Tag Archives: Southwest Human Development

Autism Q & A: What’s ahead?

On Sept. 30, 2011, President Barack Obama signed the Combating Autism Reauthorization Act (CARA) into law.

The original Combating Autism Act of 2006 created a number of initiatives that are now bearing fruit. Under that piece of legislation, funding provided to the Health Resources and Services Administration (HRSA) and the Maternal and Child Health Bureau (MCHB) developed the Combating Autism Act Initiative (CAAI) to further address autism spectrum disorders and other developmental disabilities.

Under this initiative the MCHB expanded training programs in Developmental and Behavioral Pediatrics and created two Autism Intervention Research Networks—one focused on physical health interventions and one on behavioral, mental, social, and/or cognitive health interventions. These research networks were to focus on intervention research, tool validation for interventions, guideline development and information dissemination to health professionals and especially families impacted by autism spectrum disorders and other disabilities. The results of this work will soon find its way into the hands of both professionals working with children and families and to the families themselves.

These efforts will focus on a number of areas important to families dealing with autism. One important area that is being focused on (and has more typically been the domain of non-traditional practitioners) involves the many associated medical conditions often seen in children with autism including seizures, sleep problems, gastrointestinal problems, psychiatric conditions, nutritional deficiencies and metabolic conditions. Into this effort the Autism Treatment Network (ATN), an effort supported by Autism Speaks, and involving 17 treatment and research centers in North America, has taken on the task of the Autism Intervention Research Network on Physical Health (AIR-P).

The fundamental mission of the AIR-P is to initiate research that can lead to improved care for children on the autistic spectrum (ASD) and they have developed a five year plan to focus on the treatment of associated medical conditions in children with ASD.

Activities funded under this initiative have focused on several areas including an assessment of nutrition, non-pharmacological treatments to improve sleep in children with ASD, the training of professionals, and the development of tool kits for parents and professionals (that are now available online at www.autismspeaks.org) that are aimed at empowering parents and individuals with ASD.

Clinicians in the network partner with family advisory committees to develop new ideas for tool kit development. One such example is a medication decision aid called, “Should My Child Take Medicine for Challenging Behavior.” Other tool kits have focused on topics such as blood work in children with ASD, sleep, visiting the dentist and the use of visual supports to facilitate medical care. Studies have begun to focus on the use of psychotropic medication as well as complementary and alternative medicine use. Centers are evaluating issues related to quality of life in children with ASD and their families.

While much work remains to be done and funding still needs to be provided, these are indeed exciting times. I truly believe that information is power and misinformation is toxic. I vote for information.

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. This is his final article in the series, which begins here.

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Autism Q & A: What medications are available to treat autism?

By Daniel B Kessler

There are no medications that treat the core challenges of autism, though you can bet the pharmaceutical companies and autism research centers are working on developing some. What we do have available treats only the symptoms or behaviors but that is often so important by itself.

If a child’s behavioral (disruptive behavior or aggression) or emotional (anxiety, obsessive tendencies, sensory overload, meltdowns) challenges limit his or her ability to participate in and therefore benefit from educational, therapy or recreational activities, then these symptoms may be legitimate targets for a medical approach (that means the judicious, careful trial of medications). Medication, used appropriately, doesn’t control behavior. It should allow the child to be in control of his behavior.

The decision to use medication rests with parents. Don’t let anyone tell you different. Find someone to answer your questions and address your fears. Talk to parents who have decided to go ahead and place their child on medication and those that have not. Ask them to let you know their reasons and experiences. But be careful about third-hand accounts (“I know one parent whose sister’s kid had a really bad reaction to ____”).

No parent is excited about having to use medication. Every medication has potential side effects — even “over the counter” medications or “natural” supplements.

But there is also a cost to not getting help for these behaviors. The child may not benefit as much as he or she could. While on medication a child may do better; progress more quickly, with the ability to better regulate their behavior or emotional reactions. Once again, information helps. Ask questions. Look at reliable sources of information. What is this medication supposed to do? How does it work? How long will it take to show a benefit? Has it been studied in children with autism? Has it been shown to be safe and effective? If not FDA-approved and being used off-label* has it been used for children with autism? Has this doctor used it to treat kids with autism?

Next: What are the potential side effects? 

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.

