prije 3 godine. Iako se simptomi autizma i njihova ozbiljnost razlikuju, svi oblici ove bolesti utječu na djetetovu sposobnost komunikacije i interakcije s drugima. Broj djece s dijagnozom autizma je u stalnom porastu. Nije jasno je li riječ o stvarnom povećanju ili je to posljedica veće informiranosti liječnika i roditelja. Iako ne postoji lijek za autizam, intenzivno, vrlo rano liječenje može napraviti veliku razliku u kvaliteti života mnoge djece s ovim poremećajem. Simptomi autizma Djeca s autizmom obično imaju poteškoće u tri ključna područja razvoja – socijalna interakcija, komunikacija i ponašanje. No, budući da se simptomi i ozbiljnost autizma uvelike razlikuju, dvoje djece s istom dijagnozom mogu djelovati vrlo različito i imati različite vještine. U većini slučajeva, djeca s teškim autizmom imaju vrlo izražene poteškoće ili potpunu nemogućnost komunikacije i interakcije. Neka djeca pokazuju znakove autizma već u ranom djetinjstvu, dok se druga razvijaju normalno tijekom prvih nekoliko mjeseci ili godina život, no onda iznenada postaju povučena ili agresivna odnosno, u nekim slučajevima, gube stečene kompetencije. Premda u većini slučajeva djeca s autizmom imaju jedinstven uzorak ponašanja, postoje i neki zajednički simptomi autizma. Gubitak socijalnih vještina: - Djeca se ne odazivaju na svoje ime - Imaju slab kontakt očima - Ponekad se čini da vas dijete ne čuje - Dijete se opire maženju i držanju - Dijete nije svjesno tuđih osjećaja - Izbjegava igru s drugom djecom i povlači se u vlastiti svijet - Ne traži pomoć Smanjena sposobnost komunikacije: - Dijete ne razgovara ili odgađa odgovore - Gubi prethodno stečenu sposobnost za izgovaranje riječi ili rečenica - Izbjegava kontakt očima prilikom razgovora - Govori neuobičajenim tonom ili ritmon (monoton glas) - Ne možete započeti razgovor s djetetom - Ponavlja riječi ili fraze, ali ne razumije njihov značaj - Ne razumije jednostavna pitanja ili upute Poteškoće u ponašanju: - Dijete ponavlja pokrete, primjerice ljuljanja ili zmahivanja rukom - Razvija određene rutine ili rituale i intenzivno reagira na svaku promjenu - Neprestano se kreće - Fascinirano je detaljima objekta, kao što je primjerice kotačić autića, ali ne razumije predmet u cjelini - Neobično je osjetljivo na svjetlost, zvuk i dodir, a ipak nesvjesno boli - Može imati neobične navike u prehrani, primjerice, konzumiranje samo nekoliko vrsta hrane ili sklonost prema neobičnim stvarima, poput krede ili prljavštine - Često radi stvari koje mogu dovesti do samoozljeđivanja, poput lupanja glavom od krevet ili zid Mala djeca s autizmom također imaju poteškoće s dijeljenjem iskustava s drugima. Ipak, rani razvoj socijalnih vještina od presudne je važnosti da za kasniji razvoj komunikacije i društveni razvoj. Kako odrastaju, neka djeca s autizmom ostvaruju veći angažman s drugima i pokazuju manje poremećaja u ponašanju. Neki, obično oni s najblažim simptomima, s vremenom mogu voditi potpuno ili gotovo normalan život. Drugi, međutim, i dalje imaju poteškoća s komunikacijom ili socijalnim vještinama te u tinejdžerskim godinama imaju izražene probleme u ponašanju. Jedan dio djece s autizmom sporo usvaja nova znanja i vještine, a neki imaju i umanjenu inteligenciju. Ipak, najčešće djeca s autizmom imaju normalnu do vrlo visoku inteligenciju. Ta djeca brzo uče, ali imaju problema u komunikaciji i primjeni onoga što znaju u svakodnevnom životu i društvenim situacijama. Postoji i dio djece s autizmom koji su pravi mali “mudraci”. Ta djeca imaju izuzetne vještine u određenom području, kao što su umjetnost, matematika ili glazba. Pročitajte više: Kako prepoznati autizam – prvi simptomi Kada posjetiti liječnika? Djeca se razvijaju svojim tempom, a mnoga od njih ne slijede “rokove” koje možete pronaći u nekim “roditeljskim knjigama”. No, djeca s autizmom obično pokazuju neke znakove usporenog razvoja u prvoj godini života. Ako sumnjate da vaše dijete ima autizam, razgovarajte o vašoj zabrinutosti sa svojim liječnikom. Simptomi povezani s autizmom mogu ukazivati i na druge poremećaje u ponašanju. Znakovi zbog kojih biste se trebali posavjetovati s vašim liječnikom su: - Dijete ne pokazuje sretne izraze i ne smije se u dobi do 6 mjeseci - Dijete ne oponaše zvukove i izraze lica do 9 mjeseca - Dijete ne guguće do dobi od 12 mjeseci - Dijete ne pokazuje nikakve geste (primjerice ne