ASD
Autism spectrum disorder (ASD) is a developmental disorder in which information processing in the brain is impaired. ASD starts at an early age and plays a role throughout life. It affects many aspects of life, both for the child and those around him.
Symptoms
ASD is a disorder of information processing in the brain. Characteristic of people with ASD are problems in three areas. These problems occur to varying degrees in people with ASD:
- Problems in the area of social interaction and imagination: For example, children are very introverted or do not make eye contact with others, they find it difficult to empathise with other people.
- Problems in communication and (body) language: Children often do not recognise facial expressions (angry, happy, sad), their language development is often delayed and abnormal, they take figurative statements literally.
- Limited, repetitive patterns of behaviour, interests or activities: For example, children may become totally absorbed in a particular activity so that there is no attention to anything else. Repetitive patterns can often be recognised in their behaviour.
- Over- or under-sensitivity to sensory stimuli
Diagnosis
Autism spectrum disorders fall under psychiatric disorders and are classified according to the criteria of the DSM-5, the latest version of the US manual of mental disorders, a system used worldwide. The predecessor to the DSM-5 published in 2013, DSM IV, still had several subtypes of autism, such as autistic disorder (also called 'classic autism' or 'Kanner syndrome'), Asperger syndrome and PDD-NOS. So now there is only one overarching autism diagnosis: autism spectrum disorder (ASD). There would be insufficient scientific support for the earlier subtypes of autism.
An autism spectrum disorder cannot be diagnosed by physical examination, such as a blood test or a brain scan. The diagnosis is a 'behavioural diagnosis' and can sometimes take several months. Here, one looks at the (combination of the) three symptom areas already mentioned: social interaction, communication, stereotypical behaviour and interests. The diagnosis can be made by a (child and adolescent) psychiatrist or a GZ psychologist, or by a multidisciplinary team led by a psychiatrist or GZ psychologist.
Pediatric physiotherapy support
Child physiotherapy support aims to work with your child, parents/carers and possibly teachers/school to:
- Improve participation in daily activities at home and at school
- Improving fine and/or gross motor skills
- Develop better coordination and more stable posture
- Improve reciprocal play skills (such as throwing and catching a ball together)
- Develop motor imitation skills (seeing another person do something and imitating it)
- Improve overall fitness and strength
- Improving response to sensory stimuli through sensory information processing (SI) therapy:
Your child can also, possibly after first receiving individual counselling, move on to our Fitkids exercise programme (see heading ''Fitkids''), in order to continue working on the above goals, among others. We then work in groups and the ultimate goal is to move on to a suitable sports activity.
AD(H)D
ADHD stands for Attention Deficit Hyperactivity Disorder, the global characteristics of ADHD are: problems with attention, easily distracted, hyperactivity and impulsivity. There are three types of ADHD:
- ADHD-I, formerly also called ADD type. Here, attention deficit is most prominent;
- ADHD-H, the predominantly hyperactive and impulsive type. Here, severe and persistent impulsivity and hyperactivity are in the foreground;
- ADHD-C, the combined type. Both inattentive and hyperactive type problems are present. This type of ADHD is the most common.
Diagnosis
For a diagnosis of ADHD, such problems must have existed for more than six months, not be limited to just school or home, have started before the age of seven and seriously interfere with general functioning. The diagnosis of ADHD is made by a medical specialist: usually this is a (child and adolescent) psychiatrist. This is done on the basis of criteria described in the DSM IV, a manual of descriptions of mental disorders. In addition, it is determined whether the patient does not suffer from another disorder with (partly) the same characteristics, such as Tourette's syndrome, Foetal Alcohol Syndrome or various syndromes with gene abnormalities.
In many cases, ADHD goes hand in hand with other (psychiatric) disorders. Some examples are: disorders on the autistic spectrum (such as PDD-NOS), aggressive behavioural disorders, motor disorders, anxiety and mood disorders, tics, and learning difficulties. Through the GP, a child can be referred to a so-called 2nd-line medical specialist, who can diagnose ADHD.
Treatment
Children with ADHD have a strong urge to move and often have difficulty controlling their movements. By improving sensory information processing, their stimulus processing and behaviour can improve. Work can also be done to improve fine and gross motor skills. Sometimes medication can be prescribed and there are various forms of behavioural therapy that can be used in ADHD. These include developing self-insight, learning to control impulses, rewarding desired behaviour or teaching a well-organised daily structure.
DCD
DCD (Developmental Coordination Disorder) or coordination-development disorder used to be called (developmental) dyspraxia. The disorder is relatively unknown and is often not "discovered" until primary school. About 5% of children are thought to have DCD. It is three to seven times more common in boys than in girls. The figures are not very reliable because there is no single way of diagnosing it.
Children who have DCD have difficulty learning and performing motor tasks, such as dressing and undressing, cycling, swimming, drawing, cutting and writing. Actions that are natural for other children require a lot of effort for these children. The complete list of criteria can be found in the DSM IV-TR. Clearly, if you are a little clumsy, or cannot play football very well, you do not yet have DCD. Symptoms vary with the child's age and development. Because DCD is partly a maturation problem of the central nervous system, the problems do eventually diminish somewhat. Over time, motor skills improve, although it does take more effort than in children without DCD.
DCD has no obvious cause. Often, a slight abnormality shows up on the NMR scan, but even this need not be the case. It is suspected that the movement plan is not right in these children. They are then unable to integrate different movements. You often see that these children cannot learn a motor task properly, e.g. learning to write or to roll over takes a lot of effort. The paediatric physiotherapist can carry out a motor test using the M-ABC2 test. This test compares your child's motor level with that of his or her peers and can help determine whether DCD is present. An additional examination to determine the general level of development is usually done by a remedial educationalist or child psychologist.
With paediatric physiotherapy guidance, we work on improving coordination during movement and train muscle strength and other motor skills. Children can also participate in the Fitkids exercise programme (see the heading ''Fitkids'').
OCD
OCD (obsessive-compulsive disorder) is a condition where a person has recurrent intrusive thoughts (obsessions) that make a person feel anxious or unpleasant. To reduce anxiety, a person with OCD often engages in certain physical or mental actions (compulsions). OCD is an abbreviation for the disease's English name: obsessive-compulsive disorder. It is called obsessive-compulsive disorder or OCS in Dutch. It is also referred to as a compulsive disorder or compulsive neurosis.