1. The OSHA program aims to help autistic children develop social, communication, language and academic skills through early intervention, preschool and school classes taught by specialists. 2. The program involves comprehensive assessment, individualized treatment plans, and regular re-evaluation. Treatment includes behavioral, educational, speech and social interaction therapies. 3. While autism was once considered untreatable, intensive early intervention programs like OSHA have been shown to significantly improve outcomes for many children. Certain medications can also help treat associated behaviors.

1. Prof Dr Hussein Abdeldayem
Prof of Ped Neurology, Alex University
Member of AAN, AAP, ICNA
IS AUTISMIS AUTISM
A TREATABLEA TREATABLE
DISORDER?DISORDER?

2.
ICNC 2016 Satellite Symposium
Is Autism a treatable
disorder?
April 29th
, 2016
Roma (Italy(

3. Translational neurobiology in Shank mutants - mouse models for ASD
– Michael Schmeisser (Ulm University, Germany)
Mutations in BCKD-kinase lead to a potentially treatable form of
autism with epilepsy – Gaia Novarino (IST, Vienna, Austria)
Autism Spectrum Disorder with or without epilepsy: comparative
study of 207 patients – Benedetta Berlese (A.O.U. Verona, Italy)
OSHA protocol for treating autistic children – Hussein Abdeldayem
(Alexandria University, Egypt)
Very early parents mediated intervention in TSC infants at risk for
Autism – Arianna Benvenuto (Tor Vergata University, Roma, Italy)
Autism Spectrum Disorder associated with Tourette Syndrome:
Ariprazole treatment – Leonardo Zoccante (A.O.U. Verona)

6. A successful OSHA program
for Autism
Prof Dr Hussein A bdeldayem, Dr Omayma Selim
A lex, EgyptTheOSHAprogramaimsatprogressingautisticchildrenbydivertingthemas
nearlyaspossibletotheaveragenormalaspectsof social,communication,
languageandacademicskills.Thisprogramstartedsuccessfullyin2002with2
autisticchildren(YehiaandOmar).Nowadays,thisprogramis applied
successfullyover45autisticchildreninAlexandria,Egypt.
ThecriteriaforinclusionintheOSHAprogramis:
first:theyoungertheagetostart thebetteristheresult(from2-4yearsold).
second:fullconcentofparentsforprogramstepsandinstructionsgiven
thirdly:theprogramgoesonfor11months/yearfor 2-4years.
OSHAprogramstartsbyfullneuro-psychometricassessmentaimingforaccuratediagnosis,
assessingtheseverityofthedisorderandgivingbaseinformationsforfuturefollowup.
Theassessmentincludes:
1-DS-4TRcriteria
2-CARS
3-Developmentalskills:usingChildrenBehaviorRatingScale(CBRS–Arabicversion)
4-IQ:usingStBinnet, Vinelandscale
5-languageandspeechassessment
6-fineandgrossmotorassessment
7-parentalaltitudeandadjustment
8-fullpediatricneurologyexaminationplusapplyingMCHAT
Overmultiplesessionswithvariousprofessionalteamworks(Childpsychiatrist–DrOS-,
childpsychology, speechtherapist, occupationaltherapist, pediatricneurologist-DrHA-)
Thereafter, Fulldescriptionoftheprogramwillbeexplainedtoparentsandteamwork.
Areasofwork:
1-Earlyinterventionclasses
2-preschoolclasses
3-Classesin2regularschool:oneforAmericancurriculumandthesecondforEgyptian
curriculum. Eachschoolhas3-5classesfullyequippedwithallthetools&prerequisitesof
theprogram.Ateamofspecialistsisresponsibleofcoordinating&applicationofthe
programunderthesupervisionofthechildpsychiatryconsultant(DrOS).Thisteam
includes:specialeducationteachers, speechtherapists,behaviormodificationtherapists,
socialworkersandoccupational&motortherapists.
4- for certain children: private sessions and/or home visitors are needed
Theaveragecostoftheprogramisabout1500–2500$/year/child..
Followupassessments&evaluationsareperformedregularlyevery6weekstodocument
theresponseandachievementofthechildmodificationtechniquesandfurtherdevelopment
ofsuccessiveIIP&IEP
Conclusion
ThecoreoftheOSHAprogramis:
EarlyinterventioninaWell-runprogram
&“Multi-disciplinaryteamworkisthekeyfor
helpingautisticchildrentoreachtheirpotential”
.Thanku

