Jumat, 06 Mei 2011
Autism
A. UNDERSTANDING
Autism Early childhood is a withdrawal and lost contact with reality or other people. In infants did not show signs and symptoms. (Sacharin, R, M, 1996: 305)
Autism is a disorder Infantil qualitative in verbal and nonverbal communication, imaginative activities and reciprocal social interaction that occurs before the age of 30 months. (Behrman, 1999: 120)
Autism is a disorder according to Rutter 1970 involving failure to develop interpersonal relationships (age 30 months), obstacles in the talks, language development, the phenomenon of ritualistic and konvulsif. (Sacharin, R, M, 1996: 305)
Autism in children is a pervasive developmental disorder (DSM IV, sadock and sadock 2000)
From the above understanding can be concluded that autism is a pervasive developmental disorder, or qualitative in verbal and nonverbal communication, imaginative activities and reciprocal social interaction of the failure to develop interpersonal relationships (age 30 months), obstacles in the talks, language development, the phenomenon of ritualistic and konvulsif and withdrawal and lost contact with reality.
B. Epidemiology
Prevalence of 3-4 per 1000 children. Comparison of men than women 3-4:1. Systemic diseases, infections and neurological (seizures) may show symptoms such as austik.
C. Etiology
Autism Causes include
a.Genetik (80% for monozygotic twins and 20% for twins dizigot) primarily on the child's family austik (abnormality of cognitive and speech).
b.Kelainan kromosim (fragile X syndrome or fragile).
c.Neurokimia (catecholamines, serotonin, dopamine is uncertain).
d.Cidera brain, the main vulnerability, aphasia, a deficit activating reticulum, the situation was not favorable between psychogenic and neurodevelopmental factors, changes in the structure serebellum, hipokompus forebrain lesions.
e.Penyakit organic brain in the presence of communication disorders and sensory disturbances and epileptic seizures
f.Lingkungan especially parental attitudes, and personality of children
Autism picture in the child's development is influenced by
In infancy there is failure to cuddle or comfort the child, the child does not respond when appointed and looked weak. The lack of eye contact, giving the impression of much or do not know. Older infants showed the curiosity or interest in the environment, tend bermainan without imagination and pre-verbal communication possibilities seemed annoyed and shouting.
In childhood and adolescence, children with autism show an abnormal response to the sound of children afraid of certain sounds, and tercengggang on other sounds. Talk can be disturbed and can experience silence. Those who are able to talk show abnormalities telegramatik ekolialia and construction. With the growth of the child at the time of speaking tends to stand out with abnormalities of intonation and timing.Found abnormalities of visual perception and focused concentration on the prifer (the details of a painting in part is not comprehensive). Interested in texture and can use widely senses of smell, soy sauce and touch when mengeksplorais environment.
At an early age have a special movement that seized his attention dapt (berlonjak, twisting, clapping, moving fingers). This activity keaadan rituals and settled on a pleasant or stress. Other Kelainann adalh destructive, excessive anger and akurangnya rest.
In adolescence inappropriate behavior and without inhibition, to investigate austik child sexual contacts with strangers.
D. autism KNOW HOW TO CHILDREN
Child has autism can be viewed with:
a.Orang parents need to know the stages of normal development.
b.Orang parents need to know the signs of autism in children.
c.Observasi parents, caregivers, teachers about the child's behavior at home, diteka, while playing, at the time to interact socially in a normal condition.
Signs of autism usually different in each interval.
a.Pada age 6 months to 2 years old child does not want to be hugged or become tense when removed, indifferent to face her parents, not excited in a simple game (ciluk baa or kiss bye), the child does not attempt to use the near-words. Parents need to be vigilant when children are not interested in dolls or binatan gmainan for the baby, refusing solid food or do not want to chew, if a child is interested in his own hands.
b.Pada aged 2-3 years with gejal like kissing or licking objects, accompanied by eye contact is limited, consider other people as objects or tools, refusing to be embraced, become tense or otherwise the body becomes weak, and relatively indifferent to face the two men parents.
c.Pada aged 4-5 years was marked by complaints of parents that children feel very disturbed when going through routine daily activities. If the child is finally willing to talk, not infrequently are ecolalia (repeating what other people say immediately or after a while), and children are not infrequently show a strange tone of voice, (usually high-pitched and monotonous), limited eye contact (although they could be repaired), tantrums and aggression sustainable but can also be reduced, and stimulate self-injure.
