Otizm Spektrum Bozukluğu yaşamın erken dönemlerinde başlayan ve yaşam boyu süren; sosyal ilişkiler, iletişim, davranış ve bilişsel gelişimde gecikmeye neden olan nörobiyolojik kökenli bir bozukluktur. Beyin gelişimine ait bir bozukluğun sonucu olarak ortaya çıkar. 2013 yılında Amerikan Psikiyatristler Birliği’nin DSM-5 olarak bilinen hastalık sınıflaması içinde yer alır. Asperger Sendromu, Yaygın Gelişimsel Bozukluk, Dezintegratif Psikoz ve Rett Sendromu sınıflamadan kaldırılmış ve yerine Otizm Spektrum Bozukluğu tanısı konmuştur. Böylece otizm yüksek işlevli ve düşük işlevli olarak alt tiplere ayrılmıştır. Ancak DSM-5’te Sosyal (pragmatik) İletişim Bozukluğu ayrı bir tanı kategorisi olarak yer alır. Bu kategori iletişim bozukluğu olan, onun dışında otizm belirtileri göstermeyen bireyleri kapsar.
Otizm Spektrum Bozukluğu’nun belirtileri iki temel grupta toplanmıştır: sosyal ilişkilerin gelişiminde bozukluk, hayal gücünde yoksunluk ve takıntılı, tekrarlayıcı davranışlarla beraber ilgi alanının kısıtlılığı ve darlığı.
Bugün otizm spektrum bozukluğuna neyin neden olduğu bilinmemekle birlikte, çalışmalar daha çok genetik temelli olduğunu düşündürmektedir. Otizm genetik bir zemine sahip çok faktörlü ve karmaşık bir durumdur. Çevresel faktörlerin de otizme yol açabildiğine ilişkin görüşler vardır. Hem genetik temellerin hem de çevresel faktörlerin etkileri üzerine çok sayıda araştırma yapılmaktadır.
Otizm günümüzde rastlanan en yaygın nörolojik bozukluktur ve ABD Hastalıkları Kontrol Etme ve Önleme Merkezi’nin (Centers for Disease Control Prevention) verilerine göre, her 68 çocuktan 1’inde otizm görülmektedir. Tüm ırk, ulus ve sosyal sınıflarda görülür. Ailenin gelir durumu, yaşam biçimi ve eğitim düzeyi ile otizm spektrum bozukluğu arasında bir bağ yoktur. Erkek çocuklarında kız çocuklarına oranla görülme sıklığı 4 kat fazladır. Otizm tanısı alan çocukların yaklaşık yarısında değişik derecelerde öğrenme güçlüğü ve zeka geriliği de görülebilir. Otizm spektrum bozukluğunun nörolojik nedenlerden kaynaklandığı sanılmaktadır ve otizm spektrum bozukluğu tanılı bireylerin yaklaşık %35’inde, epileptik nöbet, istemsiz hareketler gibi nörolojik sorunlar da görülebilir.
Otizmlilerin %10’u üstün zekalıdır. Soyutlama gerektirmeyen, belleğe dayalı özel becerileri olabilir. Kendi kendine okuma yazma öğrenebilir, telefon rehberini hafızasına alma gibi ham bellek gerektiren başarılar sergileyebilirler. Ancak deha denebilecek özellikleri taşıyanlar matematik, resim, müzik gibi alanlarda üstün yetenek gösterebilirler. Bunların oranı otizm spektrum bozukluğu tanısı almış bireyler içinde %1 civarındadır.
Belirtileri
1.Sosyal İletişim ve Sosyal Etkileşim
Az göz teması kurma veya kuramama.
Vücut dilini anlamada ve kullanmakta yetersizlik.
Parmağıyla istediği şeyi göstermeme.
Yüz ifadelerinde ve sözel olmayan iletişimlerinde sınırlılık.
Kendileriyle konuşulduğunda yanıt vermeme, ismi söylendiğinde bakmama.
Karşılıklı konuşma başlatma ve sürdürmede yetersizlik.
İlgileri ve duyguları paylaşmada sınırlılık, iletişimde karşılıklılıkta sorunlar.
Sosyal bağlamlara uygun davranamama.
Aşırı neşe, kızgınlık veya sıkıntı haricinde boş bir yüz ifadesine sahip olma.
Akranlarına karşı ilgisizlik, ilişki kurma, sürdürme ve ilişkiyi anlamada yetersizlik, empati yoksunluğu.
