Atypical autism

A psychoneurological disorder from the group of ASD pathologies is atypical autism. Let's consider the signs, causes, treatment methods and other features of this disease.

Autism is a broad concept that includes a number of deviations and mental disorders in both children and adults. The disease has several forms and stages, since the pathology is associated with a violation of brain structures.

According to the International Classification of Diseases, Tenth Revision ICD-10, autism is in Category V Mental and behavioral disorders:

F80- F89 Disorders of psychological development.

• F84 General disorders of psychological development.
  • F 84.1 Atypical autism.

Psychological disorder is divided into two forms depending on the presence or absence of mental retardation:

• F84.11 – with mental retardation, the diagnosis includes autistic characteristics.
• F84.12 – without mental retardation, the patient’s intellectual abilities are within normal limits. The diagnosis may include atypical psychoses.

In most cases, atypical autistics develop at the same level as healthy children in the first years of their lives. The first symptoms of the disorder appear after 3 years, while the classic form manifests itself at an earlier age. The disorder is often diagnosed in children with severe specific receptive speech disorders and mental disabilities.

ICD-10 also divides atypical autism into two subtypes depending on the age of onset:

• Not at the typical age, that is, after 3 years. At the same time, classic autism manifests itself in infancy.
• Debut before 3 years with atypical symptoms. This type applies to patients with severe mental retardation.

Regardless of the form of the disease identified, it cannot be completely cured. An individual approach is used to treat patients and adapt them to society. This helps alleviate pathological symptoms and improve the patient's life.

Epidemiology

According to medical statistics, the atypical form of autism is extremely rare. There are about two cases of atypical autism per 10 thousand of the classic form of the disease. Moreover, male patients are more likely to get sick than females.

This statistic is confirmed by scientists from Yale University. They have established that girls have certain genetic factors that protect them from psychoneurological disorders of the ASD spectrum. Some people with this pathology are able to live productively and independently, while others need lifelong support and care.

Causes atypical autism

The occurrence of non-specific pervasive developmental disorder is associated with damage to brain structures. The main causes of the painful condition include:

• Hereditary predisposition – very often patients with this diagnosis have relatives with ASD or other mental disorders. [ 1 ]
• Genetic predisposition – according to studies, the risk of developing the disorder increases significantly in carriers of genes such as SHANK3, PTEN, MeCP2 and others. But at the moment it is impossible to accurately predict the development of the disease based on the behavior of these genes.
• Maternal illnesses during pregnancy, especially in the first trimester. Uterine bleeding, intrauterine infections, complicated births, prematurity, etc. are also dangerous.
• Minimal brain dysfunction – pathological changes in the brain, in the cerebellum and subcortical structures, underdevelopment of the left hemisphere of the brain.
• Biochemical factors (incorrect enzyme metabolism, etc.).
• Impaired bone and general motor development.
• Nutritional and metabolic disorders.

The development of the deviation can be caused by epilepsy, schizophrenia, Down syndrome, Rett syndrome, Martin-Bell syndrome. Unofficial versions of the origin of ASD include childhood vaccinations with vaccines that contain mercury (thimerosal). [ 2 ] Scientists are of the opinion that the appearance of the disease in most cases is caused by a combination of genetic factors and adverse external influences.

Risk factors

Scientists have identified about 19 factors that increase the risk of developing ASD. All risk factors are divided into congenital and acquired, let's consider the main ones:

• Neonatal seizures due to hypoxia or brain damage during birth. Children who have had them have a high risk of developing autism.
• Neonatal infections.
• Prematurity.
• Threat of abortion after 20 weeks.
• Asphyxia during childbirth.
• Various postpartum complications in newborns.
• Cerebral palsy.
• Muscular dystrophy.
• Neurofibromatosis.
• Medication during pregnancy: Women who take medications for infections, diabetes, epilepsy, or mental disorders are more likely to give birth to children with ASD.
• Pregnancy after long-term use of medications.
• Asphyxia during childbirth.
• Age of the mother. The risk of giving birth to a baby with ASD is increased for women under 25 and decreases for mothers over 35. Recent studies completely refute previous studies that claimed that the risk of giving birth to a baby with autism and other disorders is significantly increased for mothers over 35.
• Hypertension, asthma, obesity in the mother. These diseases increase the risk of developing ASD in the child, regardless of whether these diseases are treated or not.

