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PRIORITIZING THERAPIES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS. NAA- NY Metro Chapter November, 2008 Patricia S. Lemer, M.Ed., N CC Executive Director Developmental Delay Resources (DDR) www.devdelay.org devdelay@mindspring.com 800- 497- 0944. AUTISM SPECTRUM DISORDERS (ASD).

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Prioritizing therapies for children with autism spectrum disorders l.jpg
PRIORITIZING THERAPIES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

NAA- NY Metro Chapter

November, 2008

Patricia S. Lemer, M.Ed., NCC

Executive Director

Developmental Delay Resources (DDR)

www.devdelay.org

devdelay@mindspring.com

800- 497- 0944


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AUTISM SPECTRUM DISORDERS (ASD)

AD(H)D LD ASPERGER’S PDD AUTISM

………………………..…………………………..

Least severe More severe Most severe


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ALPHABET SOUP

  • AUTISM LD

  • ASPERGER’S NLD

  • PDD GTLD

  • PDD-NOS SPD

  • ADD OCD

  • ADHD


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WHAT A DIAGNOSIS SAYS

  • A diagnosis describes a cluster symptoms.

  • People with the same diagnosis display the same symptoms, but do not necessarily require the same treatments.

  • Determining appropriate treatments requires knowing cause of symptoms.

  • Determining cause requires taking a complete history.

  • History must be pre-natal, natal, environmental, developmental and medical.


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TOTAL LOAD THEORY

  • The body is like a bridge, and can handle only a limited number of stressors.

  • Cumulative effect of stress factors overloads it.

  • Body’s top priority is staying well.

  • Sensory, language, social-emot. development must take a back seat to biological issues.

  • Degree of overload determines diagnosis.

  • Specific load factors determine treatment.


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GENETIC LOAD FACTORS

  • Parents with immune system dysfunction

  • Chronic fatigue, fibromyalgia, familial allergies

  • Nutritional/endocrine deficiencies, including thyroid and EFA

  • Environmental toxic exposure prenatally


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ENVIRONMENTAL INSULTS

  • Pregnancy complications - birth trauma

  • Smaller incidence of breast-feeding

  • Allergy-prone foods, including milk/wheat

  • Insufficient sensory stimulation

  • Aggressive use of medications

  • Immunizations containing toxic metals

  • Toxic metal exposure through other sources: Kuwait, Rh negative


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Group Exercise on “Total Load”

  • List possible genetic load factors in your family

  • List possible environmental insults your child(ren) may have had


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EVERY CHILD IS UNIQUE

  • Restoring health is like restoring a fine painting: you must know its history;

  • It takes at least as long to get well as it did to get sick;

  • Need for a prioritized model of therapies; don’t take therapies “off the shelf.”

  • Look at “total load” factors

  • Genetics loads the gun, environment pulls the trigger


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TAKE A DEVELOPMENTAL APPROACH

  • Lay the foundation for motor, sensory-motor, language and cognitive development, all of which must wait until health improves.

  • Development follows a predictable hierarchy.

  • Skipped developmental steps can cause later problems.

  • Uneven and spotty development increases over time without intervention.


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STEP 1

Lay the Foundations

  • STRUCTURAL

  • BIOLOGICAL

    • Dietary

    • Nutritional

  • DETOXIFICATION


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STRUCTURAL SYSTEM

  • WHAT GOES WRONG

    Organs, fluids, bones and connective tissues are out of balance due to birth or other trauma

  • SIGNS TO LOOK FOR

  • Long labor, forceps delivery, C-Section

  • Delay in sucking, reflux, vomiting or spitting

  • Strabismus, nystagmus, reduced acuity

  • Missing stages in motor development


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STRUCTURAL THERAPIES

  • Chiropractic

  • Osteopathy

  • Cranio – Sacral therapy

  • Massage

  • Other “Bodyworks” therapies


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Structural Checklist

  • What, it any, structural “load factors” does your child(ren) have?

  • What interventions have you already done?

  • Which interventions might you consider?


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IMMUNE SYSTEM

  • WHAT GOES WRONG

    • System becomes exhausted from constant assaults from too many load factors

  • SIGNS TO LOOK FOR

    • Allergies, asthma, leaky gut, skin problems

    • Chronic ear/sinus/strep infections

    • Heavy use of antibiotics

    • Dark circles, red ears and cheeks


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LOOK AT DIET

  • ROTATE

    • Grains, fruits, nuts, protein sources

  • ELIMINATE WHITE FOODS

    • Dairy, wheat flour, salt, sugars

  • SUBSTITUTE

    • Organic, natural sweeteners

  • EXPERIMENT with new products

  • COOK good quality, simple foods


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DIETARY MODIFICATION

  • Diet free of artificial colors, flavors, additives and salicylates

  • Diet free of gluten and casein

  • Diet free of yeasts, molds & sugar

  • Drink good quality & ample water

  • Special diets – GF/CF, SCD, etc.