E. Clinical manifestations
Ditemuai clinical manifestations in patients with autism:
a.Penarikan self, ability komunukasi verbal (speaking) and non-verbal that is not or less developed they are not deaf because it can mimic the songs and the terms are heard, and the lack of socialization makes estimates of potential intellectual speech pattern abnormalities, impaired ability to maintain conversation, games abnormal social, the absence of empathy and inability to make friends. In non-verbal tests that have the ability to speak quite good but is still influenced, to demonstrate sufficient intellectual capacity. Children austik perhaps isolated, extraordinary talent, analogous to the talent that idiot educated adults and spent time to play alone.
b.Gerakan stereotipik body, the striking similarity needs, interests narrow, preoccupation with body parts.
c.Anak used to sit at a long busy time on his hands, staring at the object.Preoccupations with the object of continuous and conspicuous as an adult where the child still amazed at the mechanical object.
d.Perilaku ritualistic and konvulsif reflected in the child's need to maintain an environment that remains (does not like change), the child becomes attached and can not be separated from an object, and can be predicted.
e.Ledakan angry disturbance accompanies a regular basis.
eye f.Kontak minimal or absent.
visual g.Pengamatan of finger and hand movements, chewing objects, and rub the surface indicates the strengthening of awareness and sensitivity to stimulation, whereas the loss of response to pain and lack of response to loud noise startled a sudden showed reduced sensitivity to other stimuli.
h.Keterbatasan cognitive, on the type of cognitive deficit seen in emotional processing
i.Menunjukan echolalia (repeating a phrase or word precisely) moment of speech, pronoun reversal pronomial, poetry that does not lead to the base, forms of language other odd-shaped prominence. Children are generally able to speak at about the usual age, loss of skills at the age of 2 years.
j.Intelegensi with conventional psychological tests including the functionally retarded.
k.Sikap and unusual movements such as mengepakan hand and winked, grinning faces, jumping, walking walking on tiptoe.
Characteristics typical of children who austik:
a.Defisit verbal order.
b.Abstraksi, routine memory and verbal exchange of reciprocity.
c.Kekurangan theory of thinking (understanding a perceived deficit or other people think.)
According to Baron and Kohen 1994 the main characteristics of children with autism are:
a.Interaksi sossial social and abnormal development.
b.Tidak occur normal communication development.
c.Minat and conduct a limited, fixed, repetitive, inflexible and unimaginative.
All three appeared together before the age of 3 years.
F. TREATMENT
Parents need to adjust to their children, parents must memeberikan to child care staff including nurses, or any other resident. Parents are aware adanaya scottish sosiety for autistic children and natinal austik sosiety for children who can help and can memmberikan services to children with autism. Children with autism need treatment that is multi-disciplinary educational therapy, behavior therapy, speech therapy, occupational therapy, sensory integasi, auditory integration training (AIT), family therapy and medication, so it requires good cooperation between parents, families and physicians.
Therapeutic approach can be done to tackle child austik but limited success, in behavior therapy with the use of state who happen to improve speaking skills. Destructive and aggressive behavior can be changed with menagement behavior.
Exercise and education by using educational (ie konditioning positive reinforcement operant (reward) and punishment (negative support). It is a method to overcome disabilities, to develop social skills and practical skills. Patience is required because of slow progress in children with autism.
Neuroleptics can be used to address behaviors that lead mencelakkan ourselves on aggressive, stereotipik and withdraw from social interaction.
Antagonist opiates to overcome behavior, withdrawal and stereotipik, besides speech therapy and daily handling model using training games between individuals structured dapt used.
Common behavior problems such as noise, anxiety or self-mutilation can be overcome by drugs or tioridasin klorpromasin.
The situation can not sleep can provide such responsedatif kloralhidrat, convulsions controlled with anticonvulsants drugs. Hiperkinesis which, if settled, and weight can be addressed with diet free of additives or preservatives.
It can be concluded that the therapy in autism with early detection and timely and comprehensive program and integrated therapy.
Treatment of children in autism aims to:
a.Mengurangi behavior problems.
b.Meningkatkan learning ability and development, especially language.
c.Anak be independent.
d.Anak can socialize.
G. Prognosis
Children especially who have to speak, can be grown on marginal life, can stand alone, even isolated, living in the community, but at some time in the institutional placement of children mrp final result. A better prognosis is tingakt higher intelligence, functional speech, lack of symptoms and bizarre behavior. Symptoms will change with the growth of the elderly.seizures and accidents themselves more visible on the development of age.
REFERENCES
Sacharin, rm, 1996, Principles of Pediatric Nursing, Issue 2, EGC, Jakarta
Behrman, Kliegman, Arvin, 1999, edition of Child Health, Nelson 15, Prof Translation. DR. Dr. A. Samik Wahab, Sp. A (K), EGC, Jakarta
___, 1995, Child Health Guide For Parents, Arcan, Jakarta
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