Based on the above factors, it can be concluded that non-specific pervasive developmental disorder is multifactorial.

Pathogenesis

According to the conducted research, atypical autism does not have an even single mechanism of development, both at the molecular and cellular level. The pathogenesis of the disorder is associated with gene mutations, disturbances in molecular chains and many other factors.

The risk of developing ASD is the result of the influence of many factors that act during the developmental stage and affect the functional systems of the brain.

Symptoms atypical autism

In its severity, atypical autism is similar to the classical form, but has a narrower range of symptoms.

The main symptoms of non-specific pervasive developmental disorder include:

• Problems with communication in society - this symptom is individual for each patient, since some children avoid contact with others in every possible way, while others, on the contrary, experience a lack of communication, but do not understand how to properly contact people.
• Speech problems – difficulties arise when trying to formulate and express thoughts verbally due to a limited vocabulary. At the same time, problems may also arise with understanding someone else's speech. An autistic person literally perceives figurative meanings, repeats words and phrases.
• Emotional insensitivity – disorders associated with the failure to perceive verbal signals (gestures, nods, facial expressions, postures, eye contact), perception and expression of emotions. Because of this, it seems that the patient is absolutely indifferent to what is happening. At the same time, a person may experience emotions, but not know how to express them.
• Inexpressive facial expressions - there is no gesticulation, movements and emotions look angular. There are also no role-playing games, that is, problems arise when building relationships with peers, elders and loved ones.
• Aggression and irritability – since the disease develops due to certain disorders in the central nervous system, patients react sharply to any irritants. Inappropriate behavior occurs in response to even the most harmless factors.
• Limited thinking – the patient lacks flexibility in behavior and thinking. There is a tendency towards pedantry, monotony, strict routine and stereotyped behavior. It is difficult for an autistic person to adapt to something new, he may panic from minimal changes, the appearance of new people or things in life.
• Narrow interests – the patient has an increased interest in some subject. For example, a child can play only with cars and watch only one cartoon, showing aggression when trying to diversify his leisure time.

The above symptoms may be supplemented by signs of the classic form of the disorder.

First signs

According to studies, the first symptoms of atypical autism appear much later and are less pronounced than the signs of the classic form of the disease. But this does not mean that the disorder is milder than usual. In some cases, autistic manifestations have more severe symptoms.

In most cases, an atypical autistic person develops according to the norm, but after three years, he or she begins to lose previously acquired skills. Development stops, the child develops speech disorders and a severe form of mental retardation. Stereotypes may be observed in the child's behavior.

Another characteristic feature of ASD is sensory impairments, which are associated with the peculiarities of the brain's perception and processing of visual, auditory, tactile, gustatory and olfactory information. In this case, the disorder manifests itself with the following symptoms:

• Intolerance of touching the body, head, hair. The child protests against hugs, dressing, bathing.
• Heightened sense of smell. Patients often experience increased sensitivity to certain odors.
• Attacks of "pseudo-deafness". The patient does not react to loud sounds or calls, but at the same time has normal hearing and reactions.

In atypical autism, psychoses may develop that are similar in symptoms and course, which are characterized by attacks and regressive-catatonic disorders. These psychoses develop against the background of dysontogenesis with subsequent replacement of the following stages: autistic, regressive, catatonic, with a return to the autistic stage between attacks. [ 3 ]

There are also a number of behavioral signs of the disorder that are characteristic of many forms of ASD:

Children under one year

• They don't like to be held.
• There is no fixation of gaze on the mother's face.
• The child does not use gestures to express emotions or identify needs.
• An autistic person has no need for emotional closeness with parents.
• Children do not distinguish close people from other adults and do not smile when they see them.
• The child avoids the company of other children or adults.

