1. Actuality of the Research

The prevalence of Autism Spectrum Disorders (ASD) has shown a steady upward trend. According to earlier statistics, ASD was diagnosed in approximately 4–5 children per 10,000, whereas over the past 30–40 years this figure has increased to 50–116 cases in many countries. Such a sharp rise clearly underscores the high degree of relevance of this issue [2,7].

In the process of clinical examination, data analysis, diagnosis, and the selection of treatment and rehabilitation methods for patients with ASD, it is essential to take into account not only the core clinical symptoms but also accompanying neurological alterations. In many cases, it is precisely the neurological manifestations that determine the specific nature of the disorder in autistic patients. The processes occurring in the brain play a crucial role in the manifestation of both the fundamental symptoms and associated neurological features of the disease.

ASD encompasses a wide range of primary and neurological signs, among which significant difficulties in speech and language development are especially pronounced. Patients often experience challenges in communicating with close relatives, possess a limited vocabulary, and rely predominantly on nonverbal means of communication (such as gestures or pictograms) [3,9].

Moreover, individuals with ASD frequently exhibit hypersensitivity to smell, taste, and light; may cover their ears tightly to avoid certain sounds (sonophobia); and display an extreme fear reaction to specific noises (e.g., from airplanes or vacuum cleaners) or tactile contact. At the same time, sensory indifference may be observed — such as failing to respond when called by name, ignoring loud noises, or showing apparent “deafness.” Other symptoms include self-injurious behavior, difficulty in recognizing facial expressions, and synesthesia (a condition in which stimulation of one sensory modality triggers perceptions in another — for example, auditory stimuli influencing visual or gustatory sensations).

In addition, motor abnormalities are common: dystonia, atypical gait (such as walking on tiptoes), impaired balance and coordination, lack of control over complex motor actions, stereotyped or repetitive mechanical movements (such as finger, hand, or body rocking and circular motions), and a general preference for routine behavior. Motor system underdevelopment, muscle hypotonia, deficits in motor planning and organization (dyspraxia), inadequate postural responses, as well as disturbances in static and dynamic coordination, rhythm, and movement speed are also characteristic [4,10].

Patients may exhibit slow, uncoordinated movements when walking, a forward-leaning head posture, absence of normal arm synergy, and an inability to maintain balance while standing. Alongside these symptoms, stereotypical behaviors are observed, including speech development disorders, impaired articulation, abnormal and self-injurious movements, seizures, and tics [5,12].

2. Initial Diagnosis and the "Autistic Triad"

The initial diagnosis of Autism Spectrum Disorder (ASD) is primarily based on the presence of what is known as the “autistic triad.” This triad manifests in various forms and includes the following three groups of characteristics [4,8,16]:

• limitations in social interaction;

• limitations in communication;

• restricted and stereotyped patterns of behavior.

When examining the features that fall within each group of the “autistic triad,” one encounters a number of distinctive and noteworthy phenomena.

Limitations in social interaction are characterized by a lack of response to one’s name; disregard for speech directed toward the child; fear of tactile contact and certain sounds; social withdrawal resulting from anxiety in the presence of others; atypical emotional expression; poor facial mimicry; inability to interpret body language and gestures; and difficulty in maintaining eye contact [5,8].

Limitations in communication involve a tendency toward solitude, absence of friendships, delayed speech development, inability to adapt behavior according to the situation, lack of interest in interactive games, and playing exclusively with personally preferred toys while ignoring others [1,16].

Restricted and stereotyped patterns of behavior are marked by repetitive movements, strict adherence to routine, uncontrolled repetition of simple words, fear of minor changes, fixation on specific interests, and the loss of previously acquired skills [2,15].

There are several distinct types of Autism Spectrum Disorders, which are differentiated based on the unique characteristics of each condition. According to the International Classification of Diseases, 11th Revision (ICD-11), ASD types are categorized primarily according to the degree of intellectual development and the presence or absence of functional language abilities. In the 10th Revision of the ICD (ICD-10), the following major types were identified [6,11,19]:

1. Early Childhood Autism – characterized by delayed motor development, abnormal movements, avoidance of social contact, and limited vocabulary. For instance, an infant may fail to respond to their name by eight months of age; by twelve months, exhibit a limited number of gestures or movements; by eighteen months, demonstrate avoidance of communication, failure to comprehend speech, and engagement in unusual types of play; and by twenty-four months, show an inability to imitate actions, lack of social reciprocity, and the use of a restricted set of words. However, at this age, it remains difficult to predict the future severity of ASD [2,6,13].

