![Page 1: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/1.jpg)
M I C H A E L J . LU C I D O , P H DC H A R L E VO I X C E N T E R S U P E RV I S O R
C H R I S T I N E L E N N O N , M A , L P CD D C H I L D R E N ’ S B E H AV I O RA L S E RV I C E S
CHILD ABUSE COUNCIL SPRING CONFERENCESTRENGTHENING THE SOCIAL AND EMOTIONAL
HEALTH OF CHILDREN:
AUTISM SPECTRUM DISORDER OVERVIEW
A P R I L 2 6 , 2 0 1 3
![Page 2: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/2.jpg)
Raise your hand if you personally know someone
impacted by autism or Asperger’s.
![Page 3: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/3.jpg)
CDC (1985)1 per 2500
CDC (2007)1 per 150
CDC (2009) 1 per 110
CDC(2012)
1 per 88
PREVALENCE RATE
![Page 4: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/4.jpg)
TAKING A LOOK AT AUTISM
![Page 5: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/5.jpg)
STEPHEN WILTSHIRE’S STORY
Following 20 minute ride, he drew an 18 ft long drawing of New York city in exact detail
![Page 6: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/6.jpg)
PERVASIVE DEVELOPMENTAL DISORDERSAutistic Disorder:
• Social impairment.• Communication impairment.• Restricted repetitive/stereotyped behaviors, interests, or activities.
Asperger’s disorder:• Higher functioning form of ASD.• Normal language with single words by 2-phrases by 3.
Rett’s Disorder:• Exclusively female genetic developmental disorder-progressive delays
throughout lifespan• Severe “apraxia”-inability to execute purposeful movements despite
physical capability.Childhood Disintegrative:
• “Heller’s Syndrome”- normal development from 2-10 years of age but then severe decline.
• Causes by lipid storage diseases, subacute sclerosing panencephalitis, tuberous sclerosis.
PDD Not otherwise specified:• Do not meet full criteria but have symptoms similar to the diagnoses
above.
![Page 7: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/7.jpg)
DSM-V AUTISM SPECTRUM DISORDER (ASD)
DSM-V (2010) revised label & criteria: • Autism Spectrum Disorder under one label• Rett’s disorder is considered separate of
ASD• Reduced to two criterion• Require multiple observations• Provide qualifiers such as “with
intellectual disability” or “due to Fragile X syndrome”
![Page 8: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/8.jpg)
Grandin wrote, •“As a child I remember Mother asking me time and again, ‘Temple, are you listening to me? Look at me.’ Sometimes I wanted to, but I couldn’t...”
![Page 9: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/9.jpg)
AUTISM SPECTRUM DISORDER CRITERION
Socialization and Communication• Poor eye contact• Flat expressions• No peer relationships• Odd speech• Echolalia• Misinterpret emotion• Conversation issues
Repetitive and Obsessive Behaviors• Rocking• Hand wringing• Twisting fingers• Fixated interests• Intense focus• Set routines• Preoccupied parts• Sensory issues
ASD
![Page 10: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/10.jpg)
BEHAVIORAL SIGNS AND SYMPTOMS
• Speech: monotone, rhythmic, nasally/high pitched (dysarthric), pedantic, repeating phrases (echolalic), and other idiosyncratic speech patterns.
• Eye contact: no, limited, or inappropriate eye contact- towards the ceiling, looking at the body, avoiding face/eyes.
• Gross and fine motor coordination: unable to balance on foot or tandem walk, or poor writing (dysgraphia).
• Stereotyped behaviors: hand-wringing or twisting, spinning in chair, complex whole body movement, hand-flapping, pacing.
![Page 11: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/11.jpg)
SENSORY DISTURBANCES
• Behavior “meltdowns” are often sensory related• Grandin wrote,
• “But when I was in the world of people, I was extremely sensitive to noises..The pain that racked my head when the fog horn sounded was excruciating”. (hyperacusis-sensitivity)
• “Spinning was another favorite activity. I’d sit on the floor and twirl around. The self-stimulatory behavior made me feel powerful, in control of things…I realize that non-autistic children enjoy twirling around in a swing, too. The difference is that autistic child is obsessed with the act of spinning”.
![Page 12: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/12.jpg)
UNDERSTANDING THE “BEHAVIORS”
• Common misnomers about behaviors:• He can control his meltdowns!• She is being oppositional!• He just wants it his way!• He can stop biting himself!
• It is an underlying neurological condition-first and foremost
• Most of the time is out of their control
• They struggle to be “normal”
![Page 13: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/13.jpg)
WHAT CAUSES AUTISM?
![Page 14: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/14.jpg)
IS IT THE PARENTS?
• Kanner said autism is a result of “genuine lack of maternal warmth”.
• Bruno Bettleheim said autism was caused by maternal coldness.
• Finally by 1960s, Bernard Rimland said it was a neurological disorder.
