What disorders mimic autism?
Autism Spectrum Disorder
Autism Spectrum Disorder (ASD, autism): Far-reaching developmental disorder that occurs in childhood and manifests itself through problems in social interaction, problems in linguistic and non-linguistic communication as well as restricted interests and activities with stereotypical behaviors.
In the past it was usually only used by autism spoken. Autism spectrum disorders, however, express themselves very differently, so that three types are distinguished in the German-speaking area:
- Severe early childhood autism (Kanner syndrome)
- Mild Asperger's Syndrome (most common ASA)
- Atypical autism that does not fit either one or the other type. For example, some key symptoms of the early childhood form are missing or the typical picture only shows up after the age of three.
The transitions are fluid, so that a clear assignment to a type is often not possible. New international disease classifications (DSM V and ICD 11) therefore assume a continuum and only speak of autism spectrum disorder. In everyday clinical practice, but also in early intervention and special education, a distinction is made between the types mentioned above.
The treatment includes a multimodal concept of early intervention, family counseling, psychotherapy and, depending on the symptoms, medication. The course is very variable. For some people, the symptoms decrease in adulthood, for others they even worsen. Lifelong care is often necessary.
Early childhood autism:
- Impaired contact and communication (even in infancy)
- Reduced eye contact, low-key facial expression, lack of social smile
- Passivity, preferred solitude, little imitation
- Significantly slowed down language development, 50% of children do not even begin to speak
- Stereotypical repetition of certain processes or movements
- Often fixation on certain objects, activities and time sequences
- Often intellectual disability through to intellectual disability.
- Noticeable only from the age of three
- Fleeting eye contact, poor expression on the face
- Normal mental and linguistic development
- Often special strengths or island talents, e.g. B. in memory or perception
- Often times additional symptoms of ADD / ADHD.
When to the doctor
- If for a long time you feel that your child is not interacting and communicating normally with you as a mother or father
- When the day-care center draws your attention to the fact that your child is behaving in conspicuous ways in their communication and play
- If you have the feeling that the child is not developing in a way that is appropriate for their age, for example not starting to speak.
Autism spectrum disorders cannot, as previously assumed, be traced back to a disturbed parent-child relationship. Rather, it is based on abnormalities in the structure, development, function or organization of the brain. Its causes are ultimately unclear.
A (partial) hereditary background is considered proven. Siblings of autistic children have about a 5% risk of being autistic themselves. In addition, external influences such as damage to the womb or during childbirth could play a role.
In the past, the measles, mumps and rubella vaccination was often blamed for the disease. Today this hypothesis has been proven to be refuted.
Many children derive from comorbidities such as ADD / ADHD, anxiety disorders, tics and obsessive-compulsive disorder, and epilepsy. Functional disorders are also common, such as nutritional problems, night wetting, sleep disorders and constipation.
Diagnosing autism spectrum disorder is made difficult by the fact that individual symptoms may still be normal on their own. Only when several of the above behaviors exist at the same time does a suspicion arise. In this case, the pediatrician should refer to a specialist. Standardized observation scales are available for diagnosis, such as ADOS, CARS or ADI-R. With the help of laboratory tests, magnetic resonance imaging and EEG, the doctor can rule out organic causes. The children should also be tested for hearing and vision disorders. However, a reliable diagnosis is usually only possible from the age of 18 months.
Differential diagnoses. In practice, the differential diagnosis of ADHD or ADD is often suspected. Indeed, attention deficit disorders are typical of both disorders. To differentiate, the doctor makes the following considerations:
- The fixation on a few activities, the focused, detail-oriented gaming behavior and "island-like" strengths and talents speak against ADHD and ADD.
- Weak impulse control (such as the rapid onset of tantrums when frustrated) and hyperactivity speak against an autism spectrum disorder. "Disorganization" in everyday life and erratic thinking and acting are also not typical.
