Treating Autism Part 1 with Equine Assisted Counseling

EPICTrainingJune6,2008
©KaySudekumTrotter2008
www.KayTrotter.com
EPIC TRAINING
Treating The Autism Spectrum
with Equine Assisted
Counseling
PART 1: The Autism Spectrum
Kay Sudekum Trotter PhD
Licensed Professional Counselor and Supervisor, National Certified
Counselor, Registered Play Therapist and Supervisor, Certified
Equine Assisted Counselor, and EPIC Creator (Equine Partners In
Counseling)
www.KayTrotter.com
Kay@KayTrotter.com

www.KayTrotter.com
Prevalence of Autism
• From 1994 to 2005, the number of children ages 6-
21 years receiving services for autism increased
from 22,664 to 193,637. 1
– A 754% increase
• Currently 1 in every 150 children is being diagnosed
with Autism. 2
– Estimates range as high as 1/4% to 1/2% of the
population
• These estimates include those with Autism,
Asperger's Syndrome, and PDD.
• Autism is three times more likely to affect males than
females. 1,2
– 75% of children with Autism meet criteria for
mental retardation (MR)
• But affected females are more likely to suffer
from severe MR

The Autism Clock
calculates the current
estimated U.S.
incidence of Autism
for children ages 3-22.
It was developed to
allow real-time access
to the current Autism
incidence.
The U.S. Economic
Cost is calculated
using an estimate of
$30,000 USD
annually for each
child.

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What is Autism?
Autism is a form of Pervasive Developmental
Disorder (PDD) – a group of neurobiological
disorders. There are five types or subgroups of
PDDs
1. Childhood Autism
2. Asperger’s Syndrome
3. Pervasive Developmental Disorder NOS
4. Childhood Disintegrative Disorder
5. Rhett's Disease
ASD is a behavioral disorder of speech,
communication, social interaction, and repetitive
type compulsive behavior. The most commonly
encountered are PDD NOS, childhood autism, and
Asperger's Syndrome.
All these "different" conditions have common
diagnostic and physiologic features but differ
slightly by the specific diagnostic criteria.

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Current Knowledge of Disorder
• Autism Spectrum Disorders (ASDs) are lifelong
developmental disabilities. People with ASDs have
impairments in social interaction skills, or verbal and
nonverbal communication, or by the presence of
stereotyped (purposeless and repetitive) behaviors,
interests, or activities.3
• They often have repetitive behaviors or unusual interests.
Each of the behaviors associated with ASD may range
from mild to severe.
• Some individuals may have relatively good verbal skills
and only a minimal language delay but have significantly
impaired social skills. Others may be nonverbal or have
very little ability or interest in communicating or interacting
with others.
• People with ASD often do not take part in pretend play,
have a hard time initiating social interactions, and engage
in self-stimulatory behaviors (e.g., flapping hands, making
unusual noises, rocking from side to side, or toe-walking).

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Current Knowledge continued
• There is no medical test for ASD. Typically, a diagnosis is
made after a thorough evaluation. Such an evaluation
might include clinical observations, parent interviews,
developmental histories, psychological testing, speech and
language assessments, and possibly the use of one or
more Autism diagnostic tests.
• No adjective can describe every type of Autism.
– Some individuals are anti-social, some are asocial,
and others are social.
– Some are aggressive toward themselves and/or
aggressive toward others.
• Approximately half have little or no language.
• Some repeat (or echo) words and/or phrases, and others
may have normal language skills.

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Co-Morbid Influences
• Children with an ASD may have other
developmental disabilities, such as
– mental retardation, seizure disorder, fragile X
syndrome, or tuberous sclerosis
• Most ASD children may have mental health
problems such as
– depression or anxiety
• Some children with ASDs may also have
– attention deficits, sleeping disorders, sensory issues,
sleep problems, and gastrointestinal disorders

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Major Characteristics - Infants
•Different from birth
• Two common characteristics exhibited include
– arching their back away from their caregiver to avoid physical
contact
– failing to anticipate being picked up (i.e., becoming limp)
• As infants, they are often described as either passive or
overly agitated babies.
• During infancy, many begin to rock and/or bang their head
against the crib; but this is not always the case.

