Title: Autism Spectrum Disorders: Diagnosis & Treatment
1Autism 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
2What 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.
3What 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
4What 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.
5What 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.
6What 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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7What 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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8Neurodevelopmental Impairments and School
Performance
- Sensory integration difficulties
- Specific learning disabilities
- Behavioral excesses or deficits
- Impairments in social cognition
9Anova 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
10Treatment 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
11Teaching 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.
12Pediatric 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
13Occupational Therapy Behavior
- Defensiveness
- Outbursts
- Self-injury
- Avoidance responses
- Hypervigilance
- Modulation problems
- Distractibility
- Self-stimulation
- Difficulty with transitions
- Shutting down
14Occupational 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
15Occupational 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.
16Occupational 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.
17Occupational Therapy Clinic
- Specialized swings and suspension hooks
- Ball pools
- Scooterboard ramp
- Foam crash pits
- Weighted vests, blankets and gloves
- Theraballs
- Adjustable lighting and music
18Social 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.
19Social 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
20Social 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.
21Social 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.