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Autism Spectrum Disorder (ASD)

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Title: Autism Spectrum Disorder (ASD)


1
Autism Spectrum Disorder (ASD)
  • This disorder includes Autism (299.0), and the
    Pervasive Developmental Disorders NOS, and
    Aspergers (299.80). It does not include Retts
    Syndrome or Childhood Disintegrative Disorder.

2
Objectives
  • To describe the definitions for and epidemiology
    of ASD
  • To review the current methods for screening,
    diagnosing, care and case managing, and treating
    ASD
  • To review the key features of how ASD presents in
    the children enrolled New Jerseys Behavioral
    Health system of care

3
Definition
  • ASD is a biologically based disorder of
    neurodevelopment. The deficits are as follows
  • Reciprocal social interaction
  • Communication impairments
  • Stereotyped and compulsive behavior patterns,
    activity patterns, or interest patterns
  • ASD is a lifelong developmental, neurological
    disability that affects
  • Speech and language
  • Social relationships
  • Psychological functioning
  • Development of cognition, emotions and behaviors
  • Co-occurring disorders are frequently present
    with ASD.

4
Epidemiology
  • ASD occurs in approximately 6 out of 1000
    children in the United States.
  • Aspergers occurs in approximately 3 out of 1000
    children in the United States.
  • The incidence of ASD appears to be increasing
    because of the following reasons
  • There are more and more viable births. Therefore,
    always get a pregnancy, birth, and developmental
    history. This history is hardest to accomplish
    with adoption, especially with foreign adoption.
  • Definitions have become much broader in scope
    than Kanners original description.
  • Effective early screening increases the number of
    children diagnosed.
  • The frequency of ASD diagnosis appears to be
    increasing as more dollars become available for
    treating this diagnosis.

5
Early Screening
  • The American Academy of Pediatrics stresses the
    use of an ALARM in-office approach
  • Autism is prevalent
  • Listen to parents about developmental concerns
  • Act early with the use of screening
  • Refer to appropriate professionals,
    organizations, and programs
  • Monitor incoming information and the child and
    family
  • Children who are cared for in Neonatal Intensive
    Care Units (NICU) are screened and placed in
    Infant and Toddler programs, Early Intervention
    Programs, or Fetal Alcohol and Drug Syndrome
    (FADS) Centers.
  • Child Evaluation Centers (CEC) often screen and
    diagnose children who are referred after the
    first year of life.

6
Early Screening (continued)
  • The following are examples of short form
    screening that can be done in 15-30 minutes with
    some pediatric office help if necessary. These
    tests concentrate on areas such as emotion and
    eye-gaze, communication, gestures, sounds, words,
    understanding and object use.
  • The Communication and Symbolic Behavioral Scales
    Developmental Profile (CSBS DP) are 24 screening
    tools used for ages 6-24 months.
  • Modified Checklist for Autism in Toddlers
    (M-CHAT) is a list of 23 questions for ages 18
    months - 3 and one half years. This test is often
    given at an 18 month Pediatric checkup.
  • Gilliam Autism Rating Scale GARS is a 10 minute
    classroom test for children ages 3-22 given by
    school staff to determine if there are
    stereotyped behaviors, communication lags, social
    interaction lags, and/or developmental
    disturbances.
  • Childhood Autism Rating Scale (CARS) is a 15 item
    20 minute screening for children ages 2 and up.
    It is given by clinician while doing the guardian
    and child interview.
  • ADOS (Autism Diagnostic Observation Scale) is a
    40 minute toddler to adult screening test. The
    clinician can picks up qualitative impairments in
    social interactions and communication. The test
    also finds restrictive, repetitive and
    stereotyped patterns of behavior, interest and
    activity.

7
Diagnostic Assessment
  • General Information is gathered from multiple
    sources.
  • History includes pregnancy, birth, and,
    developmental history and the childs medical
    history.
  • Family medical and psychiatric history are
    important.
  • Screening data including a parent checklist is
    gathered.
  • Physical and neurological exams are completed
    usually by a multidisciplinary team with
    professionals with specialized training in early
    childhood development and ASD.
  • The diagnosis is likely confirmed by a
    Developmental Pediatrician, Pediatric
    Neurologist, or Child Psychiatrist.
  • Evaluation data is gathered from the educational
    system. This includes a speech, hearing, and
    language therapist, occupational and/or physical
    therapist where indicated, and developmental, and
    accurate testing psychologist.
  • The educational data is added to the medical
    evaluations.
  • Ear, Nose, and Throat and geneticist evaluations
    are completed if warranted.
  • Examination for co-occurring conditions are
    always part of the process.
  • Chromosomal studies, metabolic testing for inborn
    errors of metabolism, EEG, and Neuro-imaging
    studies are tests commonly used.

