Atypical Autism

A neuropsychiatric disorder from the ASD pathology group is atypical autism. Consider the signs, causes, treatment methods and other features of this disease.

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

According to the International Classification of Diseases of the tenth revision of the 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 autists in the first years of their life develop at a level with healthy children. The first symptoms of deviation occur after 3 years, while the classic form manifests itself at an earlier age. Often, the disorder is diagnosed in children with severe specific disorders of receptive speech and mental disorders.

ICD-10 also divides atypical autism into two subspecies depending on the age of occurrence:

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

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

Epidemiology

According to medical statistics, an atypical form of autism is extremely rare. About 10 cases of atypical occur in 10 thousand of the classic form of the disease. At the same time, male patients get sick more often than women.

Such statistics are confirmed by scientists from Yale University. They found that girls have certain genetic factors that protect them from neuropsychiatric 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 of the atypical autism

The appearance of a nonspecific pervasive developmental disorder is associated with damage to the structures of the brain. The main causes of the disease state 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.
• Diseases of the mother during pregnancy, especially in the first trimester. Uterine bleeding, intrauterine infections, childbirth with complications, prematurity of the fetus and others are also dangerous.
• Minimal cerebral dysfunction - pathological changes in the brain, in the cerebellum and subcortical structures, underdevelopment of the left hemisphere of the brain.
• Biochemical factors (improper exchange of enzymes and more).
• Violation of bone and general motor development.
• Violation of nutrition and metabolism.

The cause of the development of deviations can be epilepsy, schizophrenia, Down syndrome, Rhett, Martin-Bell. Unofficial versions 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 due to 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, consider the main ones:

• Neonatal cramps due to hypoxia or brain damage during childbirth. Children in whom they happened have a high probability of developing autism.
• Neonatal infections.
• Prematurity.
• Abortion threat for more than 20 weeks.
• Asphyxia during childbirth.
• Various postpartum complications in newborns.
• Cerebral paralysis.
• Muscular dystrophy.
• Neurofibromatosis
• Drug therapy during pregnancy. Women taking medication for infections, diabetes, epilepsy, or mental illness are more likely to give birth to children with ASD.
• Pregnancy after prolonged use of drugs.
• Asphyxia during childbirth.
• Age of woman in childbirth. 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 disprove previous studies that claimed that the risk of giving birth to a baby with autism and other abnormalities is significantly increased in women in labor over 35 years of age.
• Hypertension, asthma, maternal obesity. These diseases increase the risk of developing ASD in the child, regardless of whether or not these diseases are treated.

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

Pathogenesis

According to studies, atypical autism does not have an even single developmental mechanism, both at the molecular and cellular levels. The pathogenesis of the disorder is associated with gene mutations, abnormalities in the molecular chains and many other factors.

The risk of ASD is the result of the influence of many factors acting at the developmental stage and affecting the functional systems of the brain.

Symptoms of the atypical autism

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

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

• Communication problems in society - this symptom is individual for each patient, as some children in every possible way avoid contact with others, while others, on the contrary, have a lack of communication, but do not understand how to properly communicate with people.
• Problems with speech - difficulties arise when trying to verbally formulate and express thoughts due to a limited vocabulary. In this case, problems can also be with understanding someone else's speech. Autistic literally perceives figurative meanings, repeats words and phrases.
• Emotional immunity - violations are associated with non-perception of 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 manifest them.
• Inexpressive facial expressions - no gestures, 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 are sensitive to any irritants. Inappropriate behavior arises in response to even the most innocuous factors.
• Limited thinking - the patient lacks flexibility in behavior and thinking. There is a desire for pedantry, monotony, strict routine and template behavior. It is difficult for an autist to adapt to a new one; he may panic from minimal changes, the appearance of new people or things in life.
• Narrow interests - the patient has an increased interest in any subject. For example, a child can only play 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 a 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 easier than usual. In some cases, autistic manifestations have more severe symptoms.

In most cases, atypical autism develops in accordance with the norm, but after three years, he begins to lose previously acquired skills. A developmental stop occurs, the baby develops speech disorders and a severe form of mental retardation. In the behavior of the child, stereotypical actions can be observed.

Another characteristic feature of ASD is sensory disturbances, which are associated with the features of perception and processing by the brain of visual, auditory, tactile, taste, and olfactory information. In this case, the disorder is manifested by such signs:

• Intolerance of touching the body, head, hair. The child protests against hugs, dressing, bathing.
• Increased sense of smell. Often, patients have an increased sensitivity to individual odors.
• Attacks of "pseudo-deafness." The patient does not respond to loud sounds or hails, but at the same time has normal hearing and reactions.

