Wednesday, May 11, 2022

Autism: Dispelling Myths

Here are my notes from one of the sessions at the 
Converge Autism Summit. This presentation was: Autism: Dispelling Myths by Dr. Matthew Fisher (Adolescent Psychiatrist at Springbrook Autism Behavioral).

Research GI Flora (Gut Bacteria):
  • November 2021 Australia
  • 99 Patients with ASD
  • 51 Siblings
  • 97 Unrelated Children (Picky Eaters)
  • Stool samples showed no differences in gut flora between ASD and Picky Eaters
Waiting for the Diagnosis: 
  • Prior to Pandemic wait times ~12 months
  • “Post” Pandemic wait times ~18+ months
  • Waiting for a formal diagnosis potentially misses critical developmental stages and windows for improved interventions
  • Get referrals for Occupational Therapy, Speech Therapy, and Possibly Dietary
Occupational Therapy:
  • Improve Fine Motor Skills
  • Regulate Sensory Needs
  • Assist in Education
  • ADLs (Activities of Daily Living)
  • Social Interactions and Participation
  • Special Note: OT is not intended to find you a job!!!
Dispelling the myths of OT:
Contrary to popular belief:
  • Not every child needs a weighted vest Not every child has sensory issues
  • Not every child needs OT
  • OT is not Physical Therapy

Speech Therapy:
Speech and Language Pathologists: 
  • Improve Verbal Communication
  • Improve Nonverbal Communication
  • Feeding and Swallowing Concerns
Dispelling the myths of ST:
Speech and Language Pathologists:
  • Improve Verbal Communication
  • Improve Nonverbal Communication
  • Feeding and Swallowing Concerns

Direct Contact is Overrated:
  • Direct eye contact can be overwhelming and sensory averse
  • Best to have them face you so show that they are listening

Communication and ASD:
  • Many believe that teaching augmentative communication (sign language, picture boards, etc.) will decrease the likelihood of speaking
  • Alternative Augmentative Communication (AAC) facilitates the development of speech

Overly focused on a single goal/skill:
  • Too much focus is often given to mastering a single communication goal
  • Best to cycle through functional communication, social skills, and language skills to expose them to a variety of skills needed for daily functioning

Fixation on a single mode of communication:
  • Signs, picture communication, rudimentary gestures, and verbal communication should ALL be targeted.
  • A Total Communication approach expands skills faster than a single focused approach

Picky Eaters:
  • Some children may be picky eaters however, others may overeat as they crave sensory input.
  • Some children may appear picky but have sensory aversions (texture, tastes, smells)

Other Explanations for Picky Eaters:
  • Perhaps your child just doesn’t like certain foods. . .and that’s OK!!!
  • Maybe it’s genetic (ie: Broccoli)

Early Childhood Intervention Programs:

Making the Diagnosis:
  • Formal Diagnosis should come from a Medical Doctor
  • Child and Adolescent Psychiatrist or Developmental & Behavioral Pediatrics. . .if you can find them
  • Many states “require” CARS or ADOS assessment to meet requirements for services

  • CARS: Childhood Autism Rating Scale
  • Questionnaire answered by someone familiar with the patient (parent, teacher, daycare worker)
  • ADOS: Autism Diagnostic Observation Scale
  • Structured and detailed assessment that involves tasks of varying complexity

  • A Questionnaire designed to identify those who might have developmental delays and/or ASD traits
  • The form is filled out by someone familiar with the child so results can be quite subjective
  • Results can vary widely

  • Modules based on functioning level
  • You must be specifically trained in ADOS and have the proper assessment kit
  • The scores are based entirely on the results of the test
  • Testing can take an extended amount of time

IQ Testing:
  • Intelligence Quotient
  • Often a “cut off” for services
  • Typical cut off score is 70
  • Highly dependent on the administrator of the test ◦ Requires active engagement by the child
  • You can always “fake” a low score
  • Unreliable Indicator

IQ vs. Functional Skills:
  • IQ provides a number to qualify for services
  • Adaptive Functioning – Actual Abilities
  • Tests may include: 
  • Vineland (VABS)
  • Woodcock-Johnson

ID vs. ASD
  • Intellectual Disability: The diagnosis formerly known as Mental Retardation (MR)
  • Borderline Intellectual Functioning: IQ 70-85
  • Ranges: Mild, Moderate, Severe
  • Mild: IQ 50-69
  • Moderate: IQ 35-49
  • Severe: IQ 20-34
  • Independent from ASD

Observation is the best assessment!

The Academic Diagnosis of ASD:
  • A medical/clinical diagnosis does not necessarily entitle a child to additional school resources or services
  • An academic diagnosis does not mean that the child will meet clinical criteria for the diagnosis.

What’s Up With Nonverbal ASD:
  • Nonverbal vs Minimally Verbal vs Echolalia
  • Do they use other forms of communication??? 
  • Sign Language
  • Communication Boards
  • Typing

Receptive vs Expressive Communication Can they follow commands?
  • Can they follow multi-step commands?
  • Indicator/Marker for overall progress if still nonverbal by 4 years of age

No Cause for Behaviors:
Just because you aren’t aware of a cause doesn’t mean there isn’t an actual cause!!! (antecedent)

Don’t Forget Medical Diagnosis:
  • Children with ASD often struggle to communicate discomfort, pain, or to indicate the presence of medical conditions
  • Even verbal patients often fail to recognize or convey information regarding physical symptoms

Children with ASD:
  • 25% lifetime chance of Seizure Activity
  • 25% with some form of Gastrointestinal Problems
  • Diarrhea (runny stools the most common) Constipation
  • Esophageal Reflux (GERD)
  • Eosinophilic Esophagitis (EoE)

Special Diets:
  • Gluten Free
  • Casein Free
  • Soy Free
  • You’re already dealing with picky eaters
  • Do they have a medical diagnosis or allergy? Often more trouble than it works Starting an unnecessary battle

Fish Oils:
  • Fish Oil has been found to have mild mood stabilizing properties 
  • Natural Sources yield broader health benefits than Supplements (change diets if possible)

They’ll Never Be Able To:
  • Hold a Job. . .
  • Live Alone. . .
  • Function Independently. . .
  • Complete Neurologic Maturity reached at 25 years old (18 isn’t remotely an adult brain)
  • Meanwhile in Ancient Rome. . .

Neural Wiring and Dendritic Pruning

Dendritic Pruning streamlines neural firing and functioning

Undiagnosed ASD:
  • Reactive Attachment Disorder (RAD) Abuse/Neglect/Trauma
  • Emerging Psychosis
  • ADHD & Anxiety

What happened to Aspergers?
  • “Former” Diagnosis that encompassed higher functioning ASD with no speech delays
  • Normal IQ range
  • No higher risk of medical diagnoses
  • Blame DSM-V

Closing Thoughts/Tips/Tricks:
  • Schedules
  • Logs
  • Maps
  • Pattern Recognition
  • Prescriptions

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