TREATMENT AND REPRESENTATION OF AUTISM IN ADOLESCENT
Prof.d-r.Gordana Panova, Violeta.Dzhidrova, Blagica Panova, Lence Nikolovska
Faculty of Medical Sciences, University ,, Goce Delcev '' - Stip, Macedonia
Abstract
Introduction: Autism is a disorder of neurological development, which is characterized
by a reduced ability of socialization and communication and restricted and repetitive
behavior. It is one of the toughest development disorder that occurs in childhood or in a
slightly later period and threatens the normal development of the person and his
adaptation to the social environment.
Purpose: is by comparing the two groups of people with autism from childhood and
adolescents, with the help of filling in a questionnaire, to confirm some characteristics of
adolescents with autism, some that appear during adolescence and other non change
during adolescence and remain life typical of autism.
Materials and methods: causal approach, descriptive analysis techniques: a survey,
analysis of documentation (dossier) evident sheets, Rehabilitation tests to assess body
pattern and imitation of movements.
Results are analyzed in two groups of 30 participants and one group consists of
adolescents aged 15 to 25 years, while the other group consists of 30 respondents also
child aged 5 to 15 years. Total covered 60 subjects. In both groups dominated by males
and the Center for Children and 63.3% in the Center for Youth 76.7% and total
respondents were male while 42 female 18.
Discussion: Bad pattern in children with autism (80%) and adolescents (76.7%) is usually
below expectations regarding their calendar age. In adolescents with autism usually
appears reduced or secondary mood regarding the cause and the group, while children
with autism are more excited and enthusiastic about some new games or activities in a
group, or a lot more with respect to the cause and individuals. Groups with autism during
puberty require company. The Centre for children verbally communicate 20% and 50%
in the Center for adolescents, while nonverbal communication 80% of children and 20%
of adolescents.
Conclusion: Autism is not determined by a single symptom, but with characteristic triplet
of symptoms: impairment in the ability to socialize, impairment in the ability of
communication and restricted interests and repetitive behavior. Some people with autism
are orphaned and live independently after gaining maturity, although some of them
become successful. Developed and culture of autism, within which some searching for a
cure, while others believe it, that autism should not be treated as a violation, but to tolerate
such a difference.
Keywords: autism, communication, adolescence.
Introduction
Autism is a disorder of neurological development, which is characterized by a reduced
ability of socialization and communication and restricted and repetitive behaviour.
It is one of the most difficult developmental disorders, which occurs in childhood or in a
slightly later period and threatens the normal development of the person and his
adaptation to the social environment1. The term autism comes from the Greek word
"autos" (meaning himself), and can be translated as obscurity in and selfish behaviour. It
is expressed in the way that a person does not make or lose social contacts, losing speech
and exhibit weak cognitive capabilities of the actual capabilities that exist in the area3.
Etiology and pathogenesis of autism
Psychogenic theory suggests that the way parents raise their children can cause autism.
This is the time of the presumed "cool" parents of children with autism and the
"shizofrenogenic" mothers5.
According to the biological theory of autism there are one or more abnormalities in the
brain, causing them to one or more biological factors. Autism is often associated with
signs of neurological damage, mental retardation, metabolic disorders, epilepsy, and gene
chromosomal disorders, difficulties in pregnancy and labor, viral infections and
congenital anomaly syndromes.
Autism as a result of damage to the central nervous system development.
Pneumoencefalografic trials in patients with primary autism showed dilation of the
temporal horn of the lateral ventricle left, indicating a reduction in brain mass left brain
hemisphere2.
Autopic studies have shown significant changes in cellular composition of nuclei
amygdala and hippocampus. Neurons in the hippocampus were a third smaller and
noticeably less, which is characteristic of immature configuration and is a sign of retarded
maturation.