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

A number of behavioral symptoms of the disorder that are characteristic of many forms of ASD are also distinguished:

Children up to a year

• They do not like to be on hand.
• There is no fixation on the face of the mother.
• The child does not use gestures to express emotions or identify needs.
• Autistic has no need for emotional closeness with parents.
• Children do not distinguish close people from other adults and do not smile at their sight.
• The child avoids the company of other children or adults.

Children over a year old

• The child does not repeat adult behavior.
• Difficulties in learning everyday skills.
• Pickiness in food.
• It is difficult to contact with people and to establish social ties.
• The patient does not use speech to communicate with others.
• Indifference to the outside world.
• Increased susceptibility to sounds and heightened tactile sensitivity.
• Lack of fear.
• Lack of affection for loved ones.
• Fragmented perception of the world.
• Stereotype.
• Emotional coldness.

The above symptoms are characteristic of 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 poor posture due to muscle weakness. Digestive disorders, a weak immune system, and dermatological problems are possible.

Atypical autism without mental retardation

One form of ASD is atypical autism without mental retardation (ICD-10 code F84.12), which may include atypical psychoses. Most often, under this form of neuropsychiatric pathology is meant Asperger's syndrome or highly functional autism. [4]

This disease is an atypical disorder with the preservation of mental abilities. That is, patients have normal or high intelligence, and in some cases, unique properties. But for this pathology, violations in the behavioral, communication and emotional spheres are characteristic.

Asperger's syndrome manifests itself in the first three years of a child’s life. The symptomatology is so lubricated that often the disorder is 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 turns, formal manner of conversation, monotonous speech.
• Impaired motor coordination.
• Unstable eye contact.
• Violations of non-verbal communication (limited gestures, insufficient facial expressions).
• Problems with the processing of sensory information.
• Difficulties in social adaptation.
• Intolerance to any changes.
• Emotional lability.
• Specific fears.
• Stereotypical games.
• The mental abilities of the child are within normal limits or higher.

Most often, the emergence of highly functional autism is associated with a combination of genetic and environmental factors. Children with the syndrome have difficulty in determining the feelings of others and expressing their emotions. Many children have tremor of the extremities, which is observed with the classic form of autism. Moreover, the speech of patients is devoid of emotional stain. Patients exhibit hypersensitivity to sounds, clothing, food, etc.

Compared to the classic form of ASD, children with Asperger have a normal rate of intellectual development. They look absolutely healthy children, with the exception of social inability, not everyone understands speech and manners. Because of this, difficulties arise in diagnosing the disorder. Symptoms become pronounced at an older age, which in turn significantly complicates the 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). The diagnosis of this form, as well as other types of ASD, has a number of difficulties. For children with autism, standard tests that are widely used by specialists are not suitable. That is, the baby can perform quite serious logical exercises, but not cope with elementary ones.

Patients have impaired communication, emotional and behavioral spheres. Of particular note is a symptom such as autostimulation, that is, repeated actions of a strong, obsessive nature that occur most often in stressful situations.

Types of autostimulation:

• Flavoring - the child licks everything, puts edible and non-food items into his mouth.
• Visual - the baby squints, blinks and waves its hands in front of the light source, turns the light on and off in the room, often squinting its eyes.
• Auditory - makes various sounds, taps on the ears with fingers.
• Vestibular - sways in one place, shakes hands, performs the same type of action.
• Tactile - rubs the skin, plucks itself. It can stick to textured objects for a long time, stroking them.
• Olfactory - the child searches for certain smells and hangs for a long time, tries to sniff everything.

As a rule, autosimulations are used for pleasure or complacency in stressful and stressful situations. There is an assumption that autostimulation is needed to excite the nervous system. Another hypothesis claims that repetitive actions act as a kind of blockage of excess environmental stimuli, allowing you to control the level of strong excitement.

Autostimulation is experienced not only by autists, but also by children with cerebral palsy, severe mental retardation, deafness, blindness, and somatic diseases. Despite the fact that this symptom develops in childhood, it can persist in adulthood, exacerbating after seemingly successful psycho-corrective therapy.

Atypical autism in children

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

• F84.0 - childhood autism (autistic disorder, infantile autism, infantile psychosis, Kanner syndrome).
• F84.1 - Atypical autism
• F84.2 - Rett syndrome.
• F84.5 - Asperger syndrome, autistic psychopathy.

