Hispanic Mexican Polytechnic University

Fourth semester group A

Degree in psychology
Members:
Dulce María Cruz López.
Amira Sheryln Valera Cruz.
Ingles IV
Introduction:
Autism spectrum disorder is a lifelong neurological disorder that affects the
ability to communicate and interact. It is part of a group of disorders known as
ACD and is 4 times more common in boys than in girls. Autism impairs the
ability to communicate and relate to others.

The most common symptoms appear in the first 3 years, parents identifying
that their children behave differently from children their age, symptoms such
as little or no communication, not having friends or not showing interest in
getting the attention of parents are the most common symptoms. more
common.

Autism is not a disease, it is a different way of interpreting the world around

us.
The study of the causes of autism, is oriented to the search for neurobiological
factors, evidence has accumulated that implicates genetic factors with autism,
as well as environmental factors.

In this work we will present the clinical case of Pablo, he is an autistic child of
2 years 11 months, his parents took him because they considered that he had
characteristics that other children of his age do not commonly present, he did
not say words like mom or dad, to 14 months he did not speak yet.

The causes of autism spectrum disorder are not known. Research suggests
that both genes and environmental factors play a role.

Currently, there is no standard treatment for ASD. There are many ways to
maximize a child’s ability to grow and learn new skills. The sooner you start,
the more likely you are to have more positive effects on symptoms and
abilities. Treatments include behavior and communication therapies, skill
development, and/or medication to control symptoms.
Autism spectrum disorder is a condition related to brain development that
affects the way a person perceives and socializes with other people, causing
problems with social interaction and communication. The disorder also
includes restricted and repetitive behavior patterns.

Autism spectrum disorder begins in early childhood and eventually causes

problems with functioning in society, for example, in social situations, at
school, and at work. Children usually present symptoms of autism in the first
year. A small number of children appear to develop normally in the first year
and then go through a period of regression between 18 and 24 months of age,
when symptoms of autism appear.

The main cause of Autism Spectrum Disorder is unknown, but it is known that
genetics and some environmental factors can interact with it. Changes in the
patterns of brain development are usually evident from the age of 2. These
reflect prenatal and perinatal history.

Symptoms
Some children show signs of autism spectrum disorder in early childhood,
such as decreased eye contact, lack of response when called by name, or
indifference to caregivers. Other children may develop normally during the first
months or years of life, but then suddenly become withdrawn or aggressive or
lose previously acquired language skills.

Some children with autism spectrum disorders have learning difficulties, and
some show signs of subnormal intelligence. Other children with this disorder
have normal to high intelligence, learn quickly, yet have trouble
communicating, applying what they know in daily life, and adjusting to social
situations.

Due to the unique combination of symptoms each child presents, it can

sometimes be difficult to determine the severity. In general, it is based on the
level of impairment and how it affects the ability to function.

Degrees of autism

It is very important to note that each child is unique, with a personal set of
difficulties and abilities of their own. Despite this, within Autism Spectrum
Disorder we can find 3 different degrees depending on the limitations and the
amount of support needed.

Within grade 1 we find people who need help or support in certain situations in
their lives, however, they have a certain level of independence. These people
present difficulties in initiating social interactions, they tend to use atypical
responses during the interaction and have little interest in social interaction,
however, they have the ability to communicate with their environment.

In grade 2 we can find people who need help in a notable way. These people
have a higher degree of dependency, since they present significant difficulties
in verbal and non-verbal communication, the initiation of interactions is limited,
their behavior is very inflexible when faced with changes in their environment,
and they are affected in the functioning of various contexts.

Finally, in grade 3 we find people who need a very notable and constant level
of help, have a very high degree of dependency, since they present very
significant and evident difficulties in verbal and non-verbal communication,
serious alterations in the functioning , little or no social interaction and suffer
from anxiety in the face of any type of change that occurs in their environment.
Reason for consultation
Pablo's family goes to his pediatrician with his son, 2 years and 11 months
old, because they are concerned about aspects of his development.