Children over one year old

• The child does not repeat the behavior of adults.
• Difficulty learning everyday skills.
• Picky eating.
• It is difficult to connect with people and establish social connections.
• The patient does not use speech to communicate with others.
• Indifference to the outside world.
• Increased sensitivity to sounds and heightened tactile sensitivity.
• Lack of fear.
• Lack of attachment to loved ones.
• Fragmented perception of the world.
• Stereotypy.
• Emotional coldness.

The above symptoms are typical for children under three years of age. In addition to the behavioral signs of atypical autism, the child has impaired general and fine motor skills. This is manifested by incorrect posture due to muscle weakness. Digestive disorders, a weak immune system, and dermatological problems are possible.

Atypical autism without mental retardation

One of the forms of ASD is atypical autism without mental retardation (ICD-10 code F84.12), which may include atypical psychoses. Most often, this form of psychoneurological pathology refers to Asperger syndrome or high-functioning autism. [ 4 ]

This disease is an atypical disorder with preserved mental abilities. That is, patients have normal or high intelligence, and in some cases, unique properties. But this pathology is characterized by disorders in the behavioral, communication and emotional spheres.

Asperger's syndrome manifests itself in the first three years of a child's life. The symptoms are so vague that the disorder is often diagnosed in adulthood, using various tests and differential methods.

There are a number of main signs of ASD without mental retardation:

• Adherence to rituals, repetitive actions, speech cliches.
• Inappropriate behavior in society.
• Literal perception of speech patterns, formal manner of speaking, monotonous speech.
• Impaired motor coordination.
• Unstable eye contact.
• Impaired non-verbal communication (limited gestures, insufficient facial expressions).
• Problems with sensory processing.
• Difficulties in social adaptation.
• Intolerance to any changes.
• Emotional lability.
• Specific fears.
• Stereotypical games.
• The child's mental abilities are within normal limits or above.

Most often, the development of high-functioning autism is associated with a combination of genetic and environmental factors. Children with the syndrome have difficulty identifying the feelings of others and expressing their own emotions. Many children have tremors of the limbs, which is observed in the classic form of autism. At the same time, the speech of patients is devoid of emotional coloring. Patients demonstrate increased sensitivity to sounds, clothing, food, etc.

Compared to the classic form of ASD, children with Asperger's have a normal IQ. They look like absolutely healthy children, except for social inadequacy, speech and manners that are not understood by everyone. Because of this, difficulties arise with the diagnosis of the disorder. Symptoms become pronounced at an older age, which in turn significantly complicates the process of treatment and correction of ASD.

Atypical autism with mental retardation

One of the most common forms of non-specific pervasive developmental disorder is ASD with mental retardation (ICD-10 code F84.11). Diagnosis of this form, as well as other types of ASD, has a number of difficulties. Standard tests widely used by specialists are not suitable for children with autism. That is, the child can perform quite serious logical exercises, but not cope with elementary ones.

Patients have disturbances in communication, emotional and behavioral spheres. Of particular note is such a symptom as autostimulation, i.e. repetitive actions of a strong, obsessive nature, which most often occur in stressful situations.

Types of autostimulation:

• Taste – the child licks everything, puts edible and non-food objects into his mouth.
• Visual – the baby squints, blinks and waves his hands in front of a light source, turns the light in the room on and off, and often closes his eyes tightly.
• Auditory – makes different sounds, taps on ears with fingers.
• Vestibular – rocks in one place, shakes hands, performs repetitive actions.
• Tactile - rubs skin, pinches itself. Can stick to textured objects for a long time, stroking them.
• Olfactory – the child searches for certain smells and “hangs” for a long time, trying to sniff everything.

As a rule, autosimulations are used to obtain pleasure or self-soothing in stressful and exciting situations. There is an assumption that autostimulation is needed to excite the nervous system. Another hypothesis states that repetitive actions act as a kind of blocking of excess stimuli of the environment, allowing to control the level of strong excitation.

Not only autistics but also children with cerebral palsy, severe mental retardation, deafness, blindness, and somatic diseases face autostimulation. Despite the fact that this symptom develops in childhood, it can persist into adulthood, worsening after seemingly successful psychocorrective therapy.