Nonspecific pervasive disorder is characterized by developmental delay and unwillingness to communicate with other people. The pathological condition has a wide range of manifestations: impaired speech, 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 react to them.
• Extreme fencing from the outside world.
• It makes the same type of repetitive movement.
• A limited range of interests, it is difficult to captivate a 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 engaged in the diagnosis and preparation of treatment and correctional measures. At different stages of therapy, neurologists, psychologists, speech therapists, genetics, and defectologists work with the child. If the patient’s clinical symptoms are not clear enough, the doctor will diagnose autistic behavior or atypical autism.

It is impossible to completely recover from autism, since the child does not “outgrow” this disorder. To date, a number of corrective programs have been developed that allow the child to master the skills of self-care and communication, learn how to communicate with others, control their emotions. Regardless of the form of detected autism, 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 fraught with difficulties in such areas of life:

• Social interaction.
• Training.
• Sexual relationships.
• Creation of a family.
• Choice of profession and work processes.

Without correction and proper 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 himself and his relatives.

Diagnostics of the atypical autism

When diagnosing an atypical form of ASD, a number of difficulties arise. 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 timely identify minimal deviations in the behavior or development of the child in order to prevent severe forms of the disease that are difficult to correct.

Since the symptoms of a neuropsychiatric pathology can be veiled and blurred, then for the diagnosis it is necessary:

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

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

1. The M-CHAT test is a modified screening test that is used in the diagnosis of children from 16 to 30 months. Testing allows you to identify a number of features in a child that require more detailed study. This test is used in 25 countries. In duration, it takes no more than 3-5 minutes, but allows you to approximately assess the risk of developing ASD and give recommendations for further management of the patient.  [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 of various subjects (sensory skills, socialization, health, behavior, physical development, etc.). [6], [7]

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

Differential diagnosis

Differential diagnosis of atypical autism is carried out with various neuropsychiatric pathologies and forms of ASD. So, with Asperger's Syndrome (a form of autism), unlike the classic autism spectrum disorder, there is no delay in cognitive and speech development. Diagnosis is with schizophrenia, OCD, attention deficit disorder, and mental retardation.

Diagnosis of a nonspecific pervasive developmental disorder is based on a history, clinical symptoms, and close monitoring of the child. If there is a risk of having a baby with ASD, then parents should carefully monitor the development of the baby from its first days. It is recommended to check with the child development standards set by doctors.

Development rates from 3 months to 3 years:

• 3-4 months - with interest, studies others, concentrates his eyes, watches moving objects. He smiles at the sight of his family, turns his head to the sounds.
• 7 months - reacts to the emotions of others, finds and studies objects, expresses joy and dissatisfaction with the voice, makes various sounds.
• 12 months - repeats after others, reacts to prohibitions, shows simple gestures, pronounces separate 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), performs simple instructions, makes simple sentences.
• 36 months - openly demonstrates affection for others, has an extensive range of emotions. He fantasizes, sorts objects by form and color, uses pronouns and plurals. When communicating, the child uses simple sentences and follows more complex instructions.

Of course, each child is individual and has his own pace of development. But in general, if the baby is significantly behind at each of the above stages, then this is an occasion to consult 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. With backwardness, a more general developmental delay is observed, in contrast to autism. Patients with ASD have uneven development, that is, they lag behind in some areas and are normal in others. In the process of differentiation, the social, communicative and other skills of the child are taken into account.

Treatment of the atypical autism

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

One of the commonly used treatment methods is ABA therapy (Applied Behavior Analysis). It is an applied behavioral analysis that ranks first among treatment methods for ASD.

According to the reviews of parents, in order to achieve a visible positive result of therapy, at least 10 hours of classes per week are necessary. The main advantages of ABA techniques include:

• Autistic behavior correction.
• The development of speech skills.
• Concentration of attention.
• Elimination of sensory / motor insufficiency.
• Adaptation of children to normal life at home and in society.

Also, patients are recommended such therapeutic methods:

• Sensory Integration Therapy.
• Neuropsychological correction.
• Group therapy.

