Intro to Autism

Intro to Autism

Intro to Autism

  • Introduction to Autism Treatment by
  • Gary M. Eisenberg, Ph.D.
  • 609 W. Littleton Blvd, Suite 307
  •  Littleton, CO
  • 303 808 4140

 

  • Autism  5 defined (DSM)

A. Deficits in Social  Communication and Social Interaction ..need 1, 2 and 3 to qualify

  1. Deficits in social-emotional reciprocity

  2. Deficits in nonverbal communication for social interaction     e.g. eye contact/body lang.

 3. Deficits in maintaining relationships at appropriate developmental level

B: Restricted Repetitive Behavior patterns:

   Need one of these four: 1.Speech   2.routines/ precoccupations  3. fixations 4. hypo or hyper reactive to sensory input

  • High Functioning Autism detected later
  • C. Symptoms must be present in the early developmental period ( but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)

 

  • Grandfathering in of Asperger’s and PDD
  • Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or Pervasive Developmental Disorder should be given the diagnosis of Autism Spectrum Disorder.

 

 

  • DSM-5 ASD recording nuances
  • Diagnosis allows symptoms to be current or
  •  “by history”
  • Severity: Levels 1, 2 or 3
  • With or without intellectual impairment
  • With or without language impairment

 

 

  • Social (Pragmatic) Communication Disorder..new nonspectrum diagnosis

Persistent difficulty with verbal and nonverbal communication that cannot be explained by low cognitive ability. Symptoms include difficulty in the acquisition and use of spoken and written language as well as problems with inappropriate responses in conversation.

Might be former PDD-NOS patients

 

 

  • The New Childhood Epidemic
  • CDC March 2012 data…1 in 68
  • boys (1 in 42) …….girls (1 in 189)
  • Average age of diagnosis 4 ½ to 4.
  • Alabama lower rate due to its rural nature and limited services  (1 in 176)
  • New Jersey higher (1 in 46)
  • ASD Lifetime Cost w/ intellectual impairment $2.4 M
  • Without intellectual impairment –  $1.4 million
  •  (JAMA Pediatrics, 2014)

 

 

  • And How about our Neighbors ?
  • Canada 1 in 94 (2010) was 1 in 166 in 2006
  • England 1 in 84
  • Japan 1 in 84
  • France 1 in 150 (2012)
  • South Korea 1 in 38 (2011)
  • India  1 in 66  (2013)

 

 

 

  • GENETICS OF AUTISM
  • Identical twins more likely to both be autistic than fraternal twins
  • Siblings have a 4-6% increased risk: autism is more likely to occur twice in the same family than would be expected by chance (Geshwind, 2004)
  • Family members may have lesser form of autistic-like symptoms

 

 

  • EARLY SIGNS OF AUTISM
    firstsigns.org
  • SOCIAL DEVELOPMENT DELAYS

PREDATE LANGUAGE DELAYS

Poor eye contact

Reduced responsive smiling

Diminished babbling

Reduced social responsivity

Difficulty with play and sustaining

social interaction

Study published 6/1/06 @ Kennedy Krieger Inst CARD, Balto, MD

 

 

  • Best Assessments for Autism
  • ADOS 2– Autistic Diagnostic Observation Schedule
  • CHAT – Checklist for Autism in Toddlers
  • 9 Parent Questions, 5 Interaction items
  • Modified –CHAT  (M-CHAT) (0 – 3 years)
  • Autism Spectrum Quotient –Child version( 4 – 11)
  •   Bonnie  Auyeung   120
  • Social Responsiveness Scale (SRS)

 

 

 

  • 2 factors predict the speed and degree of improvement in Autism
  • I.Q.  = speed of train (brighter children      learn faster)
  • Atypicality = degree train Is off track

 

 

  • Applied Behavioral Analysis
  • We manipulate reinforcers to increase functional and adaptive behaviors and decrease challenging behaviors.  We reinforce the good and remove reinforcer for dysfunctional behavior
  • Research shows a significant rise in IQ and Vineland Maturity Scores    1.
  • Discrete trial training (DTT) is a form of ABA generally implemented one-on-one in a distraction-free setting

 

  • HANDLING TANTRUMS
  •  Parents should have a Nonverbal and negligible reaction to bad behavior
  • Calmness in face of noncompliant behavior
  • No verbal explanations while tantruming
  • Reasons for tantrums…Escape 34%, Attention 25%,
  • Sensory 15%,   Protest 22%.  Hawley, Jrnl ABA, 2003

 

 

 

 

