Breakthroughs in autism management part 1

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This is the first part of the re-echo session I've given to special education teachers and professionals on December 18, 2011 at AJ.
Much of the contents in this presentation were based on the 2011 Autism around the world conference recently held in Zayed University Dubai.

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  • So what I decided to do is take the structure of a recent conference I attended in Dubai and that is “Autism around the world conference” which was organized by Child Learning and Enrichment Medical Center and perhaps one of the few best conferences I’ve attended since 2008 here in the UAE. That was a true conference since apart from the lectures and workshops happening simultaneously, the delegates actually had the chance to interact with experts, other professionals and some parents about issues revolving around autism. In that conference, autism was viewed in different lenses—there were psychologist, behaviourists, special educators, dieticians, optoimetrists, audiologists, physical intstructor and other experts working with autism—all of them having unique ways in managing autism issues. That conference a also a call to reframe our exisiting view of children with autism and it expanded the horizon of our understanding about what children with autism actually go through as they live along the autism spectrum. So taking these into consideration, I identified some discussions points which will be our focus for today.
  • From there, we’ll look shortly into visual stimming and autism from the optometrists perspective. We’ll try to gain insights why children with autism engage in visual stimming and look at some
  •   88,900,000 results (0.20 seconds)
  •   88,900,000 results (0.20 seconds)
  •   88,900,000 results (0.20 seconds)
  • Still not sure where it came from No substantial cause
  • 12/18/11 ©Stephen M. Shore [email_address]
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  • To enhance not to inhibit communication
  • To enhance not to inhibit communication
  • Breakthroughs in autism management part 1

    1. 1. Breakthroughs in Autism Management -1 <ul><li>Nephtaly Joel Botor </li></ul><ul><li> : [email_address] </li></ul><ul><li>: www.way2life.org </li></ul>Emerging modalities in managing autism Step Ahead 2011 (Winter) AJ Group of Schools
    2. 2. Step Ahead 2011 (Winter) AJ Group of Schools
    3. 3. What do we need to mould a child with autism into an optimally-functioning individual? YOU.
    4. 4. What to expect (morning) <ul><li>Setting the stage </li></ul><ul><ul><li>Why do we have to talk about autism </li></ul></ul><ul><ul><li>Reframing autism: defeciency vs. learning </li></ul></ul><ul><li>Re-defining autism </li></ul><ul><ul><li>Review of DSM-IV criteria </li></ul></ul><ul><ul><li>Refocusing autism (DSM-V) </li></ul></ul><ul><li>Senses and sensibilities </li></ul><ul><ul><li>Sensory processing disorder (in brief) </li></ul></ul><ul><ul><li>Vision, VRT and autism </li></ul></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    5. 5. What to expect (morning) <ul><li>Communication and autism </li></ul><ul><ul><li>PECS /Dynavox </li></ul></ul><ul><ul><li>AVAS/LENA </li></ul></ul><ul><ul><li>i-pad/i-phone </li></ul></ul><ul><li>Wrap up (morning) </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    6. 6. What to expect (afternoon) <ul><li>Autism fitness (activity based) </li></ul><ul><li>Behavioural modalities </li></ul><ul><ul><li>Joint attention (Walen & Schreibman, 2003) </li></ul></ul><ul><li>Multifactorial causes of autism </li></ul><ul><ul><li>Biomedical issues </li></ul></ul><ul><ul><li>Diet and autism </li></ul></ul><ul><li>Q&A/Conclusion </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    7. 7. Step Ahead 2011 (Winter) AJ Group of Schools
    8. 8. Setting the Stage Step Ahead 2011 (Winter) AJ Group of Schools
    9. 9. <ul><li>88.9 million </li></ul>Search engine results “autism” Step Ahead 2011 (Winter) AJ Group of Schools
    10. 10. <ul><li>5.7 </li></ul>Average age of diagnosis Step Ahead 2011 (Winter) AJ Group of Schools
    11. 11. <ul><li>1:110 </li></ul>High prevalence of autism Step Ahead 2011 (Winter) AJ Group of Schools
