Breakthroughs in autism management part 1

Breakthroughs in Autism Management -1

Nephtaly Joel Botor: [email protected]: www.way2life.org

Emerging modalities in managing autism

Step Ahead 2011 (Winter)AJ Group of Schools

mailto:[email protected]

http://www.way2life.org/


What do we need to mould a child with autism into an

optimally-functioning individual?

YOU.

What to expect (morning)• Setting the stage

– Why do we have to talk about autism – Reframing autism: defeciency vs. learning

• Re-defining autism– Review of DSM-IV criteria– Refocusing autism (DSM-V)

• Senses and sensibilities– Sensory processing disorder (in brief)– Vision, VRT and autism


What to expect (morning)• Communication and autism

– PECS /Dynavox– AVAS/LENA– i-pad/i-phone

• Wrap up (morning)


What to expect (afternoon)

• Autism fitness (activity based)• Behavioural modalities

– Joint attention (Walen & Schreibman, 2003)

• Multifactorial causes of autism– Biomedical issues– Diet and autism

• Q&A/Conclusion



Setting the Stage


Search engine results “autism”

88.9 million


5.7Average age of diagnosis


High prevalence of autism

1:110


35 BillionAnnual expenses for adult

care


Autism: before• Must have existed for hundreds or

thousands of years- “weird”, “strange”• Considered as a mental illness (“crazy”) or

mental retardation• Sent to mental asylum—with psychotics,

neurotics, etc.• Not sure where it came from• No proper intervention


Autism: now• Still not sure where it came from• No substantial cause• Genes?• Environment?• Systemic? (metabolism issues)


Autism: now• Separate diagnosis: autism spectrum

disorder


Autism: now• Available interventions (ABA, PECS, etc)• Applied research and gaining interest• Research and advocacyorganizations

(autismone.org)• More chances of a more “quality life” for

children with autism


Re-defining autism


299.00 (DSM-IV) - “autistic disorder”

Autism: Diagnosis


Autism: Diagnosis (DSM-IV)• Qualitative impairment in social interaction

– nonverbal behaviours (e.g. no eye contact)– Failure to develop peer relationships – Lack of spontaneous shared enjoyment

• Qualitative impairment in communication– Delay or total lack of spoken language– Impairment in ability to initiate/sustain

conversation

• Restricted repetitive and stereotyped patterns of behaviour (stimming/pacing/preoccupation)


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W H A T I S A U T I S M ?

A complex developmental disability that typically appears during the first three years of life. Autism Spectrum Disorder results from a neurological condition that affects the functioning of the brain.

Social interactionCommunication (but no significant clinical delay for AS)Repetitive motions and restricted interests

Anything that interferes with the central nervous system getting the needed information from the environment.

OOPS!!!!!WHAT ABOUT SENSORY INTEGRATION ISSUES?

ASA(2005)

DSMIV-TR (2000)

Miller(2000)

Reframe

•Communication

• Socialization

• RestrictedInterests


Autism: Diagnosis (DSM-V)• Publication of DSM-V in March 2013• Sensory processing disorder/issues• Researches have noted that children with

autism have significant sensory issues.• Sensory integration sensory processing• Rooted in the processing of sensory

signals


Senses and Sensibilities:Sensory processing issues


Why does Stephen Shore wear a cap?


Sensory processing disorder

• Sensory integration: ability to combine/organize signals from environment

• Sensory processing disorder - sensory signals don't get organized into appropriate responses (neurological “traffic jam”).

• Not the structure but function• Sensory stimuli can be causing discomfort,

undetectable or distorted• Self-stimulating behaviours


Why do they engage in sensory stimulating

activities?

“Children with autism feels lost in space.”

-Dr. Stephen Shore

HOW IT FEELS LIKE?

# 1. Listen to 5.

# 2. Rub 1’s back.

# 3. Lean to 1. Read loudly

# 4. Pat 1’s head and shoulders

# 5. Read to #1 in a normal voice

DO

Step Ahead 2011 (Winter)AJ Group of

Schools

Sensory processing disorder

• A lot of input coming at the same time• One sense extremely sensitive over the

other• Difficulty in putting all sensory information

together• Impaired processing at the neurological

level


Vision, VRT and autism


Why do children stim?• Visual stimming: notable behaviour of

children with autism• Stimming – repetitive body movement

thought to stimulate the senses; “lost in space” issue

• DOES THIS RELATE TO VISION????


Sight vs. Vision


Sight vs. Vision


Autism & Vision Research


DO CHILDREN WITH ASD DIFFER IN THEIR VISUAL DEFICITS COMPARED TO

NON ASD CHILDREN?

