Autism: discover the most recommended symptoms and treatments – 12/25/2023 – Balance and Health

Characterized by impaired communication, social interaction and restricted and repetitive patterns of behavior, ASD (Autism Spectrum Disorder) is a disorder that affects around 2 million people in Brazil, according to estimates from the WHO (World Health Organization) .

ASD is a permanent condition with no cure that affects neurological development and can manifest itself heterogeneously in different patients. The more severe the symptoms, the greater the level of support needed – the scale varies from 1 to 3.

There is no single cause for the disorder, but according to experts, the majority of cases have a genetic origin. External factors, such as complications during pregnancy, can also contribute to ASD during childhood.

Delays in speech and language are among the manifestations that most attract the attention of mothers and fathers in young children, explains neuropsychologist Joana Portolese, coordinator of the Autism Outpatient Clinic at the Institute of Psychiatry at Hospital das Clínicas. “We have several clinical manifestations: children who don’t kiss, don’t say goodbye or are more uncoordinated in their motor skills. They generally have sensory changes, which lead to tactile, gustatory, auditory or visual hypersensitivity.”

Diagnosis in early childhood and early treatment improve development and increase the individual’s chances of achieving autonomy, with the possibility of even reducing the level of support.

“We don’t talk about losing the diagnosis, but about being a functional person, who has language, who is literate and who will work in adulthood”, says Claudia Romano, PhD in experimental psychology and coordinator of the postgraduate course in Behavior Analysis Applied to ASD at PUC-SP (Pontifical Catholic University of São Paulo).

Studies show, however, that the disorder is usually identified later in Brazil.

“Parents notice the signs before the age of two, but sometimes the diagnosis is only given at the age of four or five. So we have a huge delay in the time when we should most intervene”, says Cristiane de Paula, coordinator postgraduate course at Mackenzie University and responsible for conducting a study with a thousand autistic families in all regions of the country.

According to the researcher, around 50% of children with ASD have some intellectual disability – of these, 1 in 3 are severe cases.

How is autism treated?

Research carried out using different scientific methodologies demonstrates the effectiveness of treatments based on applied behavior analysis (ABA). Within the approach, there are different techniques and protocols that are applied to ASD treatment, with good results in social interaction skills and in controlling impulsivity and aggression, among others.

In general (and especially in the most severe cases), the disorder is accompanied by sensorimotor impairment and other comorbidities, which makes multidisciplinary treatment essential for the development of children.

Speech therapy sessions, for example, are recommended for speech and language problems. Motor difficulties, in turn, are treated with the support of physiotherapy. Occupational therapy is aimed at sensory stimulation for children with hypersensitivity problems.

The number of sessions also varies, according to Romano, with an indication of 30 to 40 hours per week for more intensive interventions and 10 hours per week for level 1 support.

“In general, a patient with mild autism does not need the most intensive protocols and techniques in early childhood. As for support level 3, he will always need the most intensive treatment”, says the psychologist.

According to de Paula, medication is still recommended to control some symptoms, such as agitation, aggression and sleep.

Treatment for autism does not have a fixed duration and there is no definitive “discharge”. Even for mild patients, assistance must be maintained throughout life.

What’s behind the increase in diagnoses?

The prevalence of the disorder has increased throughout the world. Research published this year by the American CDC (Centers for Disease Control and Prevention) shows that 1 in 36 children under the age of 8 have autism. Other international studies indicate a prevalence of 1% to 2%.

The population’s greater access to diagnostic services and awareness on the topic are factors that help explain the increase in cases.

According to De Paula, severe cases were characterized simply as intellectual disabilities, but did not have a precise diagnosis, as they were confused with other health conditions, while mild cases were also underreported. In recent decades, however, the understanding of what autism is has undergone changes and become more comprehensive.

The most recent update to the 2013 Diagnostic and Statistical Manual of Mental Disorders classifies autism and other developmental disorders, such as childhood disintegrative disorder and Asperger syndrome, as ASD. Since then, people have been diagnosed on a single spectrum with different levels of severity.

More recently, the understanding of autism as a unique condition appeared in the WHO’s international disease code as ICD-11; the new classification is still being translated into Portuguese and should come into force in the country from 2025.

Is Brazil able to meet this demand?

Such as Sheet showed, the increase in demand for ASD treatment ended up becoming a bottleneck for Brazilian health plans, given the lack of qualified professionals and insufficient partner networks. On the other hand, the plans argue that there has been an increase in indications for therapies without scientific proof and with excessive workload.

The Mackenzie researcher agrees that there are many treatments that are not based on evidence, which can be a problem for parents. “Many mothers end up taking their children to any clinic, spending public and private money on something that doesn’t work.”

According to experts interviewed by Sheetthe definition of a specific line of care could establish therapy parameters and the level of training of the professionals who apply them.

“Ineffective treatment for a disorder that affects such important areas, which are communication and social, can have the effect of diverting development”, says Romano, from PUC-SP.

A pyramidal model, with a postgraduate supervisor responsible for preparing the therapeutic plan, a specialist coordinator and a therapeutic companion to apply the techniques and directly monitor the patient, can be important. Seeking professionals certified in ABA is also essential, he says.

The ABPMC (Brazilian Association of Behavioral Sciences) recently launched the Caba-BR certification that defines training parameters for professionals who work in the methodology. “Treatment, even based on evidence, can be very varied. So it is important that it is carried out by good professionals”, he adds.