Early childhood autism: what the different labels mean

The reports parents bring us carry several labels at once: early childhood autism, Kanner's syndrome, Asperger's syndrome, atypical autism, autistic features. They sound different, yet they largely describe the same field. Here is what stands behind each word, and which of it really changes the plan of work.

Where so many names come from

The terms appeared at different times and in different schools. In 1943 Leo Kanner described children with an early and severe withdrawal into themselves. Almost simultaneously Hans Asperger described children who talked, whose intelligence was intact, but who were socially helpless. For decades these were considered different conditions. Gradually it became clear that there is no sharp border between them: the same mechanisms produce a picture of differing severity. That is how the idea of a spectrum arose.

Label	What is usually meant
Early childhood autism	Autism that appeared before the age of three. It stresses the age of onset, not the severity.
Kanner's syndrome	The classic severe variant: early onset, marked withdrawal, speech absent or distorted, a need for constant support.
Asperger's syndrome	Speech and intelligence intact, sometimes unusually advanced. Difficulty in communication, literal understanding, narrow all-consuming interests, poor tolerance of change.
Atypical autism	The picture does not fit the classic one: either it began later, or some of the signs are missing.
Rett syndrome	A separate genetic condition, mainly in girls, with regression of skills and characteristic hand movements. It belongs to the spectrum only loosely and requires genetic confirmation.
Autistic features	Not a diagnosis but a description of behaviour. Found in alalia, developmental delay, genetic syndromes and epileptiform activity.

Four groups by severity: more practical than syndrome names

Local practice has settled on a division into four groups by the depth of the disturbance of contact. It is useful to parents because it describes behaviour rather than a label — and it suggests where to begin.

1. Complete detachment. The child does not react when addressed, does not use speech, and shows field behaviour — moving from object to object without a purpose. The first task is not speech but the appearance of contact itself.
2. Active rejection. Rigid stereotypies, rituals, a violent reaction to any change. Speech may exist as set phrases. Work begins by building a predictable environment.
3. Absorption in interests. Speech is expanded but monologic and revolves around a single topic. Dialogue does not form. Here there is something to build on — the child's interest becomes the tool.
4. Difficulty communicating with speech intact. The child is inhibited, easily hurt, lost in social situations. This is closest to what used to be called Asperger's syndrome.

What is worth checking in every case

• Hearing — by an objective method; part of "autistic" behaviour is explained by the child simply not hearing.
• EEG, including during sleep — epileptiform activity is found in a significant proportion of children on the spectrum and gets in the way of any work until it has been taken into account.
• Genetic testing — where there are distinctive facial features, congenital anomalies or regression of skills.
• An assessment by a speech pathologist — of speech understanding, play, communication and the ability to learn, not of behaviour alone.

What we use in our centers

• Visual Wave Therapy — the program is written from EEG data and works through the visual channel: the child simply watches cartoons they have chosen. For children who will not let anyone near them and cannot tolerate headphones, this is often the only possible first step.
• High-Frequency Therapy — where the main problem is that speech is not perceived as speech.
• Micropolarization — following an individual scheme of stimulation drawn up after the consultation.
• SpeechLeader — at the stage where speech exists but is made of set phrases and is no use for dialogue.
• Oxygen therapy — a supporting procedure, more often for children with the consequences of hypoxia.

What produces results day to day

• Do not break the ritual, build into it. A ritual is the child's way of coping with unpredictability. It can be widened, but not cancelled by order.
• Give warning of changes. A picture or a timer works better than explanations.
• Cut down adult speech. The more words, the less the child takes in. One phrase, one action.
• Lean on the interest. Even a narrow and odd interest is a ready-made subject for shared attention.
• Count the load. After a full day a setback is inevitable; that is tiredness, not a loss of progress.

Frequently asked questions

Are early childhood autism and ASD the same thing?

Almost. "Early childhood autism" is the older term and stresses the age of onset. Modern classifications have moved away from splitting it into separate syndromes towards the single concept of autism spectrum disorder (ASD), within which severity and the level of support needed are distinguished. Both wordings still turn up in reports written in Ukraine and the wider post-Soviet region.

Has Asperger's syndrome been abolished?

As a separate diagnostic unit, yes — in the new classifications it has been folded into ASD. As a description, no: doctors and teachers go on using it because it conveys a recognisable picture exactly. Speech is developed, intelligence is intact or high, and the difficulties lie in communication, flexibility and reading subtext.

How does Kanner's syndrome differ from Asperger's syndrome?

Roughly speaking, by the presence of speech and the level of independence. In Kanner's syndrome autism appears early and severely, and speech often does not develop or develops in a distorted way. In Asperger's syndrome the child talks, often early and in an "adult" way, and the difficulties show up in communication with peers and in intolerance of change.

My child has been given "autistic syndrome". Is that the same as autism?

Not always. "Autistic syndrome" or "autistic features" often describes behaviour that resembles autism but has grown on different ground: sensory alalia, severe developmental delay, a genetic syndrome, epileptiform activity. That is a reason to look into the cause, not to consider the question closed.

What matters more for the outlook — the form, or something else?

Not the form, but three things: the age at which help begins, the state of speech understanding, and whether there is accompanying epileptiform activity. Children with the same entry in their file end up very far apart in what they can do, and these three factors explain that gap better than anything else.

See also

• Autism in children: early signs and where to start
• Sensory alalia: a similar picture, a different cause
• Chromosomal disorders: when genetics lies behind the behaviour
• ADHD: attention deficit without autistic features
• Visual Wave Therapy: working through the EEG

This material was prepared by the specialists of the Vlada Tarasenko Speech Restoration Centers. This material is for information only and does not replace an in-person consultation with a doctor or a speech pathologist. Only a doctor can make a diagnosis.