Ivanova Violetta Andreevna, Head of the Department of Medical Rehabilitation of the Children’s Rehabilitation and Restoration Center of the Federal Scientific Center of Rehabilitation of the Disabled named after G.A. Albrecht, Ministry of Labor of Russia, 11 Bolshoy Sampsoniyevsky Ave., 194044 St. Petersburg, Russian Federation, tel.: 89811888202, e-mal: firstname.lastname@example.org
In the heading: Original researches
Year: 2020 Volume: 2 Journal number: 3
Article type: scientific and practical
Introduction. In recent years, the number of young children with speech and communication disorders has increased significantly in the practice of a child neurologist. Some of these disorders are manifestations of developmental dysphasia. However, a significant percentage of young children with speech and communication disorders demonstrate, in addition to speech disorders, symptoms of impaired social communication and restricted behavior, the clinical manifestations of which meet the diagnostic criteria for autism spectrum disorders. In the structure of healthcare in the Russian Federation, the diagnosis of autistic spectrum disorders is traditionally the responsibility of a child psychiatrist, but pediatricians and children’s neurologists primarily face early manifestations of symptoms characteristic of the spectrum of these disorders at routine appointments. The reasons for the increase in the number of children with symptoms of autism spectrum disorders have not been fully studied, but it has been proved that early detection and timely correction of these disorders, as well as often accompanying somatic disorders, significantly improves the further prognosis in terms of development and socialization of patients. This fact makes pediatricians and pediatric neurologists more responsible for timely recognition of these conditions and drawing up the correct diagnostic route.
Aim. To study the features of anamnesis, complaints, neurological, somatic and vegetative status, neurophysiological parameters in children with speech and social communication disorders in the structure of autism spectrum disorders and compare these indicators with two control groups. Identify common concomitant medical problems and the main application points for their correction when developing an individual medical rehabilitation program.
Materials and methods. The study was conducted on the basis of the Children’s Rehabilitation and Restoration Center of the Albrecht Federal Scientific Centre of Rehabilitation of the Disabled in 2019–2020. The study involved 197 children of preschool age. The main group included 91 children with speech and social communication disorders that meet the diagnostic criteria for autism spectrum disorders. Two control groups comprised 68 children with developmental dysphasia, as well as 38 children with motor and speech disorders in the structure of cerebral palsy. The average age of children in all groups was 4.3 years. The assessment of the child’s condition was carried out by a team of specialists including, in addition to a neurologist, a psychiatrist, a pediatrician, an orthopedist, a physical therapist, a medical psychologist, a speech therapist, a game therapist, and a neuropsychologist.
Results and discussion. In all the studied groups, according to the study of pre- and postnatal anamnesis, an increased number of risk factors for damage to the nervous system was revealed, but individual pathogenic factors and the periods of their impact on the developing body in different groups had differences.
Objective neurological examination in the group of autistic spectrum disorders revealed a high frequency of dissociation of muscle tone and the severity of diffuse hypotension, along with impaired coordination. The difference between the cerebral palsy group and the main group was the identification of a more severe neurological deficit while preserving the emotional sphere. The peculiarity of the developmental dysphasia group is the more frequent detection of scattered neurological micro-symptoms accompanying speech disorders. Diffuse decrease in muscle tone, as a characteristic feature, was found both in the group of autism spectrum disorders and in the group of developmental dysphasia, but the degree of severity of the sign was higher in the main group. Patterns of epileptic activity were equally common in groups of children with cerebral palsy and in the main group. The frequency of asymptomatic epileptic activity in the group of children with developmental dysphasia was lower. The study found a more frequent prevalence of latent somatic and vegetative complaints in a group of children with autistic spectrum disorders compared to two control groups. It was also found that children with autistic spectrum disorders in a greater number of cases have somatic and vegetative disorders and to maintain normal vegetative activity, they are forced to use excessive central activation of vegetative reserves.
Summary. The obtained data reveal characteristic differences in neurological, somatic and vegetative status in the group of children with autism spectrum disorders, which should be taken into account when diagnosing and drawing up an individual rehabilitation program to improve the rehabilitation prognosis.
1. World Health Organisation. ICD-11 for Mortality and Morbidity Statistics (2018): 6A02 Autism spectrum dis- order; 2018.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders. DSM-5. Washington (USA): American Psychiatric Association; 2013.
3. Eya-Mist Rodgard et al. Temporal Changes in Effect Sizes of Studies Comparing Individuals With and Without Autism: A Meta-analysis//JAMA Psychiatry.2019 Aug21; 76(11):1124-1132 doi: 10.1001/jamapsychia- try.2019.1956. Online ahead of print.
4. Kliniko-biologicheskie aspekty` rasstrojstv autis- ticheskogo spektra / pod red. N.V. Simashkovoj, T.P. Klyushnik. [Clinical and biological aspects of autism spectrum disorders / ed. N.V. Simashkova], T.P. Club play- er, (2016) Moscow: GOETAR-Media, 288 p. (in Russian)
5. N`okikt`en, Charl`z. Detskaya povedencheskaya nev- rologiya. V dvux tomax. Tom 2 / Charl`z N`okikt`en; per.s angl. [Nyokktyen, Charles. Children’s Behavioral Neurology. In two volumes. Volume. Charles Nyokktyen]; lane with English D.V. Ermolaev, N.N. Zavadenko, M.A. Ostrovskaya; under the editorship of N.N.Zavadenko. – 2nd ed. (2018) Moscow: Terevinf, 336 p. (in Russian)
6. Bujnakova I., Ondrejka I., Mestanik M. et al. Autism spectrum disorder is associated with autonomic undera- rousal // Physiol. Res. – 2016. – Vol. 65 (5). – P. 673–682
7. Mark J Taylor et al. Etiology of Autism Spectrum Disorders and Autistic Traits Over Time // JAMA Psychiatry. 2020 May 6; e200680. doi: 10.1001/jamapsychiatry.2020.0680.
Online ahead of print.
8. Margaret L Bauman Medical Comorbidities in Autism: Challenges to Diagnosis and Treatment// Neurotherapeutics. 2010 Jul;7(3):320-7. doi: 10.1016/j.nurt.2010.06.001.