  • Managing Meltdowns
    Deborah Lipsky and Dr. Will Richards
  • Meltdowns are involuntary and likely due to: sensory overload, novel situations, sudden change, demands, waiting, threats to self-image, unmet need for attention

 

  • Examples:  not understanding reasons for change, surprises, too many choices, given vague task
  • Do:
  • Reduce level of sensory stimulation by reducing surrounding activity, noise level and maintaining calmness
  • Provide consistent slow declarative statements using child’s name.
  • Allow their preoccupations since it is a coping strategy

 

 

  • Avoid confrontations when the child is tired or hungry
  • Teach skills to handle sensory overload
  • Do not present ambivalent questions such as
  • Are you OK?
  • Asking the child what he/she wants to do

 

 

 

 

 

  • Creating a Calm Down Corner
    Does your child benefit from:
  • Physical activity
  • Music
  • Artistic play
  • Fine motor play
  • Sensory Play
  • Try a stressball, counting to 10, roller pin  breathing and pulling band

Alternative Medicine for Autism

Physicians    groups:

  • Autism Research Institute (ARI) formerly called  Defeat Autism Now (DAN)
  • Known for the BIOMEDICAL MODEL
  • AUTISM.com  Autismone.org
  • CAIM (Complementary and Integrative Medicine) e.g. American College of Advanced Medicine—for Adults

 

 

  • AUTISM IS A GUT DISORDER
  • Gastrointestinal evidence includes:
  • 80% w/ GI symptoms vs 34% controls
  • Pediatrics 2006 Oct; 118(4) and Pediatrics 2007 Nov; 120 (5) n
  • Diet- cravings
  • Stool-constipation, diarrhea, encopresis
  • More allergies
  •  Lower diversity of gut microbes or bacterial flora correlated with ASD

Journal PLOS ONE, Jul 5, 2013,   Rosa Krajmalnik-Brown, Arizona State University

 

 

  • Environmental agents known to  cause ASD and learning disabilities
  • Organochlorine and Organophosphate pesticides  n

effect include neurotoxcity, personality and fetal damage….killing nerve cells and disrupt endocrine

  • Valproic Acid (Depakote)
  • Acetaminophen (Tylenol) Discouraged in Pregnancy and babies at risk for ASD/ADHD ( Decreases ASD childs ability to detoxify) Wm. Shaw, Journal of Restorative Medicine,’13
  • Flame Retardants  (disrupt thyroid function)
  • Mercury
  • Lead
  • Diesel exhaust

 

 

  • GLUTATHIONE
  • Conjugates and detoxifies not just heavy metals but also chemical toxins .
  • An antioxidant
  • Lower Levels in Autistic Child
  • Helps Gastrointestinal integrity
  • Supports Immune Function
  • JULY, 2015 Nature magazine and the University of Virginia announce that a lymphatic system has been found  in the brain i.e ASD=weakened immune system which might directly affect brain development including inflammation.

 

  • Gene Deletions can be inherited or  result of Oxidative Stress
  • GSTM1—increased susceptibility to mercury  GSTM– vulnerable to Arsenic
  • MTHFR– less glutathione
  • ALAD-increased susceptibility to lead
  • PON-1- susceptibility to pesticide toxicity,
  • Chromosome 16 deletion affecting 27 genes causing ASD behaviors
  • MOST Gene Deletions related to Autism on Chromosomes 16 and 17

 

 

 

 

 

  • CONCEPT
  • AUTISTIC SPECTRUM DISORDERS  are neurological, immune system and GI expressions of the impact of environmental toxins on genetically susceptible individuals.
  • GI abnormalities ultimately play a role in adversely affecting brain areas which control socialization, language skills, and flexible response patterns.

 

 

 

 

  • Environmentally-Friendly sites
  • http://healthychild.org/
  • SOKHOP.com
  • healthytoys.org and healthystuff.org (see CIASS)

StocktonFP.com by Dr. Stuart Freedenfeld M.D.

  • Click Educational Material, then Resources Guide(s)
  • http://themindfulhome.blogspot.com
  • Click on non-toxic baby gear and household

 

  • Detoxify your Living Space
  • Location…check whether you’re near a toxic dump site, downwind from a chemical plant, petroleum refinery or coal-fired plant or live within 300 yards of an interstate or airport  124
  • Test Your tap water and consider buying a filtration system…See Healthychild.org
  • Flooring..Natural Wood and Ceramic tile OR Cotton or Wool based are BEST
  • Use HEPA vacuum cleaner
  • Management of GI symptoms by removing the bad, adding good
  • Refer to Pediatrician, GI Specialist or Nutritionist familiar with autism…Parent must be aggressive

 

