|How do autism, ACh and ADHD go together, and do they go together?|
To understand this topic, you have to start from the very beginning. And more specifically, from the fact that in medicine, two approaches, syndromic and nosological, coexist and complement each other .
A syndromic approach is one that allows you to describe a person’s condition using “sets” of signs (symptoms). For example: depressive syndrome, includes symptoms such as low mood, anhedonia, guilt, etc. or hallucinatory-delusional syndrome with an inherent sensation of “voices” and attempts to explain their appearance by the influence of “invisible spy beams” or “the action of extraterrestrial intelligence.” But a smart doctor who thinks nosologically (trying to get to the bottom of the matter) will always ask himself (or a colleague) – and in what disease does this syndrome manifest itself? Maybe this is depression within the framework of bipolar disorder, or maybe just reactive (that is, due to a very serious trauma)? Or is it generally a depressive state in a schizophrenic patient who came out of psychosis and realized the severity of his situation? Is it important to answer these questions? Of course! After all, the prognosis and treatment strategy depends on this … In other words, when it comes to the syndrome, the diagnosis is still far away, it is rather a statement of fact – we see this, and this and this … It’s rather confusing. But in fact, we remember that, firstly, medicine is not a science, but an art, and secondly, almost always the same psychiatric diagnosis can be formulated a little differently (about egregious cases when children’s autism is taken , for example, for depression, we are not talking). However, as a rule, different words describe the general range of conditions, and the essence does not change from this … Now about autism and ADHD. Autism is a syndrome. And ADHD is a syndrome. But they, if desired, can be divided into a bunch of syndroms . And blind together. For example, autism can be described as: Developmental Speech Disorder + Hyperkinetic Disorder + Motor Stereotypic Syndrome. Formally, this will more or less correspond to reality, but it will not be an adequate diagnosis. But, here we will remember about traditions. The traditions of modern foreign psychiatry are such that due to (or “because of”) insurance medicine and complex relationships with the courts, it is more convenient for doctors to describe mental illnesses syndromologically . “What I see, I sing.” And the approach to treatment is appropriate – they can prescribe a bunch of drugs for the corresponding heap of syndromes. And even this sometimes happens: for example, a doctor has a suspicion that a psychotic state is hidden behind a motor disinhibition. And at the same time, by prescribing psychostimulants – stratter or Ritalin , this psychosis can be stimulated. But not every doctor (especially Western) will stop before this. He will say “OK! If this happens, we will begin to treat hallucinations! ” It will operate under the protocol and will be completely legally protected. Therefore, hearing about the need to align with the standards of Western psychiatry, as the standard of everything, everything, you can only smile quietly … Domestic psychiatry, condemned for condolence and rigidity, in the sense of diagnosis is sometimes much more subtle. Its weak point is closedness, poor organization and disgusting social security for people with special needs. But that’s a completely different story. Therefore, from the point of view of a nosological approach, autism and ADHD are incompatible. And motor disinhibition in autism or in children with AS has a completely different nature. And although, some venerable experts believe that ADHD may have autistic traits (i.e., individual elements of autistic behavior). Other specialists deny the possibility of combining these two diagnoses, naturally believing that they are mutually exclusive . For example, Robert Goodman writes: In both ICD-10 and DSM-IV (European and US classifications of mental illness), autism spectrum disorders (persistent developmental disorders) outweigh hyperactive disorders. Although children with autism spectrum disorder may be restless and inattentive, they do not receive a second diagnosis of hyperkinesis or ADHD. Hyperactivity is not diagnosed when restlessness and poor concentration are due to a mood disorder, anxiety disorder, or schizophrenia. That is, this approach assumes that the presence of autistic features (even if they are very difficult to see at the moment, but they were in the anamnesis), excludes such children from falling into the ADHD category. Sometimes they write “developmental disorder” and sometimes add “autism spectrum” and ” hyperdynamic disorder”. Then, when a child with AS grows up, he is diagnosed with Asperger’s syndrome, schizotypal disorder, or, if the corresponding symptoms appear (delirium, hallucinations), schizophrenia. However, although in early childhood the nature and manifestation of these disorders may be similar, the prognosis may be different. Growing up (and regardless of whether or not correctional work was carried out in this direction), some children with mild autistic traits become capable of adequate social interaction, communication and symbolic thinking (that is, the entire famous “triad of disorders”, which allows you to unambiguously diagnose autism – absent). There remains only a slight “otherness”, “eccentricity”. Sometimes initially slightly expressed “autistic traits” are aggravated, the child behaves more and more inadequately. To say in advance, in three or four years, what the forecast may be – very few people will undertake. The fact is that the brain, unlike any other organ, does not perform only one function (like, for example, the liver or lungs). And if we are talking about developmental disorders (this category can include both ADHD and autism), then there cannot be an absolutely accurate diagnosis, and even a definite, universal scheme of treatment or correction. Therefore, drug treatment is sometimes prescribed by the “selection” method, which sometimes frightens “inexperienced” parents. That is, the combination of symptoms can also be the most intricate. And hyperactivity (or rather disinhibition) is a very frequent phenomenon. Because it accompanies so many diseases. That is why such confusion arises … And therefore there is a temptation to find the doctor who will deliver the most “pleasant” diagnosis, which is easy to perceive as the most accurate. But than running in a vicious circle, listening to the “authoritative” opinions of the next professors – on the 10th or 100th, it is better to find your doctor, whom you intuitively trust and simply carry out his assignments. And study-study-study. To teach everyday skills (this is the most important thing!), To teach independence. While it is tempting for autism to be diagnosed “on two stripes,” this will not happen in the near future. After all, this is a whole continuum of conditions – with a different set of signs and symptoms. And no machine, no analysis, is better than the experienced gaze of a specialist to analyze and evaluate it. But what if, for some reason, it is problematic to see a doctor? Then, we remember – the main and main criterion is the absence of negative dynamics, that is, deterioration of the state. If you see that the child is developing slowly, at his own pace, but confidently, we gain more air and teach everything: fold the pyramid, tie the shoelaces, make a sandwich. The easiest, but most effective way is to take a chart of the child’s development in the norm (like: at 22 months old he should be able to shake an object out of the bottle) and teach where there is a lag. If the child’s condition worsens: stereotypes intensify, speech disappears, sleep is disturbed, new and new fears arise – then, no matter how far and difficult it is to get to the doctor, it will be necessary to do this. As a result, I can say that formally, theoretically, those who believe that ADHD can be combined with ACh and autism and those who believe that it is wrong are also right. It’s just that in the first case it is a syndromic approach, in the second it is a nosological one. But, given that nosology is a higher-order category, when developing a therapy and rehabilitation strategy, it is worth giving preference to it. Therefore, you do not need to be afraid, and fanatically running after the unambiguous and most accurate diagnosis is also not worth it, but you need to gradually get rid of problems. If ordinary children learn a lot on their own, then problem children have to be taught this.