Designing care for Adults with Autism

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Designing care for Adults with Autism

• Peter Carpenter

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Designing care
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What is autism

• Breakdown of processing within the brain
• Poor cross lateral communication
• Problems with higher abstraction of underlying
  pattern
• High comorbidity

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Style

• Short term work to keep person calm and safe
• Longer term work to develop person and skills

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Core Autism

• Processing difficulty -

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Core autism

• Staff training do they know? What understanding
  do they have.
• What ability level is person at
• What interests the person what is the handle.

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Core autism

• Capacity
• Understanding future consequences
• Weighing in the balance
• Environment
• not too stimulating (unless of benefit)
• Safety
• Awareness of danger
• Safety to others

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Core autism routine/choice

• Routines predictabilty
• Is it needed
• How far ahead can person work/cope with
• Do they need warning
• Does warning improve mental state or worsen
• How do we communicate future events?
• Visual Diary??
• Choice
• How much are we giving and how can they cope

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Core Autism communication

• What level of communication is person at?
• objects of reference
• pictures
• 1-2 key words
• Telegrammatic speech phrases
• Full speech
• Understanding and expression
• Do the staff understand this
• How do we develop communication

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Core autism - interaction

• How do they view people (and do staff realise)
• Objects of disturbance how to be fun
• Tools satisfy interests start to work with
  them
• Entertainment develop other entertainment,
• Companion or lover develop skills and
  understanding. May need befriender
• How keen to pass as normal
• If skills are good enough, may be held back by
  being in home for pwa

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Core autism - interaction

• Options approach (with ABA/LOVAAS in background)
• Intensive interaction
• Allowing person to lead interaction
• Working on their terms
• Enabling them to develop
• Enabling them to see people as useful and
  interactive (and mindful)

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Core autism - education

• Core to development
• Educational targets may not be conventional eg
  to get on with people
• Feedback to person day-to-day development of
  sense of self
• Development of basic life skills.
• Counselling for more able

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Comorbidity

• Sensory integration disorder
• Motor coherence catatonia
• ADHD
• Tourette
• Mood instability
• Anxiety
• Obsessions

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Sensory Integration disorder

• Can occur in other conditions (and alone)
• Can produce massive handicap and extreme
  reactions
• Isolation
• Intolerance of clothes, shower, etc
• Clumsiness

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Sensory Integration disorder

• Sound
• Touch
• Taste/smell/texture
• Proprioception limb position sense
• Vestibular
• light

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Sensory Integration disorder

• Environmental adaptation
• A stress free environment
• Sensory integration work (OT)
• Gentle exposure and development

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Motor coherence

• Problems in producing movement
• Initiating
• Freezing mid action
• Coordination dyspraxia (with proprioception)
• Stress free
• Rhythm to life
• Prompts to be worked out for person
• Full stupor treat as catatonia psychiatric
  intervention
• Check not having serotinergic crisis or
  neuroleptic malignant syndrome

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ADHD

• Common
• Developmental level?
• Lack of need to contain self?
• Can be exhausting to staff
• May need to gear in changes
• Chaos and lack of routine
• May not thank you for imposing it.
• Impulsiveness

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ADHD

• Recognise problem
• Short attention span
• Easily bored
• Shorter activities
• Boundaries
• ?medication

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Tourette

• Multiple vocal and motor tics
• Classically Build up with Tension release
• Differential diagnosis self stimulation and
  OCD.
• Can be associated with OCD and ADHD as well
  when more aggression
• In autism I think often with explosive
  aggression.

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Tourette

• Medication
• Risperidone
• Haloperidol
• Behaviour modification

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Mood instability

• Moment to moment
• ?lack of self awareness
• Major mood swings
• Awareness
• Mood stabiliser medication
• Valproate
• Carbamazepine
• Treat major mood swings conventionally
• Self development

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Anxiety

• World is an unpredictable place.
• Can be very difficult to treat pharmacologically
• SSRI, Benzo, Risperidone etc
• Environment is the key

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OCD

• When is it OCD and when interest or stimulation
• When it is interfering or stressing person
• Treat anxiety
• Control