Autism spectrum disorders
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Transcript of Autism spectrum disorders
Autistic Spectrum Disorders
Prepared by Dr Shewikar El Bakry
Ass Prof of Neuropsychiatry
Banha University
AgendaIntroduction to Autism
Clinical Picture
Red Flags
Etiology
Diagnosis
Identifying Tools
Management
History of Autism
1048700 Autism was first described in literature by LeoKanner in 1943
1048700 He called the syndrome ldquoearly infantileautismrdquo
1048700 Autism was also often misdiagnosed aschildhood schizophrenia
1048700 Early psychologists hypothesized that childrenbecame autistic due to ldquocold and unnurturingrdquo
mothers This theory was proven false in1979
Facts on Autism ndash What WeKnow So Far
Autism1048700 occurs in approximately 1 out of 250 birthsand has a 10-17 annual growth rate
1048700 typically manifests around the ages of 18months to 3 years
1048700 is found throughout the world in families of all racial ethnic and social backgrounds
occurs mostly in males The ratio is about41
Why study autism
The rate ofAUTISM
was One in 10000
BirthsJust 10 years ago
NOW AUTISM
occurs in 1 of every 150
births
AUTISM AWARENESS RIBBON
Palestine statistics
bull The Prevalencebull Ghaza strip 2649
from a population of 1324991
bull West bank 4622 from 2311204
bull The Incidencebull Ghaza strip 14 from
a population of 1324991
bull West bank 25 from 2311204
What is Autism
bull Autism is a complex neurobiological disorder
bull Inhibits a persons ability to ndash Communicate ndash Develop social relationshipsndash Often accompanied by behavioral challenges
Facts about Autism
bull One of the most severe mental disabilities that has impact on the individuals behavior
bull Putting out flames without finding the cause
Affects bullLearning capability
bullSocial up bringingbullOccupation
bullRehabilitation bullAbility for work
proficiency
By the end of 7 monthsbull Smile back at another personbull Respond to sound with soundsbull Enjoy social play
Red FlagsbullNo big smiles or other warm joyful
expressions by six months or thereafter
bullNo back-and-forth sharing of sounds smiles or other facial expressions by nine months or thereafter
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
AgendaIntroduction to Autism
Clinical Picture
Red Flags
Etiology
Diagnosis
Identifying Tools
Management
History of Autism
1048700 Autism was first described in literature by LeoKanner in 1943
1048700 He called the syndrome ldquoearly infantileautismrdquo
1048700 Autism was also often misdiagnosed aschildhood schizophrenia
1048700 Early psychologists hypothesized that childrenbecame autistic due to ldquocold and unnurturingrdquo
mothers This theory was proven false in1979
Facts on Autism ndash What WeKnow So Far
Autism1048700 occurs in approximately 1 out of 250 birthsand has a 10-17 annual growth rate
1048700 typically manifests around the ages of 18months to 3 years
1048700 is found throughout the world in families of all racial ethnic and social backgrounds
occurs mostly in males The ratio is about41
Why study autism
The rate ofAUTISM
was One in 10000
BirthsJust 10 years ago
NOW AUTISM
occurs in 1 of every 150
births
AUTISM AWARENESS RIBBON
Palestine statistics
bull The Prevalencebull Ghaza strip 2649
from a population of 1324991
bull West bank 4622 from 2311204
bull The Incidencebull Ghaza strip 14 from
a population of 1324991
bull West bank 25 from 2311204
What is Autism
bull Autism is a complex neurobiological disorder
bull Inhibits a persons ability to ndash Communicate ndash Develop social relationshipsndash Often accompanied by behavioral challenges
Facts about Autism
bull One of the most severe mental disabilities that has impact on the individuals behavior
bull Putting out flames without finding the cause
Affects bullLearning capability
bullSocial up bringingbullOccupation
bullRehabilitation bullAbility for work
proficiency
By the end of 7 monthsbull Smile back at another personbull Respond to sound with soundsbull Enjoy social play
Red FlagsbullNo big smiles or other warm joyful
expressions by six months or thereafter
bullNo back-and-forth sharing of sounds smiles or other facial expressions by nine months or thereafter
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
History of Autism
1048700 Autism was first described in literature by LeoKanner in 1943
1048700 He called the syndrome ldquoearly infantileautismrdquo
1048700 Autism was also often misdiagnosed aschildhood schizophrenia
1048700 Early psychologists hypothesized that childrenbecame autistic due to ldquocold and unnurturingrdquo
mothers This theory was proven false in1979
Facts on Autism ndash What WeKnow So Far