Parts of the brain affected by autism
Another structure of the CNS that results in
significant changes is the cerebellum. In 90% of
patients have a decreased number of Purcinievi
cells and granular cells in the hemisphere and
vermis of the cerebellum, with lower preserved
neurons olivarno core.As a result of this damage
occurs dysregulation of higher functions that are
impaired in autism (active attention, irritability,
sensory processes)7.
autism
1. Parts of the brain affected by
Epidemiological features
So far most comprehensive epidemiological study is that of Eric Fombonne, in which it
is established that the sex is that males more often than females.The diagnosis is based
on clinical and laboratory findings. In its setting participate clinical psychologist, special
education teacher, speech therapist, social worker, therapist, doctor and nutritionist.The
most commonly used diagnostic criterion is ICD-10, which was first established in 1992.
by WHO. Another diagnostic criterion is the DSM-IV, which was first used in 1994. by
the American Psychiatric Association (APA)10.The differential diagnosis includes
distinguish autism from other states. You should consider mental retardation,
schizophrenia, developmental speech disorders, sensory disorders, Rett-syndrome,
Asperger syndrome and others8.
Clinical features
The symptoms of autism vary, but the situation prevails throughout life, even if its forms
change with age.
Impairments in social interaction, remains alone in the company of others, no ability to
imitate; Apathy and impairment in social interaction and indifference to other people;
Adjusted or formal behaviour.
Impairments in social communication: underdevelopment speech; unintelligibility of
feelings, ideas and opinions of others; absence of gesture, facial expression, facial
expressions, vocal intonation, abnormal nonverbal communication, has no desire to be
present, no laughing;
Impairments of imagination: Inability to imaginative play with objects, toys or other
children and adults; Tendency of directing attention insignificant aspects of environment;
Permanent attachment of parts of objects; Repeated movements of the body, such as
rocking or strongly hitting head ; considerable anxiety because small changes in the
environment; Limited imaginative activity, which may be imitation (from a TV show)
Inability to understand the purpose of words, such as literature, verbal jokes;
Problems with language: Totally undeveloped speech or speech with minor flaws;
Echolalia - repetition of words and sentences, swapping the order of words and letters;
immature grammar, poor voice control, height, volume, intonation17.
Visual disorders and eye contact using the peripheral field of vision; cursory view of
things and people; fixing the gaze to objects or people in motor imitation problems:
difficulty in repeating movements; Mixing up-down, left-right
Problems in motor control: Walking on toes without synkiness hands; unusual posture;
Spontaneous movements, skillful or clumsy.
Emotional reactions: Anxiety, crying, shouting; Laughter - without reason.Anomalies
of physiological development, disorders of sleep and eating; Drinking large amounts of
water, absence of dizziness after a long rotation; drug resistance.
Disturbances in sexual development
Autism as a pervasive personality disorder leads to serious problems in sexual
development and behavior. Sexuality is part of the organic ripening and maturation
process, which here has a key role in nervous system development, metabolism and
secretion of hormones. Develops through social interaction and communication, through
physical contact, through games and assimilated through social rules and norms. It is an
emotional feeling for yourself and for others, it is a fantasy, the ability of imagination
capability tied to perceptions, understanding the symbolic concepts influenced by the
flow of experiences of people in general. Sexuality must be retrieved practically realized,
must be expressed in the form of the game solo or company. Development process of
maturation in adolescents with autism is accompanied by a number of disorders in the
nervous system, metabolic and hormonal processes15. Inability to understand the social
norms can often meet young people with autism who are walking naked in public and try
to masturbate or inability to empathy is possible to try to touch, kiss or hug strangers.
Because young people with autism is not able to achieve an affair with a boy or girl in
their desire becomes obsession. Due to failure in love and friendship ties and rejection of
sexual motivated physical contact comes to frustration and consequently aggressiveness
or various types of behaviors that directed towards itself. A person is withdrawing into
oneself or completely giving up sexual needs. In people with autism show early signs of
sexuality, early masturbation and even sadistic traits. Sex is characterized by wild
excitement, like an epileptic seizure or orgasm and exaggerated sexuality and sensuality5.