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

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

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

• Relief of pain. Not all patients with the disorder speak the language and can tell what worries them and where it hurts. Situations are possible when the baby bites his lips in the blood. This symptom is considered as autoaggression, although the problem is actually toothache. If the source of pain is recognized, then the patient is prescribed pain medication.
• Correction of behavioral abnormalities. ASD is characterized by auto-aggression and impulsive behavior. Properly selected antipsychotics improve the patient's condition and quality of life.
• Concomitant somatic pathology. According to statistics, more than 60% of children have gastrointestinal disorders that require medical treatment.
• Sleep correction. Very often, patients with a neuropsychiatric disorder do not sleep at night. To eliminate this problem, children are prescribed sedative drugs.
• Stimulating development. For these purposes, children are prescribed nootropic drugs. Properly selected medicine and dosage can improve the child's speech functions, achieve success in psychological and pedagogical correction.

A psychologist and a neuropathologist are involved in the selection of the treatment method; therapy is selected individually for each patient.

Diet for atypical autism

Treatment of non-specific pervasive developmental disorder involves an integrated approach that includes diet therapy. More than 75% of autists have various metabolic disorders, which are manifested in improper absorption of proteins. The most problematic proteins include gluten (found in cereals) and casein (milk and its derivatives). Neither gluten nor casein are of particular value to the human body.

Scientists have found that in humans with ASD, gluten and casein are converted to substances that are similar to narcotic drugs in their mechanism of action and properties. That is, they have a destructive effect on the mental state and behavior, exacerbating 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 gastrointestinal tract disorders, allergies, dermatological diseases.

Based on this, an autistic diet is a smart decision. Clinical nutrition is recommended to start from 6-8 months of age. For these purposes, a gluten-free and case-free menu is used separately. It is also recommended to minimize foods high in starch, preservatives, salt, sugar.

1. Gluten-free (alutenic) diet with atypical autism. This diet involves the rejection of products that are made using gluten-containing cereals (wheat, oats, rye, barley, barley malt). That is, the patient is contraindicated in baked goods, as well as purchased snacks (chips, crackers, french fries), cereal flakes and granola, canned goods with tomato paste, purchased sauces and dressings, chocolate. That is, nutrition should be based on home cooking with carefully selected foods. [9]
2. Caseless diet for patients with atypical form of ASD. The ban includes animal milk, as well as cheeses, yogurts, fermented baked milk, butter and margarine, ice cream. To compensate for vitamin D, which is found in milk, patients are prescribed mineral complexes and nutritional supplements. [10]

Both of the above diets are recommended to be practiced in conjunction with non-soybean nutrition. Soy proteins like casein and gluten are not properly absorbed, causing destructive mental and physical reactions in the patient's body. That is, all products containing soy and its processed foods are contraindicated for autists.

What can I eat with atypical autism:

• Vegetables - cauliflower, eggplant, zucchini, cucumbers, lettuce, carrots, onions, beans.
• Gluten-free cereals - risk, buckwheat, millet, amaranth, quinoa, sorghum, sago.
• Fruits - grapes, peaches, plums, pears, apricots. From fruits you can make juices, homemade preserves, mashed potatoes.
• Meat - lean pork, chicken, turkey, rabbit and other types of dietary meat.
• Fish - sardine, mackerel, herring, sprat, herring.

As a dressing for dishes, you can use vegetable oils (olive, sunflower, walnut, pumpkin, grape seed, hemp) and vinegar (wine, rice, apple). Also, greens, dried fruits, beekeeping products can be added to food.

What you can not eat with ASD:

• Sugar and artificial sweeteners.
• Preservatives and dyes.
• Products with food additives with the letter "E" in the name.
• Starchy vegetables.
• Beef.
• Meat semi-finished products.
• Shop sausages, sausages, sausages.
• Large fish (dangerous due to the risk of mercury in it).
• Eggs (except quail).

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

Prevention

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

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

• Pregnancy planning and its correct introduction (treatment of chronic pathologies and prevention of their exacerbation, regular scheduled examinations).
• Timely treatment of infectious diseases of a woman during the gestation period.
• Elimination of stress factors and irritants, abandonment of bad habits (in many parents of children with autism, vegetovascular disorders, alcoholism, drug addiction, manic-depressive syndrome).
• Amalgam fillings in the mother (such fillings are 50% mercury and can release toxin into the blood).

During pregnancy, the expectant mother is recommended to switch to a healthy diet, that is, do not eat foods with GMOs, high in gluten, casein. You should also switch to safe detergents, as household chemicals affect the body of the mother and fetus. Particular attention should be paid to drinking water, as heavy metals may be present in the crude liquid.

Forecast

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

A correctly selected treatment technique allows you to stop the progression of nonspecific pervasive developmental disorder, and in some cases 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 its condition and timely diagnosis of exacerbations of the disorder.