    12. 12. <ul><li>35 Billion </li></ul>Annual expenses for adult care Step Ahead 2011 (Winter) AJ Group of Schools
    13. 13. Autism: before <ul><li>Must have existed for hundreds or thousands of years- “weird”, “strange” </li></ul><ul><li>Considered as a mental illness (“crazy”) or mental retardation </li></ul><ul><li>Sent to mental asylum—with psychotics, neurotics, etc. </li></ul><ul><li>Not sure where it came from </li></ul><ul><li>No proper intervention </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    14. 14. Autism: now <ul><li>Still not sure where it came from </li></ul><ul><li>No substantial cause </li></ul><ul><li>Genes? </li></ul><ul><li>Environment? </li></ul><ul><li>Systemic? (metabolism issues) </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    15. 15. Autism: now <ul><li>Separate diagnosis: autism spectrum disorder </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    16. 16. Autism: now <ul><li>Available interventions (ABA, PECS, etc) </li></ul><ul><li>Applied research and gaining interest </li></ul><ul><li>Research and advocacyorganizations (autismone.org) </li></ul><ul><li>More chances of a more “quality life” for children with autism </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    17. 17. Re-defining autism Step Ahead 2011 (Winter) AJ Group of Schools
    18. 18. <ul><li>299.00 (DSM-IV) - “autistic disorder” </li></ul>Autism: Diagnosis Step Ahead 2011 (Winter) AJ Group of Schools
    19. 19. Autism: Diagnosis (DSM-IV) <ul><li>Qualitative impairment in social interaction </li></ul><ul><ul><li>nonverbal behaviours (e.g. no eye contact) </li></ul></ul><ul><ul><li>Failure to develop peer relationships </li></ul></ul><ul><ul><li>Lack of spontaneous shared enjoyment </li></ul></ul><ul><li>Qualitative impairment in communication </li></ul><ul><ul><li>Delay or total lack of spoken language </li></ul></ul><ul><ul><li>Impairment in ability to initiate/sustain conversation </li></ul></ul><ul><li>Restricted repetitive and stereotyped patterns of behaviour (stimming/pacing/preoccupation) </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    20. 20. 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 interaction Communication ( 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. ASA (2005) DSM IV-TR (2000) Miller (2000) Reframe • Communication • Socialization • Restricted Interests OOPS!!!!! WHAT ABOUT SENSORY INTEGRATION ISSUES? Step Ahead 2011 (Winter) AJ Group of Schools
    21. 21. Autism: Diagnosis (DSM-V) <ul><li>Publication of DSM-V in March 2013 </li></ul><ul><li>Sensory processing disorder/issues </li></ul><ul><li>Researches have noted that children with autism have significant sensory issues. </li></ul><ul><li>Sensory integration  sensory processing </li></ul><ul><li>Rooted in the processing of sensory signals </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    22. 22. Senses and Sensibilities: Sensory processing issues Step Ahead 2011 (Winter) AJ Group of Schools
    23. 23. Why does Stephen Shore wear a cap? Step Ahead 2011 (Winter) AJ Group of Schools
    24. 24. Sensory processing disorder <ul><li>Sensory integration: ability to combine/organize signals from environment </li></ul><ul><li>Sensory processing disorder -  sensory signals  don't  get organized into appropriate responses (neurological “traffic jam”).  </li></ul><ul><li>Not the structure but function </li></ul><ul><li>Sensory stimuli can be causing discomfort, undetectable or distorted </li></ul><ul><li>Self-stimulating behaviours </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    25. 25. Why do they engage in sensory stimulating activities? <ul><li>“ Children with autism feels lost in space .” </li></ul><ul><li>-Dr. Stephen Shore </li></ul>
    26. 26. HOW IT FEELS LIKE? <ul><li># 1. Listen to 5. </li></ul># 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
    27. 27. Sensory processing disorder <ul><li>A lot of input coming at the same time </li></ul><ul><li>One sense extremely sensitive over the other </li></ul><ul><li>Difficulty in putting all sensory information together </li></ul><ul><li>Impaired processing at the neurological level </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    28. 28. Vision, VRT and autism Step Ahead 2011 (Winter) AJ Group of Schools