Autism1048700 occurs in approximately 1 out of 250 birthsand has a 10-17 annual growth rate
1048700 typically manifests around the ages of 18months to 3 years
1048700 is found throughout the world in families of all racial ethnic and social backgrounds
occurs mostly in males The ratio is about41
Why study autism
The rate ofAUTISM
was One in 10000
BirthsJust 10 years ago
NOW AUTISM
occurs in 1 of every 150
births
AUTISM AWARENESS RIBBON
Palestine statistics
bull The Prevalencebull Ghaza strip 2649
from a population of 1324991
bull West bank 4622 from 2311204
bull The Incidencebull Ghaza strip 14 from
a population of 1324991
bull West bank 25 from 2311204
What is Autism
bull Autism is a complex neurobiological disorder
bull Inhibits a persons ability to ndash Communicate ndash Develop social relationshipsndash Often accompanied by behavioral challenges
Facts about Autism
bull One of the most severe mental disabilities that has impact on the individuals behavior
bull Putting out flames without finding the cause
Affects bullLearning capability
bullSocial up bringingbullOccupation
bullRehabilitation bullAbility for work
proficiency
By the end of 7 monthsbull Smile back at another personbull Respond to sound with soundsbull Enjoy social play
Red FlagsbullNo big smiles or other warm joyful
expressions by six months or thereafter
bullNo back-and-forth sharing of sounds smiles or other facial expressions by nine months or thereafter
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Facts on Autism ndash What WeKnow So Far
Autism1048700 occurs in approximately 1 out of 250 birthsand has a 10-17 annual growth rate
1048700 typically manifests around the ages of 18months to 3 years
1048700 is found throughout the world in families of all racial ethnic and social backgrounds
occurs mostly in males The ratio is about41
Why study autism
The rate ofAUTISM
was One in 10000
BirthsJust 10 years ago
NOW AUTISM
occurs in 1 of every 150
births
AUTISM AWARENESS RIBBON
Palestine statistics
bull The Prevalencebull Ghaza strip 2649
from a population of 1324991
bull West bank 4622 from 2311204
bull The Incidencebull Ghaza strip 14 from
a population of 1324991
bull West bank 25 from 2311204
What is Autism
bull Autism is a complex neurobiological disorder
bull Inhibits a persons ability to ndash Communicate ndash Develop social relationshipsndash Often accompanied by behavioral challenges
Facts about Autism
bull One of the most severe mental disabilities that has impact on the individuals behavior
bull Putting out flames without finding the cause
Affects bullLearning capability
bullSocial up bringingbullOccupation
bullRehabilitation bullAbility for work
proficiency
By the end of 7 monthsbull Smile back at another personbull Respond to sound with soundsbull Enjoy social play
Red FlagsbullNo big smiles or other warm joyful
expressions by six months or thereafter
bullNo back-and-forth sharing of sounds smiles or other facial expressions by nine months or thereafter
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Why study autism
The rate ofAUTISM
was One in 10000
BirthsJust 10 years ago
NOW AUTISM
occurs in 1 of every 150
births
AUTISM AWARENESS RIBBON
Palestine statistics
bull The Prevalencebull Ghaza strip 2649
from a population of 1324991
bull West bank 4622 from 2311204
bull The Incidencebull Ghaza strip 14 from
a population of 1324991
bull West bank 25 from 2311204
What is Autism
bull Autism is a complex neurobiological disorder
bull Inhibits a persons ability to ndash Communicate ndash Develop social relationshipsndash Often accompanied by behavioral challenges
Facts about Autism
bull One of the most severe mental disabilities that has impact on the individuals behavior
bull Putting out flames without finding the cause
Affects bullLearning capability
bullSocial up bringingbullOccupation
bullRehabilitation bullAbility for work
proficiency
By the end of 7 monthsbull Smile back at another personbull Respond to sound with soundsbull Enjoy social play
Red FlagsbullNo big smiles or other warm joyful
expressions by six months or thereafter
bullNo back-and-forth sharing of sounds smiles or other facial expressions by nine months or thereafter
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Palestine statistics
bull The Prevalencebull Ghaza strip 2649
from a population of 1324991
bull West bank 4622 from 2311204
bull The Incidencebull Ghaza strip 14 from
a population of 1324991
bull West bank 25 from 2311204
What is Autism
bull Autism is a complex neurobiological disorder
bull Inhibits a persons ability to ndash Communicate ndash Develop social relationshipsndash Often accompanied by behavioral challenges
Facts about Autism