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*Off-label use is the practice of prescribing a medication for a condition, or an age group, for which it has not been reviewed and “approved” by the Food and Drug Administration.  It is up to the manufacturer of the medication to submit an application for approval. However, the FDA does not have the legal authority to regulate the practice of medicine, and any physician may prescribe a drug off label.

Autism Q & A: What if I disagree with the services provided for my child?

By Daniel B. Kessler, M.D.

Budgets are the biggest obstacles to getting appropriate services for kids with autism. The reality for school administrators is that resources are limited and available resources drive choices of the services that schools can offer. It’s not that schools want to do “bad” by kids, but with limited budgets in a down economy they are faced with taking money from one group of kids and spending it on another. Never is this an easy choice. On the other hand parents of kids with special needs want what the law and increasingly the courts say is the most appropriate service. Find out what is appropriate for your child and never take no for an answer.

All children are entitled to a “free and appropriate education” (FAPE). This requires a comprehensive evaluation in all areas of suspected disability. In addition, many school district personnel will tell you that autism is a medical diagnosis (that is true), so they cannot test for it (that isn’t exactly true). Autism is also an educational eligibility category (at least by kindergarten age) and the Ninth Circuit Court of Appeals, which covers Arizona, has ruled that to not test for autism denies a student access to FAPE.

If the school district performs an evaluation that the parents disagree with or does not have sufficient resources to do the necessary evaluation, parents have the right to request an Independent Educational Evaluation (IEE) at public expense. If the school district provides you a list of evaluators to choose from, you have the right to pick another evaluator as long as that person has the appropriate credentials.

Parents are their kids’ best advocates and they are in the best position to be so. I can’t give you better advice than that provided by the Coordinated Campaign for Learning Disabilities:

• Know the rules (get help from Raising Special Kids, Arizona Center for Disability Law, Wrightslaw.com)

• Keep records (maintain an organized file of your child’s evaluations)

• Gather information (using reliable sources)

• Communicate effectively (adversarial stances are less effective, except when facing intractable professionals or administrators)

• Know your child’s strengths and interests and share them with educators

• Emphasize solutions (work together to identify ways to improve your child’s experience)

• Focus on the big picture (“don’t sweat the small stuff”) and

• Involve your child in decision making as early as you can and whenever possible (listen to the child).

Next: What medications are available to treat autism?

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.

Autism Q & A: What about social skills?

By Daniel B. Kessler, M.D.

I believe the core challenge of autism is a social challenge. I believe that social/emotional IQ is more predictive of success in our world than is cognitive IQ. Of course, that depends on your definition of success. What I wish for my families and their children is for them to be both happy and successful in three areas: school or related activity (the work of children), home and friends/leisure time activities. That’s what I wish for all kids, mine included. I want them to find work that is meaningful to them. I want them to love it and be good at it. I believe social skills are at the core of this success.

I tell parents and believe strongly that social skills can be learned but they must be taught. Taught the way we teach reading and the way we teach math. We don’t put kids who cannot read into a room of good readers and expect it to rub off. We can’t teach children with autism social skills by simply putting them in a room of typical kids. They need specific curricula, role playing, practice and homework (sorry kids). It can be done but mostly we aren’t doing it. It’s expensive. But it’s not as expensive as it would be to support them on public funds. Is it not better for everyone that children with autism become productive members of their community? Parents might need to be creative and consider partnering among themselves or with their school districts through the use of combined tuition tax credits to support additional services for their kids. It’s not easy but it’s important.

Next: When parents disagree with the services provided to their child.

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.

Autism Q & A: What is the least restrictive environment?

By Daniel B. Kessler, M.D.

What does it mean when my child is placed into the least restrictive environment? Should I want my child taught with typical kids?

Least restrictive environment (LRE) means that a student who has a disability should have the opportunity to be educated with non-disabled peers, to the greatest extent appropriate.

It is entirely understandable for parents of a child with autism to look forward to their child attending a regular classroom with typical kids. While children who experience the typical social challenges of autism will benefit from socializing with typical kids, placing them into a typical classroom doesn’t make them typical. It doesn’t rub off.

I have a problem with full inclusion of children with disabilities into regular educational classrooms immediately upon transferring to kindergarten. This would be wonderful if every teacher in our schools was trained as a special education teacher (or even understood autism), the size of the classroom was limited and the services of appropriate specialists (such as speech therapists and occupational therapists) also were available. This is not usually the case. This does not mean that certain individuals cannot make this transition remarkably well.