8
Psychological Assessment
  • Other skills are tested such as Academic testing
    by the WAIT, Language development by the Reynell,
    and socio-emotional development by the Achenbach.
  • Adaptive tests are used where verbal skills are
    quite poor. Examples are
  • Vineland Adaptive Behavior Scales (VABS)
  • Scales of Independent Behavior-Revised (SIB-R)
  • Cognitive evaluations can start before age 3. A
    list of commonly used test include
  • Bayley
  • Differential Ability Scales (DAS)
  • Stanford-Binet Intelligence Scales (SBS)
  • Wechsler Scales-(WPPSI) Preschool and Primary
    Scale and (WISC) Scale for Children
  • Varying short form or non-verbal measures
    (TONI)-Test of Non-Verbal Intelligence) that have
    to be adjusted down in scoring

9
Medical Alternative Diagnosis and or
Co-Occurring Disorders with ASD
  • Hearing Loss or Congenital Deafness
  • Lead or Heavy Metal Toxicity or Toxin Poisoning
    like (FADS) Fetal Alcohol and Drug Syndrome
    influence
  • Epilepsy including special syndromes such as
    Tuberous Sclerosis or Landau Kleffner Syndrome
  • Chromosomal Abnormalities such as Fragile X or
    Chromosome 15 abnormalities
  • Central Nervous System (CNS) Physical Abuse
    Damage
  • Other Intra-uterine or neonatal CNS Damage

10
Psychiatric Alternative Disorders or
Co-Occurring Disorders with ASD
  • Mental retardation occurs up to 75 of the time
    with Autism (299). This percentage does not
    include Aspergers or PDD NOS (299.80) diagnosis.
  • Obsessive-Compulsive Disorder (OCD) In ASD the
    symptoms is not bothersome to the children
    themselves, it may bother the parent, sibling,
    peer, aide, or teacher.
  • Tourettes or Tic Disorder
  • Elimination Disorders wetting or soiling
  • Mood Disorders
  • Anxiety Disorder other than Social Anxiety
  • Schizophrenia This diagnosis is included when
    hallucinations and or delusions are prominent for
    over one month
  • PTSD

11
Psychiatric Disorders Not Co-Occurring with ASD
  • ADHD - This is seen as very controversial in the
    medical, neurological, and psychiatric
    communities.
  • Personality Disorder Avoidant, Schizoid and
    Schizotypal Type - ASD has an earlier onset with
    more severity of symptoms
  • Communications Disorders on Axis II - The social
    features of ASD arent present
  • Reactive Attachment Disorder (RAD) - This
    diagnosis occurs with early and severe abuse and
    neglect. RAD improves with consistent care giving
    and ASD may not.
  • Selective Mutism
  • Stereotypic Movement Disorder
  • Intermittent Explosive Disorder - Other forms of
    aggression associated with ASD must be looked at
    first. This is seen as very controversial in the
    medical, neurological, and psychiatric
    communities.

12
The Possible Strengths of an ASD Child
  • Understanding of concrete concepts
  • Memorization of rote material quickly and easily
  • Recall of visual images and memories easily
  • Visual Thinking
  • Learning discrete chunks of information rapidly
  • Hyperlexic decoding written language at an early
    age
  • Long term memorization capability
  • Understanding and using concrete rules and
    sequences
  • Approaching tasks perfectionistically
  • Being precise and detail oriented
  • Maintaining a schedule
  • Being honest even to a fault
  • Extreme focusing on a task others may not
    perceive as pleasurable
  • Being charming with innocence and without
    deviousness
  • Having an excellent sense of direction
  • Being compliant to poorly understood instructions

