Transcript Autism: Treatments & Interventions

Autism: Treatments &
Interventions
Presented By:
Kristen Mahoney, MS
Wesley Spectrum Services
[email protected]
The mission of Wesley Spectrum Services is to provide transformational support to children and families as
they strive to become more independent, responsible, and caring members of the community.
PCCYFS 2012 Annual Spring Conference
Objectives
•
•
•
•
•
PCCYFS 2012 Annual
Spring Conference
2
Define Autism
Latest research
Characteristics of autism
Strategies for behaviors
Treatments available
A Show of Hands
PCCYFS 2012 Annual
Spring Conference
3
People First Language
PCCYFS 2012 Annual
Spring Conference
4
Identified Prevalence of Autism
Spectrum Disorders
PCCYFS 2012 Annual
Spring Conference
5
ADDM Network (2000-2008)
ASR
True or False: According to the CDC, Autism
affects 1 in every 88 individuals born
today.
True
PCCYFS 2012 Annual
Spring Conference
6
False
Definition of Autism
• A developmental disability
marked by qualitative
impairments of social
interaction and communication,
and by restricted, repetitive,
and stereotyped patterns of
behavior
• A “spectrum” disorder
PCCYFS 2012 Annual
Spring Conference
7
DSM-IV
5
Subtypes
of PDD
Autistic
Disorder
PCCYFS 2012 Annual
Spring Conference
8
Asperger’s
Disorder
PDDNOS
Rett’s
Disorder
CDD
ASR
True or False: Autism, Asperger’s, and
Rett’s Disorder are the 3 autism spectrum
disorders.
True
PCCYFS 2012 Annual
Spring Conference
9
False
Autism, Asperger’s and PDD-NOS are the 3
Autism Spectrum Disorders.
DSM-V
www.dsm5.org
Autism Spectrum
Disorder
PCCYFS 2012 Annual
Spring Conference
10
PA Autism Census Project
Percent of Individuals with Autism in
Pennsylvania in 2005 by Age Group
PCCYFS 2012 Annual
Spring Conference
11
PA Autism Census Project
# of Adults with Autism in PA
PCCYFS 2012 Annual
Spring Conference
12
Identification of ASD
• Average age 2 or 3 years old
• Karen Pierce and other researchers are
searching for ways to identify it as
early as 6-12 months
• All children should be screened by a
PCP at 18 and 24 months specifically
for ASD
PCCYFS 2012 Annual
Spring Conference
13
Red flags for ASD
Child may:
PCCYFS 2012 Annual
Spring Conference
14
Child may not:
•Talk/babble with unusual
tone
• Point at things
•Show extreme sensory
sensitivities
• Try to gain attention of
others
•Play with toys in unusual
ways
• Show shared enjoyment
•Display odd body or hand
movements
• Say first words by 12-14
mos.
•Seem fussy or difficult to
soothe
• Make good eye contact
•Carry objects for extended
periods of time
• Show objects to others
• Babble/talk back &forth
• Smile in response to a smile
• Enjoy cuddling
• Respond to their name
Red flags
PCCYFS 2012 Annual
Spring Conference
15
Red flags can generally be seen in
children between 18-24 months
Why Early Intervention?
• Neural Plasticity
• Why is this important when talking about
children with ASD?
PCCYFS 2012 Annual
Spring Conference
16
ASR
Although our brains
continue to change throughout
our lifetimes, increased plasticity
early in life makes early
identification and intervention for
autism critical for best results.