Children show behavior similar to autism even when they are neglected or mistreated. In these cases, however, the autism-like behavior disappears when the child is placed in an intact and supportive environment such as B. comes a suitable foster family.
Other neurological or physical diseases also lead to behavioral disorders and intellectual impairment that are similar to ASA. These include, for example, schizophrenia, fetal alcohol syndrome, metabolic diseases such as phenylketonuria or congenital genetic or chromosomal defects.
There is no cure for an autism spectrum disorder. However, it is quite possible to positively influence the deficits typical of autism. The treatment is always based on the individual case and combines psychotherapeutic and educational procedures with methods of behavioral therapy. Medicines can be used to suppress accompanying and particularly stressful symptoms, such as seizures.
- Stable environment. A stable environment is essential for a child with an autism spectrum disorder to feel comfortable and to develop according to their possibilities. Everyday life at home, kindergarten and school, therapy - everything should be made as predictable and manageable as possible .
- Early intervention. It begins at the age of 2 to 3 years and ends with school enrollment. In intensive behavioral therapy, language skills and interaction with adults (and later other children as well) are practiced. Everyday skills can also be practiced in this context, so toilet training can also be part of the therapy. How small steps the therapist takes depends on the severity of the disease.
- Group therapy. Social interaction can also be further improved with autism-specific group therapy. It is also about those affected learning to plan their actions better and to deal more confidently with anger and frustration. Such a measure lasts up to a year, but can also be repeated.
- Classic behavior therapy. This is particularly suitable when affected children and adolescents also suffer from an anxiety or obsessive-compulsive disorder.
- Medication. There is no such thing as a "drug for autism". However, some herbs can be used to alleviate accompanying symptoms. Atypical antipsychotics such as risperidone are prescribed for aggressive behavior, compulsions and stereotypes. Methylphenidate or other stimulants are said to have a positive effect on hyperactive or impulsive behavior. The tricyclic antidepressant mirtazapine is an option for depression.
- Other measures. Depending on your needs, there are many ways to train your child's individual skills. Speech therapy is a good option to further improve your speech, while occupational therapy is a good option to develop motor skills.
There is no cure for an autism spectrum disorder. How the disease develops in its course varies greatly. In some people, the symptoms recede in adulthood, in others they even worsen. Often lifelong care cannot be prevented - be it at home, by outpatients or in assisted living. Even with mild forms of the disease, everyday life is unfortunately often significantly restricted.
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What you can do as a parent
Take care of yourself. As much as you love your child - looking after them takes a lot of energy. So don't forget your own needs and take advantage of offers of help. Many affected parents benefit, for example, from self-help groups that offer mutual support and an intensive exchange of information. Get help by the hour or take advantage of short-term care to have time for yourself.
Try out offers.
Every child is different - this also applies of course to children with an autism spectrum disorder. Even if there are no scientific findings for offers such as therapeutic riding, dance or music therapy - just give it a try if you feel good about it. Optimistic promises of salvation that are associated with high financial expenses should be viewed critically.
Promote with a sense of proportion.
Your child will certainly benefit from support measures - provided you set realistic goals and do not overwhelm them. On the other hand, there is no need to overprotect your child. This is especially true if you already have an overview of possible sources of danger in your everyday environment and are able to circumnavigate them well.
Inform the environment.
Your child has special needs - which you should definitely discuss with those around you. Only in this way do your fellow human beings have the chance to correctly classify your child's behavior and react accordingly.
The Federal Association for the Promotion of People with Autism offers information and help for those affected and their relatives on its website, ranging from travel and training offers to information on legal issues: www.autismus.de
www.autismus-kultur.de is the website of a person affected personally, which bundles current news and autistic experiences into an autism guide for other affected persons and their relatives.
AuthorsDr. med. Herbert Renz-Polster, Dr. med. Nicole Menche, Dr. med. Arne Schäffler in: Health for Children, Kösel, Munich, 8th edition (2015). Revision and update: Sara Steer | last changed on at 09:23
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