  • Probiotics
  • Because antibiotics reduce good bacteria
  • Yeast fills in the space left by good bacteria and correlated with cognitive sluggishness
  • (70% antibiotic Rx not necessary including those for ear infections) David Berger MD. ARI Conf, 2011.
  • Bifidus or  Acidophilis or Lactobacillus
  • Pediatric references supporting Probiotic use after antibiotics

Systematic review of 9 placebo-controlled studies (2 in children) using various products: 60% reduction in incidence and duration of antibiotic associated diarrhea compared with placebo (P<0.01) 2002

 

Johnston BC. Cochrane Database Syst Rev, 2007

D’Souza et al. BMJ, 2002

 

Recommend 2-4 weeks of probiotics for all kids who receive an antibiotic prescription.

 

  • Multivitamin Companies
  • Kirkman’s Super Nu Thera
  • www.kirkmanlabs.com/
  • 50% ASD improve in sleep and GI function
  • Klaire Labs – Vitaspectrum           capsules/powder

 

  • Yoga –good alternative Rx for Autism

 

 

  • NUTRITION PROTECTS US
  • Food when digested becomes food proteins and amino acids which become Neurotransmitters.  Many ASD deficient in protein.
  • Minerals and vitamins are catalysts in the above process
  • Water is the transport system
  • Neurotransmitters start in the gut.

 

  •             ASD DIETS
  • Gluten-Free Caesin-Free: carbs/milk

 

  • Food Elimination: food sensitivities

 

  • Diets compensate for body’s inability to process a food’s ingredients or food proteins

 

 

  • Specific Food Reaction Diet
    Can have immediate or delayed effect
  • Or anti-allergy diet or elimination diet
  • 1. wheat      7. chocolate
  • 2. dairy        8. yeast
  • 3. eggs        9. tree nuts
  • 4  peanuts   10. fish and shellfish
  • 5. corn  11. Citrus  12.  Tomatoes
  • 6. soy   13. Aspartane, MSG  14. Vinegar
  •         15.  Strawberries                              n
  • EWG’s Clean Fifteen and Dirty Dozen, 2014
  •  Avocados were the cleanest, with only 1 percent of samples showing any detectable pesticides. Other items on the list include corn, pineapples, cabbage, frozen sweet peas, onions, asparagus, mangoes, papayas, kiwi, eggplant, grapefruit, cantaloupe, cauliflower and sweet potatoes.
  • Dirty…Apples, strawberries, grapes, celery, peaches, spinach, sweet bell peppers, imported nectarines, cucumbers, cherry tomatoes, potatoes and imported snap peas

 

  • USDA Organic: uncaged and outdoor access, fed all-organic all vegetarian, not antibiotics and no pesticides
  • Uncertified: Cage-Free, Free-Range
  • Meaningless:  Hormone-Free..it’s illegal anyway for hens to be fed hormones
  • “Natural” means absolutely nothing

 

 

  • The Yardstick of Symptom improvement…look for improvements in…

 

  • 1. language  2. bowel  3. mood  4. hyperactivity

5. skin  6. cognition  7. fatigue        8. interpersonal connectedness

 

Keep a food diary

Do a Food Challenge

 

 

  • Common Sense Autism Care
  • Add fruit and vegetables to diet
  • Reduce soda* and sugar (30g/day)
  • Avoid anything fried, transfats and buy organic
  •  Balance Protein/fats/carbs
  • Consume water
  • Omega 3s and 6s
  • Obese Children – weaker executive function, weaker working memory, mental flexibility and decision making plus lower academics (Jrnl of Obesity, 2014)
  • Amer Jrnl of Public Health, June 2014..Less than 50% of children not drinking enough water
  • Diet Tricks and Tips
  • Chinese or Indian ethnic food maybe GFCF
  • Gelatin helps digestion
  • Sometimes or often the whole family eats   the diet food
  • Slow introduction of the diet
  • Keep a diary

Preparing for Pregnancy is not just a romantic night…the next information is on preconception health

  • Obviously no smoking and little alcohol
  • Increase whole grains, vegetable, fruits, nuts and lean sources of protein
  • Eliminate white breads including pasta and pizza
  • Treat conditions: yeast overgrowth. GI/digestion
  • Take calcium, omega 3’s, folic acid, vitamin C
  • B12, B6, CoQ10, Opti_Natal, D (40-70ng/ml with K2)
  • Exercise, eat 2 servings of seafood per week.
  • Green cleaning and personal care products*                    Green This; Deirdre Imus

 

 

  • MEDICATIONS used to treat Autism

 

  • ANTIDEPRESSANTS

 