• True or False:
True
PCCYFS 2012 Annual
Spring Conference
17
False
Research on Autism
Karen Pierce (2011)
• 137 pediatricians in the San Diego region
completed a checklist at 12 month checkup
to screen for ASD
– Checklist is the Communication and Symbolic
Behavior Scale (CSBS) by Wetherby and
Prizant
• Out of over 10,000 screenings, 184 failed
and were referred for further screening and
research
PCCYFS 2012 Annual
Spring Conference
18
Research on Autism
Karen Pierce (2011)
• Reevaluated very 6 months until age 3
• Diagnoses:
–
–
–
–
PCCYFS 2012 Annual
Spring Conference
19
32 received ASD
56 receive language delay
9 received developmental delay
36 “other”
Research on Autism
Brain Scans
PCCYFS 2012 Annual
Spring Conference
20
Research on Autism
Eye Gaze
PCCYFS 2012 Annual
Spring Conference
21
Research on Autism
Eye Tracking Study
PCCYFS 2012 Annual
Spring Conference
22
Implications
• Unlikely that any single marker will
identify children at risk for ASD
• Risk is best determined by a variety of
markers and those with increased
markers are likely at greater risk
PCCYFS 2012 Annual
Spring Conference
23
Causes
Supported
•Biological Origin
•Genetic
Component
•Environmental
Factors
PCCYFS 2012 Annual
Spring Conference
24
Unsupported
• Vaccines
• Parenting
Characteristics
PCCYFS 2012 Annual
Spring Conference
25
Social And Communication
Activity:
• Look at the person sitting next to
you. Have a conversation with
them about the weather without
using the letter ‘R’
PCCYFS 2012 Annual
Spring Conference
26
Perspective Taking & Empathy
PCCYFS 2012 Annual
Spring Conference
27
Intellectual Functioning
PCCYFS 2012 Annual
Spring Conference
28
Responsiveness to Sensory Stimuli
PCCYFS 2012 Annual
Spring Conference
29
Insistence on
Sameness
& Perseveration
PCCYFS 2012 Annual
Spring Conference
30
Executive Functioning
PCCYFS 2012 Annual
Spring Conference
31
Problem Behavior
PCCYFS 2012 Annual
Spring Conference
32
Positive Behaviors
PCCYFS 2012 Annual
Spring Conference
33
Treatments
PCCYFS 2012 Annual
Spring Conference
34
Fads vs. Science
• What is a fad?
• Evidence Based Practices
PCCYFS 2012 Annual
Spring Conference
35
Where do fads come from?
• When there is no cure
• Many therapies show slow progress and
require work
• Supported by theories
• Promoted by trustworthy sources
PCCYFS 2012 Annual
Spring Conference
36
Why do people buy into fads?
• Autism is a lifelong disability
• Scientific investigation
• Bombardment of information
PCCYFS 2012 Annual
Spring Conference
37
Types of Fads
PCCYFS 2012 Annual
Spring Conference
38
Biomedical Fads
• Pharmacological Treatments
• Nutritional Interventions
• Supplements
• Megavitamins
• MMR Vaccine
PCCYFS 2012 Annual
Spring Conference
39
• Chelating
Mechanical Fads
• Facilitated Communication
• Auditory Integration Therapy
• Sensory Integration Therapy
PCCYFS 2012 Annual
Spring Conference
40
Psychological Fads
• Floor time: A developmental, individual
difference, relation-based approach (DIR)
• TEACCH (Treatment and Education of
Autistic and Communication Handicapped
Children)
PCCYFS 2012 Annual
Spring Conference
41
National Standards Report (2009)
PCCYFS 2012 Annual
Spring Conference
42
National Standards Report
PCCYFS 2012 Annual
Spring Conference
43
National Standards Report
• Antecedent package
• Behavioral package
• Comprehensive Behavioral
Treatment for Young
Children
• Joint Attention Intervention
Established
Treatments
• Modeling
• Naturalistic Teaching
Strategies
• Peer Training Package
• Pivotal Response Treatment
• Schedules
PCCYFS 2012 Annual
Spring Conference
44
• Self-management
• Story-based Intervention
ASR
True or False: Even though ABA did
not make the list of established
treatments, it is still an evidence
based practice because the
established treatments stem
from ABA.
True
PCCYFS 2012 Annual
Spring Conference
45
False
National Standards Report
•Augmentative and Alternative Communication Device
•Cognitive Behavioral Intervention Package
•Developmental Relationship-based Treatment (RDI/DIR)
•Exercise
•Exposure Package
•Imitation-based Interaction
•Initiation Training
•Language Training (Production)
•Language Training (Production & Understanding)
Emerging
Treatments
•Massage/Touch Therapy
•Multi-component Package (“eclectic”)
•Music Therapy
•Peer-mediated Instructional Arrangement
•Picture Exchange Communication System (PECS)
•Reductive Package
•Scripting
•Sign Instruction
•Social Communication Intervention
•Social Skills Package
PCCYFS 2012 Annual
Spring Conference
46
•Structured Teaching
•Technology-based Treatment
•Theory of Mind Training
National Standards Report
• Academic Interventions
• Auditory Integration
Training
UnEstablished
Treatments
PCCYFS 2012 Annual
Spring Conference
47
• Facilitated
Communication
• Gluten-and CaseinFree Diet (GFCF)
• Sensory Integrative
Package (aka sensory
integration)
Conclusion
• Behaviorally based methods are the only
methods supported by research
• Applied Behavior Analysis
PCCYFS 2012 Annual
Spring Conference
48
How can we establish
evidence based practices?
