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Autism Spectrum Disorders

Couples and Family Therapy Diversity Project
by

lauren ciesemier

on 11 October 2012

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Transcript of Autism Spectrum Disorders

Autism Spectrum Disorders (ASDs) Working with Parents and Families Development of diagnosis History of the Disorder Effects on Child Common Effects on Child and Family Symptoms of Autism Presented by: Lauren Ciesemier, Alexandra Graves, Emily Keehn, and Sarah Willmert Isolation
Cognitive delays
Comorbidity
Depression
Anxiety
Anger Effects on Family Grieving and loss
Stress
Depression, fear, and anxiety
Burnout
Financial concerns
Educational concerns for child, siblings, and friends
Social isolation
Difficulties in daily management
Higher rate of divorce and marital difficulties
Differences between mother and father Community Health Resources: Parents' Perspective Financial Implications on Family Counselor Implications & How We Can Help Life With Autism Other Considerations Questions There is no formal treatment program for ASD.
Six types of treatments:
Behavioral/Therapeutic
Educational/School-based
Medication
Dietary
Complementary and Alternative Treatments (CAM)
Early Intervention Treatments Explore color, shape, and sensory experiences
Use arts & crafts, games, and activities Activities for Individuals with Austism Report higher levels of stress and poorer levels of family functioning
Challenging behaviors cause the most stress
Parents must face the challenge of adjusting to the diagnosis and learning to navigate the service system
Parents serve as the child's caregiver, case manager, and advocate in order to obtain essential services for the child
Mother is generally the decision maker, and attends all care appointments with the child
Diagnostic process is stressful
Lack of understanding about service system
Eligibility requirements
Stress with interaction with professionals
Time and effort = financial strain
Rate of progress
Lack of coordination with service providers
Lack of provider knowledge of ASD
High staff turnover Mothers of children with ASD:
Earn 35% less than mothers of children with other health limitations
Earn 56% less than mothers of children with no health limitations
6% less likely to be employed
Typically earn $20,479 per year
Fathers of children with ASD:
Typically earn $46,382 per year
No statistically significant differences in labor market outcome
Family of children with ASD:
Earn 21% less than those of another health limitation
May increase their workforce participation to pay for additional services
Private health care limit or do not cover ASD
Estimated lifetime cost to support child with ASD: $3.2M As of December 2008, all individual and group policies, and HMO contracts must follow Public Act 95-1005.

