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  • Autism is a complex disorder with many contributing factors. While we don't have all the answers yet, you can decrease the risk to younger siblings and future pregnancies by protecting your family from known dangers like environmental toxins and thimerosal in flu shots. From Boyd Haley, Professor and Chair of the University of Kentucky Department of Chemistry: "The EPA safe level for mercury exposure from the diet is 0.1 micrograms/2.2 pounds body weight and the vaccines preserved with thimerosal has 12.5 micrograms of mercury or 125 times the EPA safe level. This makes the vaccine exposure safe if your baby weighs 275 pounds." Also, the thimerosal is injected, not ingested, which makes it more toxic, and it is delivered with aluminum that enhances the neurotoxicity. So it is surprising a physician would be so dismissive and say the thimerosal is ‘so small it is nothing to worry about.'"
  • There are numerous studies showing the relationship between chemicals in our environment and developmental delays, thyroid disruption, etc.
    One of the best sources for information on the affects of chemicals in our environment is: Environmental Working Group. Another source is Toxin Free legacy.
  • First you need to fix the hardware – by treating medical issues, then reinstall the software with a behavioral approach.
  • ABA stands for Applied Behavioral Analysis. It is considered an ‘educational' treatment for Autism. Scientific testing has shown ABA to be a valid and helpful intervention for Autistic Children and has shown a percentage of children that have recovered with ABA alone.
    Most of this testing was done before valid biomedical interventions came about. The combination of healing a child from the inside while using ABA to make up for deficits, gaps in learning, or catching up a child to their peers and may increase the percentage of recovered children.
    The value of a good consultant is that ABA can be a very complex program and having the expertise of a good consultant who has a deep well of knowledge to pull from is priceless. Thanks to advances in all treatments, today it is recommended to use a combination of approaches (e.g. biomedical and ABA, RDI, etc.) ABA alone cannot heal your child's medical conditions and Biomedical cannot make up for deficits with your child's peers.
    Many parents feel an all around approach covers all bases. To find the most qualified provider, be sure they are a "Board Certified Behavior Analyst" and contact the nearest FEAT(Families for Effective Autism Treatment) organization for provider information.
  • Powerpoint

    1. 1. Autism and Pervasive Developmental Disorders Kenneth M. Rogers, MD, MSHS Director, Child and Adolescent Psychiatry Residency
    2. 2. • History • Symptoms • Incidence • Genetics vs. Environment? • Testing/Treatment Overview
    3. 3. History of Autism • Autism was first described by Leo Kanner in 1943 • He called the syndrome “early infantile schizophrenia” • Autism was often misdiagnosed as childhood schizophrenia • Early theorists thought that Autism was due to “cold and unnurturing mothers". This theory has been debunked.
    4. 4. What Do We Know About Autism? Autism: • is a lifelong disability • is characterized by severe problems in 3 areas: communication, behavior, and social skills. • is a developmental disability • occurs primarily in males. The ratio is 4:1
    5. 5. What Do We Know About Autism? Autism: • occurs in approximately 1 out of 250 live births. • typically manifests between ages 18 months and 3 years. • is not specific or more prevalent in any racial groups or locations throughout the world.
    6. 6. What Do We Know About Autism? • There is no cure, but the earlier that it is identified and treated, the better the outcome. • There are numerous treatments including educational, social, and biological. • Better and more intensive treatment means better outcomes
    7. 7. What is an Autism Spectrum Disorder? The spectrum consists of: •Autism •Asperger’s Disorder •Pervasive Developmental Disorder NOS Major impairments: •Social Skills/Relationships •Communication •Stereotypical Behaviors •Desire for Sameness
    8. 8. Autism A. Qualitative Impairment in Social Interaction – AT LEAST TWO OF THE FOLLOWING 1. Marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction 2. Failure to develop peer relationships appropriate to developmental level
    9. 9. Autism (con’t) 3 A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) 4. Lack of social or emotional reciprocity (note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )
    10. 10. Autism (con’t) B. Qualitative Impairment in Communication – AT LEAST ONE OF THE FOLLOWING 1. Delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime) 2. In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
    11. 11. 3. Stereotyped and repetitive use of language or idiosyncratic language 4. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level Autism (con’t)
    12. 12. Autism (con’t) C. Restrictive, Repetative and Stereotyped Patterns of Behavior - AT LEAST ONE OF THE FOLLOWING 1. Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus 2. Apparently inflexible adherence to specific, nonfunctional routines or rituals
    13. 13. 3. Stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole body movements) 4. Persistent preoccupation with parts of objects Autism (con’t)?
    14. 14. II. Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years: A. social interaction B. language as used in social communication C. symbolic or imaginative play III. The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder Autism (con’t)
    15. 15. Asperger’s Disorder? I. Same Social Impairments as Autism II. The level of language delay/communication is not as great as in Autism III. The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.
    16. 16. Asperger’s Disorder (con’t) IV. There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.
