Autism

Introduction Child autism used to be called infantile autism and autism in children. It is related to psychological activities in children's perception, language and thinking, emotion, movement and social interaction. It is a developmental disorder. In taxonomy, it is currently classified as a category of psychological developmental disorders, called pervasive developmental disorders. The prevalence rate is about 4 to 10/10,000 for children according to Western reports. There have been very few reports in the past in China, and they have gradually increased in recent years. Boys are more common (male: female is about 5:1). The cause of this disease is unknown. Twin studies suggest that the same rate of disease in single-female twins is higher than that of double eggs. Both EEG and brain imaging have higher abnormal rates, but they are not specific. There are also many soft signs of the nervous system. Some diseases, such as patients with fragile X syndrome, are also associated with symptoms of autism. The earliest incidence of autism was reported to be 2-4/10,000. Epidemiological studies show that boys are significantly more than women, male: female is 4:1 There is no epidemiological investigation in China.

Cause

Kanner first proposed the diagnosis of autism in 1943, and also suggested that the cause of autism is caused by the apathy and over-formalization of parents in terms of emotions. After decades of extensive research, autism has been confirmed. Parental parenting has nothing to do with it, and the so-called indifference and parental formalization of some autistic parents actually indicate that parents may have similar obstacles of lightness. Although the cause of autism is still unclear, scholars have conducted extensive research on the etiology of autism, and more and more evidence indicates that biological factors (mainly genetic factors) and fetal intrauterine environmental factors in autism It plays an important role in the pathogenesis and has become a hot spot in the current cause research. Other factors include immune factors, nutritional factors, etc., comprehensive research, it is currently believed that autism is caused by external environmental factors (infection, intrauterine or perinatal injury, etc.) on individuals with autism genetic susceptibility caused by nervous system developmental disorders Sexual disease.

Genetic factor

In 1991, Folstein and Piven reported that the incidence of single-female twins in autism was 82%, and the incidence of twin twins was 10%. The epidemiological survey also confirmed that the prevalence of autistic siblings was 3%, much higher than the general population, and there was a family aggregation phenomenon. Even if there are no patients in the family, similar cognitive deficits, such as language development retardation, mental retardation, learning disabilities, mental disorders and significant introversion, can be found, indicating that there is a genetic basis for the onset of autism. . Further studies have found that symptoms of hereditary diseases such as fragile X syndrome, tuberous sclerosis, phenylketonuria, and Rett syndrome are associated with autism.

However, most children with autism do not have the above-mentioned hereditary diseases. Therefore, in recent years, a large number of related studies have focused on finding other abnormalities related to chromosomes and genes, from the mother's long chromosomes of chromosome 15, the X chromosome, and the long arm region of chromosome 7. It is thought to be related to autism, in which the long arm of chromosome 15 is considered to be related to dyslexia, and dyslexia is also one of the manifestations of autism, which is taken seriously. Using molecular biology techniques, a number of so-called candidate genes (Candidate Genes) that may be associated with autism, such as Serotonin transporter gene and c-Harvey-ras oncogene, have also been discovered. It should be pointed out that the results of studies on chromosome and genetic abnormalities in children with autism are not consistent. Most scholars believe that autism is probably not a single-gene hereditary disease, and polygenic inheritance is more likely.

2. Infection and Immunity Factors Some scholars have studied the role of immune and infectious factors in the etiology of autism. In terms of infection, congenital rubella virus infection and cytomegalovirus infection are thought to be related to the onset of autism. The incidence of congenital minor abnormalities in autistic twins is higher than in non-autistic twins, and these abnormalities are associated with congenital infections. Because of the high incidence of autoimmune diseases in children with autism, the T lymphocyte subsets are also different from the normal population, suggesting that autism is associated with abnormal immune system. However, the results of the study are different, and the significance in the etiology of autism is still unclear.

an examination

Related inspection

Pain EEG examination

A typical autism must have three aspects of performance:

First, language damage.

Second, behavioral damage, stereotypes, repetitive behaviors, and special attachment to certain items.

The third is the damage to the ability of social interaction. And these must be qualitative damage.

These three points must be available at the same time to consider autism.

Differential diagnosis

1. Rett syndrome is only seen in girls. It usually starts from 7 to 24 months. It develops normally before onset. The head develops slowly after onset. The acquired speech ability and social communication ability are rapidly lost, and the mental retardation is severe. The acquired hand movement skills of the hand are also lost, and there is a stereotyped movement of the hand (handwashing action or stereotyping of the finger). And often accompanied by excessive breathing, gait instability, tonic movement ataxia, scoliosis, seizures. The course of disease progresses rapidly and the prognosis is poor.

2. Childhood disintegrating mental disorder (Heller syndrome) Most of the disorders occur in 2-3 years of age. The development is completely normal before onset, and the mentality rapidly declines after onset. Other acquired abilities (including speech ability, society) The ability to communicate, self-care, etc.) has also rapidly declined and even lost.

3. Asperger syndrome, also known as child schizophrenia, has certain characteristics similar to childhood autism, which is more common in boys. Generally, the symptoms are obvious until the age of 7 years old, mainly due to interpersonal barriers, limitations, stereotypes, repeated interests and behaviors. No obvious language and intellectual barriers.

4. Expressive or Receptive Language Disorders This type of child is mainly characterized by impairment of language expression or comprehension, normal or near-normal intelligence (IQ 70), good nonverbal communication, and no qualitative defects and interests in social interaction. Narrow and rigid behavior.

5. Children with schizophrenia The main cause of the disease is pre-puberty and adolescence, and the pre-disease development is normal. After the onset, symptoms such as hallucinations, thinking disorders, apathy or inconsistency, lack of will activities, and strange behaviors are gradually emerging. To help identify.

6. Mental retardation Children with this disorder have no qualitative defects in social interaction. Although their speech level is insufficient, they are consistent with their intelligence level. There is no obvious interest in narrow and stereotyped repetitive behavior. However, if the child has both the typical symptoms of autism and the retardation of mental development, both diagnoses need to be made.

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