Autism Spectrum Disorders: Diagnosis & Treatment

1. 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

2. 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.

3. 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 changes…when 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

4. 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.

5. 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 lifetime…a 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.

6. 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.

7. 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)

8. Neurodevelopmental Impairments and School Performance • Sensory integration difficulties • Specific learning disabilities • Behavioral excesses or deficits • Impairments in social cognition

9. 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

10. 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

11. 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.

12. 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

13. Defensiveness Outbursts Self-injury Avoidance responses Hypervigilance Modulation problems Distractibility Self-stimulation Difficulty with transitions Shutting down Occupational Therapy & Behavior

14. 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 Occupational Therapy & Behavior

15. 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.

16. 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.

17. 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

18. 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.

19. 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

20. Intra-personal abilities include: an individual’s 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. Social Cognition Abilities

21. 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.