9.  DSM-5: Future of Psychiatric Diagnosis
 Publication of the fifth edition of
 Diagnostic and Statistical Manual of Mental
Disorders (DSM-5)
 in May 2013
 19 ys to develop (from 1994)
2013
1994

11. DSM-5 Field Trial Professional Volunteers .
From Darrel A. Regier, M.D.
To husseindayem@hotmail.com
 Thank you for participating in the DSM-5 Field Trials in Routine
Clinical Practice Settings! This important part of the DSM-5
Field Trials will test the feasibility and clinical utility of the
proposed diagnostic criteria and measures for routine
practices.

12. DSM-5 Field Trial Professional Volunteers .
From Darrel A. Regier, M.D.
To omayma_selim@hotmail.com
 Thank you for participating in the DSM-5 Field Trials in Routine
Clinical Practice Settings! This important part of the DSM-5
Field Trials will test the feasibility and clinical utility of the
proposed diagnostic criteria and measures for routine
practices.

13. DSM-V
No pervasive developmental
disorder term
But
ASDMild Severe

14. Autism Spectrum DisorderAutism Spectrum Disorder
ASDASD
They are defined as a group of biologically based
neurodevelopment disorders that share two
common areas of concern
Qualitative
impairments in
social interactions
Qualitative
impairments in
social interactions
Restricted and
repetitive
interests or
behaviors
Restricted and
repetitive
interests or
behaviors
Qualitative
impairments in
communication
Qualitative
impairments in
communication

15. Diagnosis of ASDDiagnosis of ASD
In DSM-IV-TR and ICD-10 diagnosis has been based
on deficits in three core domains:
(1)social impairments,
(2) communication difficulties, and
(3) stereotyped and repetitive behaviours
In DSM-5 (and the proposed ICD-11 criteria)
diagnosis is based on deficits in two core dimensions:
1.Social-communication difficulties
2.Repetitive behavior

18. ASD
male 4/ 1 female

19. ASD

20. ASD

22. 1/60 (2016)

24. So…What causes autism?
Genetic Factors
Factors that affect the
capacity for methylation
(including gender)
Factors that affect
metal handling
Environmental Factors
Vaccine AdditivesEnvironmental Exposure
To Heavy Metals
Brain Differences
Effect or cause

26. IS IT POSSIBLE TO CURE AUTISM?

27.  Autism was considered as disorder without hope, but
now it is recognized as treatable for many patients
especially who are diagnosed early and receive ,,,,,,
 INTENSIVE BEHAVIOR INTERVENTIONS

28.  MEDICAL LITERATURE SAYS NO, BUT
NOWADAYS WITH
ADEQUATE INTENSIVE REHABILITATION
SESSIONS
THE IMPROVEMENT CAN BE SO GREAT THAT IT
COULD JUSTIFY THE USAGE OF THE WORD

29. SOMETIMES
WITH ADEQUATE INTENSE REHABILITATION
CHILDREN WITH HIGH RISK FOR DEVELOPING
ASD DON’T DEVELOP IT .

30.  Improvements can be really significant, although ,
not always , not in every child. But in majority
(Who?)

31. If your patient /child is
at risk for developing
or
already with ASD ,
and if you are willing to put effort in helping him,,
attend my presentation thoroughly

33. Listen please

34. OSHA TRIANGLE
ASSESSMENT
Medical
FAMILYCHILD
Environment
DD 70%
1- Listen
2-Ask
3- Observation
4-M-CHAT
Intellectual and cognitive Function
Self and social adjustment (Vieland Scale)
Developmental Skills
Free Behavior attitude observation
Motor adjustment and coordination
language and speech assessment
CARS
Parental Attitude and Family adjustment
DSM-V

37. Treatment should be:
 Comprehensive
 Goal-driven
 Evidenced based
 Geared towards the needs of the child and family

38. OSHA Recommended Regimens
1. Start as early as possible
2. Individualized programming for each child
3. Have curricular emphasis on attention ,
communication, play and social correlation
4. Highly supportive, predictable and organized
5. At least 25-30 hours/week of educational services
6. In small classes including 1:1 time for most children
7. Teachers with special expertise in working with
children with autism / Provide training of teachers.**
8. Family counseling *** and group therapy
9. Changeable program (cont.)

