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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
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

autism spectrum disorders asd
AUTISM SPECTRUM DISORDERS (ASD)

AD(H)D LD ASPERGER’S PDD AUTISM

………………………..…………………………..

Least severe More severe Most severe

alphabet soup
ALPHABET SOUP
  • AUTISM LD
  • ASPERGER’S NLD
  • PDD GTLD
  • PDD-NOS SPD
  • ADD OCD
  • ADHD
what a diagnosis says
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.
total load theory
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.
genetic load factors
GENETIC LOAD FACTORS
  • Parents with immune system dysfunction
  • Chronic fatigue, fibromyalgia, familial allergies
  • Nutritional/endocrine deficiencies, including thyroid and EFA
  • Environmental toxic exposure prenatally
environmental insults
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
group exercise on total load
Group Exercise on “Total Load”
  • List possible genetic load factors in your family
  • List possible environmental insults your child(ren) may have had
every child is unique
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
take a developmental approach
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.
step 1
STEP 1

Lay the Foundations

  • STRUCTURAL
  • BIOLOGICAL
    • Dietary
    • Nutritional
  • DETOXIFICATION
structural system
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
structural therapies
STRUCTURAL THERAPIES
  • Chiropractic
  • Osteopathy
  • Cranio – Sacral therapy
  • Massage
  • Other “Bodyworks” therapies
structural checklist
Structural Checklist
  • What, it any, structural “load factors” does your child(ren) have?
  • What interventions have you already done?
  • Which interventions might you consider?
immune system
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
look at diet
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
dietary modification
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.
track down hidden food sensitivities
TRACK DOWN HIDDEN FOOD SENSITIVITIES
  • Artificial colors, flavors and preservatives
  • Dairy products
  • Corn
  • Wheat
  • Eggs
look at special diets
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
body ecology diet
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
diet exercise
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?
nutritional supplementation
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
biological statistics
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
clean up environment
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
vitamins minerals
VITAMINS & MINERALS
  • Zinc, chromium, selenium for detoxification of heavy metals
  • Calcium – balance with magnesium
  • DMG/B6/magnesium
  • Folic acid
  • Vitamins C, E, B-complex
testing for toxicity
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
detoxify
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
homeopathy
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
step 2
STEP 2
  • Lifestyle changes to include exercise
  • Reflex integration
  • Sensory integration/OT
  • Brain Gym
  • Vision therapy
  • Use of lenses and prisms
  • Auditory Integration
assure adequate physical exercise
ASSURE ADEQUATE PHYSICAL EXERCISE
  • Helps elimination, sleep, executive function and concentration
  • Boosts serotonin levels
  • Vestibular stimulation
  • Walking
  • Relaxation and meditation, yoga
reflexes
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
consequences of reflex abnormalities
CONSEQUENCES OF REFLEX ABNORMALITIES
  • Aberrant motor development
  • Poor lateralization
  • Hyper- or hypotonic muscles
  • Vestibular dysfunction
  • Poor binocularity
  • Eye motor difficulties
  • Perceptual problems
sensory integration
SENSORY INTEGRATION

Near senses

  • Touch
  • Movement
  • Muscles and joints (proprioception)

Far senses

  • Vision
  • Audition

All must work together!!

vestibular system
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
brain gym
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 !!
movement exercise
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?
vision
VISION
  • Different from eyesight
  • Eye movements
  • Binocularity
  • Focus, convergence
  • Visual-motor integration
  • Visual perception
  • Visualization
visual symptoms in autism
VISUAL SYMPTOMS IN AUTISM
  • Poor eye contact
  • Staring at lights and/or spinning objects
  • Looking askance
  • Side viewing
  • Stimming
  • Inflexible behavior
who evaluates treats vision problems
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

vision therapy
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
effects of lenses prisms
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
organization attention
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.
vision exercise
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?
step 3
STEP 3
  • Focus on LANGUAGE
  • Assumes that all sensory systems are GO
  • ACADEMICS - May need VISION THERAPY before READING, WRITING & MATHEMATICS emerge
  • SOCIAL SKILLS
speech language therapy
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
academics
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
social skills
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
step 4
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
therapeutic priorities for young children
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
therapeutic priorities for older children
Therapeutic Priorities for Older Children
  • Vision Therapy (VT)
      • Binocularity, Focus
      • Perception
  • Academics
  • Psychological Development
      • Social-emotional skills
      • Pragmatic language
  • Vocational Training
summary
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!