Autism Spectrum Disorders: Diagnosis & Treatment

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Autism Spectrum Disorders Diagnosis Treatment

• Presented by Andrew Bailey MA, MFT
• Founder/Executive
  Director
• The Anova Center for Education - ACE School
• Santa Rosa, San Rafael Concord California
• ACE School Staff Development Series
• Autumn 2012

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What is an Autism Spectrum Disorder?

• Autism Spectrum Disorder is a neurodevelopmental
  disorder whose manifestations occur in great
  variation in severity,
• or across a Spectrum. The essential
  features are
• Markedly abnormal development in social
  interaction and communication
• Markedly restricted repertoire of activities
  and interests
• Marked impairment in the use of multiple
  nonverbal behaviors (e.g. eye-to-eye gaze, facial
  expression, body postures)
• to regulate social interaction and
  communication.
• Failure to develop peer relationships
  appropriate to developmental level (takes
  different forms at different ages)
• Younger individuals may have little or no
  interest in establishing friendships, whereas
  older individuals may have an interest but lack
  understanding of the conventions of social
  interaction.
• Lack of joint attention with others (e.g.
  not sharing objects or experiences) or awareness
  of others feelings or needs.
• Impairment in communication is marked and
  sustained and affects both verbal and nonverbal
  skills. There may be a delay in, or total lack
  of, the development of spoken language.
• Delays in social interaction, language, and
  symbolic play must be apparent prior to 3 years
  of age.

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What Causes Autism?

• Autism Spectrum Disorders have no known causes
  and no known cures.
• Some researchers believe autism is not a single
  phenomenon but rather a collection of similar
  conditions or autisms
• Most theories have focused on the interaction
  between a genetic susceptibility or
  predisposition toward autism and environmental
  triggers such as environmental toxins. Prenatal
  or childhood injury?
• Some cases are clearly genetically transmitted
  twin studies
• and others are not so clear. Vaccines?
• Environmental toxins including chemicals,
  viruses, and bacteria can potentially cause
  genetic changeswhen and how remains unclear.
• Visit the website for the MIND Institute at the
  University of California at Davis for the most
  current resources and research

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What is the Prevalence of Autism?

• Autism has evolved from a relatively rare
  phenomenon to a commonly diagnosed childhood
  condition over the last twenty years.
• 1 in every 100 children born in the United States
  today will eventually receive an autism
  diagnosis. (1 in every 88 boys)
• Autism is the fastest growing childhood
  disability and is more common than pediatric
  AIDS, juvenile diabetes, and childhood cancer
  combined.
• Please visit the Website for the California State
  Senate Select Committee on Autism and Related
  Disorders for the most recent statistics.

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What are the Treatments for Autism?

• Can Autism be cured? Jenny McCarthy and many
  others think so.
• However
• Most scientists do not believe a cure currently
  exists, but that treatment can significantly and
  permanently reduce symptoms.
• Contemporary autism treatment takes many forms
  including some that are controversial, unproven
  and expensive. The average individual with autism
  will require 3-5 million dollars of care/services
  in their lifetimea figure that is likely to
  skyrocket.
• The most common treatments seek to teach
  developmental skills that the child is missing
  (especially language, social, and behavioral) in
  clinical or naturalistic environments, using a
  wide variety of techniques and philosophies.

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What are the Treatments for Autism?

• The most effective treatments will produce
  measurable results for only 60 of the
  recipients.
• The following is a list of the most commonly used
  treatments
• Applied Behavior Analysis (ABA) Is the most
  commonly used and empirically proven set of
  techniques for symptom reduction. Includes a
  large number of sub headings and strategies such
  as Pivotal Response Training, PECS, and TEACCH.
  Can be implemented by anyone under the direction
  of a trained Behavior Analyst
• Floortime Is a widely used technique for
  language and social development that is child
  centered and relationship driven. Unlike ABA it
  is not structured and therapist directed and does
  not rely on data to make decisions.
• Speech Therapy Is delivered by trained speech
  therapists and lay people and seeks to teach
  communication and social skills. A wide variety
  of specialized techniques are utilized.
• Occupational Therapy Is delivered by trained
  Occupational Therapists and lay people and seeks
  to teach self regulation and motor skills. A wide
  variety of specialized techniques are utilized.
  

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What are the Treatments for Autism?