39. Cont-
9. Regular re-evaluation, progress and adjustment :
every 3 months
10.Use functional analysis of behaviors
11.Provide transitional planning

40. Treatment should include
 Behavioral based models
 Play and relationships based models
 Educational model of treatment
 Speech therapies
 Educational therapies
 Social interactions therapies
 Medication
 Alternative / complementary medicines approaches

41. CRITERIA OF AUTISTIC CHILD

46. GROUP ORIENTATION

47. 1/1 or 1/2

58. Pharmacologic interventions DO NOT
treat the underlying ASD core.
They can improve the child's
functioning and his ability to
participate in behavioral interventions.
Pharmacological interventions

60. They are usually prescribed for:
Inattention
Hyperactivity, and impulsivity
Aggression, outbursts, and self-injury
Anxiety
Obsessive compulsive behaviors, rigidity, and repetitive behaviors
Depressive symptoms
Sleep dysfunction
Pharmacological interventions

61. Pharmacological Role
1- Atypical antipsychotic*: FDA approved
as resperidone and aripiprazole
2- Selective serotonin reuptake inhibitors **:
(for anxiety) sertraline, fluoxetine
3- Insomnia:
Melatonin
4- Mood stabilizers/ AED:
as valproic acid, Carbamazepine
5- ADHD :
as Methylphenidate, Atomoxetine
6- omega 3 and 6 /zinc

62. (Risperidone*)(Risperidone*)
 dopamine blocker (antagonist )
 5-HT2A antagonist
*available
as a 1 mg/mL oral solution)

63. Rispadex
(Risperidone*)
 Only FDA approved (10/2006 )
 Duration: at least 6 mo

64. ARIPIPRAZOLE (Aripiprex)
 Atypical antipsychotic ( partial
DOPAMINE AGONIST )
 FDA approved at 2013-2014*

65.  FDA APPROVED FOR ASD
1- decrease irritability, aggression , SIB
2- decrease hyperactivity
3- decrease stereotype
Resperidone: for insomnia

66.  S/E:
1- weight gain
2- sleepiness
3- drooling
4- tremors
5- tardive dyskinesia
Gradual withdraw
Not with CBZ or fluoxetine

67. Complementary and Alternative
Therapies
NON - Inclusive
Because Few studies
 Vitamin B6
 Magnesium
 Dimethyl glycine
 Diet: Gluten / Casein free
 Hyperbaric Oxygen Therapy
 Secretin
Insufficient
No controlled studies
 Antifungals
 IV immunoglobulin
 Chelation therapy
 GABA
 Stem cell therapy
 Coenzyme Q
OTHERS*

68. 9/2015

72. Non Biological based practices
 Acupuncture
 Auditory integration training
 Alpha Stimulant Set
 Biofeedback and neurofeedback
 Chiropractic*
 Hypnosis
 Hippotherapy (therapeutic horseback riding
 Sensory integration therapy
 Transcranial magnetic stimulation
 Yoga

73. Alpha waves stimulant

74. Alpha cranial stimulation
session

75. NEUROFEEDBACK

76. Complementary
approaches
Music
Quoran
Pets

81. Factors with positive outcomes for OSHA
 Age: early identification
 Higher cognitive abilities
 CARS score (mild ASD)
 NO clinical Seizures
 Not Secondary ASD

82. please refer
 Failure to Attend to human voices
 Failure to Look at face and eyes of others
 Failure to Orient to name
 Failure to Demonstrate interest in other children
 Failure to imitate
 NO babbling, pointing or gesturing by 12 mo
 NO single words by 16 mo
 NO 2 words spontaneous phrases by 24 mo
 Any loss of language or social skills at any age
Auditory assessment is needed (ABR)
Screening for autism: M-CHAT

84. 1

88. LAMAR (FEB 2012)

92. Sherin

112. Rispadex
(Risperidone*)
 Improve:
 Aggression
 Improve language development
 Improve communication
 Decrease self-injury
 Repetitive behavior
 Hyperkinesia
 Good sleep