How to help children who still can't call mom and dad until 18 months old?

There is a group of autistic children who have social interaction and communication difficulties, narrow interests and stereotyped repetitive behaviors in their daily lives; but some of them have extraordinary levels and abilities in music, painting, calculation, date calculation, mechanical memory and recitation. Therefore, some people figuratively compare these children to "star children", describing them as having ears that are not deaf, but turning a deaf ear to sounds; eyes that are not blind, but turning a blind eye to people and things around them; voices that are not dumb, but they don't know how to speak. They are like a group of aliens and visitors from outer space, just like the stars in the sky, living only in their own world and space.

Before the arrival of World Autism Awareness Day on April 2, the reporter interviewed Guo Xuesong, director of the Rehabilitation Department of Harbin Children's Hospital, and Shi Wenhong, a national second-level psychological counselor and director of the Child Health Education Department, and asked them to provide popular science interpretations on the topic of autism.

Autism, a global problem

Autism, also known as autism spectrum disorder, is a serious developmental disorder characterized by abnormal communication skills, narrow interests, stubborn behavior patterns, and language skills with or without abnormalities caused by poor development of brain function. Studies have shown that about 1/2 of children with this condition have intellectual disabilities, about 1/3 to 1/4 of children have epilepsy, and different proportions of children suffer from sleep disorders, gastrointestinal problems, etc. Director Guo Xuesong introduced that as one of the fastest growing diseases in the world, autism has now become a "world problem" that seriously affects the quality of life and population health. The latest prevalence of autism announced by the US Centers for Disease Control and Prevention in 2021 is 1/44; my country's preliminary estimate of the prevalence is 0.7%, of which 14-year-old children with autism are as high as 2 million, accounting for the first place among all types of mental disabilities.

Children with autism are characterized by not being able to speak or speaking late. A few parents are concerned that their children do not make friends with their peers and lack interaction and seek medical treatment; most parents believe that "noble people speak late" or think that their children's language development is delayed, and fail to go to the hospital for diagnosis and treatment in time and receive systematic rehabilitation treatment. Guo Xuesong pointed out that since autism usually has no significant characteristics before the onset of the disease and is easily ignored by parents, if the following conditions occur before the age of 2, further evaluation is required: lack of response to verbal laughter but particularly sensitive to music, like to watch spinning things; lack of interest in ordinary toys but fascinated by some unconventional toys and objects; like to run back and forth or spin, and will not play interactive games; lack of visual contact with others, no response when called; will not actively point to objects, and when necessary, grab the hands of adults and drag them to the required objects; until 18 months old, they still cannot call mom and dad.

If you find any abnormality, you need to see a doctor immediately

When abnormalities are found in some of the above aspects, you must go to a specialized medical institution as soon as possible for diagnosis by a professional doctor. Director Guo Xuesong explained that autism is the result of early brain development changes and neural reorganization. There are currently no biomarkers. The relevant diagnosis is based on the behavioral performance of the child in question. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders of the United States or the 10th revision of the International Classification of Diseases, the diagnosis is made through history collection, mental and physical examinations, psychological assessments and other auxiliary examinations such as CT, magnetic resonance imaging, electroencephalograms, evoked potentials, etc. If necessary, chromosome and family whole exome second-generation sequencing, CNV (gene copy number variation), blood and urine metabolic screening and other genetic metabolic disease-related examinations are performed. Neuropsychological examinations can understand the abnormalities of neuropsychology in children with autism, which is of great significance for judging the severity and prognosis of the disease and formulating individualized training plans.

If a child is diagnosed with autism, parents do not need to worry too much or be panic, because the child's brain is in a period of rapid development, is dynamically changing, and has strong plasticity. Director Shi Wenhong emphasized: Early detection, early behavioral intervention, and early education can significantly improve the poor prognosis of children with autism. It is generally believed that the intervention effect is more obvious before the age of 6, and before the age of 4 is the best intervention period; and the younger the age, the higher the training intensity, and the better the effect. Director Guo Xuesong suggested that we should seize the "three stages" of the golden intervention period, and the early intensive stage: mainly to improve the child's basic learning skills; the integration preparation stage: mainly to train the reserve skills that children should have when entering a collective environment; the preschool integration stage: mainly to improve the child's self-learning ability and self-care ability in a collective environment, and the social skills among peers.

Unlock the "heart lock" of sick children with love

As for the treatment of autism, rehabilitation training and psychological intervention are the main approaches. Shi Wenhong introduced that rehabilitation training is one of the most effective methods recognized at home and abroad to improve the core symptoms of autism and improve the quality of life of patients. The goal is to promote the language development of children, improve social interaction skills, and master basic life skills and learning skills. Most autistic children cannot adapt to kindergarten education before school age, and can receive rehabilitation education training in rehabilitation institutions or inclusive kindergartens. After their language communication and social skills improve during school age, some patients can go to ordinary primary schools to study with children of the same age.

As for psychotherapy, the more classic psychotherapy method is applied behavior analysis, which is to issue instructions to the children to make them respond, and then the therapist will strengthen their good behaviors and weaken bad behaviors according to the way of response. In addition, for children with autism, it is more conducive to their communication with therapists and open their "closed" hearts through games such as sand trays and paintings, or in a relaxed environment. In particular, art intervention is the most self-healing means for such children. For example, music and art are also the best ways for children to coordinate their hands and brains. At the same time, we should encourage children to get close to and integrate into nature, so that these "star children" can grow up healthily in the fragrance of nature with love and freedom.

Director Shi also suggested that parents actively participate, understand and grasp the crux of their children, learn appropriate parenting skills and coping skills, and through clever guidance, let autistic children establish a connection between the visual, auditory, taste, olfactory, and skin proprioception systems, and integrate the senses throughout the family environment. The stimulation of children's vestibular proprioception and touch can help improve the coordinated development of autistic children's brain functions, ultimately promote the adaptability and language development of such children, and build a colorful emotional world for children.

Finally, Director Guo Xuesong commented that the mystery of the cause of autism has not been solved yet, and there is still a lack of specific intervention methods. For this reason, the United Nations General Assembly passed a resolution to designate April 2 of each year as "World Autism Awareness Day" starting in 2008 to raise people's attention to the prevention, diagnosis and treatment of autistic patients and social integration. Zhang Haidi, President of the China Disabled Persons' Federation, pointed out during a survey of rehabilitation institutions in Beijing last year that an autism rehabilitation department should be established in the China Rehabilitation University to cultivate professional autism rehabilitation talents. During this year's Beijing "Two Sessions", the number of motions and proposals involving autism (spectrum) increased significantly compared with previous years, and the scope involved was also wider, with urgent needs for early screening, medical insurance, employment, etc. for autistic people being voiced one after another.

Director Guo emphasized that autistic children should have equal development opportunities and enjoy a normal life. She called on all sectors of society to pay attention to the autistic group, actively help them integrate into society, and use love to open the "heart lock" of autistic children!