• The following are medical or biological
  interventions that are mostly unproven but are
  commonly delivered
• Dietary restrictions or changes especially
  those eliminating dairy, gluten, and artificial
  flavors or colorings. There is some evidence to
  support the idea that autism is a metabolic
  disorder that affects brain functioning.
• Hyperbaric Oxygen is an expensive but
  relatively safe treatment involving the
  individual receiving oxygen at high pressures.
• Chelation Therapy involves injections of
  certain substances into the body that are
  intended to bond with and remove the heavy metals
  (mercury et al) that are suspected of causing the
  autism.
• Pharmaceutical interventions involve the
  ingestion or application of a potentially large
  number of substances or compounds that are
  intended to cure or treat symptoms of autism.
  The compounds and substances are formulated and
  delivered based on a particular hypotheses about
  the cause of autism (mercury, fungus, allergy,
  genes, etc)

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Neurodevelopmental Impairments and School
Performance

• Sensory integration difficulties
• Specific learning disabilities
• Behavioral excesses or deficits
• Impairments in social cognition

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Anova Method of Education - AME

• AME is an intensive educational and
  treatment program designed for a rapidly growing,
  poorly understood, and acutely underserved
  population of school age children and young
  adults.
• Simultaneous application of treatment modalities
  is essential Four primary components of AME
• Social Cognition Therapy/Speech Therapy
• Highly Individualized Academic Instruction
• Occupational Therapy/Sensory Integration
• Behavior Analysis/Positive Behavior Support
• Customized classroom and therapy environments
  with extensive specialized equipment/technology.
• Highly trained team of teachers and therapists

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Treatment Fundamentals

• Consistency and structure in the classroom and on
  campus
• Posted schedule of daily school activities
• Simple and redundant classroom rules - posted
• Consistent expectations among all teaching staff,
  SLP, OT, APE, administration.
• Imminent reinforcers in place
• Staff use consistent therapeutic vocabulary
• for prompting and error correction

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Teaching Strategies for Success

• Teaching adaptive skills as effective replacement
  behaviors
• Teach students pivotal replacement behaviors that
  can be used in a variety of situations and
  community settings (e.g. asking questions,
  seeking out help, recognizing their own sensory
  overload).
• Teach students appropriate escape behaviors such
  as asking for a break when overwhelmed.

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Pediatric Occupational Therapy

• Specialized treatment to address complex sensory
  and motor difficulties in children, including
• Sensory Integration Dysfunction
• Sensory defensiveness
• Impaired visual perceptual skills
• Impaired visual-motor integration
• Impaired fine or gross motor coordination
• and planning.
• Auditory processing difficulties

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Occupational Therapy Behavior

• Defensiveness
• Outbursts
• Self-injury
• Avoidance responses
• Hypervigilance

• Modulation problems
• Distractibility
• Self-stimulation
• Difficulty with transitions
• Shutting down

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Occupational Therapy Behavior

• Registration problems
• Delayed responses
• Heightened auditory visual sensitivity
• Sluggish proprioceptive system

• Impaired integration
• Poor motor planning
• Impaired balance
• Poor protective responses
• Inadequate sense of own body

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Occupational Therapy Interventions

• The OT perspective
• Sensory Integration is involved in every
  human behavior, including the complex sequences
  of verbal and motor behaviors that are required
  to succeed in school.
• Assessing behavior from a sensory integration
  perspective helps to identify sensory needs that
  drive behavior, including maladaptive responses
  that interfere with educational performance.

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Occupational Therapy Interventions

• The OT perspective
• Improved sensory processing results in improved
  behavior, social interaction, and learning
• Certain strong sensations can be used to
  influence the efficiency of sensory processing.
  These sensations may include spinning, brushing,
  swinging, and many others.

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Occupational Therapy Clinic

• Specialized swings and suspension hooks
• Ball pools
• Scooterboard ramp
• Foam crash pits
• Weighted vests, blankets and gloves
• Theraballs
• Adjustable lighting and music

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Social Cognition Deficits

• Our students experience profound deficits in
  social cognition that limit their ability to
  take the perspective of others in social
  situations. The combination of a bright and
  verbally expressive child with social cognition
  impairments can lead to serious emotional and
  behavioral problems, particularly around school
  environments.

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Social Cognition Deficits

• Often viewed as eccentric, odd or manipulative
• Frequently become the victims of teasing and
  bullying
• Display deficits in language pragmatics and
  prosody
• Can be extremely literal and have difficulties
  utilizing language in a social context

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Social Cognition Abilities

• Intra-personal abilities include
• an individuals affective range and intensity
• the ability to discriminate among emotions
• the ability to label their emotions appropriately
• the ability to use them to guide their actions

• Interpersonal abilities include
• the ability to decode the underlying feelings,
  intentions, and motivations of others
• to recognize specific characteristics of others
  (e.g., age, gender, and ethnicity)
• to influence others to behave in desired ways.

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Social Cognition Therapy

• The ACE School utilizes Social Cognition
  Therapy in assisting students to understand the
  internal world of others. Complex and nuanced
  social issues are broken down and made more
  concrete to increase student comprehension for
  use in their daily lives. A specific vocabulary
  is used throughout the day to reinforce or
  correct various social behaviors (see charts).
  Compassionate nagging and other real-time
  interventions are used to allow students to see
  the immediate effects of their social behaviors
  on others. Individual and group treatment is
  delivered in the classroom, clinic, and across
  the school milieu to promote skill retention and
  generalization.