Autism

What is it about ?

According to the latest international definition from DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, the diagnosis of autism spectrum disorder (ASD) is made in children and adolescents who share two basic characteristics, considered to be the basic features of autism :

• persistent deficits in communication and social interactions observed in various contexts;
• the restricted and repetitive nature of behaviors, interests and activities.

These characteristic traits are present, to varying degrees of severity, from an early age and persist throughout life. These features are often accompanied by the following symptoms, also to varying degrees:

• cognitive disorders ;
• language disorders and learning disabilities ;
• motor disturbances, emotional disturbances and behavioral disturbances ;
• anxiety ;
• self-harm;
• aggressive behaviour ;
• sleeping troubles and eating behavior.

Autism Spectrum Disorder (ASD) is a trdubious neurological development, which means that the disease influences the structural development of the brain and is incurable.

ASD manifests itself in different forms and the ability of young patients to progress can also be very variable. This variability is accentuated in the presence ofother possible illnesses such asepilepsy where the attention deficit disorder with or without hyperactivity (ADHD). In summary, each individual with an autism spectrum disorder has a unique profile.

Causes of autism

The causes of autism have already been the subject of numerous publications. Some theories have been interpreted in such a way that the family is accused of contributing to the development of the disease. These accusations left emotional traces, which continue to this day. Scientific advances in recent decades have swept aside these theories, but have not yet determined the exact cause of ASD. It is now clearly established that the TSA has several causes. THE’heredity plays an important but complex role. There is no universal gene for autism, but a number of genes likely increase susceptibility to the disease. Knowledge of genetics is in full development and new links are regularly established, mainly with the development of the nervous system.

In the meantime, some hypotheses as to the cause of the ASD were permanently excluded, including the measles, rubella and mumps vaccine (MMR), which has been presumed to play a role in the development of ASD.

What is its frequency?

A recent global study estimates the frequency of ASD at 62 in 10,000 people (or 1 in 161 births). In Belgium, this corresponds to some 70,000 people. However, a recent American study estimates it at 1 in 68 children.

The frequency of ASD appears to be increasing for some reason that is not known. The possible explanations are:

• better identification of ASD by healthcare providers, who are now better trained in it;
• the great attention devoted to ASD in the media;
• adaptations of the definition of ASD.

Autism spectrum disorder (ASD) is more common in boys than in girls, according to a 4: 1 ratio.

How to recognize it?

Autism remains present throughout life, although its form changes with age. The symptoms vary. Autism can result in a abnormal development in the following fields:

Social interaction

• The use of eye contact, facial expressions and gestures is limited.
• The child remains withdrawn in the company of other people.
• Attention is minimal or absent: the child is not looking in a certain direction (eg towards objects or people).
• The child has trouble putting himself in someone else’s shoes.
• The child does not have the capacity to imitate.

Communication and speech

• About a third of children with autism experience a slowdown in language and speech development around the age of 1.5 to 2 years. The child no longer uses words that he has already learned.
• The child does not babble, gesture, or speak their own language.
• Skills in terms of interaction and dialogue are not sufficiently developed.

Operation and areas of interest

• The child has repetitive and stereotypical movements of the body or of the hands.
• The child shows a persistent interest in certain parts of objects.
• The use of the imagination is limited during (role) plays.
• The child has significant anxiety about small changes in the environment.

Others

• The child suffers from anxiety, sleeping troubles and of eating disorders.
• He has outbursts of anger, aggression or self-destructive behavior.
• Out of 100 children with autism, 45 to 50 have an intellectual disability.

How is the diagnosis made?

The doctor may suspect a developmental disorder such as autism based on characteristic abnormalities in your child’s behavior. If necessary, he will refer you to a child psychiatrist.

What can your doctor do?

Individual rehabilitation program

• A targeted rehabilitation can be beneficial for the development of the child, but also for the quality of life of the child and his family. Every autistic child needs an individual rehabilitation program. For this program to work best, it is important that the family, daycare (or school), and therapists actively participate.
• Children with autism need a personal assistant at the daycare. This is also the case at school, in order to allow intensive rehabilitation and training.
• Usually, rehabilitation also includes individual therapy or group therapy. The needs are determined on a case-by-case basis between physiotherapy, speech therapy, occupational therapy, …

Psychosocial intervention

The basic approach to communication and social interaction difficulties is ideally a psychosocial intervention. The term encompasses all types of intervention (behavior, development, teaching, etc.) aimed at improving the psychological functioning and well-being of a child, as well as his integration into society.

the interactive game, involving parents, caregivers and teachers (as well as other children around the school-age child), is a good method to apply. The objective pursued is to increase the level of joint attention and commitment of the child.

Cognitive-behavioral therapy

To control the anxiety disorders, a cognitive behavioral therapy is recommended for children who are sufficiently developed to participate.

Medications

If all other interventions have not been (sufficiently) effective, or if they cannot be implemented due to the severity of the behavioral disturbances, a medical treatment can be considered.

What can you do ?

• Often the autistic child needs to be accompanied and receive instructions constantly, which requires a lot of energy from the family.
• Parents generally feel that they are receiving the mosthelp and support from professionals with whom they are in close contact, such as the rehabilitation counselor, speech therapist or occupational therapist.
• THE’temporary help constitutes an important support for the family.
• A parent training may be useful in the treatment of autism spectrum disorders, both for the parent and for the child. As part of the therapy, the involvement of people close to the child, such as parents, is indeed essential to learn to apply the skills acquired by the child in different situations and different environments.

Want to know more?

• Cognition – Health Passport
• Autism – AVIQ – Agency for a Quality Life

• Autism – Understanding, Helping, Finding Resources – Participate
• Autism day after day; Understand to act – Participate
• How to communicate with an autistic child? (video) – Handéo

• APEPA – Association of Parents for the Development of People with Autism
• Inforautism – Association for the defense of the rights of people with autism and their families, information on autism, and for the improvement of the quality of life of people with autism
• Survival guide for non-autistic people living with autistic people (and vice versa) – AFFA – Association francophones des Femmes Autistes

• Autism reference centers – INAMI – National Institute for Sickness and Invalidity Insurance

Sources

• Foreign clinical practice guide ‘Autism spectrum disorders’ (2000), updated on 20.03.2017 and adapted to the Belgian context on 28.02.2019 – ebpracticenet
• Belgian practice guide ‘Managing autism in children and adolescents: a clinical practice guide’ (2014) – KCE – Federal Center for Expertise in Health Care