Autism: Treatment Trends

Transcription

1 Lewis County Autism Coalition Friday, November 2 nd, 2012 Autism: Treatment Trends Glenn C. Tripp, M.D. Developmental Behavioral Pediatrics Medical Director, Developmental Services Mary Bridge Children s Hospital Tacoma, Washington (253) glenn.tripp@multicare.org

2 Autism: Practice Parameters 2000 P.A.Filipek, MD, et al. Practice Parameter: Screening and Diagnosis of Autism. Neurology, 55: , (101 references) 2007 C. P. Johnson, S. M. Meyers, and the AAP Council on Children with Disabilities. Identification and Evaluation of Children with Autism Spectrum Disorders. Pediatrics, 120: , 2007 (334 references) S. M. Meyers, C. P. Johnson, and the AAP Council on Children with Disabilities. Management of Children with Autism Spectrum Disorders. Pediatrics, 120: , 2007 (245 references) Schafer and Mendelsohn. Genetics evaluation for the etiologic diagnosis of autism spectrum disorders. Genetics in Medicine, Vol 10 (1):4-12 (2008) Caring for Washington Individuals with Autism Task Force. Autism Guidebook for Washington State. Revised/printed: 2009.

3 Outline Pharmacologic Complementary/Alternative Traditional therapy services Early intensive behavioral intervention Educational

4 Pharmacologic Seizures Sleep problems Attention/concentration Anxiety Emotional self-regulation Repetitive, self-injurious behaviors

5 Complementary/Alternative Gluten-free/casein-free diet Dietary supplements Oxidative stress supplements Elimination of infections Non-biological interventions Miscellaneous therapies

6 Complementary/Alternative Gluten-free/casein-free diet Dietary supplements Vitamin B 6 Magnesium Omega-3 fatty acids Probiotics Vitamin C Multivitamins Oxidative stress supplements Elimination of infections Non-biological interventions Miscellaneous therapies

7 Complementary/Alternative Gluten-free/casein-free diet Dietary supplements Oxidative stress supplements Dimethylglycine Methylcobalamin Folic acid, folinic acid, and folate Amino acids Elimination of infections Non-biological interventions Miscellaneous therapies

8 Complementary/Alternative Gluten-free/casein-free diet Dietary supplements Oxidative stress supplements Elimination of infections Intravenous immunoglobulin Antiviral agents Antibiotics Anti-yeast treatments Non-biological interventions Miscellaneous therapies

9 Complementary/Alternative Gluten-free/casein-free diet Dietary supplements Oxidative stress supplements Elimination of infections Non-biological interventions Auditory integration therapy Sensory integration therapy Behavioral optometry Craniosacral therapy Miscellaneous therapies

10 Complementary/Alternative Gluten-free/casein-free diet Dietary supplements Oxidative stress supplements Elimination of infections Non-biological interventions Miscellaneous therapies Chelation Hyperbaric oxygen therapy Secretin Mind-body therapies

11 Traditional Medical Therapies Speech and language Occupational therapy Physical therapy Mental health counseling

12 Applied Behavioral Analysis B. F. Skinner (1930) O. Ivar Lovaas (1970) ABA: a method of teaching that uses reinforcement to motivate and shape desired behavior. ABC s : Antecedent > Behavior > Consequence

13 Applied Behavioral Analysis Discrete trial teaching Incidental teaching Pivotal response treatment Verbal behavior DIR/Floortime Relationship development intervention SCERTS

14 Applied Behavioral Analysis Discrete trial teaching (DTT) Teaches basic skills (attention, directions, imitation) 1:1 with trained instructor Verbal, visual, gestures Contingency rewards Incidental teaching Pivotal response treatment Verbal behavior DIR/Floortime Relationship development intervention SCERTS

15 Applied Behavioral Analysis Discrete trial teaching Incidental teaching Teaches incidentally, without instruction Example: paper without crayons; forces the child to ask for crayons Pivotal response treatment Verbal behavior DIR/Floortime Relationship development intervention SCERTS

16 Applied Behavioral Analysis Discrete trial teaching Incidental teaching Pivotal response treatment (PRT} AKA: natural language paradigm Child directed; parent led, naturalistic setting Development of overarching behaviors that affect other behaviors (motivation, initiating communication with others, self-management) Verbal behavior DIR/Floortime Relationship development intervention SCERTS

17 Applied Behavioral Analysis Discrete trial teaching Incidental teaching Pivotal response treatment Verbal behavior B.F. Skinner (1957) Uses similar instruction as with DTT Encourages child to make greater use of language Knowing language is different from using language. DIR/Floortime Relationship development intervention SCERTS

18 Applied Behavioral Analysis Discrete trial teaching Incidental teaching Pivotal response treatment Verbal behavior DIR/Floortime Stanley Greenspan, MD & Sabrina Wieder, PhD Emotional development is the basis for learning Must achieve six developmental milestones; must be taught in ASD Relationship development intervention SCERTS

19 Applied Behavioral Analysis Discrete trial teaching Incidental teaching Pivotal response treatment Verbal behavior DIR/Floortime Relationship development intervention Steven Gutstein, PhD & Rachelle Sheely, PhD Six primary deficits in ASD Encourages social interaction and motivates child towards interpersonal exchanges Emphasizes negative effects of sensory overload SCERTS

20 Applied Behavioral Analysis Discrete trial teaching Incidental teaching Pivotal response treatment Verbal behavior DIR/Floortime Relationship development intervention SCERTS Barry Prizant, PhD et al Social Communication, Emotional Regulation, and Transactional Model Three primary foci: social communication, joint attention, and symbolic behavior

21 Educational Services Individuals with Disabilities Education Act (IDEA) Part C: 0-3 years (IFSP) Part B: 3-21 years (IEP) Children are eligible for a free, appropriate, and adequate public education in the least restrictive environment

22 Eligibility for Special Education (WAC A-01035) Eligibility categories: Developmental delay (3-8) Speech or language impairment Specific learning disability Intellectual disability Autism Emotional behavioral disability Hearing impairment Visual impairment Deaf-blindness Other health impairment Orthopedic impairment Traumatic brain injury Multiple disabilities Autism spectrum disorder: Developmental disability that: Significantly affects verbal and nonverbal communication + social interaction Often associated with repetitive behaviors, stereotyped movements, resistance to change in daily routines, and/or unusual sensory experiences Adversely affects educational performance Not primarily due to emotional or behavioral disturbance May manifest >3 years of age