Anamnesis

The parents explain that Pablo's development was apparently normal until he
was 12-13 months old: he looked, laughed, crawled at 9 months, played hide-
and-seek, etc. From that age the parents' concern began because his son's
eye contact decreased, he did not say "dad" or "mom", he was more serious,
he stopped eating some solid foods, etc. For about half a year he has fluttered
when he really likes something (on time). He started bipedalism at 14 months.
He currently does not speak (he only emits vowel sounds or chains of
syllables), he has not acquired sphincter control, he is affectionate with his
relatives, but he does not look for the other children to interact with them in the
nursery, he does not point, he goes looking for parents to ask for help if he
can't help himself (stretches their arm or raises their arms to be picked up),
eats mashed foods (rejects solid foods he used to eat) and still nurses to
sleep or when sick (helps him chill out). The parents report that he does not
react to pain when he falls and that he gets upset with the screams and cries
of other children. If the parents do not interrupt him, he can spend a long time
doing the same action (it is very repetitive). He plays very little in a functional
way, and uses the toys to continually hit them against the floor or table. He
likes round objects and reacts with intense tantrums if they are taken from his
hands. Parents report that when they change his routines he also reacts with
protest or tantrums.
Last year he started P-2 in an ordinary school, with a slow adaptation and ups
and downs throughout the course. He just wanted to go to the patio and there
he ran up and down.
He is an only child, and the parents initially do not report any important history
in the family, although they comment that the paternal grandfather has a
"special" character, has never had any friends, is inflexible with other people,
and cannot stand the hustle and bustle . A cousin of the mother explained that
she had a language delay (remember that she started to speak well after the
age of 5), and the mother has heard that another maternal cousin has been
diagnosed with attention deficit hyperactivity disorder ( ADHD) and takes
medication.

Pablo has not had a relevant medical history.

CSBS-DP

The CSBS-DP scale assesses 7 language predictors: emotion and use of eye
contact, use of communication, use of gestures, use of sounds, use of words,
comprehension, and use of objects in play. It allows evaluating socio-
communicative skills between 6 months and 2 and a half years of age in
children, and between 6 months and 6 years of chronological age, as well as
detecting possible symptoms corresponding to ASD and other socio-
communicative development problems.

In the case of Pablo, the score on the CSBS-DP scale is worrisome in all
areas of communication, language, symbolization and total, as reflected in the
following table:
M-CHAT

The M-CHAT, in its revised and follow-up version (M-CHAT-R/F), is a

questionnaire combined with follow-up questions to detect developmental
disorders within the ASD, valid for children between 16 and 30 months of age.
, which consists of 2 stages. In a first stage, parents must complete a total of
20 dichotomous questions (yes/no). Questions 2, 5 and 12 "yes" indicate risk,
and the other questions "no" indicate risk. In a second phase, the professional
asks about the questionnaire items that the child has failed. They are added
up with a total score and the M-CHAT-R is categorized. A positive result is
considered if the total score is ≥3, or if it is positive for more than 2 items
considered critical. An M-CHAT-R score between 8 and 20 is considered high
risk, so follow-up questions can be dispensed with and the patient can be
referred directly to a specialist. If the M-CHAT-R score is <3, it is considered
low risk and the pediatrician will be in charge of supervising the patient's
follow-up. A score between 3 and 7 is considered medium risk and is
combined with the follow-up questions. If the M-CHAT-R/F result is still ≥2, the
screen is considered positive and the patient should be referred to a
specialized neurodevelopmental team for evaluation and treatment.