13
Care and Case Management
  • Care and case management are extremely important
    because they can provide movement to the correct
    care venues as soon as possible. This can
    prevent secondary effects of delayed language
    development, delayed social development,
    co-occurring pediatric, neurological, and child
    psychiatric conditions.
  • The first possible step usually occurs in NICU,
    where the child and family are often directed to
    Early Intervention Services.
  • The next likely step occurs in a Pediatric Office
    (well baby visit, or crisis visit). Initial care
    and case management is initiated in the doctors
    office.
  • The next step depends on the complexity of the
    child, the age of diagnosis, the comfort of the
    childs Pediatrician and the level of
    specialization of the area or state the child
    and family are in. These are possible next step
    referrals.
  • Developmental Pediatrics Office with possible
    care management
  • Pediatric Neurology office
  • Child Psychiatry office

14
Care and Case Management (continued)
  • ASD referrals to school systems follow the law
    described in the Individuals with Disabilities
    Education Act (IDEA). This special education law
    is divided into three major venues Early
    Intervention ages 0-3, Preschool disability ages
    3-5 and Special Education ages 5 through 21. The
    management of the psychological , speech and
    language, occupational therapy and physical
    therapy workup can be evaluated and assigned as
    needed in all three venues.
  • The obstacle is ages 0-3 where the state has the
    choice of which agency handles the Early
    Intervention Programs and the servicing of it.
    States can initiate it through the department of
    education, the department of health, the division
    of retardation or developmental disability or
    even a behavioral health division.
  • An Early Intervention Program EAP manager can
    wind up in a case or care management role or a
    screening role for a family. They have to sort
    out where to start and to make sure follow-up
    takes place. Much of the coverage may not be
    linked to the employees mental health plan. An
    EAP needs to create medical and educational
    linkage. They also may be asked by many parents
    difficult to answer questions about diagnosis,
    treatment qualifications, treatment approaches,
    progress measures and times that treatment should
    be in place. An EAP needs to stay current to
    answer these questions or refer them to the
    personnel in the treatment team that can.

15
ASD Treatments Often Discussed and Current
Evidence, Efficacy, and Risks
Intervention Evidence Basis Risks Reported Lead Professional Comments
Applied Behavioral Analysis (ABA) Controversial and non-replicable Overuse high financial risk extended timeframes and non-delineated ages Special Education/Psychologist Requires a coordinated team, a trained parent, and a credentialed ABA Therapist better than traditional psychotherapy for changing abnormal, maladaptive behaviors
Chelation None Significant MD Mostly Testimonial
Intravenous Immunoglobulin None Significant MD Mostly Testimonial
Dimethyl glycine None unclear MD or nutritionist Mostly Testimonial
B6-Magnesium None unclear MD or nutritionist Some attempts at controls
Casein and gluten-free diet None Can make dietary OCD even worse MD or nutritionist The wrong child can get worse
Secretin Enzyme None GI Problems MD or nutritionist
Cranio-sacral Therapy None Can cause spinal complications with incorrect manipulation Chiropractor
Speech and Language Therapies including Auditory and Sensory integration, Sign Language None alone None reported Speech and Language Therapists May be useful as ancillary treatment approaches
16
Effectiveness of Medications Prescribed for ASD
Symptom Relief. All Medication Treatment
Approaches Should be Low dose and Slow
Type of Medications Stimulants Alpha Adenergics SSRIs Remeron Anti-Convulsant Mood Stabilizers Glutamatergics Neurolepic-Haldol Atypical Antipsychotics Risperdol only one approved by FDA for ASD use
Target Systems
Hyperactivity and impulsivity Possibly Effective Possibly Effective Occasionally Effective
Explosivity Aggressivity and Poor Conduct Control Occasionally Effective Occasionally Effective Possibly Effective
Perseveration, Compulsive Behavior and Stereotypic Behavior Occasionally Effective Possibly Effective
Psychotic Thinking Occasionally Effective Occasionally Effective
Social Isolation Occasionally Effective Occasionally Effective
Anxiety, Depression and Self Injury Possibly Effective Occasionally Effective Occasionally Effective
Irritability and mood instability Occasionally Effective Possibly Effective
Sleeplessness Occasionally Effective Occasionally Effective
17
Side Effects Profile for Different ASD
Medications
Stimulants Alpha Adenergics SSRIs Remeron Anti- Convulsant Mood Stabilizers Glutamatergics Neurolepic- Haldol Atypical Anti- Psychotics-Risperdol only one approved by FDA for ASD use
Side Effects
Agitation and Hypomania Mild Moderate
Suicidal Thoughts Mild
Sedation Moderate Mild Mild
Weight Gain Mild Mild Mild Significant
Increase Prolactin Effect Mild
EPS Severe Mild
Higher Sugar and Lipid Profile Moderate
Moodiness Moderate
Irritability Moderate
Tics Mild
Poor Appetie Moderate
Poor Sleep Moderate
Changed Pulse Rapid Slowed
Arrhythmia Mid Mild
18
NJ-ASD Slides (18-25) ASD in Children Enrolled
in New Jerseys Behavioral Health System of Care
(n215)
Average Age 11.7 years Children 13 and under
61
Gender Distribution within entire NJ System of
Care population Male 63, Female 37
19
ASD in Children Enrolled in New Jerseys
Behavioral Health System of Care (n215) cont
Average IQ 59 71 of sample had an IQ below 70
and are therefore Mentally Retarded (MR)
20
Challenges and Complexities

Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215) Challenges found on Assessment Tool Chart History (n215)
Developmental Disabilities Developmental Disabilities Developmental Disabilities Developmental Disabilities Developmental Disabilities Developmental Disabilities 215 100
Special Education Special Education Special Education Special Education Special Education Special Education 213 99
Neurological Factors Neurological Factors Neurological Factors Neurological Factors Neurological Factors Neurological Factors 202 94
Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical 185 86
Mental Health Mental Health Mental Health Mental Health Mental Health Mental Health 180 84
Psychotropic Meds Psychotropic Meds Psychotropic Meds Psychotropic Meds Psychotropic Meds Psychotropic Meds 157 73
Questionable Best Practice Meds by way of Texas Algorithms Questionable Best Practice Meds by way of Texas Algorithms Questionable Best Practice Meds by way of Texas Algorithms Questionable Best Practice Meds by way of Texas Algorithms Questionable Best Practice Meds by way of Texas Algorithms Questionable Best Practice Meds by way of Texas Algorithms 157 73
Biological, Adoptive, Relative, Foster Parent or Guardian Abuse, Neglect, Medical Disorder, Psychiatric Disorder, Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or Guardian Abuse, Neglect, Medical Disorder, Psychiatric Disorder, Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or Guardian Abuse, Neglect, Medical Disorder, Psychiatric Disorder, Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or Guardian Abuse, Neglect, Medical Disorder, Psychiatric Disorder, Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or Guardian Abuse, Neglect, Medical Disorder, Psychiatric Disorder, Developmental Disorder or Criminality Biological, Adoptive, Relative, Foster Parent or Guardian Abuse, Neglect, Medical Disorder, Psychiatric Disorder, Developmental Disorder or Criminality 118 55
Reaction to Trauma Reaction to Trauma Reaction to Trauma Reaction to Trauma Reaction to Trauma Reaction to Trauma 112 52
Protective Services Protective Services Protective Services Protective Services Protective Services Protective Services 105 49
Delinquency Delinquency Delinquency Delinquency Delinquency Delinquency 31 14
Substance Abuse Substance Abuse Substance Abuse Substance Abuse Substance Abuse Substance Abuse 3 1

21
Challenges and Complexities (continued)

Dangerousness Breakdown (n215) Dangerousness Breakdown (n215) Dangerousness Breakdown (n215) Dangerousness Breakdown (n215) Dangerousness Breakdown (n215) Dangerousness Breakdown (n215)
Dangerousness within study population Dangerousness within study population Dangerousness within study population Dangerousness within study population Dangerousness within study population Dangerousness within study population 163 76
Sub-Categories of Dangerousness Sub-Categories of Dangerousness Sub-Categories of Dangerousness Sub-Categories of Dangerousness Sub-Categories of Dangerousness Sub-Categories of Dangerousness    
Danger to Others Danger to Others Danger to Others Danger to Others Danger to Others Danger to Others 103 63
Self-Mutilation Self-Mutilation Self-Mutilation Self-Mutilation Self-Mutilation Self-Mutilation 41 25
Suicidal Suicidal Suicidal Suicidal Suicidal Suicidal 39 19
Sexual Aggression Sexual Aggression Sexual Aggression Sexual Aggression Sexual Aggression Sexual Aggression 20 12
Firesetting Firesetting Firesetting Firesetting Firesetting Firesetting 13 8

