Transcript Presentation Title Here

Providing Care and
Health Supports for
Students with Autism
Laura M. Stough, Ph.D.
Department of Educational Psychology
Center on Disability and Development
Texas A&M University
April 26th, 2013
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Center Overview
Mission
To support the self-determination, community integration
and quality of life of persons with disabilities and their
families.
Core Functions
• Community Services and Outreach
• Research and Evaluation
• Information Dissemination
• Graduate Studies and Interdisciplinary Training
Defining Autism
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Defining Disability
• Mashaw and Reno (1996) document over 20
definitions of disability used for purposes of
entitlement to public or private income support
programs, government services, or statistical
analysis
What is Autism Spectrum Disorder?
 Autism spectrum disorder is a lifelong
developmental disability
 Neurologically based with no clearly known cause
 Found in every race, culture, ethnic group and
economic background
 Causes impairment in information processing,
communication, learning, and social behavior
 No known cure
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IDEA versus APA
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Under IDEA, autism is defined as:
.....a developmental disability significantly affecting
verbal and nonverbal communication and social
interaction, generally evident before age three, that
adversely affects a child’s educational performance.
APA DSM 5 refers to this criteria as
“social communication or social reciprocity”
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Other characteristics often associated with autism are
a) engaging in repetitive activities and stereotyped
movements,
b) resistance to environmental change or change in
daily routines, and
c) unusual responses to sensory experiences.
APA DSM 5 refers to this criteria as
“restrictive or repetitive behaviors”
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The Autism Spectrum
• Autism/autistic disorder
• Asperger syndrome/Asperger disorder
• Pervasive developmental disorder not otherwise
specified/PDD-NOS
No longer included by APA in DSM 5
• Childhood Disintegrative Disorder
• Rett Syndrome
Statistics on Autism
• Overall, about 12% of school-aged children in Teas
are diagnosed with some type of disability
• ASDs are almost 5 times more common among
boys (1 in 54) than among girls (1 in 252)
• Individuals with an ASD have an average
prevalence of about 1% in North America
• Over the last 12 years, the prevalence of autism has
increased by 289%
• In 2011, 1 in 88 children were diagnosed with an
autism spectrum disorder (ASD)
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Increasing Disability Rates
1.Advances in neonatal medicine
2. Advances in emergency medicine
3. Aging of population
4. People with disabilities live longer
5. Liberalization and expansion of the definition of disability
6. More accurate counting
Associated Factors
• ASDs tend to occur more often in people who have
certain genetic or chromosomal conditions.
• About 10% of children with autism are also identified
as having Down syndrome, fragile X syndrome,
tuberous sclerosis, and other genetic and
chromosomal disorders
• Over a third of children with ASDs also have an
intellectual disability
• An additional third have an IQ in the borderline
range (IQ 71-85).
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Behavioral Characteristics of
Autism Spectrum Disorder
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Autism Spectrum Disorder in Schools
• Most of the children can be served in the general
education curriculum with varying levels of outside
support
• Have specific educational needs
• May have associated health disorders
• May be at risk for secondary causes of health
disorders
• How ASD is expressed and the level of support
needed in the educational environment varies
• Do not learn incidentally from their environment,
need direct teaching of social and academics
Autism (Kanner’s or classical)
• Severe impairment in social interaction
• Most students with autism have limited verbal ability
• Many students display repetitive or stereotypical
behaviors
• Many students with autism have sensory dysfunction
o Tactile, auditory defensiveness
o Visual and auditory processing differences
o About 1/3 also have seizures
Asperger syndrome
• Have trouble with:
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Social interaction
Communication (especially pragmatic aspects)
Lack of flexibility of thought
Rigid or atypical interests
Communication
Impaired pragmatic communication skills
Limited verbal ability or mutism
Commonly display echolalia
Sometimes unaware of how to ask for help or poor
control of vocal tone and volume
• Lack of facial expression, limited gestures
• Poor understanding of body language of others
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Social Skills
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Atypical play and social skills
Dislike change, preference for routines
Lack of empathy
Like things that are concrete and predictable
Like collecting, assembling
Appear to prefer their own company
Do not learn incidentally from their environment,
they need direct teaching of social and academics
Motor and Sensory
• May have difficulties with integration of senses
• Can experience perceptual overload: too much
sensory information can cause stress, anxiety, or