2. Kanner’s Syndrome – characterized by withdrawal into one’s inner world, lack of communication with the external environment, and echolalia (repetition of words or phrases). Although language may develop, it does not enable the individual to function fully in society and typically requires constant supervision [14].

3. Asperger’s Syndrome – marked by egocentrism, perception of communication as insignificant, unusual or obsessive interests, and a low level of empathy. Despite these traits, motor development is generally normal, which often leads to this syndrome being mistaken for mere eccentricity [17].

4. Rett’s Syndrome, although previously classified within ASD, is now regarded as a distinct genetic disorder associated with specific mutations. It occurs exclusively in females and is commonly characterized by the loss of purposeful hand movements and severe impairment of motor coordination [3,18].

5. Adult Autism can manifest in two main forms. The first involves the persistence of childhood autism symptoms into adulthood, where the severity of manifestations may fluctuate over time; in such cases, psychotherapeutic intervention plays a crucial role. The second form appears in adulthood as a response to stress or other psychological factors — resembling a depressive condition. Over time, such individuals may experience significant deterioration in social functioning, actively avoid communication, neglect close relationships, withdraw from social contact, and show decreased concentration, passivity, and loss of interest. They often lose the ability to establish new relationships or interact effectively with others. Nevertheless, despite these communication difficulties, some individuals with adult autism are able to achieve notable professional success. Adult autism frequently presents atypically, meaning that not all components of the classical triad may be evident [18].

6. High-Functioning Autism (HFA) – distinguished by a high level of intellectual ability and often regarded as a variant of Savant Syndrome, where superior IQ coexists with certain mental impairments. High-functioning autism may also coexist with other types of ASD, such as Kanner’s or Asperger’s syndromes [19].

Thus, a review of the literature indicates that the diversity of ASD types, the variability of their clinical features and neurological manifestations, and the complexity of their progression — combined with pronounced cognitive and emotional disturbances and a profound impact on social life — present considerable challenges for both diagnosis and treatment. The limited efficacy of pharmacotherapy, the difficulties in selecting appropriate rehabilitation approaches, and the overlap of symptoms with other conditions emphasize the need for further refinement of early medical, neuropsychological, and pedagogical interventions. Such advancements are essential for improving rehabilitation outcomes, preparing children for social adaptation, and reducing disability rates.

3. Purpose of the Methodological Recommendations

The purpose of the methodological recommendations is to improve rehabilitation approaches for children with Autism Spectrum Disorders (ASD), taking into account the limitations and stereotyped nature of the “autistic triad” — namely, restricted social interaction, impaired communication with others, sensory disturbances, and repetitive patterns of behavior and conduct.

4. Research Materials and Methods

This scientific study was devoted to analyzing the clinical features of Autism Spectrum Disorders (ASD) in children and, based on these findings, to developing and selecting appropriate rehabilitation methods.

In total, 68 children (100%) — both boys and girls diagnosed with ASD — participated in the study. Based on the identified clinical characteristics, a comprehensive rehabilitation program was applied. The children were examined and treated at the Republican Mental Health Center (Bukhara Branch) and the “Alfa Medical Center” private clinic, both in inpatient and outpatient settings, during the period from 2022 to 2024.

To ensure the reliability and validity of the research, all 68 children were divided into two groups:

• Group 1 (Main Group) – 36 children (52.9%) who received the proposed comprehensive rehabilitation program;

• Group 2 (Control Group) – 32 children (47.1%) with ASD who underwent conventional treatment (see Figure 1).

Figure 1. Distribution of patients into groups

As illustrated in Figure 1, the number of patients in the two groups was nearly identical, with no statistically significant differences between them. The children’s ages were distributed according to internationally accepted normative standards (see Table 1).