bull One of the most severe mental disabilities that has impact on the individuals behavior
bull Putting out flames without finding the cause
Affects bullLearning capability
bullSocial up bringingbullOccupation
bullRehabilitation bullAbility for work
proficiency
By the end of 7 monthsbull Smile back at another personbull Respond to sound with soundsbull Enjoy social play
Red FlagsbullNo big smiles or other warm joyful
expressions by six months or thereafter
bullNo back-and-forth sharing of sounds smiles or other facial expressions by nine months or thereafter
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
What is Autism
bull Autism is a complex neurobiological disorder
bull Inhibits a persons ability to ndash Communicate ndash Develop social relationshipsndash Often accompanied by behavioral challenges
Facts about Autism
bull One of the most severe mental disabilities that has impact on the individuals behavior
bull Putting out flames without finding the cause
Affects bullLearning capability
bullSocial up bringingbullOccupation
bullRehabilitation bullAbility for work
proficiency
By the end of 7 monthsbull Smile back at another personbull Respond to sound with soundsbull Enjoy social play
Red FlagsbullNo big smiles or other warm joyful
expressions by six months or thereafter
bullNo back-and-forth sharing of sounds smiles or other facial expressions by nine months or thereafter
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Facts about Autism
bull One of the most severe mental disabilities that has impact on the individuals behavior
bull Putting out flames without finding the cause
Affects bullLearning capability
bullSocial up bringingbullOccupation
bullRehabilitation bullAbility for work
proficiency
By the end of 7 monthsbull Smile back at another personbull Respond to sound with soundsbull Enjoy social play
Red FlagsbullNo big smiles or other warm joyful
expressions by six months or thereafter
bullNo back-and-forth sharing of sounds smiles or other facial expressions by nine months or thereafter
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
By the end of 7 monthsbull Smile back at another personbull Respond to sound with soundsbull Enjoy social play
Red FlagsbullNo big smiles or other warm joyful
expressions by six months or thereafter
bullNo back-and-forth sharing of sounds smiles or other facial expressions by nine months or thereafter
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
By the end of 12 monthsbull Use simple gestures bull Imitate actions in their play bull Respond when told ldquonordquo
Red FlagsbullNo back-and-forth gestures such as
pointing showing reaching or waving bye
bullNot answering to onersquos name when called
bullNo babbling ndash mama dada baba
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
By the end of 18 months
bull Do simple pretend play bull Point to interesting objectsbull Use several single words unprompted
Red FlagsbullNo single words by 18 months
bullNo simple pretend play
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
By the end of 2 years (24 months)
bull Use 2- to 4-word phrasesbull Follow simple instructionsbull Become more interested in other childrenbull Point to object or picture when named
Red FlagsbullNo two-word meaningful phrases
(without imitating or repeating)bullLack of interest in other children
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Red Flag Any loss of speech or babbling or social skills
Regression at any age is cause for immediate referral
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Watch Video How to Recognize the Early Signs of Autism YouTube at blinkxwmv
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picture
No real fear of dangers
Inappropriate laughingor giggling
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
17
Apparent insensitivityto pain
May not want cuddling
Clinical Picture
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
18
Sustained unusual orrepetitive play
Uneven physical or verbal skills
May avoid eye contact
Clinical Picture
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
19
May preferto be alone Difficulty in expressing
needs May use gestures
Clinical Picture
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
20
Inappropriate attachments to objects
Insistence on
sameness
Clinical Picture
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
21
Echoes words or phrases
Inappropriate response or no response to sound
Clinical Picture
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
22
Spins objects or self
Difficulty in interactingwith others
Clinical Picture
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picture