Provides treatment for children with ASDs under 21
Annual coverage for up to $36,000 per year, including diagnosis and treatment
Does not apply to self-insured, non-public employers, welfare plans, or union plans
Subject to pre-existing conditions Health Insurance American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Brookman-Frazee, L., Baker-Ericzén, M., Stadnick, N., & Taylor, R. (2012). Parent perspectives on community mental health services for children with autism spectrum disorders. Journal Of Child & Family Studies, 21(4), 533-544.
Carlson, T., McGeorge, C., & Halvorson, S. (2007). Marriage and family therapists’ ability to diagnose Asperger’s syndrome: a vignette study. Contemporary Family Therapy: An International Journal, 29(1/2), 25-37.
Center for Disease Control Dat and Statistics, Autism. 10/05/2012 www.cdc.gov-2700
Cidav, Z., Marcus, S. C., & Mandell, D. S. (2012). Implications of childhood autism for parental employment and earnings. Pediatrics, 129(4), 617-623. doi:10.1542/peds.2011
DeRosier, M. E., Swick, D. C., Ornstein Davis, N., Sturtz McMillin, J., & Matthews, R. (2011). The efficacy of a social skills group intervention for improving social behaviors in children with high functioning Autism Spectrum Disorders. Journal of Autism & Developmental Disorders, 41, 1033-1043.
Hartley, S. L., Barker, E. T., Seltzer, M., Greenberg, J., Bolt, D., Floyd, F., & Orsmond, G. (2010). The relative risk and timing of divorce in families of children with an autism spectrum disorder. Journal Of Family Psychology, 24(4), 449-457.
Illinois Department of Insurance, Illinois Insurance Facts. 10/4/2012 (2009) http://insurance.illinois.gov
Ingersoll, B., Meyer, K., Bontere, N., & Jelinek, S. (2012). A comparison of developmental social-pragmatic and naturalistic behavioral interventions on language use and social engagement in children with Autism. Journal of Speech, Language, and Hearing Research, 55, 1301-1313.
Karst, J., & Hecke, A. (2012). Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation. Clinical Child & Family Psychology Review, 15(3), 247-277.
Lovaas, O. (1987). Behavioral treatment and normal educational and intellectual functioning in young autistic children. Journal of Counseling and Clinical Psychology, 55(1), 3-9.
Mayes, S., Calhoun, S., Murray, M., & Zahid, J. (2011). Variables associated with anxiety and depression in children with autism. Journal Of Developmental & Physical Disabilities, 23(4), 325-337.
National Institute of Child Health and Human Development. Autism Spectrum Disorders. Retrieved 9 October 2012. www.nichd.nih.gov
National Insutitute of Health. (2011). Autism spectrum disorders. www.nichd.nih.gov
Prosper with Autism. Have you seen these Autism Statistics? Retrieved 5 October 2012. www.myaspergers.net
Stone, W. L. & DiGeronimo, T. F. (2006). Does my child have autism? A parent’s guide to early detection and intervention in autism spectrum disorders. San Francisco, CA: Jossey-Bass
Volkmar, F. R. & Weisner, L. A. (2009). A practical guide to autism: What every parent, family member and teacher needs to know. Hoboken, NJ: John Wiley & Sons, Inc.
Webb, J. T., Amend, E. R., Webb, N. E., Goerss, j., Beljan, P. & Olenchak, F. R. (2005). Misdiagnosis and dual diagnosis of gifted children and adults: ADHD, Bipolar, OCD, Asperger's, Depression and other disorders. Scottsdale, AZ: Great Potential Press, Inc.
White, S., McMorris, C., Weiss, J., & Lunsky, Y. (2012). The experience of crisis in families of individuals with autism spectrum disorder across the lifespan. Journal Of Child & Family Studies, 21(3), 457-465.
Wilder, L. K., Taylor Dyches, T., Obiakor, F. E., & Algozzine, B. (2004). Multicultural perspectives on teaching students with Autism. Focus on Autism and Other Developmental Disabilities, 19(2), 105-113.
World Health Organization. ICD 10 Version: 2010. Retrieved 5 October 2012 www.who.int/en/ References Autism Speaks - www.autismspeaks.org
Autism Society - www.autism-society.org
Autism Fact Sheet, National Institute of Health - www.ninds.nih.gov/disorders/autism/detail_autism.htm
Social Thinking - www.socialthinking.org Helpful Resources Behavior Management Therapy (Applied Behavior Analysis)
Speech and Language Therapy
Occupational Therapy
Physical Therapy Behavioral & Therapeutic Treatments IDEA (1990) - all children are entitled to free, public education from ages 3 to 21
Individualized Education Program (IEP)
Developed by a team of people including:
Parents
Teachers
Case managers
Caregivers
School psychologists
School social workers
Other child development specialists Educational and School-Based Treatments Used to treat symptoms not ASD.

Common symptoms treated with medication:
High energy levels
Lack of focus
Anxiety
Depression
Seizures

Types of medications commonly used:
SSRIs
Tricyclics
Anti-psychotics
Stimulants
Anti-anxiety

