And... Alternative And... Alternative Treatment Options for Treatment Options for those with ADHD and those with ADHD and PDD PDD

Attain a diagnosis Collaborate with the child’s team

Resource teacher/personnel Child’s parent(s)/guardian(s) Child’s physician Social Worker(s) Other team members School principal, Teacher’s, EA’s (only if

appropriate)

Explore treatment options Here it is key to know the child’s

parent(s)/guardian(s) If you do not, make a meeting, phone call, or e-mail

to get to know them

This will help you to build a collaborative relationship here

greater positive changes from medications shown in children who had mothers who were more interactive and rewarding prior to med. implementation (Barkley, 1981) 

13 guiding questions to medication use

(Morris & Kratochwill, 1998)

Stimulants (ADHD) Major types used: Ritalin, Dexedrine, Cylert, Adderrall,

Concerta

Use: short-term academic performance, teacher and parent behaviour ratings, aggression (Ritalin only) and social functioning (Ritalin only)

Common side-effects: can worsen or lead to tics/Tourette’s disorder, hypertension, psychosis, cardiovascular diseaese, liver problems (Cylert)

Anti-depressants (both ADHD and Autism) Major types used: tricyclics (Tofranil, Norpramine), Selective

Serotonin reuptake inhibitors (Prozac, Zoloft), Wellbutrin

Use: treat mood disorders (depression, anxiety), agression

Common side-effects: cardiac changes, nausea, insomnia, skin problems

(Kollins et al., 2001)

Anti-psychotics (Autism and ADHD) Major types:

typical: haldol atypical: Risperidone, Olanzapine (acts on serotonin

and dopamine receptors)

Use: psychosis (both), self-injurious behaviour, (autism), tantrums (autism), aggression (both), conduct disorder (both)

Common side-effects: withdrawal symptoms, weight gain, tardive dyskinesia (Parkinson like tremors), sudden death, seizures

Anti-epileptic (AED) (Autism when seizures occur)

(Morris & Kratochwill, 1998)

Step 1: Ensure proper steps taken in diagnosisIe. use various testing

methods/procedures

Step 2: Proper Dose Regime

Step 3: Review and re-assessment of medication effectiveness and use

use different testing procedures including double-blind studies so parents and teachers do not knows what dose or if the child is on medication (informed consent key here)

- also in this step parents and teachers should complete a weekly side-effects questionnaire (Barkley and Murphy, 1998)

- varying dose trials by week (ie.21, 5mg capsules (3 times/day) of Ritalin, 15, 10 mg capsules, and one bottle with 21 capsules containing only filler (dextrose) 

end of each trial week teachers and parents should complete the behavioural-ratings and side-effects questionnaires and return them to the evaluating individual

  Note: evaluation procedure above only

valuable for stimulants, other meds longer lasting

Consult your physician regularly

Talk to your child’s teacher and in school personnel

Ensure physicians are in contact with the school to ensure proper communication amongst groups involved

Re-assess as the child ages and grows

ADHD is characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity (APA, 1994)

There are three basic forms of ADHD: hyperactivity type, inattentive type and combined type

ADHD affects 3 - 5 % of all school aged children (APA, 1994), 2-9% in Canada (Ken and Andrea McCluskey)

Multimodal greatest gains from medication and behavioural interventions (MTA Cooperative Group, 1999)

Should be noted though that multimodal didn’t reduced symptoms any more than medication alone

There are 5 disorders that fall under the pervasive developmental disorder umbrella:

Autism (includes Asperger’s)PDD-NOSChildhood Disintegrative DisorderRette SyndromeFragile X

(Autism Society of America)

"Autism is a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities.

(Autism Society of America)

In 2007, the Centers for Disease Control and Prevention estimated that about 1 in every 150 eight-year-old children in the US was on the spectrum

Between 1994 and 2006 the number of school-aged children classified as being on the spectrum increased from 22, 264 to 211, 610 (IDEA data, 2009)

diagnosed using a series of interviews, observational tools, and checklists (Kluth and Shouse, 2009)

often diagnosed by age 3 and in some cases by eighteen months (Kluth and Shouse, 2009)

“Many on the spectrum are not diagnosed at all in childhood; it is not uncommon for people to be diagnosed in adulthood (Kluth and Shouse, 2009)”

common characteristics

Challenges in:

1. Social interactions

2.Verbal and non-verbal communication

3. The ability to learn (in the usual settings)

4. Repetitive behaviours

5. Unusual or severely limited activities and interests

Degree and severity of characteristics differ amongst individuals with autism

(Autism Society of Canada, 2010)

Seizures and Epilepsy (Use of Anti-epileptic drugs)

Sleep Disorders Bowel Disease Gastrointestinal Disorders Pica (eating of non-nutritional objects

frequently) Anxiety disorders (ie. Obsessive-compulsive

disorder, phobias) Depression Dyslexia and other learning disabilities ADHD

(Autism Society of America, 2010)

Anti-psychotics (most widely studied)

4 approved by the FDA:

risperidone (Risperdal) clozapine (Clorazil) olanzapine (Zyprexa) quetiapine (Seroquel)

Only risperidone has been investigated in a controlled study and was approved by the FDA in 2006 for the treatment of autism

Anti-depressants

serotonin-specific reuptake inhibitor (SSRIs)

Effective in treating depression, anxiety, and OCD present in some individuals with ASD

(Autism Society of America, 2010)

Is it worth it with autism?

Applied Behavioural Analysis (Siri and Lyons, 2010)

Visual Schedules Sensory Tools Communication

Lists and Scripts (Patrick, 2008) Social Stories (Gray, 2010) Video Modelling Teaching Social Skills

Accepting “No”Hygiene “Hand Washing Song”

School Clinicians Autism Society of Manitoba Autism Society of Canada Autism Society of America Professional Development Opportunities Books

The autism checklist Temple Grandin: The Way I See It

Magazines (Autism: Asperger’s Digest Magazine)

The internet (tons of personal accounts and information on YouTube)

1. What is the parents attitude toward pharmacotherapy?

2. How old is the child? pharmacotherapy can lead to severe side effects and

be less effective for children under 4 ()

3. Severity of the child's current symptoms?

4. Have other therapies been used? families initial contact with professional

5. Does the child have a history of tics, psychosis or thought disorder? - if so stimulants should be used with more caution

6. Can the family afford the medication and associated costs (e.g. follow-up visits)?

  

7. How does the child feel about medication and its alternatives?

8. Does the household include a substance abusing member? - sustained release formula - lower potential for abuse

(Kollins et al., 1999)

10. Is the child highly anxious, fearful or to complain about psychosomatic disturbances?

  11. Does the physician have the time to monitor medication

effects properly?   12. Is the child or adolescent involved in competitive sports

in which urine screens for elicit drug use screens are routine

13. Is the older adolescent being considered for the military or considering this as an option?

 

Basic Principles of ABA:

Scientific method of collecting data to promote behaviours in students with autism ABA Chart

Uses the principles of Operant Conditioning to intact change in individuals

Use of rewards (tangibles, likes) to motivate individuals

Errors are corrected immediately to build continuous success (trials never end on a negative)

Trials continue until mastery and then are revisited periodically to promote maintenance of behaviours

(Clarke in Siri and Lyons, 2009)

• Must be linear (ie. either straight across or up and down)

• Must be adapted and appropriate for each individual

• Can be simple or complex

•Removing pieces as you go allows the student to see what’s been done and what’s next (BUILDS IN PREDICTABILITY)

White Noise Machine Rice Bin Squeeze Balls

Weighted Lap Pad Incandescent

Lamp

Rose coloured Glasses

HatClassroom Swing Exercise Ball