Providing Integrated Care for Individuals on the Spectrum &
Caregivers What Works and What Doesnt? A. Charate, MA, LCPC, CDAC,
BCIA Board Certified C. McCarthy, MA, LPC A. Sarup, BA
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Overview Background Information Integrative Care Series
1.Working together as a Team with Caregivers 2.Personalized
Individual Therapy & Neurofeedback 3.Working with Schools,
Social Workers, and others
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What is Known FASD is associated with life-long cognitive and
behavioral impairments Primary behaviors are misunderstood
Inappropriate interventions or punishments are used Individuals are
left frustrated and discouraged Secondary behaviors are pervasive
in adolescence through adulthood Develop maladaptive behaviors to
cope with a sense of rejection, failures, loneliness, and lack of
meaningful relationships
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Experience at the Center Identify caregivers and providers
knowledge on FASD Provide needed education How FASD affects that
particular individual Pre and post treatment Quantitative EEG
(QEEG) analysis Connecting abnormal brainwave patterns and
associated behaviors QEEG Guided Neurofeedback trainings Individual
therapy & consultation to parents Skills coaching, social
skills groups
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Patience and Skill Based Approach Rely on research and what we
know Brain damage is the most serious aspect of FASD and presents
the greatest challenges to learning and functioning in school
Effects: Cognition Behavior Social Skills * The damage is permanent
but it can be accommodated, but not cured.
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Working together as a Team with Caregivers The first step into
truly integrated care
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Caregivers Initial Consultation Identify where they are in the
process of treatment and their knowledge of FASD Corroboratively
create a treatment plan to ensure mutual understanding and an
obtainable goal Problems experienced from an individual and family
system perspective Their support systems and other strengths Their
motivation for change Some parents are willing to partner, some
just rely on us for treatment Validation, identify the issues,
answer concerns, provide explanation, instill hope Gears of the
Vital Relationship to Impart Change
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Self-Care for Parents Observation of stress management How does
couple function? Date night, preferably sans talking about the
child(ren) Establish a daily 30 minute routine for self Find ways
to decompress and relax just like counselors. Case Example:
Lou
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Personalized Individual Therapy & Neurofeedback The second
crucial approach of integrative care.
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Individualized Treatment Person-centered Provide treatment that
is applicable to the clients functionality Provide one on one
treatment Develop rapport to facilitate openness and change Assess
willingness to change and insight Teach them what to do rather than
what not to do
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Strategies for working with clients with FASD Clients
Difficulties 1.Visual or hearing impairments 2.Impulsive decisions
and statements. 3.Difficulty with Abstract Concepts 4.Memory
Deficits 5.Attentional Issues 6.Difficulty with Transitions Counter
Difficulties 1.Use Visual Cues 2.Role Play Clients often need to
practice situations with counselors repeatedly 3.Create attainable
goals 4.Model appropriate behavior Teach how to get someones
attention in an appropriate way Reinforce desired behavior
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Individual Therapy- Dialectic Behavioral Therapy 1980s: Marsha
M. Linehan for adults with Borderline Personality Disorder
symptoms: Unstable self-image Unstable relationships Unstable
emotions Inappropriate, intense anger or difficulty managing their
anger when it occurs Significant impulsivity act before thinking
Symptoms for BPD and FASD overlap DBT aims to teach the children
coping skills which directly targets these symptoms Therapist will
help clients identify triggers to emotions, label and rate her
emotions, and teach strategies such as: Mindfulness Asking for help
appropriately Recording emotions daily Emotional regulation
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Individual Therapy- ACT Acceptance and Commitment Therapy:
Accept thoughts (dont fight them) Learn skills to cope with
thoughts Allow them to come and pass Staying within the present
moment, i.e. mindfullness. The opposite of mindlessness. Mindless
lives involve constantly thinking about the past, schedules, plans,
work, etc. without taking time to be in the present moment. Focus
on becoming aware of all incoming thoughts and feelings and
accepting them, but not attaching or reacting to them Mindfullness
allows our clients to more aptly deal with current stressors and
distressing feelings with a flexible and accepting mindset
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Cognitive Defusion Most individuals, will experience their
thoughts as facts. Therapist can help defuse these thoughts into
much broader statements. Separating themselves from facts I am
anxious! I am having a feeling I have noticed that I am having a
feeling
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Assessments Pre treatment and post treatment Quantitative EEG
Analysis (QEEG) Pre and post treatment CNS Vital Signs testing
measures core neurocognitive brain. Attention, memory, executive
control, processing speed, cognitive flexibility, social anxiety,
reasoning, working memory and more (computerized tests)
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Neuroplasticity Human brain is plastic It can change and adapt
under the correct circumstances If the brain experiences trauma to
one location, then other location takes over its specific function
It requires some cognitive efforts and trainings in order to make
the needed changes Mental & emotional states Sensory
informational processing Memory formation and retrieval Cognitive
and decision-making processes Communications from all of the above
THE BRAIN CAN BE STRENGTHENED AND CHANGED, IF IT IS CHALLENGED
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Pre-Treatment Q-EEG Pre-treatment helps us develop protocols
based on the presenting symptoms and brain-mapping results A QEEG
offers comparative norms for clients based on age, gender,
handedness Completely non-invasive treatment Measures brain waves
which produce a signal that can be used as feedback on brain
activity to teach self-regulation Typical treatment includes 30
minutes neurofeedback followed by 30 minute parent consultation and