Does not seek opportunities to interact withothers
Unwillingness andor inability to engage incooperative play
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picture
Fails to produce appropriate facialexpressions to specific occasions
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picture
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picture
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picture (Social Skills) bull bull Lack of awareness of the existence or
feelings of othersbull 1048700 Severe impairment in the ability to relate
to othersbull 1048700 Aloof and distant from othersbull 1048700 Appears not to listen when spoken to
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picture (Social Skills)
Fails to produce appropriate facial
expressions to specific occasions
1048700 Avoids eye contact
1048700 Difficulty with changes in environment and
routine
1048700 Does not seek opportunities to interact with others
1048700 Unwillingness andor inability to engage in
cooperative play
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picture (Communication Skills)
bull Deficits or differences in communication skills
are common with individuals with autism
bull 1048700 Difficulties in using and understanding both
verbal and non-verbal languagebull 1048700 Failure to initiate or sustain conversational
interchangebull 1048700 Abnormalities in the pitch stress rate
rhythm and intonation of speech
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picture (Communication Skills)
bull Poor receptive and expressive skillsbull 1048700 May echo words (echolalic speech)bull 1048700 May use screaming crying tantrumsbull aggression or self-abuse as ways tobull communicatebull 1048700 Repeating words or phrases in place of
normal responsive languagebull Does not refer to self correctly
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picturebull Unusual and repetitive movements of the body that
interfere with the ability to attend to tasks or activities such as hand flapping finger flicking rocking hand clapping grimacing or eye gazing
bull Marked distress over changes in seemingly trivial aspects of the environment
bull 1048700 Laughing crying or showing distress for reasons not apparent to others
bull 1048700 Unreasonable insistence on following routines in precise detail
Behavior Skills
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picturebull Unresponsive to normal teaching methodsbull 1048700 Acts as deafbull 1048700 Apparent over- or under-sensitivity to painbull 1048700 No fear of real dangerbull 1048700 Uneven gross and fine motor skillsbull 1048700 May not want to cuddle or be cuddledbull 1048700 Inappropriate attachment to objectsbull 1048700 Noticeable physical over-activity or extreme
under-activity
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Clinical Picturebull May use an adultrsquos hand like a tool for
accomplishing tasksbull 1048700 Does not spontaneously imitate the play of other
childrenbull 1048700 Tendency to spend inordinate amounts of time
doing nothing or pursuing ritualistic behaviors
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Etiology
bull Psychoanalyticalbull Geneticbull anatomical brain areas annomelies bull Infectionbull Vaccinationbull Prenatal and perinatal factorsbull Environmentalbull Toxins
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
bull Common physical findings in ASDbull (all consistent with expected and reported findings of severe mercury toxicity)bull ndash Blocked ldquomirror-neuronsrdquo in frontal cortex (inability to respond tobull momrsquos feelings love gaze smile)bull ndash Inflammatory Bowel Diseasebull ndash Increased size of frontal lobe and white matterbull ndash Cerebellar atrophy (reduced number of Purkinje cells)bull ndash Increased ldquoneuronal packingrdquo in cortexbull ndash Cytoarchitectural changes in subcortical structuresbull ndash Micro-and astroglia activation with leaky blood brain barrierbull ndash Altered glutamate receptorsbull ndash Hippocampal damagebull ndash Elevation of inflammatory cytokines in brain and CSF MCP-1bull IFNgammabull ndash IgA deficiency and increased IgEbull ndash Lymphopeniabull ndash T-cell abnormalitiesbull ndash Abnormal NK cell function
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
F84 Pervasive developmental disorder F840 Childhood autismF841 Atypical autismF842 Retts syndromeF843 Other childhood disintegrative disorderF844 Overactive disorder associated with mental
retardation and stereotyped movementsF845 Aspergers syndromeF848 Other pervasive developmental disordersF849 Pervasive developmental disorder unspecified
International Classification of Diseases 10
