Childhood autism, also known as autism, is a developmental disorder that occurs in early childhood and is characterized by emotional bonding, verbal interaction, stereotyped repetitive movements, narrow interests, and poor cognitive functioning. It is a broad developmental disorder involving language, perception, emotion, thinking, interpersonal interaction, and movement, and is the most studied disorder in this category. The prevalence of this disorder is about 2 per 10,000 by more stringent criteria. Since the DSM-III-R and DSM-IV relaxed the diagnostic criteria and applied the name “autistic disorder”, the prevalence statistics have increased. In France, it is 5.35 per 10,000, in Canada it is 8-10 per 10,000, and in Japan it is 13-16 per 10,000. Male: female = 4-5:1, while in China the statistics are 6-9:1; some people believe that the condition is more severe in girls. In Chinese medicine, it also belongs to the category of five delays or dullness. That is, poor language development, dull lack of language and emotion and lack of social interaction ability. Since Kanner proposed the concept of autism in 1943, many scholars have studied the cause of autism from family, psychosocial, physiopathological, anatomical, biochemical, immunogenetic, etc., but the cause is still unclear. Family psychosocial factors: Psychogenic theorists believe that the susceptibility (or vulnerability) of the child’s physique deserves attention, and that the parents themselves are as cold as “refrigerators”, and that the child’s illness is caused by the pathological interaction between mother and child due to bad emotions. 2. Genetic studies: According to the study of the homozygosity rate in families and twins, it is suggested that there is a subgroup that develops the disease through recessive genetic inheritance. It is also believed that autism is closely related to chromosomal fragile loci. 3. Pre-birth (or pre-pregnancy) and perinatal factors: Brain damage due to various causes is the cause of autism soon after birth, such as infections, birth injuries, asphyxia, etc. 4. Immunological studies: reduced number of T lymphocytes, reduced number of helper T cells and B cells, lack of suppressor-induced T cells and reduced activity of natural killer cells can be observed in some affected children. 5. Neuropathological studies: 30-75% of the children have clumsy movements, choreiform movements, abnormal posture and gait, suggesting dysfunction of the basal ganglia, neostriatum, middle part of the frontal lobe or limbic system. 6, neurotransmitter studies: immature development of 5-HT and catecholamines, due to abnormalities in the pineal-subthalamic-pituitary-adrenal axis, causing an increase in 5-HT and endorphins as well as a decrease in ACTH secretion, plasma endorphins and solitude in affected children. Plasma endorphins are related to the severity of emotional numbness and stereotyped movement of children. (1) Congenital pathogenic factors: It is inherited from the parents and has its roots in the congenital disease of the family, and can also be due to adverse effects and malignant stimulation during the normal development of the fetus, such as maternal invasion by foreign evil, accidental trauma or emotional injury. (B) Acquired pathogenic factors: Acquired factors can aggravate the disease. Inadequate care, neglect of the child’s diet and care, injury to the spleen and kidney, or injury to the heart and spleen caused by the child’s mental atrophy, dullness, mental retardation, reduced language, pale skin, etc. Clinical Manifestations】 I. Lack of social interaction: the child cannot establish affection with people around him, even with his parents. The child held in the arms will not put the body close to the mother, and does not smile, will feel the child weak and cold. By 6 or 7 months of age, the child is still unable to distinguish between relatives and strangers. They do not understand others’ likes and dislikes, they do not look at each other, and when they are a little older, they do not establish friendship with other children. Language interaction disorder: About 50% of children with this condition never develop useful language. Some have delayed language development, and when they do speak, they have strange intonation, or only words, or simply imitate language, or use the wrong pronouns. They are also unable to respond to others because they do not understand their words. Third, narrow interest and compulsive behavior: not interested in children’s toys, but some non-toy things as a peculiar preference, can be enduring, such as a brick, play can not be put down. Or an object can not be restrained to touch with the hand, put on the nose to smell, or twist their fingers, etc.. Some children with better intelligence often ask the same question repeatedly and never get tired of it. Perception and movement disorders: dullness and numbness to certain stimuli, such as the fingers are crushed without pain, sometimes to the sudden sound also as if nothing, call their names also do not respond. However, they are particularly sensitive to certain stimuli, such as the sound of a flute, the roar of a vacuum cleaner or sudden changes in light intensity, which can cause avoidance and irritability. The child often cannot sit still, walks or jumps aimlessly, and also sometimes hits his