Disorders of Autistic

Spectrum

. Methods of work with children.

Initiative of parents in autism.

What is Autism?

• Autism belongs to the group Pervasive development problems and is characterized with a number of neurologic disorders, including disorders of social interaction development, speech and communication, and accompanied with stereotypic kinds of behavior.

PDP Classification

Pervasive Development Problems1.Disorders of Autistic spectrum• Canner Syndrome • Asperger Syndrome • Atypical Autism• 2 Children's disintegrated disorder• (Heller Syndrome)• 3 Ret Syndrome

What is spectrum?

• Autism can be deep one with serious disorders, or light one with light autistic changes. As Autism is different and each child can have different symptoms, Autism is described as Disorders of Autistic Spectrum

• Autism remains with an individual throughout all his (her) life and the first symptoms appear from the age of 18-24 months.

• Autism is syndrome (set of symptoms)• Autism is a retrospective diagnosis (put for

long before occurrence of first signs and symptoms, based on complaints of parents and supervision over a child.

• Autism can be accompanied with disorders of sensor (touch) perception, thinking and cognitive development.

• The reasons is: there is not a uniform proved reason, but results of scientific researches testify to genetic reason of Autism....

• Till now there are no specific biological markers of Autism, presence of this disorder is defined only depending on behavior of a person.

• Autism is not a mental disease and it does not appear in view of bad treatment of a child by parents to the child, no matter how awful it could be.

• Autism is an “invisible infringement”, there are no phenotype characteristics and often a child makes an impression of an ill-bred and spoilt child.

• Frequency of cases – 1 per 150 children• Ration between boys and girls is 4:1• .... the diagnosis can be established already at the age

of 24 months and remains the same in not less than in 80% of all cases

• It is important to know early signs of Autism to avoid wrong diagnostics, treatment and treatment of a child.

• Since till now there are no specific biological markers of Autism, presence of this disorder is defined only depending on behavior of a person.

• At the moment Autism cannot be cured completely. Autism is not children's disorder. A child with Autism will grow into an adult with Autism.

Approach to diagnostics Talking to parents

• Studying of a development history for revealing of signs of Autism at early ages

Talks to tutors (teachers) / employees of a kindergarten / partners

• Observing a child in various situations and during various time

• Assessment of speech / language development • Assessment of sensor and motor integration • Assessment by DSIM-4 criteria• Assessing scale of children's Autism

Довбня, Морозова; Душанбе, Август 2008; 10

DSM-10 DSM-41. Qualitative infringements of social interaction (for example, inadequate estimation of social and emotional signals; insufficient use of social signals)

1. Qualitative infringements of social interaction (for example, at such nonverbal ways of communication, as visual contact, etc., at establishing of contacts with contemporaries, display of feelings)

2. Qualitative infringements of speech (for example, insufficient use of speech for communication, insufficient emotional response to verbal and nonverbal reproach to other people, changed speech melody)

2. Qualitative infringement of communicative abilities (for example, delay or pause in development of speech, speech stereotypes, absence of the typical to the age role and imitation games)

3. Specific interests and stereotypic behavior (rigidity and adherence to a routine order in daily training, resistance to changes)

3. Specific repeating or stereotypic forms of behavior, interests and activity

4. Nonspecific problems - fears, phobias, disorders of dreams and food intaking habits, fury attacks, aggression, self-damages

4. Beginning before the age of 3 years, as well as delay or anomalies of functional abilities

5. Demonstration of symptoms to the age of 3 years

 

Довбня, Морозова; Душанбе, Август 2008; 11Modeling Clinical Outcome of Children With Autistic Spectrum Disorders; James Coplan, and Abbas Jawad;

PEDIATRICS Vol. 116 No. 1 July 2005

Children's Autism Rated Scale (C.A.R.S E. Shopler)

• Identification and classification of Autism• Defining of light, medium and

heavy forms of Autism)• 15 spheres of inspection

• Attitude to people• Imitation• Emotional response• Possession of a body• Use of subjects• Adaptation to changes• Sight use• Hearing use• Use of sense of smell, touch.• Nervousness and fears• Verbal communication• Nonverbal communication• Activity level• Level and coordination of intellectual response• General impression

Parents are offered various ways assistance aimed at treatment of a child (basically – nootropic medicines, medicines affecting brain blood circulation, vitamins and bio-additives)

• Analyses of modern western literature and study of the practical experience devoted to treatment of children with infringements of autistic spectrum did not reveal data about efficiency of the above mentioned methods. A number of medicines are not applied at all in the pediatric practice.

Ways of assistance• Information and resource support of a family• Support of parents’ self-help groups.• Training of parents and experts to modern,

well-tested methods of treating children with Autism.

• Training of medical staff to early revealing of Autism and methods diagnostics.

• Introducing methods of intensive early intervention in the public healthcare system.