Atypical autism in children

Childhood autism is a severe disorder of mental development. According to ICD-10, there are four types of autism spectrum disorders (ASD):

• F84.0 – childhood autism (autistic disorder, infantile autism, infantile psychosis, Kanner syndrome).
• F84.1 – atypical autism.
• F84.2 – Rett syndrome.
• F84.5 – Asperger's syndrome, autistic psychopathy.

Non-specific pervasive disorder is characterized by developmental delay and reluctance to interact with other people. The pathological condition has a wide range of manifestations: speech disorders, motor skills, attention, perception. The most common signs of ASD in children include:

• The child does not make contact with other people and does not respond to them.
• Extreme isolation from the outside world.
• Performs monotonous, repetitive movements.
• Limited range of interests, it is difficult to captivate the child with something new.
• Destructive behavior, aggression.
• Mental retardation (in some forms of autism, the patient's intelligence is normal or above average).

The above symptoms appear in children at an early age, but become more pronounced after three years.

A psychiatrist is involved in diagnostics and development of treatment and correction measures. At different stages of therapy, neurologists, psychologists, speech therapists, geneticists, and defectologists work with the child. If the patient's clinical symptoms are not clear enough, the doctor makes a diagnosis of autistic behavior or atypical autism.

It is impossible to completely cure autism, since a child does not "outgrow" this disorder. To date, a number of corrective programs have been developed that allow a child to master self-care and communication skills, learn to communicate with others, and control their emotions. Regardless of the form of autism identified, patient care should be comprehensive with mandatory psychological and pedagogical correction.

Complications and consequences

Problems in building social and emotional contacts in society are the main complication of non-specific pervasive developmental disorder. Also, atypical autism is associated with difficulties in the following areas of life:

• Social interaction.
• Education.
• Sexual relations.
• Starting a family.
• Choice of profession and work processes.

Without correction and properly selected therapy, ASD leads to complications such as social isolation, depression, suicidal tendencies. If the atypical disorder occurs with speech disorders and mental retardation, then this leaves a negative imprint on both the patient and his relatives.

Diagnostics atypical autism

A number of difficulties arise when diagnosing the atypical form of ASD. Because of this, the disorder is often detected in adolescence, when the symptoms of the disease become too pronounced. Therefore, it is very important to promptly identify minimal deviations in the child’s behavior or development in order to prevent severe forms of the disease that are difficult to correct.

Since the symptoms of psychoneurological pathology can be veiled and vague, then to make a diagnosis it is necessary:

• Conduct a comprehensive medical and psychological examination of the patient using special tests.
• Long-term observation of the child’s behavior, analysis of his everyday skills, behavior, and communication abilities.

For diagnostic purposes, international test systems are used to identify early signs of ASD:

1. The M-CHAT test is a modified screening test used in the diagnosis of children aged 16 to 30 months. Testing allows identifying a number of features in a child that require more detailed study. This test is used in 25 countries around the world. It takes no more than 3-5 minutes, but allows for an approximate assessment of the risk of developing ASD and recommendations for further patient management. [ 5 ]
2. ATEK test – indicated for children over 30 months. Testing is aimed at identifying problems and tracking their dynamics. The test consists of 77 questions on various topics (sensory skills, socialization, health, behavior, physical development, etc.). [ 6 ], [ 7 ]

If, after conducting research and diagnostic tests, the doctor has every reason to believe that the child is sick, but his symptoms differ significantly from the usual picture of ASD, then the patient is diagnosed with atypical autism.

Differential diagnosis

Differential diagnostics of atypical autism is carried out with various psychoneurological pathologies and forms of ASD. Thus, with Asperger's syndrome (one of the forms of autism), unlike the classic autism spectrum disorder, there is no delay in cognitive and speech development. Diagnostics are carried out with schizophrenia, OCD, attention deficit syndrome, mental retardation.

Diagnosis of non-specific pervasive developmental disorder is based on collecting anamnesis, studying clinical symptoms and careful observation of the child. If there is a risk of having a child with ASD, parents should closely monitor the development of the baby from the first days. It is recommended to check the norms of child development established by doctors.