    29. 29. Why do children stim? <ul><li>Visual stimming: notable behaviour of children with autism </li></ul><ul><li>Stimming – repetitive body movement thought to stimulate the senses; “lost in space” issue </li></ul><ul><li>DOES THIS RELATE TO VISION???? </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    30. 30. Sight vs. Vision Step Ahead 2011 (Winter) AJ Group of Schools
    31. 31. Sight vs. Vision Step Ahead 2011 (Winter) AJ Group of Schools
    32. 32. Autism & Vision Research Step Ahead 2011 (Winter) AJ Group of Schools
    33. 33. 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 6-2008 AOA/EUROPEAN PUBLIC HEALTH RISK ASSEST. FEB 2007 VESTIBULAR/VOR SKILLS 6% / 10% Step Ahead 2011 (Winter) AJ Group of Schools
    34. 34. Vision controls GROSS MOTOR Vision controls FINE MOTOR Vision controls SELF-ESTEEM Step Ahead 2011 (Winter) AJ Group of Schools
    35. 35. Vision rehabilitation therapy <ul><li>Studies associating visual stimming to visual deficits than can be rehabilitated </li></ul><ul><li>Done by a neurodevelopmental optometrist </li></ul><ul><li>Very limited practitioners; general optometrist population </li></ul><ul><li>may not be trained </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    36. 36. Vision rehabilitation therapy Neurosensory Testing Step Ahead 2011 (Winter) AJ Group of Schools
    37. 37. Vision rehabilitation therapy Step Ahead 2011 (Winter) AJ Group of Schools
    38. 38. Vision rehabilitation therapy Hand-held therapy Computer-assisted therapy Step Ahead 2011 (Winter) AJ Group of Schools
    39. 39. VRT: Neuroplasticity Training Before During After Step Ahead 2011 (Winter) AJ Group of Schools
    40. 40. Areas improve by VRT <ul><li>Tracking (following objects) </li></ul><ul><li>Fixation (locate objects; required in reading) </li></ul><ul><li>Focus change (accomodation) </li></ul><ul><li>Depth perception (distances) </li></ul><ul><li>Peripheral vision (see things w/o focus) </li></ul><ul><li>Binocularity </li></ul><ul><li>Convergence (eyes towards each other) </li></ul><ul><li>Visualization (mind’s eye) </li></ul><ul><li>Visual sensory integration (combine visual info) </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    41. 41. Supporting research American Optometrist Association, 1998 Step Ahead 2011 (Winter) AJ Group of Schools
    42. 42. Communication Modalities Step Ahead 2011 (Winter) AJ Group of Schools
    43. 43. Why? <ul><li>Communication impairment being a notable characteristic of autism </li></ul><ul><li>Communication is so essential (80%) </li></ul><ul><li>Functional communication </li></ul><ul><li>Express desires, needs etc. (self advocacy) </li></ul><ul><li>Socialize/interact </li></ul><ul><li>Allowing an opprotunity to express themselves (if not verbal/spoken, how?) </li></ul><ul><li>AACs (augmentative/alternative) </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    44. 44. PECS <ul><li>Picture Exchange Communication System </li></ul><ul><li>Standard practice in autism management </li></ul><ul><li>Giving voice to non-verbal children with autism </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    45. 45. PECS: Stages <ul><li>1. Initiate communication </li></ul><ul><li>2. Seek pictures/request </li></ul><ul><li>3. Discriminate pictures </li></ul><ul><li>4. “I want ________.” </li></ul><ul><li>5 . “What do you want?” </li></ul><ul><li>6. Make comments </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    46. 46. PECS: Issues <ul><li>PECS or not PECS? </li></ul><ul><li>Parents’ fears: will not learn spoken language? </li></ul><ul><li>Studies show that PECS actually supports spoken language </li></ul><ul><li>Remove PECS or not? </li></ul><ul><li>POINT: Parental/family involvement </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    47. 47. PECS: Parental involvement <ul><li>Using PECS at home </li></ul><ul><li>Parents collaborating with therapists/educators </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    48. 48. Dynavox <ul><li>Portable digital AAC device </li></ul><ul><li>Picture-based (doesn’t contradict with PECS) </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    49. 