Rather, and this is typically true for their initial kindergarten experience, children with autism should have access to the general education curriculum, or any other program that non-disabled peers would be able to access, and be provided with supplementary aids and services necessary to achieve their educational goals. But they should be taught in classrooms more likely to meet their special education needs.

Next: Teaching social skills to a child with autism.

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.

Autism Q & A: Questions about schooling

What happens to my child when my child no longer qualifies for Early Intervention Services?  What preschool services would he qualify for?  Will he continue to qualify for services outside of school?

When a child is about to turn 3 years old, his or her early intervention team will meet with your family and discuss a transition meeting with the school district he is eligible to attend. It may be determined that he will automatically continue to qualify for services or his testing will be updated from what was done in order to qualify for intervention services in the first place. However, if your child has made significant gains you might want to request an updated evaluation so that his educational program, which changes from an Individualized Family Service Plan (IFSP) to an Individualized Educational Plan (IEP), will continue to be the most appropriate to his needs.

Any child who is receiving special education services is supposed to receive a comprehensive re-evaluation every three years.  The transition should be seamless even though the team and location of services may be different.  If your child received speech therapy or occupational therapy that was home-based, this is likely to end at this time.  These services are supposed to now be provided through the school district.

However, if it is determined that these services (therapies) are “medically necessary” it may be possible to continue through your private insurance or the Arizona Health Care Cost Control System (AHCCCS).  In addition it is more likely that services under DDD and/or ALTCS will continue to support services above what is provided by school if your child is diagnosed with autistic disorder.  However, it is important to know that for most preschools in Arizona autism is not considered a preschool eligibility category though it is in many other states.  Your child is likely to be made eligible either under developmental delay (DD) or speech and language impairment (SLI) though occasionally you may see another eligibility category.

Next: The transition to kindergarten.

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.

Autism Q & A: What is behavioral therapy?

By Daniel B. Kessler, M.D.

Behavioral therapies are among the most commonly applied intervention methods for autism and the most studied. Many of the intensive behavioral therapies (or Early Intensive Behavioral Interventions — EIBIs) that have been studied are based on the concepts of Applied Behavioral Analysis (ABA).

Applied behavior analysis is a science that involves using modern behavioral learning theory to modify behaviors. Behavior analysts focus on the observable relationship of behavior to the environment. By functionally assessing the relationship between a targeted behavior and the environment, the methods of ABA can be used to change that behavior. Though highly effective for large numbers of children at early ages and later, ABA therapies are not for everyone. Some individuals are put off by the perception of a highly robotic intervention in a disorder characterized by difficult social interactions.

Forms of ABA are not the only tested interventions for children with autism. Other methods, such as Floortime™, are perceived to be more interactive and flexible. Floortime™ (or DIRFloortime™) is designed to both follow the child’s lead and at the same time challenge the child toward greater mastery of social, emotional, and intellectual capacities. DIRFloortime™ emphasizes the importance of the role of parents’ and other family members’ emotional relationships with the child.

Programs and providers increasingly are looking to implement blended models to obtain the benefit of multiple interventions. The Denver Model (which interweaves multiple perspectives) and the child-directed Pivotal Response Training (which blends rewards with play techniques) are examples. The Relationship Development Intervention (RDI) model developed by Dr. Steven Gutstein tends to focus on the social challenges of autistic individuals. Relationship-based models give importance to the relationships that help children reach and master early developmental milestones often missed or not mastered in children with autism spectrum disorder. Examples of these early milestones are engagement and interest in the world, intimacy with a caregiver and intentionality of action.

Often it comes down to what is available and what you can afford in a given community. There is a growing body of evidence that developmental/relationship-based approaches with very young children are showing promise and represent an important and valid treatment approach. Such is the model for the Side-by-Side Program (SxS) at Southwest Human Development, which involves parents and their toddlers. Increasingly parents are looking to train themselves and provide therapy at home.

Next: Will insurance pay for therapies?

Daniel B. Kessler, M.D., is a developmental and behavioral pediatrician and medical director of the Children’s Developmental Center at Easter Seals Southwest Human Development. His private practice, where he provides evaluation and treatment for children and adolescents, is located at Southwest Human Development.

The views he expresses in this series are based on his training, his reading of the literature and his more than 30 years of experience taking care of hundreds of kids on the autism spectrum. The series begins here.