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Major Characteristics -
Toddlers
• Approximately one-half of Autistic children
develop normally until somewhere between
1 1/2 to 3 years of age; then Autistic
symptoms begin to emerge.
• Some people in the field believe that
Candida albicans, vaccinations, exposure to
a virus, or the onset of seizures may be
responsible for this regression.

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Children
• Tend to fall behind their same-aged peers in the areas of
communication, social skills, and cognition.
• Dysfunctional behaviors may start to appear, such as self-
stimulatory behaviors (i.e., repetitive, non-goal directed
behavior, such as rocking, hand-flapping), self-injury (e.g.,
hand-biting, head banging), sleeping and eating problems,
poor eye contact, and insensitivity to pain, hyper-hypo-
activity, and attention deficits.
• Insistence on ‘sameness’ or ‘preservative’ behavior.
• Overly insistent on routines; if one is changed, even
slightly, the child may become upset and tantrum. Some
common examples are: drinking and/or eating the same
food items at every meal, wearing certain clothing or
insisting that others wear the same clothes, and going to
school using the same route.
• One possible reason for ‘insistence on sameness’ may be
the person's inability to understand and cope with novel
situations.

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Adolescents
• Difficulty with the transition to puberty
• Approximately 25% have seizures for the
first time during puberty, which may be due
to hormonal changes
• Behavior problems can become more
frequent and more severe
• Others experience puberty with relative
ease

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Childhood Autism
• Autism has its origins in the first weeks or months of
life, and is always presents before 36 months of age.
These children may have some speech
developmental and social interactive regression,
usually around 18 months of age.
• Autism is associated with various kinds of
neurobiological symptoms, ranging from3
– persistence of usual reflexes
– high rates of seizure disorder (25%)
• Characterized by marked problems in
– social interaction
– delayed and deviant communication (speech is absent in
about 50% of cases)
– insistence on sameness motor behaviors
(hand flapping, body rocking)
– insistence on sameness and resistance to change

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Childhood Autism continued
• Childhood Autism must meet the specific
DSM IV criteria and will therefore
present with:
• poor eye contact, pervasive ignoring, language
delay, and other features
• These children will have a severe
impairment in
– speech, communication, or social interaction
• Many of them will be completely non-
verbal and "in their own world"

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Asperger’s Syndrome
• A form of Autism that is characterized by concrete and
literal thinking, obsession with certain topics, excellent
memories, and being ‘eccentric.’
• Affects language less, yet there are difficulties with
appropriate speech and communicative development.
These children have social interaction difficulties and
impairments related to a restricted, repetitive, stereotype
behavior.
• These kids may have very high IQs, may do very well
academically, have a superior memory for "unimportant"
details, such as the birth dates of all baseball players,
some historical or geographical trivia.
– These individuals are considered high-functioning and are
capable of holding a job and of living independently
• These individuals may talk repetitively about a certain topic
without understanding that it may be boring to others.

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Asperger’s Syndrome
continued
• The "amount" of memory of these individuals is incredible
and one may expect different degrees of impairments with
Asperger's Syndrome. This may involve more or less
memory and more or less social communicative
impairment with regards to being able to live
independently.
• Many people with this condition remain undiagnosed
because of their ability to compensate with their memory
or excellent academic abilities, yet they are considered by
others to be “socially inept,” “weird,” “nerds,” “bizarre,”
“eccentric,” etc.

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A typical example of a child
with Asperger's Syndrome
• They think we know what they know and think. They can’t imagine
that we don’t know what they are thinking or what they know.
• A typical example of a child with Asperger’s Syndrome would be
that of a child who has some odd behaviors, poor eye contact,
“sluggish” social interaction abilities, and an extreme interest in a
central topic such as a washing machine.
• The child likes to sit and watch the washing machine rotate,
knows everything about it including its operative and professional
manual.
• Such a child, when he has a play date, may try to involve his
friend in his most exciting interest (the washing machine) without
realizing how boring it is to others and that will be the end of the
play dates forever.
• This pattern may present itself in different degrees and
circumstances, but the principal is the same:
– the lack of the ability to understand how other people perceive what
you do, say, or express with body language and facial expressions.