Development norms from 3 months to 3 years:

• 3-4 months – studies surrounding people with interest, concentrates his gaze, follows moving objects. Smiles when he sees his relatives, turns his head to sounds.
• 7 months – reacts to the emotions of others, finds and studies objects, expresses joy and dissatisfaction with his voice, makes various sounds.
• 12 months – repeats after others, reacts to prohibitions, shows simple gestures, pronounces individual words, actively “talks” to himself, reacts to his name.
• 18-24 months – inherits the behavior of others, enjoys the company of other children, understands many words, recognizes objects (color, shape), carries out simple instructions, pronounces simple sentences.
• 36 months – Openly shows affection for others, has a wide range of emotions. Imagines, sorts objects by shape and color, uses pronouns and plurals. When communicating, the child uses simple sentences and follows more complex instructions.

Of course, every child is individual and has his own pace of development. But in general, if the baby is significantly behind in each of the above stages, then this is a reason to see a doctor and undergo a comprehensive examination.

For example, to differentiate autism from mental retardation, it is very important to identify problems in the child's developmental profile. In mental retardation, there is a more general developmental delay, unlike autism. In ASD, patients have uneven development, that is, they are behind in some areas and normal in others. The differentiation process takes into account the child's social, communication and other skills.

Treatment atypical autism

To select a method for correcting ASD, the form of atypical autism and the individual characteristics of the patient are taken into account. In most cases, it is impossible to completely get rid of the disorder. But special methods have been developed that can improve the quality of life of an autistic person. [ 8 ]

One of the most frequently used treatment methods is ABA therapy (Applied Behavior Analysis). It is an applied behavioral analysis, which is the first among the treatment methods for ASD.

According to parents' feedback, at least 10 hours of classes per week are required to achieve a visible positive result of therapy. The main advantages of the ABA method include:

• Correction of autistic behavior.
• Development of speech skills.
• Concentration of attention.
• Elimination of sensory/motor impairment.
• Adaptation of children to normal life at home and in society.

The following treatment methods are also recommended to patients:

• Sensory integration therapy.
• Neuropsychological correction.
• Group therapy.

Such treatment is most often carried out in specialized rehabilitation centers. Parents also actively participate in the therapy. They are taught the correct behavior with a child with the syndrome, avoiding unwanted manifestations. Thanks to this, parents can independently develop the baby, promoting his full integration into society.

In autistic disorders, pathological manifestations are very often observed that successfully respond to drug therapy. Such treatment allows to increase the productivity of correctional therapy, and in some cases, taking medications becomes urgently necessary.

Drug therapy prescribed to a child with ASD is aimed at:

• Pain relief. Not all patients with the disorder can speak and tell what bothers them and where it hurts. There may be situations when a child bites his lips until they bleed. This symptom is considered autoaggression, although in fact the problem is toothache. If the source of pain is identified, the patient is prescribed painkillers.
• Correction of behavioral deviations. ASD is characterized by autoaggression and impulsive behavior. Correctly selected neuroleptics improve the patient's condition and quality of life.
• Associated somatic pathologies. According to statistics, more than 60% of children have gastrointestinal disorders that require drug treatment.
• Sleep correction. Very often, patients with a psychoneurological disorder do not sleep at night. To eliminate this problem, children are prescribed sedatives.
• Stimulating development. For these purposes, children are prescribed nootropic drugs. Correctly selected medication and dosage allow improving the child's speech functions, achieving success in psychological and pedagogical correction.

The choice of treatment method is made by a psychologist and a neurologist; therapy is selected individually for each patient.

Diet for atypical autism

Treatment of non-specific pervasive developmental disorder involves a comprehensive approach, which includes diet therapy. More than 75% of autistics have various metabolic disorders that manifest themselves in the improper absorption of proteins. The most problematic proteins include gluten (found in cereals) and casein (milk and its derivatives). Neither gluten nor casein have any particular value for the human body.

Scientists have found that in the body of a person with ASD, gluten and casein are converted into substances that are similar in their mechanism of action and properties to narcotics. That is, they have a destructive effect on the mental state and behavior, aggravating the existing complex of various disorders. It is also believed that these proteins in combination with fungal infections can lead to increased intestinal permeability. This increases the risk of developing gastrointestinal disorders, allergies, and dermatological diseases.

