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HYPERKINETIC BEHAVIOR WITHIN THE AUTISM SPECTRUM DISORDER
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In the present study it is described the case of a child with the diagnosis of autism accompanied by hyperkinetic behavior. The 5 years old child has autisticsyndrome and he manifests irascibility, aggressiveness and irritability. It was found that the diagnosis of autistic syndrome with aggressive behavior is encounteredmore frequently. The dynamics of this pathology is explained by correlating the anamnesis data with the clinical interview and the psychologicalevaluation. In the end the psychotherapeutic program is exposed.
Autism is a developmental disorder considered to be one of the most severe neuropsychiatric disorders of childhood. It is a neurobiological disorder affecting the child until the age of 3, until this age the deficiencies are obvious and a diagnosis can be established.
Autism involves all aspects of development, cognitive, behavioral, coarse motion, fine motion, all sides relating to the normal development of a child are affected .
Regarding the aggressive behaviors that occur in autistic children, there may be no direct correlation with respect to autism and these provocative behaviors, autism not being their cause.
The deficient areas of children with autism syndrome, such as the inability to effectively communicate what they want or to make requests, will lead to feelings of frustration and confusion, anxiety or even lack of control.
For these people deficient behaviors are the first form of communication with the outside environment, with people around, these are even manners to make their desire or need „heard” .
Age: 5 years.
From the anamnesis data taken from the mother we learn that the boy has been developed relatively normally until the age of 2 years, unfortunately it has been observed that the utterance of the most simplistic sounds was difficult. He would often isolate himself from family.
The child has attended the nursery where he also continued to isolate himself, becoming aggressive and extremely irascible from the smallest external impulses, sometimes all these attitudes being accompanied by physical violence. At home his behavior was loosely modified, parents trying to avoid or settle the conflicting moods which may have a negative psychological impact on the child. His expression is intelligent, proportional developed body, normal stature.
Autistic syndrome through isolation towards the surrounding world, the aggressiveness towards his own persona as well as towards colleagues at kindergarten, irritability, irascibility. It was also noted that he has spoken very late his first words and he conducted a series of relatively simple tasks in a longer time than usual .
Only child, from a difficult pregnancy (developing infections throughout it's course imposing treatment with substances that were dangerous to the fetus); the birth was caesarean, prematurely. Neonatal jaundice presented in normal limits, it was breast fed for aprox. 1.5 months and has been vaccinated according to the MS plan.
Psychomotor development by stages of age:
– He held his head at 4 months;
– He stood upright at 5-6 months;
– He walked without support at 11 months;
– He babbled at 8 months;
– The first word he told was at 1 year and 4 months, currently he pronounces 3 words.
Currently the child is living with his parents and his paternal grandparents in the urban environment.
Both parents have medium studies, the mother herself takes care of the child, and the father is working. The relations between the family members are somewhat harmonious, although the father does not make his presence felt; overprotective mother and grandmother.
N.A. has been attending kindergarten since he was 4 years old with a 4 hours program. The clinic exam was normal, as well as the neurological one, although the latter indicated a high rate of serotonin and some rather minor anomalies in some cerebral areas, especially in the ones responsible of emotion and social relations.
Psychological exam: neat street outfit; mobile mimic and gestures, according to his disposition; inconstant visual contact, sometimes he doesn’t answer when he is called; hyperactive behavior, he eats alone, his games are fairly stereotypical; he doesn’t sleep alone and has an extremely agitated sleep; he is easily frightened; language
– unstructured; attention – stereotypical.
EVOLUTION AND PROGNOSTIC
Nowadays, numerous studies talk about hyperkinetic behavior and aggression within the autism spectrum disorder. Putting more emphasis on early therapeutic intervention, especially behavioral intervention on which manages to reduce these maladaptive behaviors of the child. Data from the literature shows that this hyperkinetic behavior with attention deficit accompanied by aggression is not part of a group of disorders unrelated to autismspectrum disorder, but it is a symptom within it, being a way in which the child reacts to the environment.
A possible hypothesis in the development of this syndrome might be the drugs taken by the mother during pregnancy. There is also the possibility that this syndrome originated as a result of the activation of certain genes, unknown until now, but which are believed to trigger autism. In addition, recent studies show that people who suffer from autism have increased levels of serotonin, a chemical substance that is transmitting messages inside the brain.
We assume that the long absence of the father in key moments of the child’s development contributed to the establishment of such a syndrome, he had the need for balanced support from both the father and the mother, the father’s role could not be substituted with the hyper-protectiveness displayed by the grandmother.
In the case presented, we aimed to relieve symptoms that disrupt the integration into the community and the family functioning of the patient, taking into account his hyperactive behavior, attention deficit, and especially his aggressiveness. For this, the therapeutic plan was structured on two levels of intervention: medicinal and psychotherapeutic. In the case of psychotherapeutic intervention it will take account of the fact that his father is not actively involved in the child’s education and the parents will be counseled in their turn for this purpose.
Psychotherapeutic intervention consisted of the forming of a behavioral therapy program, initiated in a specialized center, where N.A. will participate 3-4 hours a day, while in the rest of the day parents will continue the program at home. The role of his parents is essential because the child always has to dispose of such a recovery program.
As for medication intervention, it relieves behavioral symptoms (hyperkinetic, psychomotor instability, aggression towards himself, etc.) and will stimulate development.
What is directly observed are obvious behaviors (the child hits, pushes or bites), but what is not so visible may create future explanations regarding these behaviors: the child is frustrated because he cannot communicate; he is hitting his teacher and his classmates, not knowing how to attract their attention; the child does not understand the rules of behavior (he does not have self-conscience, nor to others, he has deficient social reasoning). These causes can be identified by observation and careful evaluation and can be used as a basis in behavioral intervention.
The key to the treatment is mainly psychotherapy, which will help the kid to replace his maladaptive behaviors with ones that are functional and accepted.
Family counseling is also very important, because the family has the role of co-therapist what facilitates the child’s evolution towards an adapted and functional social behavior.
Early treatment of such symptoms can help the child with autism to develop to their maximum potential, being able to integrate themselves into society and to actively participate in his own life as well as in the life of those around him.