• Creation of a special intensive development program class for children with severe cases of Autism.• Training teachers of preschool and high

school institutions to inclusion of children with Autism in the system of secondary education.• Publicity of the Autism problem in the

society for the purpose of achieving positive attitude to people with Autism. (Mass media)

Programs of assistance.1. Intervention on a behavioural basis

- Applied and verbal behavioural analysis. Modification of behavior (ABA, VBA) - Training according to the Lovaas method (DTT)

2. Training to alternative communication System of communication through exchange of images (PECS)

- Macaton 3. Cognitive methods of developing social skills

- TEACCH4. Ergo-therapy (OT)5. Touch integration (SIT)6. Methods of training on the basis of the development theory • Method of training Acupuncture (“Greenspan” Floor Time

Model (DIR)7. Inclusion programs for preschool institutions

Intervention on a behavioral basis.

• Are based on scientific principles of behavior, encouraging socially-useful interactions and reducing negative aspects of behavior.

• Reducing to maximum risk of failures, supporting feelings of success from a carried out task.

• At intensive and regular intervention, development of generalization and summarization of skills in the natural, functional environment takes place.

• Individual approach.• Parents become prime and basic instructors for children.

Principles

Precedence consequence

What occurs before

behaviour Beha-vior

What occurs after

behaviour

Components

• Method of faultless training• The full physical prompt• Immediate reinforcement of a correct, but

even prompted action• Use of different reinforcements• Gradual removal of prompts and

reinforcement

What is reinforcement for me, may not be reinforcement for you!

FOOD

Toy

PRAISE

Activity your child likes

KISS

Stereotypic fixation object

Intervention by training to alternative communication.

• Improves understanding and speech expression.• Is based on value of visual symbols for children

with communicative difficulties for improvement of interaction with people (photo, pictures, symbols)

• Use of visual schedules improves communication of even nonverbal children and stimulates realized speech among speaking children.

PECSHow?

PECS has six stages of implementation:

1. Physical exchange;

2. Spontaneity increase

3. Training to discrimination;

4. Structure of a sentence;

5. Answer to the question “What do you want?";

6. Commenting

Intervention by introduction of structural training.

• Means preparation of a structural environment and methods of training based on decrease of irritating and distracting moments, as well as encouragement of an individual’s independent actions.

• Providing of predictability of an environment and sequence of events for decreasing level of a child’s nervousness and confusion.

• Use of visual prompts in a daily and school environment.

Advantages of structural training1. Increases abilities and skills of a child2. Makes an environment more distinct

and accessible to a child with Autism.3. Promotes biggest independence of a

child.4. Excludes distracting and irritating

factors.

Intervention based on therapy of touch integration

• Promotes improvement of perception, processing and reaction to touch information. (Vestibular, pro-prioceptive and tactile systems)

• Use of special techniques and activities based on individual touch difficulties of a child.

• Promotes improvement of organization, activation or relaxation of a child depending on a situation and individual needs.

• Are used together with the complex ergo-therapy.

Calming techniques• Warm bath• Technique of deep pressure• Friction on a back • Technique of pressure on a joint• Rolling in a blanket• Soft ball, immersing in a big pillow• Extension• Skin contact• Slow rocking (a rocking chair, a hammock, in a bed-sheet• Clothes of lycra• Smell of lavender, vanilla, banana• Low classical music• Embraces• Twilight and silence• Сompressing fingers

Exciting techniques• Fresh cool air• Fast unpredictable movement (on a ball, on a

trampoline)• To drink cold water• Games with cool water• Sprayers and douches• Loud rhythmical music• Musical toys• Cause and effect games• Bright room with a set of visual irritators

Organizing techniques• Vibrating massage• Indifferent environment • Hanging• To pull-push• Chewing• To blow bubbles, a pipe• Swimming• Rhythm• Heavy waistcoat• Roller board

Interventions based on the development theory. (Floortime - Greenspan), RDI)

• Recognizes that a child develops a cognitive sphere (its ability to think, comprehend, remember) language, emotional and social skills through interaction with other people, first of all parents or prime instructors.

• Games with a leading role of a child. (According to Greenspan – an interactive game where an adult follows game instructions of a child, promotes desire of a child to co-operate with the world around him (her).

• Improves quality of child’s communication, taking into account his (her) touch needs.

Principles1. Observation of a child2. Approach to a child (when joining a child, an adult

should catch an emotional condition of a child). Involving a child in a game it is necessary to vary with gestures and words, mimicry and tone of voice for providing pleasures to a child and making his (her) activity richer.

3. Following a child. (A child leads a process, a adult plays a role of an assistant. The primary goal of an adult is to support initiatives of a child and his (her) actions. Mirroring

Exact copying of a child’s actions. It establishes a child’s trust to you.

4. To extend and expand ideas of a child. Creating an invented game based on experience and ideas of a

child, connected with his (her) daily routine.

“Look at me and you will see me and only then my Autism”

• I am, first and first of all, a child. Yes, I have Autism, but I am not “autistic”, neither “autist” as a matter of fact.

My Autism is only one aspect of my nature. It does not define me as a personality.

“Parents’ initiative in Autism”

• Conference on Autism• Trainings on Autism for parents and experts• Opening of the program for children with

Autism from 3 to 12 years of age, who do not have access to kindergartens and schools.

• Parents’ club.• The “mum-child” program