pokazuje na stvari ili maše) do dobi od 12 mjeseci - Dijete uopće ne govori do dobi od 16 mjeseci - Dijete ne izgovara nikakve fraze do dobi od 2 godine - Dijete gubi stečene vještine komunikacije ili socijalne vještine u bilo kojoj dobi Uzroci autizma Autizam nema poznatih uzroka. S obzirom na složenost bolesti, kao i činjenicu da se simptomi i njihova ozbiljnost razlikuju, vjerojatno postoji više mogućih uzroka. Genetika i okolina mogu igrati ulogu. Genetski problemi koji utječu na autizam Čini se kako je nekoliko gena uključeno u autizam. Neki mogu učiniti da su djeca osjetljivija na poremećaje, drugi utječu na razvoj mozga odnosno na način na koji moždane stanice komuniciraju. Također, neki geni mogu odrediti težinu simptoma. Utjecaj gena se razlikuje u svakom individualnom slučaju, no sigurno je da je vrlo bitan, bez obzira je li riječ o nasljednom genetskom poremećaju ili onom koji se razvio spontano. Okolišni čimbenici koji utječu na autizam Znanstvenici trenutno istražuju imaju li na autizam utjecaj čimbenici poput virusnih infekcija, komplikacija u trudnoći ili štetnih tvari. Jedna od najvećih kontroverzi u autizmu je tvrdnja da postoji veza izmađu autizma i nekih dječjih cjepiva, osobito MMR cjepiva protiv ospica – zaušnjaka – rubeole. Unatoč opsežnim istraživanjima, nema pouzdanih studija koje pokazuju vezu između autizma i cjepiva. Faktori rizika nastanka autizma Autizam jednako zahvaća svu djecu, ali neki čimbenici povećavaju rizik: - Spol djeteta – dječaci imaju četiri do pet puta veću vjerojatnost da razviju autizam od djevojčica - Obiteljska anamneza – obitelji koje imaju jedno dijete s autizmom imaju povećan rizik da će i drugo dijete razviti poremećaj - Ostali poremećaji – djeca s određenim medicinskim poteškoćama imaju veći rizik od autizma. Ti poremećaji uključuju Fragile X sindrom, nasljednu bolest koja uzrokuje intelektualne probleme, gomoljastu sklerozu, stanje u kojem se u mozgu razvijaju benigni tumori, te neurološki poremećaji kao što je Tourettov sindrom i epilepsija, koja uzrokuje napadaje. - Dob roditelja – postoje indikacije da dob roditelja predstavlja faktor rizika za nastanak autizma odnosno da je autizam češći kod djece koja imaju starije roditelje. Ipak, nije provedeno dovoljno istraživanja kako bi se potvrdile ove teze. Liječenje autizma Ne postoji lijek za autizam, pa čak ni terapija koja bi odgovarala svima. Liječenje je vrlo individualno, a cilj je prvenstveno povećanje djetetovih sposobnosti smanjivanjem simptoma i podrška u razvoju i učenju. Liječenje autizma može uključivati terapije usmjerene na: - Ponašanje i komunikacijske terapije – mnogi programi su usmjereni na rješavanje niza socijalnih, jezičnih i bihevioralnih poteškoća povezanih s autizmom. Terapija je djelomično usmjerena na smanjenje problema u ponašanju i stjecanje novih vještina, dok je drugi fokus na tome kako postupati u društvenim situacijama ili pomoći djetetu da ostvari bolju komunikciju. - Obrazovanje – djeca s autizmom mogu vrlo dobro usvajati nova znanja u sklopu strukturiranih obrazovnih programa. Razvijeni programi stručnjaka i razne aktivnosti poboljšavaju djetetove socijalne i komunikacijske vještine, ponašanje i vještinu improvizacije. Predškolska djeca koja su upućena na intenzivnu, individualnu terapiju vrlo dobro napreduju. - Obiteljska terapija – tijekom obiteljske terapije roditelji i članovi obitelji mogu naučiti kako razviti interakciju i komunicirati sa djetetom na način koji njemu odgovara, kako rješavati probleme u ponašanju te kako razviti vještine koje su potrebne bi pomogli djetetu u njegovom razvoju. - Lijekovi – premda se autizam ne može izliječiti, određeni lijekovi mogu pomoći vašem djetetu u kontroli simptoma. Primjerice, antidepresivi mogu biti propisani za anksioznost ili antipsihotici za probleme u ponašanju. Lijekovi se propisuju i ukoliko je autizam popraćen hiperaktivnošću djeteta. Alternativne metode liječenja autizma U liječenju autizma koriste se mnoge alternativne i komplementarne metode kojima se nastoje smanjiti simptomi autizma. Primjer su kreativne terapije, koje su usmjerene na smanjenje djetetove osjetljivosti na dodir ili zvuk kroz glazbu ili slikanje; terapije bazirane na poboljšanju senzornih sustava i sl. Djeca s autizmom različito reagiraju na ovakve oblike terapija i zato se preporučuje savjet potražiti od stručne osobe.