Revised M‐CHAT Autism Screening Questionnaire for Young Children with

Follow-up Interview (M‐CHAT‐R/F)TM

Instructions for use

The M-CHAT-R/F is designed to be used with the M-CHAT-R; the M‐CHAT‐R
is valid for screening children between 16 and 30 months of age, to assess
the risk of Autism Spectrum Disorders (ASD). Users should be aware that
even with the interview, a significant number of children who do not pass the
M-CHAT-R will not be diagnosed with ASD. However, these children remain at
risk for other disorders or developmental delays and therefore screening is
being warranted for any child who tests positive.
1. If you point to something across the room, does your child look at it? (FOR
EXAMPLE, if you
points to a toy, stuffed animal or animal, does your child look at it?)
2. Have you ever wondered if your child is deaf?
3. Does your child play make-believe or make-believe games? (FOR
EXAMPLE, “pretends” to drink from
an empty cup, talks on the phone or feeds a doll or stuffed animal,…)
4. Does your child like to climb on things? (FOR EXAMPLE, to a chair, stairs,
or slide,…)
5. Does your child make unusual movements with his fingers near his eyes?
(FOR EXAMPLE,
move their fingers near their eyes in an unusual way?)
6. Does your child point with a finger when he wants to ask for something or
ask for help? (FOR EXAMPLE, point to
a toy or something to eat that is out of reach?)
7. Does your child point with a finger when he wants to show you something
that catches his attention? (BY
EXAMPLE, point to a plane in the sky or a very large truck on the street)
8. Is your child interested in other children? (FOR EXAMPLE, looks closely at
other children,
smile or approach them?)
9. Does your child show you things by holding them up or holding them up for
you to see – not for
ask for help but only to share it with you? (FOR EXAMPLE, shows you a
flower or
stuffed animal or toy car)
10. Does your child respond when you call his/her name? (FOR EXAMPLE,
turns, talks
or babble, or stop what you were doing to look at him?)
11. When you smile at your child, does he or she smile back at you?
12. Does everyday noise bother your child? (FOR EXAMPLE, the vacuum
cleaner or the music, even
when is it not excessively high?)
13. Does your child walk alone?
14. Does your child look you in the eye when you talk to him/her, play with
him/her, or dress him/her
15. Does your child imitate your movements? (FOR EXAMPLE, waving,
clapping, or some
funny noise you make?)
16. If you turn to look at something, does your child try to look at what you are
looking at?
17. Does your child try to get you to look at him/pay attention? (FOR
EXAMPLE, he wants you to
pay a compliment, or say "look" or "look at me")
18. Does your child understand you when you tell him to do something? (FOR
EXAMPLE, if you don't
gestures, does your child understand “put the book on the chair” or “bring me
the blanket”?)
19. If something new happens, does your child look at you to see how you
react to it? (BY
EXAMPLE, if he hears a strange noise or sees a new toy, does he turn to face
you?)
20. Does your child like movement games? (FOR EXAMPLE, he likes to be
rocked, or
to make him "the horse" sitting on his knees)
Treatment
Establish a treatment program for the evolutionary problems that Pablo
presents, with a naturalistic base, that is, working in natural environments,
training parents and nursery professionals in how to follow Pablo's initiative,
and promoting a positive state of mind that favor their social and
communicative motivation. A specific number of objectives will be established,
specifying the steps to achieve them, generalizing the intervention in all the
contexts in which the child lives and carrying out an evaluation of the
objectives achieved through continuous records. Throughout this process, it is
essential to train parents in ASD, accept the diagnosis and offer the necessary
help of all kinds, including the financial benefits to which Pablo is entitled
Conclusions:
We conclude this research by stating that autism is a brain development
disorder that hinders social interaction and communication and causes
restricted and repetitive behavior, and that manifests itself before a child is
three years old. The chances of it affecting the male sex are three times
greater than those affecting the female sex. The degree of severity and
symptoms of this disorder have a very wide range and can even go unnoticed,
especially in mildly affected children or when they are found masked by more
debilitating deficiencies. Autism is not treated with surgery or medication,
although in some cases medications may be given to improve certain
symptoms, such as aggressive behavior or attention problems. Autism
continues to be a difficult condition for those who suffer from it and their
families, but the current outlook is much more encouraging than that of years
ago. Evidence shows that early intervention produces long-term improvement
in the child. This can be a help and support for parents in caring for their child

References

Centre, F. (2022). Qué es el Autismo: características del Trastorno del

Espectro Autista. Neural. https://neural.es/que-es-el-autismo-
caracteristicas-generales/
CurSoPsiQuiaTria. (2020a). Caso clínico | Tema 9. Los trastornos del
espectro autista. I Curso de psiquiatría del niño y del adolescente para
pediatras. https://www.cursopsiquiatriasema.com/caso-clinico-tema-9-
los-trastornos-del-espectro-autista/
CurSoPsiQuiaTria. (2020b). Caso clínico | Tema 9. Los trastornos del
espectro autista. I Curso de psiquiatría del niño y del adolescente para
pediatras. https://www.cursopsiquiatriasema.com/caso-clinico-tema-9-
los-trastornos-del-espectro-autista/
Trastorno del espectro autista - Síntomas y causas - Mayo Clinic. (2021, 29
julio). https://www.mayoclinic.org/es-es/diseases-conditions/autism-
spectrum-disorder/symptoms-causes/syc-20352928#:~:text=El
%20trastorno%20del%20espectro%20autista,interacci%C3%B3n
%20social%20y%20la%20comunicaci%C3%B3n.