    17. 17. Early Symptoms 18 Months to 3 Years • Feeding problems, such as poor nursing ability. • Apathetic and unresponsive-showing little or no desire to being held and cuddled • Constant crying or the unusual absence if crying • Disinterest in people or surroundings • Repetitive movements such as hand shaking, prolonged rocking, head banging • Sleep problems • Insistence on being left alone
    18. 18. Early Symptoms 18 Months to 3 Years • Difficulty in toilet training • Odd eating habits and preferences • Late speech, no speech, or loss of previously acquired speech • Sleep problems, such as needing only a few hours of sleep each night • Doesn’t play with toys or others • Fails to respond to affection • Prolonged temper tantrums
    19. 19. • Autism Diagnostic Interview – Revised (ADI-Revised): 2-4 hour interview with parents of child’s history • Autism Diagnostic Observation Schedule (ADOS) – one-hour structured and unstructured interaction with child • Childhood Autism Ratings Scales (CARS) • E-2 Diagnostic Checklist – Parents’ checklist scored for no charge. Download pdf file from www.autism.com Diagnostic tools
    20. 20. Early onset vs. regression Source: Autism Research Institute
    21. 21. Genetic or environmental cause? • Studies of identical twins reveal: – Co-occurrence is 40-80%; if 100%, then only due to genes; so genes are important, but so are unknown environmental factors – 5-10% chance siblings of ASD children will have autism – 25% chance of major speech delay … so carefully monitor siblings
    22. 22. No straight lines from genes to behavior Genetic vulnerability + environmental exposure Remember: Genes alone produce proteins – not behaviors
    23. 23. Which Genes? • The cause is multifactorial • Many genetic studies of autism, but they generally disagree: too few subjects and too many genes • Probably 10-20 genes involved in complex manner • In two similar conditions, Fragile X and Rett’s Syndrome, a single gene has been identified for each
    24. 24. Which Environmental Causes? • No general agreement • Possible causes with limited scientific data include: – High levels of heavy metals (e.g., mercury, lead, aluminum) due to limited excretion because of low glutathione – Excessive oral antibiotic usage (gut damage = poor health and neurodevelopment due to poor digestion of nutrients) – Vaccine damage (especially MMR) – Exposure to pesticides – Lack of essential minerals (iodine, lithium) – Other unknown factors
    25. 25. Rapid increase in incidence • 1970’s: 2-3 per 10,000 • 2007: 1 per 150 (U.S.); 1 per 58 (U.K.) • In the U.S., affects 1 in 80 boys, since 4:1 boy:girl ratio • In California (which has best statistics), autism now accounts for 45% of all new developmental disabilities
    26. 26. Why rising rate of autism?  Partly due to better awareness/diagnosis, but that is only modest effect (per study by MIND Institute)  Not due to genetics – gene pool changes slowly  So, primary reason is most likely increased exposure to environmental factors (mercury, antibiotics, MMR, pesticides, iodine deficiency, other?)
    27. 27. Prognosis? Two major lifetime studies: Autism: 90% of adults unable to work, unable to live independently, < 1 social interaction/month Asperger (50% with college degrees): Similar prognosis – social skills, limited use of intellectual abilities Grim prognosis if untreated, but many treatments now available, and there is MUCH
    28. 28. Treatment Strategies • Autism is a constellation of symptoms rather than a disease. There is not a single treatment that works for everyone. • The treatment is multi-modal and multidisciplinary. • Education will almost always be the lead discipline. • Plans should be comprehensive and re- evaluated frequently.
    29. 29. Co-Morbid Disorders • Co-morbidity is common • Common co-morbid conditions – Mental retardation – Anxiety – Depression – ADHD/Impulsivity • Co-morbid conditions must be addressed separately
    30. 30. Behavioral therapies • ABA – most widely accepted/implemented – evidence based – well documented results • Storyboarding • Pivotal Response Training • Sensory Integration Therapy • Floor Time • Relationship Development Intervention (RDI)
    31. 31. Applied Behavior Analysis (ABA) • Pioneered by Dr. Ivar Lovaas at UCLA in the 1960s. • Research study (1987) evaluated 19 young autistic children ranging from 35 to 41 months of age. Children received over two years of intensive, 40-hour/week behavioral intervention. • Nearly half of the children improved so much they were indistinguishable from typical children. They went on to lead fairly normal lives. • Of the other half, most had significant improvements, but a few did not improve much.
    32. 32. Several variations today, but general agreement that: • Usually beneficial, sometimes very beneficial • Most beneficial with young children, but older children can benefit • 20-40 hours/week is ideal • Prompting, as necessary, to achieve high level of success, with gradual fading of prompts • Therapists need proper training and supervision • Regular team meetings needed to maintain consistency ABA Today
    33. 33. Other Evidence-Based Therapies – Speech Therapy – Occupational Therapy/Physical Therapy – Physical Therapy – Sensory Integration – Auditory Integration Therapy (AIT) – Vocational Therapy

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