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Changes in 2013hellip Diagnostic and Statistical Manual of Mental Disorders 5th
Edition (DSM-5) revisionsminus Autism spectrum disorders
bull Includes autism Asperger syndrome PDD-NOS and child disintegrative disorder (CDD)
minus Concentrates on required featuresbull Socialcommunication deficitsbull Restricted repetitive patterns of behavior interests activities
o Addition of sensory criteriaminus Increases specificity while maintaining sensitivity
bull Important to distinguish spectrum from non-spectrum developmental disabilities
bull Improves stability of diagnosis
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Assessment
The Autism Diagnostic Observation Schedule-Generic (ADOS-G)
Autistic Diagnosis Interview (ADI-R)
Vineland Adaptive Behavior Scales
Mullenrsquos communication Scales
M-CHAT CHAT Pervasive Developmental Disorder
Screening Test CSBS Caregiver Questionnaire
Screening Tool for Autism in Two-Year-Olds (STAT)
Childhood Autism Rating Scale Autism Behavior Checklist (ABC)
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
SECTION A- لألهل توجه أسئلة
يهتز و األهل ركبة على الجلوس أو بالمراجيح طفلك يستمتع هلآخرين أطفال صحبة في طفلك يستمتع هل
السلم على الصعود أو األشياء تسلق طفلك يحب هل( ( البخ أو األستغماية يلعب أن طفلك يحب هل
شاي طقم باستخدام يشربه و شاي كوب يحضر مثال بأنه طفلك يتظاهر األوقات بعض في هل( أخرى ( بأشياء يتظاهر أن ممكن لعبة
( يطلبها ( التي األشياء على المشاورة في السبابة طفلك يستخدم هل ( عليه ( المشار الشيء بهذا استمتاعه ليبين السبابة طفلك يستخدم هل
( أو ( يسقطهم أن بدون والعربيات كالمكعبات صغيرة بأشياء اللعب أن طفلك يستطيع هلفمه في يضعهم
( لك ( ليريها األب أو األم أخرى أشياء أو لعبه طفلك يحضر هل
للمرض المبكر اإلكتشاف
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
SECTION B-
الحكيمة أو العام الممارس خالل من بالمالحظة تتم
في أ- الطفل نظر هل الزيارة أثناء فيعينيك
وقل ب- مسليا يكون أن ممكن شئ على أشر ثم منتبها الطفل أجعل ( وجه ( على وانظر مثال دميه هذه أنظر أن ( له التأكد يجب تشير كنت ماذا إلى ليرى الطفل نظر هل الطفل
ولم إليه تشير كنت ما إلى فعال نظر ) الطفل يديك إلى فقط ينظر
ج- الشاي من كوب لك يجهز أن منه واطلب شاي وبراد األكواب من لعبه طقم أعطيه ثم منتبها الطفل اجعلالتظاهر ( ممكن ويشربه البراد من الشاي يصب بأنه الطفل يتظاهر هل( مختلفة بلعب
د- أشياء مع هذا كرر اللمبة إلى بالسبابة الطفل يشاور هل النور مثال إلى يشير أو يريك أن الطفل اسأل
هذا ( على لإلجابة يشير وهو وجهك إلى ينظر أن أيضا يجب نور كلمة معنى يفهم الطفل يكن لم إذا أخرى
بنعم)فوق ( ه- مكعب كم المكعبات من برج يبنى أن الطفل يستطيع هل
بعضه)
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Training of Early Head Start Staff
Early Screening and Diagnosis of ASDsndash What are the early signs of ASDndash Why is early diagnosis importantndash How to screen for autism at an early age appropriate
screeners (MCHAT)ndash Effective ways to collaborate and share information
with families about the screening possible need for referral and benefits of beginning intervention early
ndash How to make an appropriate referral for a child who fails a screening
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Data Collection for Analysis and Program Changes
bull Design student progress measurement systemsbull Conduct assessment and evaluationbull Use data-based decision-making
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
The emergence of anew autism model
bull Older modelbull bull Genetically determinedbull bull Brain basedbull bull Treatable but not
curable
Is autism a BRAINbull DISORDER
bull Newer modelbull bull Environmentally triggeredbull bull Genetically influencedbull bull Both brain and bodybull bull Metabolic abnormalities play big
rolebull bull Treatable and recovery possible
bull OR is itbull A DISORDER THATbull AFFECTS THE BRAIN
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Management Plan
Should address
bull Establishing goals for languagecommunication interventions
bull Establishing goals for educational interventionbull Prioritizing target symptomscomorbid conditionsbull Monitoring multiple domains of functioningbull Behavioral adjustmentbull Adaptive skillsbull Academic skillsbull Socialcommunication skillsbull Social intervention with family members and peersbull Monitoring medications
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Treatmentbull Goals
ndash Minimize core features and associated deficits ndash Maximize functional independence and QOLndash Alleviate family stress
bull Educational interventionbull Developmental Therapies
ndash Communicationndash Sensory fine motor gross motor
bull Behaviorally Based treatmentsndash Core and associated symptomsndash Social skills