Table 1. Distribution of children by age and gender

Figure 2. Distribution of children in groups by age and gender

In children with ASD, a comprehensive rehabilitation approach was implemented, taking into account the severity of clinical manifestations as well as the overall severity of the disorder. This approach aimed to provide broad therapeutic effects, foster the development of social, communicative, and daily living skills, address maladaptive behaviors, and improve the quality of life of both the child and the family. The practical rehabilitation protocol included various methods such as behavior analysis (ABA therapy), sensory integration, speech therapy activities, and neuropsychological and cognitive-behavioral exercises.

Additionally, children participated in sessions with consultations from a neurologist-rehabilitologist, special education teacher, psychologist, and physical therapy specialist (occupational therapist). As another rehabilitative tool, transcranial magnetic stimulation (TMS) was applied, which involves the non-invasive and painless delivery of brief magnetic pulses to specific regions of the cerebral cortex. The outcomes of the implemented comprehensive rehabilitation program were compared with those obtained from patients who underwent conventional treatment over a 3–4 month period (Table 2).

Table 2. Intergroup comparison of ASB "triad symptoms" in rehabilitation

Analysis of the results presented in Table 2 revealed that patients who underwent primary, comprehensive medical, pedagogical, neuropsychological, and social rehabilitation demonstrated significant improvements in social interaction markers, notable enhancements in communicative limitations, and reductions in atypical behaviors after three months. When compared to the control group, these changes were markedly greater.

For example, in comparison with the pre-treatment period, the effects of rehabilitation in the primary and control groups were distributed as follows: lack of attention to directed speech – 78.2% vs. 22.4%; atypical emotional responses – 61.0% vs. 35.9%; difficulty understanding gestures – 60.7% vs. 23.7%; tendency to isolation – 63.5% vs. 28.1%; behavioral adaptation – 64.6% vs. 29.2%; selective play with preferred toys only – 71.3% vs. 21.4%; repetitive movements – 67.9% vs. 32.1%; adherence to specific daily routines – 60.7% vs. 31.8%; unsupervised repetition of simple words – 69.2% vs. 17.6%; fear of minor changes – 66.2% vs. 33.4%; and rigid attachment to specific interests – 72.1% vs. 33.8%.

This analysis demonstrates that the primary group, i.e., patients who received the enhanced comprehensive rehabilitation program, showed significantly more positive outcomes compared to the control group (P<0.001). Such results were interpreted as indicating high efficacy of the intervention.

Subsequently, we conducted an assessment using the M–CHAT-R/F (Robins, Fein, & Barton, 2009) scale, comparing pre-treatment and post-treatment statuses in both groups, showing a distribution pattern similar to that described above. The M–CHAT-R/F scale was applied from infancy (6–24 months).

The results of this scale were interpreted as shown in Table 3. Based on Table 3, the positive effects of the three-month comprehensive rehabilitation program were evident. In the primary group, a sharp reduction in ASD symptoms was observed in early childhood, with a very low risk of disorder progression. Among school-aged children, 20% demonstrated similar positive changes, and among younger school-aged children, the figure was 14%. The extremely high risk of ASD progression was detected in only 8% and 5.6% of preschool and early school-aged patients, respectively, and these children were referred to specialists for continued rehabilitative treatment.

Table 3. Identifying disease dynamics on the M–CHATR/F (Robins, Fein, & Barton, 2009)

Children who received conventional rehabilitation methods achieved substantially lower results. At the parents’ request, these children were also referred to specialists for application of comprehensive rehabilitation methods after three months.

The next stage involved evaluating the dynamics of ASD and communicative impairment severity, using the CARS scale (Schopler, Reichler, DeVellis, & Daly, 1980) (Table 4).

According to CARS, the severity of ASD and communicative impairment showed considerable improvement in the primary group. Specifically, 4 children (11.1%) demonstrated a complete reduction of ASD symptoms, reaching practically normal functioning; 25 children (78.1%) exhibited mild or moderate forms of autism (an improvement from severe to mild forms, representing a 1.5-fold reduction compared to pre-treatment levels); and 6 children (16.7%) had severe autism, compared to 17 children (47.2%) prior to treatment, indicating a 2.8-fold decrease. This analysis contrasts markedly with the results of the control group, further confirming the high efficacy of the comprehensive rehabilitation program (Table 4).