• Parent Education
• Use data based decision making
• Hire a Board Certified Behavior Analyst
(BCBA)
• www.bacb.org
PCCYFS 2012 Annual
Spring Conference
49
Recall
PCCYFS 2012 Annual
Spring Conference
50
Question and Answer
PCCYFS 2012 Annual
Spring Conference
51
References
PCCYFS 2012 Annual
Spring Conference
52
American Psychiatric Association. (2000). Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition,
Text Revision. Washington, DC.
American Psychological Association. (2011). Diagnostic
and statistical manual of mental disorders, Fifth
Edition. Retrieved from www.dsm5.org
aware4autism (2006). Early signs of autism – Stacking
blocks, no eye contact. http://www.youtube.com
Centers for Disease Control and Prevention. (2012). Data
and statistics. Retrieved from the Centers for Disease
Control and Prevention website:
http://www.cdc.gov/ncbddd/autism/data.html
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007).
Applied behavior analysis (2nd ed.). Upper Saddle
River, NJ: Pearson.
Ganz, J. B. (2007) Classroom Structuring Methods and
Strategies for Children and Youth with Autism
Spectrum Disorders. Exceptionality, 15(4), 249-260.
References
Greenspan, S. (2005) Credulity and gullibility among
service providers: An attempt to understand why snake
oil sells. In Jacobson, J. W., Foxx, R. M., & Mulick, J. A.
(Eds.). Controversial therapies for developmental
disabilities: Fad, fashion, and science in professional
practice. Mahwah, New Jersey: Lawrence Erlbaum
Associates, Inc.
Kay, S. & Vyse, S. (2005). Helping parents separate the
wheat from the chaff: Putting autism treatments to the
test. In Jacobson, J. W., Foxx, R. M., & Mulick, J. A.
(Eds.). Controversial therapies for developmental
disabilities: Fad, fashion, and science in professional
practice. Mahwah, New Jersey: Lawrence Erlbaum
PCCYFS 2012 Annual
Spring Conference
53
Associates, Inc.
Lovaas, L., Newsom, C., & Hickman C. (1987). Selfstimulatory behavior and perceptual reinforcement.
Journal of Applied Behavior Analysis, 20(1), 45-68.
References
Metz, B., Mulick, J. A., & Butter, E. M. (2005). Autism: A
late-20th-century fad magnet. In Jacobson, J. W., Foxx,
R. M., & Mulick, J. A. (Eds.). Controversial therapies for
developmental disabilities: Fad, fashion, and science in
professional practice. Mahwah, New Jersey: Lawrence
PCCYFS 2012 Annual
Spring Conference
54
Erlbaum Associates, Inc.
National Autism Center (2010). National Standards Project.
Retrieved from http://www.nationalautismcenter.org
National Research Council. (2001). Educating Children with
Autism . Washington, DC: The National Academies
Press.
Patoine, B. (2006, January 1). Relatives’ Brains yield autism
clues. The Dana Foundation. Retrieved from
http://www.dana.org
Pierce, K., Carter, c., Weinfeld, M., Desmond, J., Hazin, R.
Bjork, R., & Gallagher, N. (2011). Detecting, studying,
and treating autism early: The one-year well-baby
check-up approach [Abstract]. Journal of Pediatrics,
159(3), 458-456.
References
PCCYFS 2012 Annual
Spring Conference
55
Pennsylvania Department of Public Welfare: Bureau of
Autism Services. (2009). Pennsylvania Autism Census
Report: Final Report.
UC San Diego Autism Center of Excellence (2012).
Identifying and treating early. Retrieved from
http://autism-center.ucsd.edu/treating-earlyautism/Pages/default.aspx
UC San Diego Autism Center of Excellence (2012).
Discovering the causes. Retrieved from http://autismcenter.ucsd.edu/what-causesautism/Pages/default.aspx
UCSDMedicalCenter (2010). Eye tracking study of toddler
with autism. Retrieved from http://www.youtube.com
Watterson, B. (2012). Calvin and Hobbes. Retrieved from
www.gocomics.com
Zarembo, A. (2011). Autism Boom: An epidemic of disease
or discovery? LA Times December 2011.