  • ATYPTICAL ANTIPSYCHOTICS

 

  • STIMULANTS

 

 

  • Antidepressants
  • Most frequently used
  • Increase Serotonin
  • Reduce repetitive thoughts
  • Reduce anxious behavior
  • LUVOX
  • LEXAPRO
  • ZOLOFT

 

  • ATYPICAL ANTIPSYCHOTICS
  • FOR UNMANAGEBLE CHILD
  • DO RISKS OUTWEIGH GAINS?
  • Weight gain and sedation
  • Reduce aggression, hyperactivity, irritability, self-injury, tantrums
  • RISPERADOL was only drug approved for autism but now…Abilify
  • NEW Risks: Type 2 Diabetes (JAMA 2013).
  •  Gynecomastia ($2.5 M law suit won against makers of Risperadol in Philadelphia)

 

 

  • Stimulant Meds (usually used for ADHD)  in ASD
  • ADHD in ASD
  • Visual hyperfocus
  • Poor auditory filter
  • Internal distractibility
  • need to look away to listen
  • Criterion is distractibility and hyperactivity

 

  • TEACHING THE CHILD WITH AUTISM

 

  • 1.  Rapport Building
  • Check your body language
  • 2.  Establish clear expectations
  • BEES…there
  • Be ready
  • Be on time
  • Be responsible
  • Be respectful
  • 3.  Positive Reinforcement

 

  • More visual less verbal communication
  • Embrace their fixations….But…do not overuse them
  • Use an entry point
  • ENGAGE with music or a limited use of their preoccupations
  • Be creative in finding visual ways to communicate

 

 

 

  • TEACHING EFFECTIVELY
  • Visual Timers for the beginning and end of an activity, break time and reward time
  • Schedule activities in the following order:
  • Easy, hard, easy

 

 

  • A Student with Autism may need help to…..
  • Talk with others
  • Follow rules and take turns
  • Understand others feelings
  • Make friends
  • You can also help by
  • Reminding them
  • Modeling good behavior
  • Reinforce with high 5
  • Be patient

 

 

 

 

  • Teaching Peers about Autism
  • Peer-Mediated Social Skills Training
  • Research at UCLA by Dr. Connie Kasari found peer-mediated social skills training superior to adult 1:1 training
  • STEPS TO TEACH OUR HELPFUL PEERS….
  • teach the pre-selected peers to recognize and appreciate individual differences
  • Organizing play role, (making suggestions for play activity)
  • Sharing with focal child
  • ..
  • Then short session supervised by teacher
  • Generalization is then accomplished through embedded intervention (peer sits next to focal child) or class wide peer buddy system (e.g. rotating buddies)

 

  • Use the Incredible Five-Point Scale to
    Rate Fear, Anxiety and Anger + practice
  • By Authors Kari Dunn Buron, Mitzi Curtis

• 5 I can’t control it. I want to go to a calm place out of the classroom.

• 4 I want to relax in a quiet place.

  • • 3 I can’t concentrate on the task and want to observe the activity nearby
  •  • 2 I am getting upset about the activity that I am working on. But I still want to be in a the class
  •  • 1 I feel great

 

  • Video Modeling teaches the following
  • Social interaction and Play
  • planning ahead, learning from mistakes.
  • Individual Activities of Daily Living
  • Calming
  •  Perspective taking (understanding others mental state to predict their behavior)
  • Appropriateness

 

THE NATIONAL STANDARDS PROJECT HAS DETERMINED VIDEO MODELING TO BE EVIDENCE BASED (2009)

  • Video Self Modeling is even better
  • Child themselves is the central character
  • Often for lower functioning child
  • See the relevant video repeatedly, often immediately prior to the opportunity
  • Short, short , short  …90 seconds maximum

 

  • Apps for Iphone: Imovie and Reel Director

 

  • Rules for making videos
  • Can be used as therapy for simple behaviors
  • e.g. taking turn, walking down hall without chatting
  • Start with simple and likely-to-be-successful behaviors
  • Shoot from waist up
  • Positive behaviors goals only
  • Avoid backlight, hold camera steady..
  • Tutorials available on Windows Movie Maker and   Imovie

 

  • Other Calming Ideas
  • Tactile Grounders: weighted blankets, Tube socks filled with rice which can be miked or frozen
  • Anxiety Appointments (for student in therapy)
  • Sensory Calming Box.. objects from each sense

e.g. lemon skittles, lotion, glitter bottles, aroma (in candle) picture of Mom or dog, play dough, kaleidoscope, ipod with calming music, scented cotton balls using essential oils possibly

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