Treatment of people with autism Approach to autism requires structured, flexible and
imaginative solutions. There are different types of therapy including changes in behavior
or behavioral therapy, SPEECH-speech therapy, sensory integration therapy, vision
therapy, music therapy, therapy with pictures, SPELL, TEACH method, SON-RISE
PROGRAM, AIT, LOVAAS, Daily Life or Higashi, PECS, BRT (Behavioral Relaxation
Training), drug therapy and various types of diets that are used as a treatment in autism.
Our closer spaces (in Belgrade) is used BIM method (Belgrade integrative method)6.All
well-designed approaches to intervention in itself involve elements of communication
therapy, development of social skills, sensory therapy failure and modification of
behavior, and are conducted by specially trained professionals with harmonious and
coordinated skills for this job. People with autism generally train for establishing
functional lifestyles - safely pass through the street, make a simple choice or apply for
help when they need it, and this can be difficult to achieve even with those with autism
have average level of intelligence. Behavioral therapy: working with people with autism
behavioral approach limits the application of the principles of operational learning. This
principle includes shaping constructed forms of behavior through underpinnings of
behaviors that lead to a preset order and averzirzivni incentives or nepotkrepuvanje of
behaviors that prevent achieving the objective12.
Educational Program - Teacch program: Teacch (Titch) is a state program of work
and education people with autism and other people with problems in the field of
communication and their families, that the best approach to their difficulties and allows
achieving a greater degree of autonomy in life7.
Treatment of firmly holding or holding therapy:Treatment of a firm grip she founded
Martha Welch. It is very clear in determining that the lack of primary reason for tying
autizmot.Autizmot is caused by the inability to establish a primary relationship between
mother and child. Holding is not only a mechanical act of holding, but also psychological
content.
Sensory integration:Sensory integration, an important neurobiological organization
and use of sensory input. It is a process in which the brain organizes sensory experience:
touch, movement, body awareness, vision, hearing, experiencing gravity only information
an individual uses in learning and responding to the environment. This therapy is trying
to encourage the development of the nervous system and prevent behavior that does not
fit, creating sensory input through planned construction activities that have an educational
and therapeutic role.
Daily life therapy (Daily life or Higashi)
The methodology of work of daily life therapy is not a follower of any theory of autism,
but naturally developed based on experience in the teaching of children with autism who
were located in Higashi school9.
BIM (Belgrade integrative method) Belgrade integrative method is developed based on
Higashi or method of daily life therapy from Boston and the method of re-education
France. Group and individual work with parents and work with siblings of children with
autism17.
Treatment of relaxation behavior
Relaxation treatment as used for influencing the behavior to reduce anxiety, anxiety, pain
or stress. Najistrazhuvan treatment relaxation applied in developmental disorders is a
progressive relaxation (PR). This treatment provides a series of clamping and releasing
the muscles, the individual to become aware of the sensations that the body performs with
contractility and releasing the muscles. So, when a person is anxious, you can apply this
therapy only after identifying the tension or anxiety. Alternative form of progressive
relaxation is treatment rekalsacija behavior (Behavior Relaxation Training-BRT)11.
Drug therapy
Pharmacotherapy is a relatively young discipline and its actually start taking in 1952 when
Delay and Deniker synthesized substance used the therapeutic goals. It is a
chlorpromazine (Largactil), which it described as a substance that leads to psychomotor
calm, relaxation and emotional affective indifference of psychotic symptoms in the
insane, and it antipsychotics or neuroleptics. In general, neuroleptics soothe psychotic
experiences (tension, motor agitation), sedatives act anksiolitichki calming the
polisinaptichkite reflexes in the CNS, and sulpiride act directly on the hypothalamus and
Papezoviot round. The pacification of this round allows those successful therapeutic
approaches that seek to reconstruct and rebuild the life experiences of people with
psychotic disorders. Thus, drug therapy appears only as an aid to therapeutic procedures
in individuals with autism. Thus a person is preparing for the adoption of adequate,
current techniques or therapies that are currently applied in the world working with this
populations5.