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Pervasive Developmental
Disorder NOS
• Present similarly to the kids who have Autism but will
have a lesser degree of a severe impairment.
• These kids are more likely to be verbal and have
some degree of verbal or non-verbal effective
communication, yet they must have the Autistic
features and a severe impairment in
– social interaction, communication, or repetitive
stereotype behavior
• This term is reserved for children with a severe
impairment who do not fully qualify for any other
Autistic diagnosis, due to age of onset or
combination of Autistic features.

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Childhood Disintegrative
Disorder
• Form of Mental Retardation in which the long arm on
the X chromosome is constricted.
• Approximately 15% of people with Fragile X
Syndrome exhibit Autistic behaviors.
• Behaviors include: delay in speech/language,
hyperactivity, poor eye contact, and hand-flapping.
– The majority of these individuals function at a mild to
moderate level.
• As they grow older, their unique physical facial
features may become more prominent (e.g.,
elongated face and ears), and they may develop
heart problems.

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Rett Syndrome
Affects mostly females and usually develops
between 1/2 to 1 1/2 years of age.
• These are girls who develop normally until 6
months of age and regress
• Their regression is associated with
microcephaly (small head). The head size
seems to stop growing from 6 months and
on, from the time of the observed
regression.
• Behaviors include: loss of speech, repetitive
hand-wringing, body rocking, and social
withdrawal.
– Those individuals suffering from this disorder
may be severely to profoundly mentally retarded.

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Williams Syndrome
• Autistic behaviors including:
– developmental and language
delays, sound sensitivity, attention
deficits, and social problems.
• In contrast to many Autistic
individuals, those with Williams
Syndrome are quite sociable
and have heart problems.

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ASD Sensory Processing
Considerations in Treatment
• Hearing auditory detail is impaired
– Tone is the language not the words
– Parrot TV commercials because they always
sound the same
– Stretch out and enunciate consonants
– Hearing can be like a bad cell phone connection
• Visual Processing
– Signs of Visual Processing Difficulties
• Finger flicking near eyes
• Tilts head
• Hates escalators
• Difficulty catching a ball
• Eye exams may be normal

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Issues
• Children with sensory-motor differences
have trouble perceiving and moving
effectively and comfortably in the world.
• This means they are at risk for missing the
beat in the “dance of relationships.”
– Example: A playmate may call a child’s name to
join in a game. If there is a delay before that child
is able to process and respond to that invitation,
the playmate may feel ignored and move off in
search of other friends. A parent may tap the
child on the shoulder to get his or her attention,
but that light touch may be perceived as so
threatening that the child instinctively lashes out -
and another chance for purposeful interaction is
lost.

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Issues
• Immature lower brain areas
• Abnormal brain circuits between
brain regions
• Sensory problems are variable
• Word-based tasks may be processed
in visual areas of the brain
• Less frontal cortex utilization

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References
1 Center of Disease and Control and Prevention, Autism Community Report,
Retrieved from:
www.cdc.gov/NCBDDD/autism/documents/AutismCommunityReport.pdf
2 Stephen M. Edelson, Ph.D. - Center for the Study of Autism
Retrieved from: http://www.featnt.org/readarticle.php?article_id=52
3 American Psychiatric Association, 2000. Diagnostic and Statistical Manual of Mental
Disorders (4th ed., text revision) (DSM-IV-TR). Washington, DC: American
Psychiatric Association.
4 Yale School of Medicine, Yale Child Study Center Autism, Retrieved from:
http://www.med.yale.edu/chldstdy/autism/autism.html
5 FightingAutisum.org
6 Stanley Greenspan, “Reconsidering the Diagnosis and Treatment of Very Young
Children with Autistic Spectrum or Pervasive Developmental Disorder” Zero to
Three (Vol. 13, No. 2, 1992)
7 Anne Donnellan and Martha Leary, Movement Difference and Diversity in
Autism/Mental Retardation (DRI Press, 1995)

Treating Autism Part 1 with Equine Assisted Counseling

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