— The number of children suffering from ASD is increasing in Russia and around the world. According to the World Health Organization, autism is seen in one out of every 100 children. Are there currently tests and analyzes that can diagnose autism even at birth?
Unfortunately, there are no specific tests to determine whether an unborn or newborn child has autism. However, some risk factors for autism in children are now known.
– What are these factors?
– Risk factors include: gestational diabetes mellitus, maternal antiepileptic therapy with valproic acid during pregnancy, the threat of miscarriage.
There are also interesting scientific publications that analyze the diet of the mother in the pre-pregnancy period – preparation for pregnancy and during pregnancy. These studies have shown that Mothers of children with autism before and during pregnancy were nutritionally deficient: there was less meat and vegetables in the diet, and also less calcium intake.
Is it possible to say that vegans and vegetarians are more at risk?
– This topic requires further study.
– Are there any markers in the mother that can be definitively associated with the child’s future autism?
“There is an active scientific search for such markers in the world and they are already being groped for, for example, immunological, neurophysiological and metabolic abnormalities are identified. There is a lot of new and interesting stuff here, but so far it is impossible to say that this child will definitely develop autism if there are such aberrations, this is still impossible.
– How often does the so-called retrieval occur in autism, when the baby develops normally until the age of one and a half to two years, begins to speak, communicate, and then forgets all this?
– Loss of social or communication skills with ASD is possible at any stage of life. However, in some hereditary diseases, such a loss of skill occurs.
– At what age can neurodevelopmental disorders that may indicate ASD in an infant be noticed earliest?
– Just a few days ago, I gave a presentation on the early diagnosis of ASD at a scientific and applied conference at the Russian National Research Medical University. NI Pirogov gave a talk entitled “Autism. Doctors, Patients, Parents: Together for People with ASD”. Infant neurodevelopmental disorders can be detected already in the first two months of life. It is already known that at this age the baby can give an emotional response, smile. At about 2 months, the child starts walking, makes coughing sounds, follows the movement of the toy with his eyes, holds his head in a supine position and starts babbling at 4 months. If all this is absent, you should be careful because this may indicate deviations in the psychomotor development of the child. Parents know their child best, so there are no worries If there is, it is worth informing the doctor at the visit.
– But some children smile right after birth…
Yes, but this is different. This smile is not for a smile, dear face, from inner pleasure, from satiety. The important thing as a communication tool is the baby’s smile. If there is no such smile, it may also be a sign of a developmental deviation.
What other red flags are there of autism?
– These include: not responding to the name, often the child pretends to be deaf, does not smile at other people, does not use pointing gestures, does not use any words up to 16 months, idiomatic speech up to 24 months.
— So, an important marker is still communication? Even if the child doesn’t talk, behaves strangely, has tantrums, but communication is not difficult, isn’t that probably autism?
– Of course, the lack of communication skills is an important sign of deviations in the cognitive development of the child. Parents may express to the pediatrician their fear that the child is not playing with other children for some reason, but is often caught up in some monotonous, repetitive activity. But a pediatrician can only suspect deviations in neurodevelopment and refer the child for consultation with a neurologist and other specialists. For example, if a child is pretending to be deaf, they should have a hearing test.
The diagnosis of “Autism Spectrum Disorder” can only be made after a screening and examination by a psychiatrist.
– Is it true that autistic children are mostly born to parents after the age of forty?
The age of the parents is important. The number of genetic disruptions increases with age, and so does the probability of new mutations. Heredity is also important. If there is a patient with autism in the family, the risk of having another child with autism in the family increases.
-Some families have two or even three children with autism…
– Yes, it’s very sad. It should also be said that it is a so-called syndromic pathology. The clinical picture of some syndromes is similar to autism. Therefore, after the birth of a child with autism, the involvement of a geneticist is often required for differential diagnosis and planning of a future pregnancy.
– At what age can you no longer suspect “autism” for the first time, but reliably diagnose it?
– The age at which OSB risk screening is carried out in Russia is determined by order of the Ministry of Health of the Russian Federation dated June 13, 2019 and numbered 396n. This is 24 months. M-CHAT-R/F parents are then surveyed. This is a questionnaire of twenty questions that can be answered “yes” or “no”, each with a score. When scoring: 0-2 low risk, 3-7 medium risk, and 8-20 high risk of ASD. There are also true and false positive results. Also, in any case, you need to conduct an in-depth examination with a pediatrician, neurologist, audiologist, understand. With the average and high risk of ASD, it is imperative to consult a psychiatrist because only he or she has the right to make a diagnosis of ASD.
– What would a psychiatrist prescribe to a small child in the event of such a diagnosis? Are these drugs or training methods?
– In Russia there is the concept of early aid. Currently, an early aid service has been established in Moscow and other regions of the Russian Federation. When a pediatrician classifies a young child as at risk and a psychiatrist diagnoses ASD, these children may be placed in the 0 to 3 year old early intervention service target age group. Parents can seek and seek help from an interdisciplinary team of health professionals, educational psychologists, and social workers. The child is definitely kept under the supervision of a psychiatrist, psychological correction is made and behavioral therapy method is used. Currently, psychotropic drugs are not used in ASD, and their prescription is possible only under strict indications prescribed by a psychiatrist.
It should be said that the earlier the diagnosis of ASD is made and the earlier the corrective treatment is started, the better the health, behavior, socialization and quality of life of the child.
It is important to understand that children with autism often have diseases associated with ASD.
What are the most common comorbidities in autism?
A fairly broad spectrum of somatic diseases is associated with autism. For example, according to some scientific studies, food allergies and gastrointestinal diseases are 2.5 times more common among children with autism. The most common injuries are sprains, dislocations. Dental problems are much more common.
In addition, children with autism have sensory problems. One of these problems may be a violation of taste sensitivity. For this reason, picky eating behavior is so common in a child with ASD that they do not eat as much food. And expanding the diet is often very difficult.
A research team at the Research Institute of Pediatrics and Child Health is working to change approaches to the organization of medical care for children with ASD. The state of health of children is studied with the participation of medical specialists: pediatrician, psychiatrist, neurologist, psychologist, allergist, gastroenterologist, geneticist, audiologist and others. Laboratory and instrumental studies are carried out. The new data obtained will help create an effective model of early and dynamic multidisciplinary care for a child with ASD, with parent involvement, that can significantly improve the child’s health and quality of life.
Is it true that there are more children with ASD every year?
– While this question may be difficult to answer, the point may be to improve the diagnosis. by latest data ASD was detected in 3.6-7.3% of the cases among school children, which is one of the studies conducted in New Jersey, USA. Significant differences were found in the prevalence of autism spectrum disorders depending on ethnicity, socioeconomic status, and size of school district.
In the Russian Federation, the prevalence of ASD accepted by the Russian Ministry of Health is 1%. The high degree of variability in epidemiological indicators for ASD depends on the region of the study, the sample, and the methodology used.