Objective: characteristics of adolescents with autism (knowledge of the parts of the body
the ability to imitate the movements, socializing, sexual interest; nutrition; reaction
apparatus; awareness of smell and taste; aggressiveness; avtoagresivnost, destructiveness,
and thus the need for communication, receptive speech, seizures, drug therapy, diseases
and other conditions). By comparing the two groups of people with autism, from
childhood and adolescents, by filling in a questionnaire, to confirm some characteristics
of adolescents with autism, some that appear during adolescence and others not change
during adolescence and remain life typical characteristics of autism.
Methods and materials: causal method, descriptive analysis, survey, analysis of
documentation (dossier) evidencioni sheets-defectologic tests to assess body pattern and
imitation of movements.
Results are analyzed in two groups of 30 participants and one group consists of
adolescents aged 15 to 25 years, while the other group consists of 30 respondents also
child aged 5 to 15 years. Total survey covered 60 subjects. In both groups dominated by
males and the Center for Children and 63.3% in the Center for Youth 76.7% and total
respondents were male while 42 female 18.
Discussion: Statistical differences between children and adolescents with autism.
Figura 2.Knowledge of the parts of his body in adolescents with autizam
From figure 2 can be seen that in relation to the knowledge of the parts of the body, there
is no statistically significant difference between adolescents and younger children with
autism or organization body pattern in children with autism (80%) and adolescents
(76.7%) is usually below expectations regarding their calendar age.16 No statistically
significant difference between the two groups in terms of the percentage of respondents
who knowledge of the parts of the body appropriate to the age, that can be observed that
adolescents do not progress significantly in relation to children with autism.
Figura 3.Sexual interest in adolescents with autism
Figure 3 indicates a statistically significant difference between adolescents and
respondents from childhood.Puberty in January causes sexuality and autistic individuals
with recurrent anxiety or excitement. Because the process of development and maturation
in adolescents with autism is accompanied by numerous disorders of the nervous system,
metabolism and hormonal processes comes to distortions of sexuality or to immoral
sexual behavior or wild excitement in the form of an epileptic seizure or orgasm or to
ignore sexuality and withdraw into themselves resulting in the occurrence of aggression
and self-aggression17.
Figura 4.Sociability in adolescents with autism
Figure 4 shows that there is a statistically significant difference between adolescents and
respondents from childhood. People with autism during puberty require company, but
that their need for conviviality they express differently. In fact under conviviality not
mean friendly relations, but desire or habit "not to be alone" in a room or in a particular
activity13.
Figura 5.Mood of adolescents with autism in terms of cause and group
Figure 5 shows that appear statistically significant difference between adolescents and
children with autism, or in adolescents with autism usually appears reduced or secondary
mood regarding the cause and the group, while children with autism are more excited and
enthusiastic about games or some new activities in a group, or a lot more with respect to
the cause and the group10.
Figura 6.Mood of communication of adolescents with autism
Adolescents often communicate and have a desire to communicate verbally. From Figure
6 can be found statistically significant differences between adolescents and those with
autism from childhood. The Centre for children verbally communicate 20% and 50% in
the Center for adolescents, while nonverbal communication 80% of children and 20% of
adolescents.When it comes to aggression, no significant statistical difference between
autistic children and adolescents, that proved that aggressiveness is characteristic of
adolescents with autism14.
Conclusion
Autism is a variable disorder psychological development or biological breakdown of the
brain, which is characterized by the inability to develop language communication and
other forms of social communication. Covers a wide range of disorders, ranging from
mild to severe degrees. Autistic individuals are described as living in "their world".
Autism occurs more frequently in men and about 30% of autistic people get epilepsy.
With aging all features of autism becoming poizrazeni.Autizmot not determined by a
single symptom, but with characteristic triplet of symptoms: impairment in the ability to
socialize, impairment in the ability of communication and restricted interests and
repetitive behavior. Symptoms usually develop gradually, but there are exceptions in
some children with autism, who initially develop normally and then regress their
development. Although the measures taken with regard to education and learning for
understanding the world in the early period of childhood can help them become able to
take care of themselves, to communicate and socialize, there is no cure that works 100
percent.
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