head, taps, bites hard objects, shakes, or rotates his body. V. Mental retardation: 40-60% of children have an IQ below 50, 25% of children have an IQ between 50 and 70, and 25% of children have an IQ above 70. According to the level of intelligence, autistic children can be divided into high IQ type, i.e. normal or close to normal IQ, and low IQ type, i.e. with obvious intellectual defects. Those who go to the doctor are mostly of the low IQ type, while those with better intelligence are mostly regarded as eccentric by parents rather than as diseases. [Diagnosis and Differential Diagnosis] Diagnostic points: (a) Western medical diagnosis points 1. qualitative defects in social interaction; 2. qualitative defects in verbal communication; 3. repetitive stereotypes, narrow interests, and adherence to the same environment and lifestyle. The total number of contents of the above three manifestations needs to be more than 7, of which 1 must have at least 2 contents, and 2 and 3 must have at least one content each. And exclude other pervasive developmental disorders such as childhood schizophrenia, mental retardation, Rett, Heller, and Asperger syndromes to make the diagnosis. Atypical autism is a disorder in which only some of the symptoms meet the criteria for autism, as well as an atypical age of onset, i.e., often after the age of 3 years. Screening tests for autism include scales such as the Autism Behavior Rating Scale (ABC scale) and the Childhood Autism Rating Scale (CARS). (2) Key points of identification in Chinese medicine: The disease is characterized by poor social interaction, dullness, lack of interest, perceptual impairment or mental retardation, and is mostly regarded as a deficiency of the heart and spleen and liver and kidney yin deficiency in Chinese medicine. Differential diagnosis: 1. mental retardation: poor social adaptability but without the social interaction and speech disorders manifested by autism, without narrow interests, stereotypical repetitive movements, keeping the environment unchanged, etc. MR children are poor in intelligence but still able to communicate with others with simple speech and posture. 2. Schizophrenia; the onset is commonly in preadolescence or adolescence, with a high prevalence in families, and symptoms such as hallucinations, delusions, thought breakdowns, and confusion of words. In intelligence test scores, schizophrenia has higher comprehension than children with autism. 3. Childhood ADHD: There is hyperactivity, attention deficits, impulsive capriciousness, and often learning difficulties, but no social interaction deficits. 4. Other pervasive developmental disorders: (1) Asperger syndrome: similar to the features of childhood autism, with impaired social interaction, narrow interests and stereotyped repetitive movements, differing from childhood autism in that language and cognitive development are not delayed, and most children have normal intelligence but clumsy movements. (2) Rett syndrome: The etiology is unclear, and it is a progressive encephalopathy seen only in girls so far. Early development is normal, with onset at 7 to 14 months of age. Subsequently, progressive decline in language, movement and intelligence occurs from the original acquisition. Neurological symptoms and signs are more prominent, such as ataxia, dystonia, and scoliosis or kyphosis. Children with increased muscle tone in the upper limbs may have a special posture of upper limbs bent in front of the chest or forehead, and some even have severe symptoms of generalized ankylosis. (3) Heller syndrome, also known as infantile dementia or childhood disintegrative psychosis: there is a period of definite normal development before the onset of the disease, usually 3 to 4 years, with at least 2 years being normal. The onset of the disease is preceded by a “prodromal period” in which there is irritability, anxiety, and irritability and hyperactivity. After a few months, various abilities regress rapidly, so that the abilities acquired in the past are quickly lost. It is characterized by little language, poor expression, excessive activity, repetitive movements, loss of interest in the surrounding environment, inability to take care of oneself, and even inability to control urination and defecation. Treatment】 I. Principles of treatment: This disease is a neurobiological disease caused by a variety of causes, the exact cause has not been elucidated, so comprehensive treatment must be carried out, in addition to parental involvement and behavior modification and special education training in a highly structured environment. The goal of medication is to modify specific symptoms. The medication must be based on a correct diagnosis and must be tailored to the type of psychopathology. The cooperation of the child’s family is obtained and the advantages and disadvantages of the medication are carefully evaluated. If the treatment is effective, the medication should be used continuously for 2-6 months after obtaining the optimal dose, and then discontinued for 1-2 months for control to evaluate the need for continued treatment and the emergence of side effects. Western medical treatment (a) Psychological and behavioral treatment 1. Special education: Early detection and early educational training so that the condition can be expected to improve greatly. Education is suitable for autism at any age, and the use of individualized education can maximize the child’s potential abilities. 