На сайте МАИР опубликована статья профессора Рахманова В.М. «Особенности клинических проявлений аутизма и сферы аутичных нарушений в системе медицинской и психосоциальной реабилитации и их современная классификация». «Characteristics of Clinical Manifestation of Autism and Autistic Sphere of Disorders in the System of Medical and Psychosocial Rehabilitation and Their Modern Classification»
Prof. Dr. Vagif Rakhmanov, Director of Research Institute of Children’s and Family Psychiatry, Psychotherapy, Psychology, Medical and Psychosocial Rehabilitation, Ukraine Despite numerous and longstanding scientific research, the problem of medical and social rehabilitation of patients suffering Autism (A) and Autistic Sphere of Disorders (ASD) is still unsolved.
According to the data of various authors, Childhood A occurs with from 2-4 up to 6-15 children in 10000 people. Two-thirds of children suffering Early Childhood Autism (ECA) are diagnosed with mental retardation. At the same time 1 of 10 children with mental retardation suffer A. If we combine A with mental retardation, this number increases up to 20 cases in 10000 people. Still, there are inconsistencies in the views on pathologic nature, structure, taxonomy of A and ASD. In practice, it is impossible to define reasons of A and ASD with 30-40% of children.
After thorough interrogation of mothers, we can observe consistent correlation with psychogenic factors during perinatal and postnatal periods in the aetiopathogenesis of these disorders. Vagif Rakhmanov IT 2In order to evaluate the relevance of aetiopathogenetic factors, including acute and chronic psyco- traumatic factors that affect psyco- sensorial, psychomotor, psycho- verbal development of children, and to develop new methods of psychosocial rehabilitation, we have examined 350 children aged from 2 to 17.
Basing on diagnostic results, we conducted complex statistical data analysis concerning 121 children (96 boys and 25 girls). Besides principal diagnosis (enuresis, encopresis, habit spasm, stuttering, and sensorineural hearing loss) after the examination, there were diagnosed cases of verbal retardation: dyslalia, dysarthria, dyslexia, dysphagy, expressive language disorder, impressive language disorder, incoherence, iteration etc.
Provided a classification of variants of clinical manifestation of autism (A) is grounded upon one or several leading pathopsychological symptoms (syndromes), their expressiveness, breach of relations in micro- and macro environment.
1. Hyperactive form is characterized by hyperactive behavior in micro- and macro environment. We distinguish a) hyperactivity with attention deficit, nervousness, mood swing, impulsion, motor stereotypy, unformed intellectual activity (moderate or profound mental retardation), psychomotor and psycho- verbal delay, uncontrolled behavior; b) hyperactivity with fairly moderate affectability and mood swing, impulsion, easy cognitive activity of mild mental retardation, psychomotor and psycho- verbal delay and relatively controlled behavior.
We should differentiate hyperactivity in the family environment and hyperactivity in society (in public places, in particular, at school).
Manifestations of hyperactivity at school are more indicative. Behavioral disorders, associated with excessive mobility that takes place mostly at home, are less specific. They can testify about the child suffering the oppositional defiant disorder.
2. Aloofness (dispassionateness, detachment) is characterized by detachment from real life and out-of-body experience, breach of communication skills, dispassionateness towards the environment, dysontogenesis retardation and delay with following cognitive retardation, psychomotor, psycho- verbal, psycho- sensor delay. Underdeveloped imitation.
Aloofness is more profound than detachment and is characterized by social and emotional withdrawal. The difference between these two conditions is defined according to the levels of non-attachment to sensible objects.
Herewith among clinical manifestations, we can observe emotional aloofness, communicative (social aloofness), and combined form. Aloofness comes gradually as the last stage of detachment.
3. Obnubilation is characterized by disorder of consciousness with mild black vision. There are observed difficulties in getting around, lack of understanding the world, threshold shift of all external (sensor) irritants, difficulties in psychic behavior often with psychomotor, psycho- verbal, psycho- sensor retardation, less often with disinhibition. Absence of imitation.
4. Apathetic form is characterized either by lowered emotions, indifference to oneself, super inhibition towards the environment, or by short-termed psychic activity in order to satisfy physiological needs, or by strong outer motivation (demonstration of a favorite toy, meal). Such children retain nonverbal communication and imitation.
5. Sensitive form is characterized by tearfulness, crying, monotonous crying, etc., and increased sensitivity towards the environment, occurring events, in combination with anxiety about new environment, new people, events, actions, nyctophobia, monophobia (often “symbiosis” with mother).
6. Mixed form: hyperactive-aloof; hyperactive-obnubilated; hyperactive-obnubilated-aloof; sensitively hyperactive; apathetic-sensitive.
7. Constitutionally (genetically) caused form is observed in the frame of family and relatives.
8. Autism. Normotonic form in clinical practice comprehends psychic activity, social behavior, affection. It is characteristic for the children undergone appropriate treatment and rehabilitation measures and staying in friendly social and living conditions. They have behavior that is more congruent, glance, nonverbal, verbal communication, and retained developed imitation, formal social and emotional perception. These conditions are unstable. After stopping treatment and rehabilitation measures and in case of negligible psycho-traumatic situation child’s state can worsen and exacerbate.
9. Atypic form (AA) is characterized by the idiopathic appearance in families with friendly social and living conditions (in past medical history there are organic reasons, CNS and chromosomal pathologies, derangement of metabolism, traumas). AA constitutes 50% of cases of ASD.
The difference between AA and ECA is that the former arises with physiologic crisis periods, increases and acts as an impulse in the manifestation of different forms of A, plays not only the pathogenic role but also is accompanied by the manifestation of A in their structure. Herewith the sufficiently distinct manifestation of psychopathologic symptoms (breach of communication in micro- and macro environment limited stereotypies) are absent.
Offered classification will be instrumental in more selective and effective medical and psychosocial rehabilitation of children suffering A and ASD.