22
Medical Features (despite incomplete histories)

Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children Medical Features of the 215 Children
Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical Fragile Medical 184 86
Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use Speech delayed (age 3), deafness, language board use 78 36
Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome Fetal Alcohol Drug Syndrome 36 17
Seizures (all types) Seizures (all types) Seizures (all types) Seizures (all types) Seizures (all types) Seizures (all types) Seizures (all types) 36 17
Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) Motor Delay (age 5) 32 15
NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) NICU of one or more months or prematurity (35 or less weeks gestation) 22 10
Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea Respiratory Distress - Low APGAR w/cord strangulation or need for oxygen respirator or tracheotomy in the newborn period, or sleep apnea 19 9
Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system Spina Bifida, Movement disorders, Tic disorders, CP, or hypotonia of nervous system 17 8
Asthma Asthma Asthma Asthma Asthma Asthma Asthma 14 7
Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) Chromosome Abnormalities or Severe Case syndromes) 16 7
Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes Congenital heart or heart rhythm disease with or without surgery or strokes 10 5
Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years Physical Trauma Pre-birth or Massive injury in the first 2 years 11 5
Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) Metabolic Problems (Thyroid - Diabetes other) 11 5
Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) Eye Surgeries (Abnormalities or retinopathy) 9 4
Obesity Obesity Obesity Obesity Obesity Obesity Obesity 6 3

23
Family Features

Family Features of the 215 Children Family Features of the 215 Children Family Features of the 215 Children Family Features of the 215 Children Family Features of the 215 Children
Percentage of Families with documented features Percentage of Families with documented features Percentage of Families with documented features Percentage of Families with documented features Percentage of Families with documented features 119 55
Physical and/or Sexual Abuse or Neglect Physical and/or Sexual Abuse or Neglect Physical and/or Sexual Abuse or Neglect Physical and/or Sexual Abuse or Neglect Physical and/or Sexual Abuse or Neglect 44 20
Psychiatric Features Psychiatric Features Psychiatric Features Psychiatric Features Psychiatric Features 35 16
Substance Abuse Features Substance Abuse Features Substance Abuse Features Substance Abuse Features Substance Abuse Features 33 15
Physical Illness Features Physical Illness Features Physical Illness Features Physical Illness Features Physical Illness Features 25 12
Chronic Stress (Exhaustion) Features Chronic Stress (Exhaustion) Features Chronic Stress (Exhaustion) Features Chronic Stress (Exhaustion) Features Chronic Stress (Exhaustion) Features 20 9
Retardation Features Retardation Features Retardation Features Retardation Features Retardation Features 14 7
Severe Separation or Divorce Conflict Severe Separation or Divorce Conflict Severe Separation or Divorce Conflict Severe Separation or Divorce Conflict Severe Separation or Divorce Conflict 10 5
Criminal Features Criminal Features Criminal Features Criminal Features Criminal Features 8 4

24
ASD in Children Enrolled in New Jerseys
Behavioral Health System of Care (n215) cont
Referral Source Breakout
Due to the complexity of cases the average time
for key parties to decide services and level of
care or placement is 23hrs
Family Juvenile Court -1
Dept of Children Families -44
Dept of Developmental Disabilities 8
Protective Services (DYFS) 18
DCBHS Administration 1
DCBHS Case Management
Organizations 24
DCBHS Mobile Response 1
25
Hard to Place ASD Children
  • In state placement may not be possible because of
    the combination of special needs. At one time 49
    ASD children or 23 of total (215) were placed
    out of state.
  • The problem of Sexual Aggression often leads to
    Out of State Placement. Fourteen ASD children or
    7 of the total (215) had this dangerous problem.
    The same 14 children made up 29 of the ASD Out
    of State population (49).
  • Out of state placements can create special needs
    in visitation, state expenses and state staff
    supervision.