Secretin - a hormome for digestion - is NOT recommended for ASD Medication Based on individual cases
There is no specific diet to treat ASD
Belief that food allergies and/or lack of vitamins may cause symptoms of ASD
Biomedical interventions may require a change in diet
Must be recommended by pediatrician and nutritionist Dietary Approaches Special diets
Chelation - process to remove heavy metals from the body (i.e. lead)
Biologicals - secretin
Body-based systems - deep pressure
Controversial and outside doctor recommendations
Approximately 1/3 of parents have tried these
10% of those who have tried, are using a potentially dangerous treatment Complimentary and Alternative Treatments (CAM) Extremely important to provide early intervention
Found to improve child's development
Children from birth - 3 years old
Not necessary to have formal diagnosis to begin early intervention
Speech & language therapy is most important to begin early invervention Early Intervention 1997 - NIH formed Autism Coordinating Committee (NIH/ACC) to enhance efforts in finding a cure
2007 - NIH began funding 11 Autism Centers of Excellence (ACE) to investigate:
Early brain functioning
Social interactions between infants
Rare genetic variants and mutations
Association between Autism-related genes and physical traits
Possible environmental risk factors and biomarkers
A potential new medication treatment Research in Treatment Access to treatment is a factor.
Treatment differs by age.
70% of parents use Occupational, Social Skills, and Speech therapy
Delay or regression of normal functioning
Social interaction
Communication
Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities 5+7= (cc) image by anemoneprojectors on Flickr Populations affected Growth and Affects of ASDs Growth comparison during the 1990s U.S. population increase: 13%
Disabilities increase: 16%
Autism increase: 172% 1943 First formally studied by Leo Kanner 1950 "Refridgerator mother" theory Asperger Syndrom studied by Hans Asperger Idiot/Savant connections 1980 Autism added to the DSM 1990 IDEA allows individuals with ASDs to receive Special Education services 1994 Asperger Syndrome and PDD-NOS added to the DSM Future "Autism Spectrum Disorders"
Changes to the DSM-V (May 2013) Current diagnostic critera from DSM IV-TR Prevelance in U.S.A. Genetics
Prenatal and perinatal risk
Neuroanatomical findings
Immunizations?
Gastrointestinal connection? Diagnostic Process Level 1
Level 2
Autisim Diagnostic Interview-Revised (IDI-R)
Autism Diagnostic Observation Schedule (ADOS) Asperger's Syndrome distinguished by lack of delay in verbal development Associated Risk Factors How Are ASDs Diagnosed? Autism vs Gifted
Three domains of impairment:
1. Communication
2. Social
3. Behavioral Symptoms can be overlapping An individual who shows, or has the potential for showing, an exceptional level of performance in one or more of the following:
- General intellectual ability
- Specific academic aptitude
- Creative thinking
- Leadership ability
- Visual or performing arts Giftedness is not a single entity, but a spectrum of several dimensions. Gifted Common Symptoms of Autism Impaired language and communication skills
Delayed development of spoken language
Does not look people in the eye during interactions
Impaired social skills
Does not:
Initiate social interactions with adults or peers
Show enjoyment in interactive or turn-taking games with adults, such as patty-cake or peek-a-boo
Show interest in other children, such as watching them or playing near them
Join another child in play
Show an interest in making friends
Imitate the actions of other children
Initiate play with other children, such as greeting them or handing them a toy
Restricted interests and Repetitive Activities (Behavior)
Becoming preoccupied with a particular activity or toy, or interest in a way that is unusual in its intensity.
Children might find comfort or security in repetition of certain routines, patterns or rituals.
Some children with autism also demonstrate unusual sensory responses.
Demanding rigid adherence to rituals or routines Inborn Intensities of Gifted Children Intellectual Overexcitability
Curiosity, asking probing questions, concentration, problem solving, theoretical thinking

Imaginational Overexcitability
Rich imagination, fantasy play, animistic thinking, daydreaming, dramatic perception, and use of metaphors

Emotional Overexcitability
Show a heightened concern for and reaction to the environment around them. They form strong emotional attachments to people, places, and things and are often accused of overreacting.
Ex: Children who may cry when they see a homeless person on the street, displays of rage, possibly related to losing a game, feeling left out, needing to be the best etc.

Psychomotor Overexcitability
They love movement for its own sake, and they show a surplus of energy that is often manifested in rapid speech, fervent enthusiasm, intense physical activity, and a need for action (as cited in Piechowski, 1979, 1991)
A child with psychomotor Overexcitability has a particularly high potential of being misdiagnosed with ADD/ADHD

Sensual Overexcitability
The sensory aspects of everyday life—seeing, smelling, tasting, touching, hearing—are much more heightened than for others.
These intensities are what the authors use to describe the behaviors of a gifted child or adult and how they could be misconstrued as symptomology for another mental disorder such as autism. Diagnosis/ Misdiagnosis of ASDs vs. Gifted What Autism feels like Schools and community agencies Small group counseling Families and parents Leisure activities
Support groups
Music and art at home
Sensory table
Using the iPad or iPhone Two key points to consider in assessment process

1. Examine the child's behaviors when they are with others who share their intellectual passion

2. Examine the child's insight regarding how others see them and their behaviors Understanding that early detection is very important
1. Using Screening tools and looking at scores
DSM-IV criteria
2. Obtain medical evaluations
Physical exam, hearing exam, CT/ MRI scan
Geneticists or neurologists
3. Observation (ASD vs. Gifted)
Range of behavior in different situations
Interviewing parents of child's developmental milestones Implications of using accurate diagnostic assessments and interpreting results
Misdiagnosis
Practicing autonomy of the child and respecting the limits of the child Counseling Professionals and Families Educating family members about ASD diagnosis (or giftedness)

Don’t neglect parents or siblings

Providing resources
Support groups
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