Autism spectrum disorders are characterized by a severe and widespread disturbance of several areas of development. As described in the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, they manifest in difficulties in relationship, communication, interaction and the presence of restricted and repetitive behaviors, interests and activities.
It is a very wide spectrum, a range of intensity and frequency of symptoms, which affects each person differently. Therefore, the approach to autism spectrum disorders from the Aspace Catalunya Foundation consists of understanding and understanding the mental functioning of each person individually.
Knowledge of how a person with autism perceives the world is essential in the early stages of life. Early intervention is a key element to promote development. For a few years now, els Early Care Centers (CDIAP), note a significant increase in ASD diagnoses, a phenomenon detected by several organizations worldwide. according to Autism Spain (2011) the incidence of ASD is 1 child for every 150. This proportion can be contrasted with that provided by the Autism Society of America (2006) which spoke of an increase in the diagnosis of 172% and with Autism Speaks (2012) placed it at one child for every 88.
This increase is explained in part by better detection and also because the "spectrum" concept has made it possible to include patients with milder symptoms who were previously underdiagnosed and has made it easier for them to access therapeutic and educational resources.
DETECTION AND UNDERSTANDING OF AUTISM SPECTRUM DISORDERS
It should be noted that advances in the knowledge of autism allow us to detect the first warning signs within the first year of life. Coordination and networking with paediatrics and nursery schools allows the earliest detection and referral to the reference early care center when the child already shows some symptoms of autism or risk factors are observed.
In early childhood, we must take into account the presence of pathological signs and the absence of milestones specific to the stage of development in which the child is. Clinical observation and specific instruments such as the M-Chat questionnaire ((The Checklist for Autism in Toddlers) and the ADBB scale (Alarm Distress Baby Scale) will allow us a first assessment.
After, during the diagnostic process the administration of the ADOS Test is the reference test for the evaluation and diagnosis of autism and generalized developmental disorders in individuals of different ages and levels of language development.
From the moment the first warning signs are detected, a diagnostic process begins, in which the family is an active part. The knowledge that parents have about the difficulties and also about the interests and what motivates their child are key both in the diagnostic process and in the therapeutic one.
From the early care team of Aspace Catalunya early care, the approach to autism spectrum disorders is multidisciplinary with interventions coordinated from the physiotherapy, the psychology, the speech therapy, social work and the neuropediatrics. The complexity of the disorder makes a good diagnosis and a global intervention in the various areas of development essential.
Behavior is the most visible part of what is happening, what a child with autism is perceiving, feeling and processing. Intense reactions, repetitive movements or sudden changes can often be incomprehensible to us, because they do not respond to the patterns with which we usually function and which make up the social norms we have learned.
For a child with autism, the relationship with all the stimuli it receives from the outside: lights, sounds, smells, textures and from its own body, hunger, thirst, pain, joy, that is to say, everything that makes up our external and internal world is experienced as a chaos of very high intensity, difficult to understand and therefore to tolerate. This generates a high and sustained state of anxiety, and consequently a need for shelter and closure in oneself; an encapsulation that isolates him from this world that is perceived as hostile.
The therapeutic intervention will have as its main objective, to mitigate this suffering and accompany the child with autism to the discovery and desire of a world of relationships and emotions. When we talk about therapeutic intervention, we talk about making the child's environment as therapeutic as possible, and teamwork is essential: family-school-therapist.
THERAPEUTIC INTERVENTION FOR AUTISM SPECTRUM DISORDERS
The interventions, orientations and work within the therapeutic environment will be the basis for the generalization of the goals achieved in the child's natural environment. The therapist's expertise in understanding the child with autism and the knowledge of the child's family are the key to the developmental process. The age of detection, the cognitive level and the severity of the symptomatology are important in the evolutionary prognosis.
The therapeutic work will be aimed at a deep understanding of what the child perceives, accompanying him in integration, giving meaning to what is happening to him, and providing him with resources to help him express himself and communicate .
The defense mechanisms that a child with autism spectrum disorder needs to use, to tolerate all external and internal inputs, although they have a common pattern, are idiosyncratic and variable in frequency or intensity depending on each person.
Stereotypies, repetitive movements with the hands or the body, are visible in many children with ASD, and have multiple variations. It is necessary, in each case, to understand what triggers them, what has overwhelmed the child at that moment: an intense sound or a change of space, for example, can represent an overflow and an intolerable, unintegrated sensation, and which therefore makes no sense.
The objectives of the therapeutic plan carried out by the professionals of the Fundació Aspace Catalunya are framed within the immediate environment of the child and its design takes into account the area of closest possible development. In other words, it will be an intervention that, within the relationship with the child, provides the conditions to help him develop and go a little beyond his competences.
INTELLECTUAL DISABILITY AND AUTISM SPECTRUM DISORDERS
People with a diagnosis of intellectual disability may associate difficulties within the autism spectrum. Although the CDIAP of Aspace Catalunya intervenes in all cases of diagnosis of ASD, from the age of 5 we continue to visit them in our foundation when they present a cognitive deficit as the main diagnosis and associate aspects or features of the disorder.
Approaching treatment from the perspective of cerebral palsy or other causes of intellectual disability is extremely complex. The difficulties in daily life are often not justified by their level of intelligence, but rather by the lack of interest or attention in certain activities which means that they do not perform them correctly, but it can also be due to a cognitive problem, or both
Language is affected and usually also language comprehension. The development of the game is interfered by the difficulties of accessing the representative and symbolic world and their preferences for sensoriality. In addition, users very often have comorbidities associated with gait disturbances, epilepsy or auditory or visual sensory deficits, among others that must be taken into account in order to address them correctly.
BIBLIOGRAPHY
Viloca L. The autistic child: detection, evolution and treatment. Barcelona: Carrilet Collections. 2012
tustin F. Autism and child psychosis, 1972. Paidos, Psychiatry
Autism spectrum disorder in early care. Multidisciplinary and plural approaches, Working Group of theCatalan Early Care Association, 2019-2021
Brun, JM; Villanueva, R: (comp) Children with Autism. experience and experiences. book promotion Valencia, 2004
Network resources
Carrilet, Services for people with autism
