AUTISM A GROWING CONCERN

Robyn SmithDepartment of Physiotherapy

UFS2012

Learning outcomesAfter this module the learner is to be able to:

Be able to define and understand what autism is Be able to identify the key areas of development that are

affected by autism Be able to identify autistic spectrum characteristics in a

child Be able to identify the possible causes of autism Be able to provide a brief overview of treatment options

available and used in the child with autism Understand the role of the physiotherapist, and therapy

approach to be used the child with autism

How common is Autism? Autism is on the increase Incidence 1/110 children Statistics are of

concern Boys: 1/70

Autism is not going away and is going to have a huge impact on society in future years

Autism Awareness Little known about autism World Autism day 2 April to raise awareness Lack of treatment facilities Lack of trained persons to help autistic

children, burden often falls solely on parents

What is autism?

Grouped as part of the Autistic Spectrum Disorders (ASD)

Also including Asperger’s Syndromes A complex neurodevelopmental disorder, that is present

from early on in life Involving the impairment of social interaction as well as

deficits in language and communication Also often accompanied by rigid and repetitive

behaviours Development of the child with autism is frequently uneven

with areas of strength alongside areas of difficulty.

What is autism? Other conditions may be present in addition to the

‘core features’ of autism. These are numerous and commonly include sensory processing problems, seizures, physical disorders, sleep problems, depression and high levels of anxiety, which may give rise to behavioural or other problems.

May have difficulties in forming and maintaining friendships and in realising their academic and employment potential.

The child and their families are also at high risk of social exclusion.

Causes of Autism Caused by abnormalities in brain structure or

function. Brain scans show differences in the shape and structure of the brain in autistic versus non-autistic children

The exact cause of autism has not been established to date.

Causes of autism Epigenetic – disorder has a strong genetic link.

Abnormalities of chromosome 5 have now been linked to an increased risk for autism

strong familial genetic disposition with one autistic child has a 1/20 chance of having another, one twin is autistic 90% chance other is

Has been linked to the Measles-Mumps & rubella vaccination may be contributing factor

???? Environmental factors

CHARACTERISTIC BEHAVIOUR

SocialisationImpaired social interaction is the hallmark of autism

Do not make eye contact Fail to respond to their names Appear not to hear you at times Resist cuddling or holding Unaware of other peoples feelings Prefer to play alone and retreat into their “own

world”

Communication Start talking later than others, some children are

non-verbal Often loose previously acquired sentences and

words Never make eye contact when asking for something Abnormal articulation and voice often singsong or

robotic like Cannot initiate or continue a conversation Repeat words or sentences verbatim without

understanding how to use them

Behaviour Repetitive movements e.g. rocking, spinning

and hand flopping Develops routines and rituals Become upset at the slightest change in

routine or ritual Constantly moving Fascinated by parts of objects e.g. spinning of

wheels of a toy car Overly sensitive to light, touch and sound –

have lot of sensory integration problems

Treatment of AutismThere is no cure for autism

Therapies and behavioural intervention are aimed at addressing specific symptoms with the hope of brining about an improvement

Treatment options

More than 700 treatment options

Good to use various treatment options but most importantly do not forget about reaching the child

Ring of professionals

surrounding the child

Educational and behavioural therapies

Children often need a very structured learning environment and often cannot be mainstreamed.

How one teaches is more important than what one teaches Need to teach them to interact socially, emotional regulation and

different ways of finding a route through activities Various educational programmes used with success e.g. SNAP

programme, TEACCH, PECS, SCERTS model Appropriate school placements Appropriate vocational placements If acting out in a group revert to activities in isolation Make use of reward system Can make use of their obsessions during therapy

 

Need to find a route through

activities for the child

Educational aspects to focus on

Try and teach child to concentrate -go back to basics . Break tasks down into its simplest components to limit anxiety and stress

Tell them when an activity is over Social stories Visual timetable –breakdown of activities and must run in

order Objects of reference First and then boards Zoning of areas Communication books, boards and devices

Speech and language therapy

To address language and communication skills

Occupational therapy Address sensory integration problems Cognitive stimulation very important Perceptual activities

SENSORY ISSUES !!!!

Deep pressure and brushing with a soft brush often work well to calm children down

“Bear Hug” Unrolling ear Blowing things e.g. Whistle, bubbles etc

Physiotherapy Not always referred to physiotherapy

Due to the core nature of their problems the physical aspects may be overlooked

Many of these children also have: Developmental delays Low muscle tone Co-ordination and balance problems

Medication Various medications can be used in the treatment

of Autism

Mood stabilising medications e.g. Tegretol, Lithium Antipsychotic medications e.g. Risperdal Antidepressant and Antianxiety Medications e.g.

Prozac Stimulant medications for ADHD e.g. Ritalin Non Stimulant medications for ADHD e.g.

Strattera

Alternative therapies Stem Cell therapy

Controversial therapy. Value of stem cell therapy in autism still under investigation. Stem cell therapy illegal in most countries.

HBOTRemains controversial, efficacy has not been proven in the case of autism

References Smith, R. 2010. Paediatric dictate, UFS (unpublished). Griesel, D. 2010. PANDA autism seminar (unpublished) List of Autism medications for children . Available online

at http://www.child-autism-parent-cafe.com/autism-medication.htmlRetrieved on 18/03/10

Research autism available online at http://www.researchautism.net/pages/autism/indexRetrieved on the 18/03/10

Autism fact sheet. 2010. available online at http://www.ninds.nih.gov/disorders/autism/detail_autism.htm