Based on this, a diet for autists is a reasonable solution. It is recommended to start therapeutic nutrition from 6-8 months of age. For these purposes, a separate gluten-free and casein-free menu is used. It is also recommended to minimize products with a high content of starch, preservatives, salt, sugar.

1. Gluten-free (alutene) diet for atypical autism. This diet involves refusing products that are made using gluten-containing grains (wheat, oats, rye, barley, barley malt). That is, the patient is contraindicated in bakery products, as well as store-bought snacks (chips, croutons, French fries), cereal flakes and muesli, canned food with tomato paste, store-bought sauces and dressings, chocolate. That is, nutrition should be based on home cooking with carefully selected products. [ 9 ]
2. A casein-free diet for patients with an atypical form of ASD. Milk of animal origin, as well as cheeses, yogurts, fermented baked milk, butter and margarine, and ice cream are prohibited. To compensate for vitamin D, which is contained in milk, patients are prescribed mineral complexes and food supplements. [ 10 ]

Both of the above diets are recommended to be practiced in combination with a soy-free diet. Soy proteins, such as casein and gluten, are not properly digested, causing destructive mental and physical reactions in the patient's body. That is, all products containing soy and its semi-finished products are contraindicated for autists.

What can you eat with atypical autism:

• Vegetables – cauliflower, eggplant, zucchini, cucumbers, lettuce, carrots, onions, beans.
• Gluten-free cereals – ryegrass, buckwheat, millet, amaranth, quinoa, sorghum, sago.
• Fruits – grapes, peaches, plums, pears, apricots. Fruits can be used to make juices, homemade jam, and puree.
• Meat – lean pork, chicken, turkey, rabbit and other types of dietary meat.
• Fish – sardines, mackerel, sprat, herring.

Vegetable oils (olive, sunflower, walnut, pumpkin, grape seed, hemp) and vinegar (wine, rice, apple) can be used as dressings for dishes. Greens, dried fruits, and bee products can also be added to food.

What you shouldn’t eat with ASD:

• Sugar and artificial sweeteners.
• Preservatives and colorants.
• Products containing food additives with the letter "E" in the name.
• Starchy vegetables.
• Beef.
• Semi-finished meat products.
• Store-bought sausages, hot dogs, frankfurters.
• Large fish (dangerous due to risk of mercury content).
• Eggs (except quail eggs).

When composing a diet, it is necessary to monitor the body's reaction to certain products. Especially to citrus fruits, mushrooms, nuts, apples, tomatoes, bananas. If the diet is correctly composed, it gives positive results and can be made lifelong. In addition to the diets described above, patients are recommended ketogenic and low-oxalate nutrition.

Prevention

To date, no effective methods have been developed for the prevention of psychoneurological pathologies, including atypical autism.

There are a number of general recommendations for parents that can reduce the risk of having a baby with ASD:

• Planning pregnancy and its proper introduction (treatment of chronic pathologies and prevention of their exacerbation, regular scheduled examinations).
• Timely treatment of infectious diseases in women during pregnancy.
• Elimination of stress factors and irritants, quitting bad habits (many parents of children with autism are diagnosed with vegetative-vascular disorders, alcoholism, drug addiction, manic-depressive syndrome).
• The mother has amalgam fillings (these fillings are 50% mercury and can release a toxin into the blood).

During pregnancy, the expectant mother is recommended to switch to a healthy diet, i.e. not to consume products with GMOs, high gluten content, casein. You should also switch to safe detergents, since household chemicals affect the body of the mother and fetus. Particular attention should be paid to drinking water, since unpurified liquid may contain heavy metals.

Forecast

Atypical autism has a favorable prognosis if it occurs without mental retardation and was diagnosed in a timely manner, i.e. detected at an early stage. In other cases, the outcome of the disease is ambiguous, since the scenario for the development of ASD can be very different.

A properly selected treatment method allows to stop the progression of non-specific pervasive developmental disorder, and in some cases to completely restore the patient's condition. In this case, the patient will continue to be constantly monitored by a neurologist, psychologist and psychiatrist. This is necessary to monitor his condition and timely diagnose exacerbations of the disorder.