Table 4. Dynamic assessment of the severity of ASD and communicative disorders according to the CARS scale

The study did not exclude the observation of neurological changes in patients with ASD during the rehabilitation process. In this case, the same brain changes indicated both the main symptoms of ASD and neurological concomitant lesions. The scope of neurological lesions in ASD is very wide, they are early lesions of the psychomotor state, impaired sensitivity and its processing, monotony of movement and mental reactions, hypermobility, high excitability. Movement stereotypes, impaired motor coordination, dyspraxia, expressive motor skills, speech development, articulation disorders, tics, seizures were observed with such symptoms. During the 3-month rehabilitation period, we identified quite positive, noticeable changes in children (Table 5).

Table 5. Dynamic changes of neurological signs in ASB rehabilitation

Table 5 shows that a wide range of neurological symptoms detected in children with ASD significantly decreased after rehabilitation in the main group, and there was also a significant decrease in the second, control group, but this decrease was significantly different when compared to Group 1.

For example, among the observed changes in the sensory system, reductions were noted in sonophobia (30.6%, 1.5-fold), phonophobia (36.1%, 2.1-fold), hyperosmia (33.3%, 1.6-fold), sensory indifference (38.9%, 2.2-fold), synesthesia (44.4%, 1.4-fold), and visual tracking impairments (38.9%, 2.3-fold). Similar differences were observed in the motor system and in stereotypical behaviors.

Regarding the specific characteristics of these neurological signs, the children in the study exhibited heightened sensitivity to smell, taste, and light; covered their ears tightly to avoid certain sounds (sonophobia); showed extreme fear of objects such as airplanes or vacuum cleaners and of physical contact. At the same time, sensory indifference was observed in the form of failing to respond when called, ignoring certain loud sounds, self-injurious behaviors, inability to recognize facial expressions, and synesthesia (cross-modal sensory influence, e.g., auditory stimuli affecting visual or gustatory perception). Over the three-month rehabilitation period, these manifestations were substantially reduced.

Children with ASD also demonstrated motor impairments characterized by incompleteness and disharmony, as well as polymorphic motor disturbances. These included muscle dystonia, atypical gait (toe-walking), impaired balance and coordination, uncontrolled complex movements, stereotyped and repetitive mechanical movements (fingers, hands, body shaking, or rotational movements), adherence to routine, delayed motor development, muscle hypotonia, impaired planning and organization of movements (dyspraxia), inadequate postural reactions, motor disharmony, impaired static and dynamic coordination, and disrupted rhythm and speed in complex movements. During walking, children exhibited slow, disharmonious movements, forward head posture, lack of arm synergy, and inability to maintain balance when standing.

Simultaneously, stereotypical behaviors were analyzed, revealing impaired speech development, articulation difficulties, atypical and self-injurious behaviors, grasping abnormalities, and tics. Post-rehabilitation, some of these alterations persisted in certain children, which was associated with severe, prolonged ASD, insufficient early rehabilitation interventions, or, in some cases, parental neglect regarding therapeutic activities.

5. Conclusions

1. Implementing the proposed comprehensive rehabilitation program from early childhood and continuing periodic interventions until the child reaches school age—incorporating medical, social, pedagogical, psychological, medical-psychological, and physical rehabilitation—prepares the child for social life, improves daily functioning, self-regulation, and social interaction, and significantly facilitates family-related challenges and the integration process into preschools and schools. The use of neurological markers, specialized tests, and scales allows for systematic monitoring of interventions in autism spectrum disorder (ASD).

2. These methods enable early ASD diagnosis, selection of appropriate early rehabilitation strategies, preparation of the child for social life from infancy, and timely intervention in cognitive, speech, articulatory, motor, sensory, and behavioral domains. This reduces the risk of severe complications and positively impacts social, medical, and economic outcomes.

3. The comprehensive rehabilitation program allows for early, qualified neurological, medical-psychological, pedagogical, and physical interventions, preventing profound disability, and supporting the child in independent functioning, social integration, and active participation in daily activities.