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TRACK DOWN HIDDEN FOOD SENSITIVITIES

  • Artificial colors, flavors and preservatives

  • Dairy products

  • Corn

  • Wheat

  • Eggs


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LOOK AT SPECIAL DIETS

  • Feingold

  • Yeast-free

  • GF/CF

  • Specific Carbohydrate Diet (SCD)

  • Body Ecology Diet (BED)

  • Minimze use of “prepared” foods

  • Rediscover your kitchen

  • Take cooking classes; buy books


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BODY ECOLOGY DIET

  • 7 Principles - acid/alkaline, 80/20, food combining, contraction/expansion

  • Fermented Foods

  • Coconut oil, kefir and pudding

  • Celtic sea salt

  • Only nutritionally dense foods


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Diet Exercise

  • What foods are missing in your families diet?

  • What foods does your family eat too much of?

  • What can you do to improve the quality of your families diet?

  • Which “special diets” have you tried?

  • Why did it work or not?

  • Which “special diet” might be best for your family?


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NUTRITIONAL SUPPLEMENTATION

  • Closes the gap between what is eaten and what the body needs

  • Helps with poor absorption

  • Detoxifies environmental chemicals

  • Heals the leaky gut

  • Repairs the nutritional deficiencies

  • Boosts the immune system


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BIOLOGICAL STATISTICS

  • 99% - Omega 3 Fatty Acid Deficiencies

  • 90% - Zinc Deficiencies - Copper Excess - Immune Disregulation

  • 80% - Chronic Diarrhea / Constipation

  • 80% - > 5 Ear or strep infections

  • 50-70% - Mercury (Hg) Toxic


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CLEAN UP ENVIRONMENT

  • Use non-toxic cleaners

  • Use natural fiber clothing and household items

  • Eliminate pesticides

  • Drink filtered water

  • Watch art materials

  • Eliminate passive smoking


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VITAMINS & MINERALS

  • Zinc, chromium, selenium for detoxification of heavy metals

  • Calcium – balance with magnesium

  • DMG/B6/magnesium

  • Folic acid

  • Vitamins C, E, B-complex


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TESTING FOR TOXICITY

  • Urine, hair and blood tests for recent exposure

  • Immune system testing and observation for past exposures

  • “Challenge”tests

  • Stop all ongoing exposures


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DETOXIFY

  • Reduce exposures

    • Amalgams, some fish, new construction

  • Homeopathic detox

    • Assists the body to heal itself from inside

  • Chelation

    • Promising; changing protocols

    • Nutrients

  • Sauna

  • All require strict medical supervision


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HOMEOPATHY

  • 200 year old approach that helps the body’s ability to heal itself

  • Based on the concept that like cures like

  • Addressess whole body, not just physical body

  • People get sick from the outside in;

    they get well from the inside out

  • Homotoxicology – a safe way to detox slowly from the deepest cellular level


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STEP 2

  • Lifestyle changes to include exercise

  • Reflex integration

  • Sensory integration/OT

  • Brain Gym

  • Vision therapy

  • Use of lenses and prisms

  • Auditory Integration


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ASSURE ADEQUATE PHYSICAL EXERCISE

  • Helps elimination, sleep, executive function and concentration

  • Boosts serotonin levels

  • Vestibular stimulation

  • Walking

  • Relaxation and meditation, yoga


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REFLEXES

  • Over 100 involuntary movements that are controlled by the brain stem

  • In infancy protect and assist with survival

  • Lead to the development of movements

  • As they integrate person gains volitional control over body

  • Result is skilled, intentional behavior

  • If unintegrated, interfere with behavior



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CONSEQUENCES OF REFLEX ABNORMALITIES

  • Aberrant motor development

  • Poor lateralization

  • Hyper- or hypotonic muscles

  • Vestibular dysfunction

  • Poor binocularity

  • Eye motor difficulties

  • Perceptual problems


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SENSORY INTEGRATION

Near senses

  • Touch

  • Movement

  • Muscles and joints (proprioception)

    Far senses

  • Vision

  • Audition

    All must work together!!


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VESTIBULAR SYSTEM

  • Balance system

  • Located in the inner ear

  • Key to well-integrated sensory function

  • Connected to:

    • Language center of the brain

    • Digestive tract

    • Eye muscles

  • Requires suspended equipment


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    BRAIN GYM

    • Learning is not all in your head

    • Educational kinesiology

    • Integrates top with bottom, left with right and front with back

    • Can benefit everyone

    • Takes only a few minutes each hour

    • KIDS LOVE IT !!