2. Behavior training and behavior modification: It lies in developing insufficient behavior, reducing excessive behavior and eliminating undesirable behavior. The first step in the training process is to train the ability to take care of oneself in life, to establish basic behavioral norms, and to train interpersonal cooperation attitudes. 3.Comprehensive sensory training: Before training, we should check what kind of sensory disorder the child has, whether it is retardation or allergy, and make a specific training plan according to its developmental level. There are five types of training for sensory integration disorders: (1) vestibular sensory integration disorder training; (2) muscle and joint kinesthetic disorder training; (3) visual-spatial perception disorder training; (4) auditory-verbal disorder training; (5) tactile and other response disorder training. （Central excitatory drugs: Used to improve fidgeting, impulsive behavior and inattentiveness. Commonly used drugs for tomoxetine, also available methylphenidate: 0.3mg/kg/d, for long-term behavior change dose of 0.7 ~ 1mg/kg/d, the maximum daily dose should not exceed 60mg. 2. Anti-psychotic drugs: (1) haloperidol: used to improve agitation, aggression and stereotypes or emotional instability. The general dosage is 0.25-4mg/d. (2) Risperidone: It can relieve hyperactivity, self-injury, aggression and attachment to objects. The initial dose is 0.25-0.5mg/d, taken orally twice daily, and the maximum daily dose can be increased gradually at the discretion of the patient, not exceeding 2.5mg. 3. Antidepressants: (1) Sertraline: 12.5-200mg/d for children over 7 years old; (2) Escitalopram 5-20mg/d. (3) Clomipramine: for children with OCD. The initial dose is 25mg/d, divided into 2 oral doses. Every 3-6 days, each time increase 1mg/kg, the maximum daily amount is 150mg, the course of treatment for more than 4 weeks; (of course, for obsessive-compulsive symptoms can also be used the above new 5-HT reuptake inhibitors, only with a larger dose). 4. Anti-opiate drugs: Naltrexone Hydrochloride is a kind of opiate antagonist, which improves social interaction and self-injurious behavior of autistic children. The dosage is 0.5~2mg/kg/d. 5. Vitamins: Vitamin B6 combined with magnesium has a significant improvement effect on the behavior of some children. Vitamin B6 dosage of 15-30mg/kg/d (or 700-1000mg/d), magnesium dosage of 10-15mg/kg/d (or 380-500mg/d), with magnesium can reduce the side effects of high-dose B6 treatment (a large number of B6 can cause numbness of the limbs, etc.). Chinese medicine treatment (a) identification and treatment 1. heart and spleen deficiency: symptoms: dullness, low intelligence, language development is backward, rarely use language to interact with others, lack of interest, hair atrophy, face, skin pale, less food and loose stools, light tongue and weak pulse. Treatment: Benefit qi, tonify blood, strengthen the spleen and nourish the heart. Recipe: Gui Spleen Tang, “Zheng Shi Class”: Atractylodes Macrocephala, Fu Shen, Astragalus, Longan Flesh, Sour Jujube, Ginseng, Mu Xiang, Licorice, Angelica Sinensis, Yuan Zhi, it is also advisable to add ginger and jujube in water decoction. Acupuncture and moxibustion treatment: Acupuncture points are: Foot San Li, Hou Xi, He Gu, Feng Fu, Shang Xing and Tai Chong. Liver and kidney yin deficiency Symptoms: poor physical development, inattention, irritability, imitation of language or stereotypical repetition of language, failure to establish normal interpersonal relationships with others, spontaneous sweating and night sweating, frequent urination, or urine loss, heat in the hands and feet. Red tongue with little coating and thin pulse. Treatment: Nourish kidney yin and nourish liver blood. Acupuncture and moxibustion treatment: Heart and spleen deficiency: select Foot San Li, Qi Hai, Shen Men, Nei Guan Xue Liver and kidney Yin deficiency: select Guan Yuan, Tai Chong, Dazhi, Bai Hui, and Si Shen Cong points. The main points of care are: to care for the child, to mobilize parents to actively participate in preventing aggressive behavior and self-injury, self-harm, and destructive behavior. Try to make the family and the child understand the benefits of various treatments, in order to obtain support and cooperation, so as to observe the effects of treatment and side effects of drugs. Prognosis: The prognosis is poor. Only a few patients can reach or approach normal social life, but there are difficulties in getting along with others and some bizarre behaviors. Children with autism who have an IQ of >70 and who are able to use interactional language at the age of 5-7 years have a better prognosis. If the initial IQ is below 50-60 and interactional language has not developed by the age of 5, the prognosis is poor and may result in lifelong disability. On the contrary, there is a 50% chance that the child will have a good social adjustment to adulthood, but only 1 to 2% will become a “normal person”. About 1/5 of children with epilepsy develop seizures by adolescence, and the prevalence of epilepsy is especially high in children with severe mental retardation, and the prognosis for those with epilepsy is even worse once they have it.