Araştırmalar otizm spektrum bozukluğu tanısı konmuş çocukların yaklaşık yarısının yaşamları boyunca sessiz kaldıklarını göstermiştir. Bazı otizmli bebeklerde yaşamın ilk 6 ayında babıldama (ba-ba gibi sesler çıkarma) olur, fakat sonra kesilir. İşaret diliyle veya özgün elektronik aletlerle iletişim kuran fakat hiç konuşmayan örnekler de vardır. Dil gelişimi 5-8 yaşına kadar gecikebilir. Tanı koymada konuşmanın gecikmesi veya yokluğu önemli bir işarettir. Çok iyi dil kullanımı olan olgular da mevcuttur. Konuşan otistik bireyler dili olağandışı tarzlarda kullanırlar. Konuşmada yaygın olarak, kelimelerin tekrarlanması (ekolali), sen-ben zamirlerinin karıştırılması ve soru cümlelerinin uygunsuz kullanımı (örneğin “acıktım” yerine “acıktın mı” ifadesi), bağlaçları kullanmama, gerekenden detaylı anlatımlar ve sorulara kitap alıntılarına benzer uzun yanıtlar verme gibi durumlara rastlanır.
Konuşulanı anlama alanında ise özellikle birden fazla isim söz konusuysa kişi bunları karıştırabilir; ses benzerliği olan sözcükleri ayırt etmede, mecaz kullanımları ve esprileri anlamada güçlükler yaşayabilir.
Otizmli bireyler konuşmanın tarzıyla ilgili sorunlar da yaşarlar. Ses yüksekliğini, tonunu ve seslerdeki vurguları mevcut duruma uygun olarak ayarlayamama, kontrol edememe bu sorunlar arasında sayılabilir. Sözel olmayan iletişimi, yani iletişim sırasında kullanılan göz, kol ve el hareketleri gibi tüm mimik ve jestleri anlamada, dolayısıyla kullanmada güçlük çekerler.
2. Takıntılı davranışlar (stereotipik) ve sınırlı ilgi alanı.
Tekrarlanan ya da takıntılı motor davranışlar, sıra dışı beden ve el hareketleri (parmak ucunda yürümek, kendi etrafında dönmek, sallanmak, parmaklarını gözlerinin önünde hareket ettirmek).
Aynılık üzerinde ısrar etme, rutinlere aşırı bağlılık, esnek olmayan davranış özelliği.
Sabit ve sıradışı ilgiler.
Belli ses, doku ya da koku gibi bir veya birkaç duyudan gelen uyaranlara karşı aşırı tepki verme veya tepkisiz kalma.
Sembolik oyun da dahil olmak üzere hayal gücünden yoksunluk.
Otizmde oyun oynama veya oyun kurma becerilerinde sorun görülür. Çocuk oyuncak bir kamyonu amacına uygun kullanacağına, tekerleğini çevirip durabilir. Bazı otistikler oyunları sadece belli kalıp ve sırayla oynamada ısrarcılardır. Dikkat edildiğinde bu sıraların tekrardan ibaret olduğu gözlenir. Yaratıcı oyun yetenekleri yoktur.
Takıntılı davranışlarına, farklı yüzeyleri koklama, tatma, yüzeylere dokunma veya vurma; çamaşır makinesi sesi gibi mekanik gürültüleri dinleme; ışığı açıp kapama; objeleri çevirme; kafa vurma; sıralı karmaşık vücut hareketleri; cansız cisimleri belli bir hat üzerine yerleştirme; yatma alışkanlıklarında katı bir düzen; yemek masasında hep aynı yere oturma; yaprak ve zincir gibi nesnelere bağlanarak bunları sürekli yanında taşıma gibi örnekler verilebilir.
Ne Yapmalıyım?
Çocuğunuzda yukarıda sayılan belirtilerden bir veya birkaçı varsa mutlaka bir uzmana danışmalısınız. Otizm tanısı sadece uzman doktor tarafından konulabilir.
Erken tanı ve erken yasta müdahale hızlı yol alınması açısından hayati derecede önem taşır. Otizm tanısı en erken çocuk 12 aylıkken konulabilmektedir.
Otizm Spektrum Bozukluğu tanısı alan çocuklar dış görünüş açısından akranlarından farklılık göstermezler. Çocuk ruh hastalıkları uzmanı ya da çocuk nöroloğu çocuğunuzu gözlemler, gelişim testleri yardımıyla ve size sorular sorarak tanılama yapar. Çocuk Ruh Sağlığı ve Hastalıkları Anabilim Dalı Bölümü bulunan üniversite hastanelerine veya çocuk ruh hastalıkları uzmanı veya çocuk nörologu bulunan Sağlık Bakanlığı’na bağlı devlet hastanelerine başvurabilirsiniz.
Otizmin geçerliliği kanıtlanmış tek tedavisi yoğun özel eğitimdir. Küçük çocuklar çok daha fazla öğrenme potansiyeli taşırlar. Otizm Spektrum Bozukluğu tanısı almış bir çocuk ne kadar erken özel eğitime başlarsa, o kadar çok potansiyellerini açığa çıkarma şansına sahip olur. Özellikle ailenin de içinde olduğu eğitim çalışmalarından küçük yaşlarda olumlu sonuçlar alınmaktadır.
Kaynak; Prof.Dr Barış Korkmaz Ah Şu Otizm, 2017
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