DR. JEFFREY BECKER/VISION-NEUROSENSORY SPECIALIST

ASD CHILDREN VISUAL SKILL NON ASD CHILDREN

66%/ 62% FINE MOTOR SKILLS 15%/ 6%

71%/68% BINOCULAR SKILLS 18%/ 20%

55%/ 49% ACC/FOCUSING SKILLS

8%/ 7%

62%/ 66% OCULOMOTOR SKILLS 14%/ 12%

51%/ 72%

TRACKMAN PHD 6-2008AOA/EUROPEAN PUBLIC HEALTH RISK ASSEST. FEB 2007

VESTIBULAR/VOR SKILLS

6% / 10%



Vision controls GROSS MOTOR

Vision controls FINE MOTOR

Vision controls SELF-ESTEEM

Vision rehabilitation therapy

• Studies associating visual stimming to visual deficits than can be rehabilitated

• Done by a neurodevelopmental optometrist

• Very limited practitioners; general optometrist population

may not be trained



Neurosensory Testing






Hand-held therapy

Computer-assisted therapy

VRT: Neuroplasticity Training


Before

During

After

Areas improve by VRT• Tracking (following objects)• Fixation (locate objects; required in reading)• Focus change (accomodation)• Depth perception (distances)• Peripheral vision (see things w/o focus)• Binocularity• Convergence (eyes towards each other)• Visualization (mind’s eye)• Visual sensory integration (combine visual

info)Step Ahead 2011 (Winter)AJ Group of

Schools

Supporting research


American Optometrist Association, 1998

Communication Modalities


Why?

• Communication impairment being a notable characteristic of autism

• Communication is so essential (80%)• Functional communication• Express desires, needs etc. (self advocacy)• Socialize/interact• Allowing an opprotunity to express

themselves (if not verbal/spoken, how?)• AACs (augmentative/alternative)


PECS

• Picture Exchange Communication System

• Standard practice in autism management

• Giving voice to non-verbal children with autism


PECS: Stages

1. Initiate communication2. Seek pictures/request3. Discriminate pictures4. “I want ________.”5 . “What do you want?”6. Make comments


PECS: Issues

• PECS or not PECS?• Parents’ fears: will not

learn spoken language?• Studies show that PECS

actually supports spoken language

• Remove PECS or not?• POINT:

Parental/family involvement


PECS: Parental involvement

• Using PECS at home• Parents collaborating

with therapists/educators


Dynavox

• Portable digital AAC device

• Picture-based (doesn’t contradict with PECS)


Dynavox supports…

• Communication and language development

• Positive behaviour• Social participants• Classroom participation• See how it’s used.


However,

• I find it too costly!• 43000 aed!!! • May not be cost-

effective


OPTION: iPad/iPod/iPhone More and more applications being

developed for low cost unlike other computer-mediated AAC device

• 4000 aed (iPad) + 300 aed (software)

• 4300 aed vs. 43000 aed!!!


Ways iPad tech can support• Communication application (proloquo2go)• Vocab/speech (kindergarten.com)• Language reinforcement (Talking Tom)• Occupational therapy (Dexteria)• Reading• Sequencing• Scheduling


proloquo2go

“Talking Tom”

www.kindergarten.com

“Dexteria”

iPAD generation plus

• (+) Simple user interface• (+) Children are attracted to it• (+) Increase the child’s social

acceptability (i.e. in inclusive classrooms)• Our Role:

– Make sure tech doesn’t become an obsession/opportunity to stim

– Learning not entertainment


www.lenafoundation.org

Other technologies: LENA

• LENA Foundation• LENA (Language ENvironment Analysis) System•World’s first automatic language collection and analysis tool


http://www.lenafoundation.org/


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It's a simple four-step process. Parents start first thing in the morning and follow these instructions:




Other technologies: AVAS

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It's a simple four-step process. Parents start first thing in the morning and follow these instructions:

•Will come out on 1st quarter 2012•In English and Arabic•Diagnostics and therapeutics• picture-based articulation•Graphic feedback on sounds• Real time feedback•Vocal range, timbre, projection, weight, transition•Listening training•Voice triggering



Picture-based flashcard (with real-time feedback in articulation



31 logarithmic parameters to diagnose and that can be recorded

and viewed again



“Blow the candle”



Stories for oral reading exercise


Wrap Up• Autism is prevalent• There’s a call to redefine and reframe

autism• Sensory processing is an issue• Growing use of technology in autism

intervention• Something to watch



Education

Breakthroughs in autism management part 1