Transcript Improving Children’s Health The Unique Needs of

1
Copyright Cardiff University
Rachel Brooks
Senior Lecturer
Elspeth Webb
Reader
Cardiff University
Paediatric members of Cardiff
Tertiary ASD Assessment team
Copyright Cardiff
University
2
Copyright Cardiff
University
Cardiff Tertiary ASD Assessment team
• Accept referrals only of children already
assessed at secondary level
▫
▫
▫
▫
Complex co-morbidity
Diagnostic uncertainty
Forensic concerns
Child protection concerns
3
Copyright Cardiff University
Sensory processing abnormalities
(SPA):
Challenges in the diagnosis & assessment of
children referred for possible social &
communication disorders
Copyright Cardiff
University
4
Introduction
Copyright Cardiff
University
• SPAs – what are they
▫ Abnormalities in the neurological processing or interpreting of
sensory stimuli
▫ Visual, auditory, fine touch, proprio-reception, smell, taste, pain
• How common are they in ASD
▫ Most recent work suggests that at least 80% (and perhaps all)
children on the spectrum will have SPAs
▫ Large and growing academic literature
• This talk
▫ A personal view and personal approach to the challenge of SPAs in
autism assessment based on 15 years experience and a lot of
thinking
5
Copyright Cardiff
University
Various scenarios
a) Children with SPA (with or without other co-morbidity)
who do not have ASD
b) Children whose SPA has shifted them, functionally,
along the ASD spectrum (normal to pathological, mild to
severe)
c) Children with both conditions in which teasing out which
particular neuro-pathology accounts for which
symptoms can be challenging
d) Children with multiple co-morbidities
e) Demand avoidance – pathological or adaptive?
6
Copyright Cardiff
University
Children with SPA without ASD.
Have adaptive behaviours which can appear:
▫ Odd and socially inappropriate
 Hypersensitivity e.g.
 to smell – either extreme avoidance (crisps and school
dinners) or explore the world through smell (ooh your pen
has been next to the chewing gum)
 to textures - clothes
▫ Socially avoidant and withdrawn
 hoodies, baseball caps, socks on hands, poor eye contact all as a result of sensory defensive strategies
7
Copyright Cardiff
University
Children with SPA without ASD - Cont:
Have adaptive behaviours which can appear:
▫ Averse to affection
 - abnormal seeking of comfort
▫ Egocentric
 exaggerated personal space (won’t share
sofa)
▫ Repetitive
 seeking proprio-receptive feedback
8
Copyright Cardiff
University
Case 1: Girl 12 years
• LDs
▫ co-morbid anxiety disorder and OCD (very strong FH
of both with several family members diagnosed)
• Inappropriate school placement
▫ Quiet (almost elective mute) and still at school
▫ Aggressive and unmanageable at home
• Very poor proprio-receptive feedback
▫ Bizarre arriving home from school “ritual”
9
Copyright Cardiff
University
SPA shifting children along the spectrum
SPA
Anxiety
Low
mood
Autism
(severe)
Autism
(mild)
Cusp
Traits
“normal”
10
Copyright Cardiff
University
Case 2: Boy 14 years
▫ Isolated, but severe and missed, SPA
 Autism diagnosed aged 12 on very high ADOS score
▫ Symptoms misunderstood by school and family
 Avoidance of physical contact, including as a baby
 Hidden friends and social network & hidden humour
 “this computer is mine” – seen as repetitive behaviour
 Shaved head every 6 – 12 months
 Hated new clothes
 Low mood, alienated and defended – lack of smiling mistaken
for lack of facial expression
▫ Some Aspergian personality traits
11
Copyright Cardiff
University
Co-morbid ASD and SPA
Explaining symptoms and planning intervention
• Sleep
▫ Poor clock or abnormal proprio-reception?
• Eating
▫ Limited repertoire - driven by sensory problems or
repetitive behaviours?
• Aversion to physical contact
▫ Driven by sensory defensiveness or autistic aloofness?
• Aggression
▫ Sensory defensiveness or arising out of triad problems?
(holding)
12
Copyright Cardiff
University
Multiple co-morbidities
ADHD; ID; DCD; OCD; anxiety; depression;
epilepsy; sensory impairment etc.
Simply increases
▫ the complexity of the child
▫ the need for imaginative assessment
▫ and creative solutions
▫ provided by an experienced and knowledgeable
multidisciplinary team who can work together in whatever
combination a particular child needs
13
Copyright Cardiff
University
Conclusion
• Professionals assessing and managing children with
possible or actual social and communication disorders
need to be well versed in SPAs
• They mimic, exacerbate and change autistic symptoms
• OT is a crucial component of any ASD service, both at
the level of assessment, and therapeutics
• Assessment requires a team who assess children in
more than one setting