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    Movement Exercise

    • What movement activities is your family participating in on a regular basis?

    • What are some opportunities to turn daily activities (such as going to and from school) into movement?

    • How can you integrate tools like Brain Gym and Reflex integration into your day?


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    VISION

    • Different from eyesight

    • Eye movements

    • Binocularity

    • Focus, convergence

    • Visual-motor integration

    • Visual perception

    • Visualization


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    VISUAL SYMPTOMS IN AUTISM

    • Poor eye contact

    • Staring at lights and/or spinning objects

    • Looking askance

    • Side viewing

    • Stimming

    • Inflexible behavior


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    WHO EVALUATES & TREATS VISION PROBLEMS

    • Ophthalmologist – MD - looks at pathology, disease, structure

    • Optometrist – OD – looks at function

    • Occupational Therapist –OT

    • Psychologist – Ph. D.

    • Educator – M. Ed.

      All look at end-product skills


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    VISION THERAPY

    • Delivered by behavioral optometrist

    • Always done in the context of movement

    • Uses lenses therapeutically

    • Facilitates using the 2 eyes effectively

    • Teaches eyes to move, align, fixate and focus as a team

    • Coordinates messages from eyes with brain for perception and cognition


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    EFFECTS OF LENSES & PRISMS

    • Research shows those with autism benefit greatly from yoked prism lenses

    • Send different messages to the brain

    • Brain interprets new information and integrates it

    • Magnify or make thing smaller

    • Make objects appear closer or further away

    • Change spatial perception

    • Give the brain a preview of what is possible


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    Organization & Attention

    • A well-organized body is like a well-rehearsed orchestra: it is in tune.

    • Organize the body from large motor to the smallest parts:

      • Lower body, trunk, shoulder, arm, wrist, hand.

      • Lower body, trunk, neck, head, eyes.

    • Organize yourself before another person.

    • Take your own view before another’s.

    • Organize on the body before on the paper.


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    Vision Exercise

    • What visual symptoms does your child(ren) manifest?

    • Are they frequent or infrequent?

    • How are they related to your child(ren)’s Total Load?

    • Who has evaluated your child(ren)’s vision?

    • Is it time to (re)evaluate vision?


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    STEP 3

    • Focus on LANGUAGE

    • Assumes that all sensory systems are GO

    • ACADEMICS - May need VISION THERAPY before READING, WRITING & MATHEMATICS emerge

    • SOCIAL SKILLS


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    SPEECH-LANGUAGE THERAPY

    • Often the first place families turn

    • Oral-motor issues related to prematurity

    • Interaction with feeding/eating problems

    • Co-treatment with OT

    • Consider missing links to talking

    • Role of movement and vision

    • Moves from general to specific

    • Relationships between receptive, expressive language, reading and writing


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    ACADEMICS

    • Use strengths to improve weaknesses

    • Look at process, not end product

    • Encourage thinking not memorization

    • Use child’s meaningful life experiences

    • Understand the role of VISION in reading, writing, mathematics


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    SOCIAL SKILLS

    • The most complex outcome of sensory integration

      • Touch (tactile defensiveness)

      • Vestibular or Balance

        • Where am I, where are you?

        • Vestibular relationship to vision + language

      • VISION

        • Focus

        • Giving meaning to body language

        • Depth perception


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    STEP 4

    • TRANSITION & ESTATE PLANNING

    • REVISIT NUTRITIONAL NEEDS with hormonal changes

    • VISION THERAPY moves from binocular to visual thinking

    • VOCATIONAL TRAINING

    • LEISURE TIME ACTIVITIES & HOBBIES


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    Therapeutic Priorities for Young Children

    • Structural and Biological

      • Osteopathic/Chiropractic/CranioSacral

      • Dietary Modification

      • Nutritional & Immuno therapies

  • Sensory-Motor OT, PT, AIT

    • Gross Motor

    • Fine motor, vestibular

    • Speech/Language


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    Therapeutic Priorities for Older Children

    • Vision Therapy (VT)

      • Binocularity, Focus

      • Perception

  • Academics

  • Psychological Development

    • Social-emotional skills

    • Pragmatic language

  • Vocational Training


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    SUMMARY

    • Take a developmental approach

    • Educate yourself about options

    • Re-evaluate at least annually

    • Keep good records

    • Find good support systems

    • Emphasize a child’s strengths

    • Try the least restrictive environment (LRE)

    • HAVE FUN!


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