26
ASD Summary and Conclusion
  • Early childhood onset
  • Chronic, extensive, pervasive neurologic
    disorders
  • Inclusive of more than one developmental domain
  • Conditions often exist on Axis I, II, and III
  • Diagnoses are rarely precise
  • The evaluation, diagnosis and treatment are
    COMPLEX
  • Child psychiatrists and mental health
    professionals are often involved after Pediatric,
    Developmental Pediatric, and Pediatric
    Neurological professionals
  • Much of the intervention is conducted in
    educational settings

27
ASD Summary and Conclusion (continued)
  • Cost of treatment is high. The funding is complex
    and often involves federal early screening,
    diagnosis, and treatment funds special education
    (including speech, occupational and physical
    therapy) funds Medicaid Medicaid Waiver funds
    Medicare funds and private insurance funds where
    applicable.
  • Individual and adjustable treatment planning is
    important because of growth potential and changes
    in treatment course. The latter includes
    vocational training when needed.
  • A mature integrated system of care works best for
    an ASD child.
  • Continued and expanded research is needed in ASD
    because of its confusing and complex nature. The
    federal government through the 2006 Combating
    Autism Act (CAA) has created a special Road Map
    for ASD to gather all the different initiatives,
    and research proposals in all federal departments
    and agencies involved through the Inter-Agency
    Autism Committee. This committee will make a
    yearly report to Congress on gains in the field
    of Autism.

28
General References
  • Summary of best practices and policy
    recommendations from NIMH Subcommittee
    http//www.nimh.nih.gov/autismiacc/summary.pdf
  • Autism and Hope, Symposium at the Brookings
    Institute, December 14, 2005
    http//www.brookings.edu/comm/events/20051216autis
    m.htmTRANSCRIPT
  • Dawson, G, Watling, R. (2000) Interventions to
    facilitate auditory, visual, and motor
    integration in Autism A review of the evidence.
    Journal of Autism and Developmental Disabilities,
    30 No.5 415-422
  • Filipek, P.A. et.al. (1999) The screening and
    diagnosis of autistic spectrum disorders. Journal
    of Autism and Developmental Disorders, 29,
    439-484
  • Herbert, J. D. , Sharp, I. R. , Guadiano, B. A.
    (2002) Separating fact from fiction in the
    etiology and treatment of Autism A scientific
    review of the evidence. The Scientific Review of
    Mental Health Practice
  •  Lovaas, O. I. (1987) Behavioral Treatment and
    Normal education and intellectual functioning in
    young autistic children. Journal of Consulting
    and Clinical Psychology 155, 3-9
  • Posey, D. J, McDougle C. J, Autism A three-step
    practical approach to making the diagnosis
    Current Psychiatry Vol. 1, No. 7, July 2002,
    20-28
  • Smith, T. , Groen, A. D. , Wynn ,J. W. (2000)
    randomized trial of intensive intervention for
    children with pervasive developmental disorder.
    American Journal of Mental Retardation
    105,285-296 . Erratumin Americal Journal of
    Mental Retardation, 105,508 and 106, 208.
  • Smith, T. ,Lovaas, N. W. ,Lovaas O. I. (2002)
    Behaviors of children with high- functioning
    autism when paired with typically developing
    versus delayed peers. Behavioral Interventions
    17, 129-143
  • The National Autistic Society. Diagnostic
    options a guide for health professionals
    www.nas.org.uk/nas/jsp/polopoly.jsp?d306a3280
  • Aspergers Disorder links http//www.disabilityr
    esources.org/ASPERGERS.html

29
Resources for Families
  • Resources are also available through the Center
    for Disease Control National Center for Birth
    Defects and Developmental Disabilities, 1-800 -
    CDC-INFO and online at www.cdc.gov/ncbddd/autism/
    actearly/
  • Local resources can also be found by contacting
    the Autism Society of America (ASA) at 1 -800
    -3AUTISM or online at www.autism-society.org.
  • To locate the appropriate resource in specific
    states, parents can call 1-800-695-0285 or log on
    to the National Dissemination Center for Children
    with Disabilities at www.nichcy.org/
  • American Academy of Pediatrics
    http//www.keepkidshealthy.com/welcome/conditions/
    autism.html
  • National Institutes of Mental Health
    http//www.nimh.nih.gov/publicat/autism.cfm
  • Reaching for a Brighter Future Service
    Guidelines for Individuals with Autism Spectrum
    Disorders/Pervasive Developmental Disorders
    (ASD/PDD) http//www.psychmed.osu.edu/AutismBook_
    1.pdf
  • Autism Society http//www.autism-society.org
  • Learn the Signs developmental milestones
    http//www.cdc.gov/ncbddd/autism/actearly/default.
    htm
  • Autism Research Institute http//www.autismwebsi
    te.com/ARI/index.htm
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