escape behaviors
• Difficulties with bilateral coordination, fine and gross
motor skills
• Poor motor planning and body awareness
Strengths
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Exceptional visual memory skills
Can have tremendous focus when interested
Good vocabulary with higher IQ ASD
Can possess advanced knowledge in particular
area of interest (splinter skills)
Medical and Functional
Support Needs
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Mortality and Causes of Death
• Mortality risk of individuals with ASD is nearly twice
that of the general population
• Epilepsy was the most common cause, and
occurred at even a higher rate than did epilepsyrelated mortality in the general population
• Infectious is another common cause of death
associated with ASD
Mouridsen, Bronnum-Hansen, Rich, & Isager, 2008
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Additional Causes of Death
Accidents
Suicide
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Other Medical Conditions
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Sleep disorders
Weight control problems
Allergies
Intolerance to certain foods or additives
Gastrointestinal disturbances
Teeth grinding
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Psychiatric Conditions Associated with Autism
• 70% of children ages 10-14 years have at least one
comorbid disorder
• 41% have two or more comorbid disorders
• Most commonly diagnosed are:
o Social anxiety disorder (29%)
o Attention-deficit/hyperactivity disorder (28%)
o Oppositional defiant disorder (28%)
Simonoff, Pickles, Charman, Changler, Loucas, & Baird, 2008)
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Medications
Medication does not treat the underlying neurologic
problems associated with autism. Medication only helps
the behavioral manifestations of the disability.
--Most common medications are antipsychotics:
- Risperidone (Resperdal)
- Olazapine (Zyprexa)
- Aripiprazole (Abilify)
- Quetiapine (Seroquel)
--Antidepressants and stimulants may also be prescribed
--Seizure medication is also very common
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Seizures
• Occur in approximately 25% of students with ASD
• Become informed of:
o The type of seizures a student has
o Medication required and the side effects
o What is “normal” for each student and when medical assistance should
be requested
• If:
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A seizure lasts longer than 5 minutes,
The child stops breathing,
This is the first known seizure, or
The child becomes injured
…Refer to a physician
What is Self-Injurious Behavior?
• Self-inflicted physical harm severe enough to cause
tissue damage
• Cutting, burning, hitting, kicking, bruising, bonebreaking, head banging, biting, hair-pulling,
scratching
• Interference with the healing of wounds
• Other acts of self-inflicted physical harm severe
enough to cause tissue damage or marks that last for
several hours
Why a Primary Concern?
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Health reasons
Danger to others
Liability
To teach new skills and behaviors
Inappropriate & disturbing
Additional disabilities may occur
Challenges in Providing Services
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Deficits in communication
Deficits in social understanding
Limited intellectual ability
Dislike changes in daily routine
Apparent insensitivity to cold
Apparent insensitivity to pain
Stress causes more anxiety and behavioral problems
Best Practices and
Misconceptions
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Research-Based Interventions
• Despite a number of promising medical finding on
the neurological systems of children with autism,
only behavioral interventions consistently have
been found to significantly and positively impact
the negative characteristics of autism. Specifically,
o Applied Behavior Analysis (ABA) Interventions, and
o Pivotal Response Training (PRT)
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Vitamins, minerals, metals, and diet
• Research has not found that abnormal amounts of
vitamins, minerals, or other nutrients are linked with
ASD
• Research has not found that eliminating proteins,
such as gluten are linked with ASD
• Research has not found that chelation therapy is of
benefit to children with ASD
• Research has not that special dietary interventions
are consistency of benefit for children with ASD
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Vaccinations and ASD
• Studies have particularly focused on
o The MMR vaccine
o Vaccines containing thimerosal, and
o On the total number of vaccines administered close together
• There is no scientific proof that some childhood
vaccines, such as the MMR vaccine, cause ASD
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Other Therapies
Complementary or alternative therapies are commonly
used by families of children with autism
-estimated 31-74% of families will use
-70% are biologically based
-most families believe they work
Common therapies include:
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Vitamins
Gluten-free diet
Casein-Free diet
Specific carbohydrate diet
Omega-3 fatty acid supplements
Probiotics
Melatonin
What does this imply for your practice?
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Post Test
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Center on Disability
and Development
Texas A&M University
Presented by Laura M. Stough, Ph.D.
[email protected]