bull Medical or biologic treatmentsbull Support family in home and community
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Treatments and EducationalStrategies
bull Autism is not a disease There is not a single treatment such as a drug or therapy program that will work for all individuals with autism
bull 1048700 Treatment often comes in the form ofbull individualized plans designed to meet all areas of needbull 1048700 Meeting the challenges of autism is better described as
educational rather than treatmentbull 1048700 No single program or service will fill the needs of
everyone with autism Strategies to help a person with autism should be part of a comprehensive plan
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Early intervention programs
ldquopsychosocial interventions can change the disorders courserdquo
bull Such programs involve highly focused and individualized teaching activities targeting all areas of development
bull Several different programs egTEACCH (Treatment and Education of Autism and related communications handicapped children)
bull LOOVAS methodbull The Denver modelbull LEAP (learning experiences and alternative program for
preschoolers and parents)
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Psychopharmacology
Adjunct to educational developmental amp behavioral treatments
So far no evidence of impact on core symptoms
Evidence supporting is variable
Toolkit ndash handouts for MD amp families
bull Treat target symptomsndash Stereotypiesndash Withdrawalndash Obsessionsndash Irritabilityndash Hyperactivityndash attention spanndash self-injurious behavior ndash Aggressionndash sleep
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Treatment
Atypical antipsychotic Abilify (Aripiprazole) oral formulation was approved November 24 2009 by the FDA for the treatment of irritability associated with ASD in children aged 6-17 years
Data based on two 8 week randomized placebo-controlled multicenter studies evaluating its efficacy for improving mean scores on the Caregiver-rated Irritability subscale of the Aberrant Behavior Checklist (ABC-I)
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Biologically Based
SupplementsB6Magnesium B12DMG TMG Vitamin A Vitamin CFolateOmega 3 Fatty Acids
Elimination DietsCasein gluten free
Off-label medications
Secretin
bull Immunendash Antifungal therapyndash Immunotherapy steroidsndash AntibioticsAntiviralsndash Stem cell transplantation
bull Immunization-relatedndash With-hold immunizationndash Chelation
bull Hyperbaric oxygen therapy (HBOT)
Always others coming alonghellip
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
52
GUT Issues must be dealt with before dealing with the heavy metal issue
There are 3 main issues common to all autistic Children
1 Yeast Overgrowth
2 Leaky gut
3 Heavy Metal Accumulation
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
53
Another approach to therapy
Dealing with the yeast overgrowthDealing with the leaky gutHeavy metals and their effectsChelationMethylcobalamin
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
SpeechLanguage Therapy
bull Behaviorally based intensive structured teaching ndash Eg Verbal Behavior
bull Augmentative strategiesndash Sign languagendash PECSndash Aided augmentative alternative system(s)
bull Decrease non-communicative languagebull Developmental-pragmatic approaches
ndash appropriate use of language in social situationsndash eg SCERTSndash Social skills training
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Content Areasbull Communication
ndash Teaching the child to use nonverbal communicative gestures
ndash Teaching motor imitationndash Teaching the meaning and important of
communicationndash Teaching symbolic representation
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Environmental and Classroom Arrangement
bull Employ visual strategiesbull Use techniques of structured teachingbull Use consistency in designing the learning
environmentbull Monitor and modify environmental stimuli
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Behavioral Intervention
ABA (Applied Behavioral Analysis)General behavioral teaching approach involves reinforcement and consequences to shape behavior
All of our parents used it
Involves the A B CrsquosNot airway breathing circulation
Antecedent Behavior Consequence
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Motor and Sensory
Occupational therapy is the assessment and treatment of physical and psychiatric conditions using specific purposeful activity to prevent disability and promote independent function in all aspects of daily life
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Motor and Sensorybull Sensory Integrative Therapy and Autism
