Autism spectrum disorders

Clinical variants and therapy of stuttering

Speech fluency disorder, known as stuttering, typically debuts at the age of four to five years. Transient forms are recorded in four percent of children, whereas persistent disorders are observed in only one percent. Two main forms are distinguished in the pathogenesis, radically differing in causes and course:

1. Neurotic variant (logoneurosis): Develops against a background of acute psychological trauma, such as severe fright or a stressful family environment. Patients predominantly show anxious personality traits and are acutely distressed by their speech defect. Symptoms sharply worsen at moments of high responsibility. Associated manifestations often occur: fear of public speaking (logophobia), sleep disturbances, and emotional lability. The prognosis is quite favorable — the vast majority of patients recover from symptoms after completion of puberty. Treatment focuses on psychotherapeutic methods: hypnosis, a "period of silence" before working with a speech therapist, and autogenic training.
2. Organically conditioned (dysontogenetic) variant: Has no connection with psychological stress, but arises as a result of minimal brain dysfunctions (intrauterine infections, birth injuries). Speech acquires a stereotypic, monotonous character, outwardly resembling hyperkinesias. Deterioration of the condition is provoked by exogenous factors (intoxications, somatic diseases). Patients are less critical of their condition. Therapy is based on the use of muscle relaxants and nootropic drugs.

Features of the course and management of enuresis

The diagnosis of urinary incontinence is valid only after the child reaches four years of age. The pathology is widespread among boys (occurring almost twice as often as in girls). As with speech disorders, two fundamentally different mechanisms of development are distinguished:

• Dysontogenetic (primary) form: Characterized by the absence of a formed reflex from birth. The disease proceeds with a certain periodicity, independent of stresses. Such children often reveal micro-anomalies of development (malocclusion, spinal deformities) and signs of mental infantilism. Patients are usually calm regarding their problem.
• Neurotic (secondary) form: Arises after a long period of normal bladder control under the influence of psychotraumatic situations (for example, the threat of family breakup). It is accompanied by pronounced experiences of the patient and other manifestations of neurosis.

The therapeutic arsenal includes a wide range of medications: from tricyclic antidepressants and anticholinergics to non-steroidal anti-inflammatory drugs and stimulants (in case of excessively deep sleep). A special place is occupied by behavioral methods of psychotherapy, including the use of biofeedback devices and paradoxical therapy.

Tic disorders and Gilles de la Tourette syndrome

Tics represent involuntary movements or sounds that manifest predominantly in children over seven years of age. They are closely associated with obsessive-compulsive neurosis. The key difference between neurotic tics and neurological hyperkinesias is that the patient is able to temporarily suppress them by an effort of will, perceiving them rather as a bad habit. Provocateurs of exacerbations are fear and increased attention from others. Treatment begins with psychotherapy and sports, and if ineffective, mild neuroleptics in small doses are added.

A much more severe variant is Gilles de la Tourette syndrome, which has a pronounced hereditary nature. The disease starts in early childhood with simple motor tics (blinking, grimaces). In adolescence, the clinical picture becomes more complex:

• Vocal tics join (muffling, grunting).
• Complex, sometimes aggressive or sexually colored movements appear.
• In a third of patients, coprolalia develops—the uncontrollable shouting of obscene language.

Pharmacological management of the syndrome includes the use of antipsychotics (haloperidol), clonidine-type drugs, and in the presence of pronounced obsessions, antidepressants. It is important to note that drug therapy only controls the manifestations of the disease without leading to a complete cure, and its effectiveness may decrease over time.

Class and exam questions

What else to study on this topic

• Pathological personality development in prolonged logoneurosis
• Differential diagnosis of organic brain diseases (chorea, parkinsonism) and tics
• Specifics of partial mental infantilism in dysontogenetic enuresis
• Mechanisms of coprolalia formation in Tourette syndrome

Other topics of the section "Chapter 27. Features of mental disorders in childhood and adolescence"

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