behavioral modification through psychotherapy Skills coaching using
DBT/ACT therapy skills Social Skills groups/ Project Good Buddies
Parent support groups Charting progress every 10-15 sessions
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Normal QEEG https://www.google.com/search?q=Normal+QEEG
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18 months Post Treatment Follow Up
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Three Years Post Treatment Follow Up
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Instilling Hope The EEG helps people objectify the symptoms in
a world where symptoms are often reported in the subjective Helps
explain the childs behavior is somewhat out of their control at the
moment. IS Tangible evidence that you can see and helps family
understand that the client IS trying but their brain is not
functioning optimally For the child or the young adult, its much
more understandable as to why they are struggling in school and
they have more willingness to come for treatment
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Neurofeedback Neurofeedback helps regulate overstressed or
underactive brains and is helpful with issues of focus and
attention, behavioral issues, sleep concerns, headaches, and
emotional issues The essence of neurofeedback / eeg biofeedback is
that when a monitor displays your brainwave activity, you can
quickly learn to change that. Audiovisual feedback system based on
the principle of Operant Conditioning Crucial that clients come
regularly and twice a week Begin to see results at 20-30 session
mark Re-assess and possibly change location During and Post
Treatment QEEG Other conditions that can benifit from neurofeedback
include: ADD / ADHD, Anxiety, Insomnia, Headaches Migraines,
Chronic Pain, OCD, Anger, Conduct Disorders, Learning Disorders,
Sensory Processing Disorders, Neurodevelopmental conditions, and
ASD
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Would Medications Interfere with Training? Based on a survey
with over 150 clinicians, it was widely reported that more than
half their neurofeedback clients started neurofeedback while taking
one or more medications. Neurofeedback is complimentary to many
treatment approaches and tends to act synegistically to
medications. May improve the response or stabilize the effects. The
theory about reducing dosages is that as the brain becomes more
activated during training, it works more efficiently. The same
dosage seems to have a stronger effect on a more efficient brain,
and thus reduction may be required.
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Other Neurotherapies Low Energy Neurofeedback Stimulation
(LENS) Uses feedback directly from the skin of the scalp and
requires no visual or conscious feedback The result is a changed
brainwave state, and much greater ability for the brain to regulate
itself It addresses the underlying neuropsychological functions as
a rehabilitation tool increasing the self-regulatory capabilities
of the brain Disrupts the dysfunctional patterns and letting the
brain re-establish the connections. Coherence Training Measures how
well-coordinated the communication is between one area of the brain
to the other If two areas are communicating too little or too much,
it can interfere with the efficiency of the brain QEEG brain map is
a tool that helps assess coherence
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Abnormal Asymmetry & Coherence
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Training Results
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Working with Schools, Social Workers, and others The Final Step
of fully integrative care
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Indiscriminate Lack of Knowledge throughout Multiple Systems
Secondary behaviors place an immense emotional, financial, and
social burden on individuals and their caregivers Need for constant
vigilance to manage their cognitive and behavioral challenges
Extremely limited support from providers, community members, and
extended family
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Barriers at the Systems Level Delayed diagnosis Difficulty in
qualifying for services Limited availability for required services
Difficulty in maintaining services and supports Lack of
knowledgeable professionals An inadequate amount of effective
services A shortage of providers who accept Medicaid
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Adaptive Behaviors Ability to care for self, interact in a
social world and function in the community Fetal Alcohol Spectrum
Disorder Demonstrate lower level of adaptive behavior relative to
their intellectual functioning Significant executive functioning
deficit Plan, organize and shift attention in a goal directed way
Adolescents and young adults are required to inhibit impulses, plan
goal directed activities in increasingly complex and social
situations Gap widens between peers
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What is needed? 1.Access to disability services based on level
of disability functioning rather than IQ 2.A quality neuropsych
assessment to help develop learning and behavioral plans
3.Additional educational support to enable these children to stay
in the school environment 4.An FASD expert in every school
district, judicial system and employment services that will act as
advocate 5.Assistance in planning leisure and unstructured
times
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What works vs. What doesn't What doesn't work? Speaking slow
and using visualizations Teach them what they should do. Cool Down
Breaks before lessons Repeat, repeat, repeat Reward appropriate
behavior Understand they are trying Clear concise instructions What
does? Using analogies and complex instructions Tell them what not
to do Punishment Lecturing in the moment. Expecting immediate
learning Giving up too quick Complex instructions
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In the Schools Common Issues for Teachers to Understand Lower
than average IQ Difficulty with planning and organizing Short term
memory problems Context-specific learning and difficulty accessing
information on demand Poor grasp of abstract concepts Developmental
delays in language, motor, and social skills Difficulty reading
social cues for appropriate behavior Poor sensory integration Math
deficits causing difficulties in Counting money Making change
Maintaining budgets and Reading analog clocks How Students with
FASD Learn Best Concrete hands on learning Good expressive language
skill but difficulty understanding what others say Teach how to ask
for help How to appropriately handle frustration and disappointment
Teach self talk Limit transitions
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The Neurofeedback, Counseling, and FASD Institute of Illinois.
24W500 Maple Ave. Naperville, IL 60540 PH: (630) 548-4501