49. Dynavox supports… <ul><li>Communication and language development </li></ul><ul><li>Positive behaviour </li></ul><ul><li>Social participants </li></ul><ul><li>Classroom participation </li></ul><ul><li>See how it’s used.  </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    50. 50. However, <ul><li>I find it too costly! </li></ul><ul><li>43000 aed!!! </li></ul><ul><li>May not be cost-effective </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    51. 51. OPTION: iPad/iPod/iPhone <ul><li>More and more applications being developed for low cost unlike other computer-mediated AAC device </li></ul><ul><li>4000 aed (iPad) + 300 aed (software) </li></ul><ul><li>4300 aed vs. 43000 aed!!! </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    52. 52. Ways iPad tech can support <ul><li>Communication application (proloquo2go) </li></ul><ul><li>Vocab/speech (kindergarten.com) </li></ul><ul><li>Language reinforcement (Talking Tom) </li></ul><ul><li>Occupational therapy (Dexteria) </li></ul><ul><li>Reading </li></ul><ul><li>Sequencing </li></ul><ul><li>Scheduling </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    53. 53. proloquo2go
    54. 54. “ Talking Tom”
    55. 55. www.kindergarten.com
    56. 56. “ Dexteria”
    57. 57. iPAD generation plus <ul><li>(+) Simple user interface </li></ul><ul><li>(+) Children are attracted to it </li></ul><ul><li>(+) Increase the child’s social acceptability (i.e. in inclusive classrooms) </li></ul><ul><li>Our Role : </li></ul><ul><ul><li>Make sure tech doesn’t become an obsession/opportunity to stim </li></ul></ul><ul><ul><li>Learning not entertainment </li></ul></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    58. 58. www.lenafoundation.org Other technologies: LENA <ul><li>LENA Foundation </li></ul><ul><li>LENA (Language ENvironment Analysis) System </li></ul><ul><li>World’s first automatic language collection and analysis tool   </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    59. 59. Other technologies: LENA It's a simple four-step process. Parents start first thing in the morning and follow these instructions:                                                                                                                                                                                                                                                                               1 2 3 Step Ahead 2011 (Winter) AJ Group of Schools
    60. 60. Other technologies: LENA
    61. 61. Other technologies: LENA
    62. 62. Other technologies: AVAS It's a simple four-step process. Parents start first thing in the morning and follow these instructions:                                                                                                                                                                                                                                                                               <ul><li>Will come out on 1 st quarter 2012 </li></ul><ul><li>In English and Arabic </li></ul><ul><li>Diagnostics and therapeutics </li></ul><ul><li>picture-based articulation </li></ul><ul><li>Graphic feedback on sounds </li></ul><ul><li>Real time feedback </li></ul><ul><li>Vocal range, timbre, projection, weight, transition </li></ul><ul><li>Listening training </li></ul><ul><li>Voice triggering </li></ul>1 2 3 Step Ahead 2011 (Winter) AJ Group of Schools
    63. 63. Other technologies: AVAS Picture-based flashcard (with real-time feedback in articulation Step Ahead 2011 (Winter) AJ Group of Schools
    64. 64. Other technologies: AVAS 31 logarithmic parameters to diagnose and that can be recorded and viewed again Step Ahead 2011 (Winter) AJ Group of Schools
    65. 65. Other technologies: AVAS “ Blow the candle” Step Ahead 2011 (Winter) AJ Group of Schools
    66. 66. Other technologies: AVAS Stories for oral reading exercise Step Ahead 2011 (Winter) AJ Group of Schools
    67. 67. Wrap Up <ul><li>Autism is prevalent </li></ul><ul><li>There’s a call to redefine and reframe autism </li></ul><ul><li>Sensory processing is an issue </li></ul><ul><li>Growing use of technology in autism intervention </li></ul><ul><li>Something to watch  </li></ul>Step Ahead 2011 (Winter) AJ Group of Schools
    68. 68. Step Ahead 2011 (Winter) AJ Group of Schools

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