is based on the idea that some people struggle to receive process and make sense of information provided by the senses For example some people with autism are hyper-sensitive (over-sensitive) to some things such as loud noises but hypo-sensitive (under-sensitive) to other things such as pain
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Sensory Integration Strategies
Some examples of treatment approaches
bull Oral sensory motor development can be aided by whistles blowers and bubble blowing kits
bull Fine motor A number of toys like cone and ball catch puppets etc
bull For kids with fidgety fingers many blocks fixes etc that help them focus
bull Gross motor Bean bags Therabands
bull Vestibular and Proprioception Swings trampoline
bull Tactile Fabrics brushes
bull High arousal anxiety weighted jackets ldquosquishesrdquo
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Motor and Sensorybull Hippo Therapy
Dance Movement Therapy
Chiropractic Therapy
Coloured FiltersWeighted
Items
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Other
bull Animal Therapybull Dolphin Therapybull Assistance Dog
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Psychotherapy
bull Play provides a safe psychological distance from their problems and allows expression of thoughts and feelings appropriate to their development
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
bull Play ndash social physical constructive symbolic
and independentndash Age-appropriate play skills ndash Individual teaching and directly guided in
inclusive preschool experiences
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Psychotherapy
bull Holding Therapybull CBTbull Music Therapybull Art Therapy
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Behavioural and Developmental
bull Relationship Development Intervention focuses on a childrsquos difficulties with flexibility of thought emotional regulation and perspective-taking
bull RDI is based on the idea that children with autism have missed key developmental milestones ndash such as social referencing joint attention ndash that enable them to think flexibly regulate their emotions and understand social situations
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Behavioural and Developmentalbull Social Storiestrade and Autism
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Typical Daily Schedules of Intervention
730-830amHome dressing and mealtime programs
900-1200Inclusive preschool intervention
1200-130Mealtime programs hygiene programs
130-430 11 structured teaching programs
430-530 Play indoors and outdoors530-700 Chores mealtime program
communication programs
800-Bedtime Book routines
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
bull Role of families ndash Families are at the helm of their childrsquos
treatmentndash Parents are the primary teachersndash Home visits are scheduled as needed
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-
Questions
- Autistic Spectrum Disorders
- Agenda
- History of Autism
- Slide 4
- Facts on Autism ndash What We Know So Far
- Why study autism
- Palestine statistics
- What is Autism
- Facts about Autism
- By the end of 7 months
- By the end of 12 months
- By the end of 18 months
- By the end of 2 years (2
- Slide 14
- Slide 15
- Clinical Picture
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Clinical Picture (2)
- Clinical Picture (3)
- Clinical Picture (4)
- Clinical Picture (5)
- Clinical Picture (6)
- Slide 27
- Clinical Picture (Social Skills)
- Clinical Picture (Social Skills)
- Clinical Picture (Communication Skills)
- Clinical Picture (Communication Skills) (2)
- Clinical Picture (7)
- Clinical Picture (8)
- Clinical Picture (9)
- Etiology
- Slide 36
- International Classification of Diseases 10
- Changes in 2013hellip
- Assessment
- الإكتشاف المبكر للمرض
- Slide 41
- Training of Early Head Start Staff
- Data Collection for Analysis and Program Changes
- The emergence of a new autism model
- Management Plan
- Treatment
- Treatments and Educational Strategies
- Early intervention programs
- Psychopharmacology
- Treatment (2)
- Biologically Based
- GUT Issues must be dealt with before dealing with the heavy met
- Another approach to therapy
- SpeechLanguage Therapy
- Content Areas
- Environmental and Classroom Arrangement
- Slide 57
- Behavioral Intervention
- Motor and Sensory
- Slide 60
- Motor and Sensory (2)
- Sensory Integration Strategies
- Motor and Sensory (3)
- Other
- Slide 65
- Psychotherapy
- Slide 67
- Psychotherapy (2)
- Behavioural and Developmental
- Behavioural and Developmental (2)
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Questions
-