![Page 15: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/15.jpg)
TEMPLE GRANDIN’S STORY
Graduated with a doctoral degree in animal science, wrote many books on autism and animal issues
![Page 16: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/16.jpg)
A FEW THEORIES ON THE CAUSE OF ASD
•No single theory explains ASD
•Genetic and heredity•Abnormal development•Physical health issues•Autoimmune problems•Environmental toxins
![Page 17: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/17.jpg)
HEREDITY & GENETIC ABNORMALITIES
• Monozygotic twins as high as 60-95% and siblings are 45-60 times greater to develop autism
• First degree relatives might have psychiatric issues like depression, OCD, anxiety disorders, etc
• X Chromosome as a factor?• Fragile , Turner’s syndrome, Klinefelter, Rett, Prader-
Willi, Timothy, Phenylketonuria, and Angelman syndromes.
• Reason for higher rates in males? (XY vs. XX in females)
![Page 18: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/18.jpg)
DEVELOPMENTAL GROWTH
• 20-30% have seizures, up to 72% abnormal EEG
• 75% smaller head circumferences at birth, but rapid growth by first year in the 85th percentile
• 100-200g heavier brain weight in autism• Deficits in Emotion centers: amygdala, prefrontal cortex, temporal lobes, & thalamus
• Dysregulated neurochemicals like serotonin, dopamine, melatonin, and oxytocin
![Page 19: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/19.jpg)
NEUROLOGICAL PATHWAYS FOR ASD
![Page 20: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/20.jpg)
GASTROINTESTINAL PROBLEMS
• Gastrointestinal problems as high as 84%• Constipation, problems going to the bathroom, etc• These health issues impact moods, behaviors,
appetite• Interaction between the gut and the brain is
important to understanding ASD-serotonin?• Food allergies is strongest link to GI issues
• Food allergies have been attributed to conditions like celiac disease, which lead to the abdominal problems
![Page 21: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/21.jpg)
AUTOIMMUNE RESPONSE
• Lowered immune response• High opioid activity
• High pain thresholds- high endorphin levels• Endocrine system related to thyroid
• Concerns regarding hypothyroidism or low thyroid will impact brain development
• Considered an iodine deficiency in prenatal and neonatal development
![Page 22: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/22.jpg)
ENVIRONMENTAL TOXINS• Industrialization increased exposure to
neurotoxins• Heavy metals like mercury, lead, or cadmium• Pesticides such as cyanide.• Clothing, food, building materials, personal care
• New Jersey has highest rates for autism & asthma-has highest pollution levels in the nation
• Wakefield: vaccines link to autism retracted• 18 controlled epidemiological studies found no link
• No one factor accounts for autism
![Page 23: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/23.jpg)
E V I D E N C E D B A S E D P RAC T I C E SDIAGNOSING AUTISM
![Page 24: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/24.jpg)
WHAT IS EVIDENCED-BASED PRACTICE?
American Psychological Association (2006):• EBP: “integration of the best available
research with clinical expertise in the context of patient characteristics, culture, and preferences”.
• EBP is comprehensive with assessment, case formulation, therapeutic relationship, and specific decision-making process integrating research and intervention together.
![Page 25: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/25.jpg)
A NEED FOR COMPREHENSIVE CARE
• Psychological evaluation• Behavioral, OT, and Speech Assessments• Psychiatric evaluation and medications• Dietary modifications and supplements• Behavioral interventions• Individual/group therapy• Parent Training• Case management• Employment assistance• Occupational therapy• Speech therapy• And many more!!!
EBP service
s:
![Page 26: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/26.jpg)
HISTORY OF LACK OF FUNDING FOR SERVICES
Costs are $35 billion per year nationwideAverage costs:$29,000-$43,000 per yearHistory of disparity of Federal fundingPresident proposed $1 billion increase of
annual federal spending on autismMichigan Department of Community
Health expanded autism services
![Page 27: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/27.jpg)
MDCH AUTISM SERVICES EXPANSION
• Created the 1915i State Plan Amendment and 1951b Mental Health Specialty Services and Support Waiver
• Started April 1, 2013 • Consist of early identification-average age of child being diagnosed with autism is age 8 in Michigan.
• Targeted18 months through age 5
![Page 28: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/28.jpg)
ASD SCREENING AND DIAGNOSIS• Screening forms by parent and referred by
pediatrician • Modified Checklist for Autism in Toddlers (16-30 mo.)• Social Communication Questionnaire (ages 2 )
• Referred to Access Center for a more in depth diagnostic evaluation.
• Evaluation will consist of an in depth clinical interview, assessment, and other tests for behaviors, ability, language, etc as needed.• Diagnosis must be confirmed by a fully licensed
psychologist or physician/psychiatrist.
![Page 29: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/29.jpg)
QUESTIONNAIRES ASSESSMENT
• Autism Diagnostic Interview-“Gold standard” (ADI)
• Autism Spectrum Rating Scales (ASRS)• Autism Treatment Evaluation Checklist (ATEC)• Modified Checklist for Autism in Toddlers
(MCHAT)• Asperger Syndrome Diagnostic Scale (ASDS)• Gilliam Autism Rating Scale: 2nd Edition (GARS2)• Childhood Autism Rating Scale (CARS)• Social Communication Questionnaire (SCQ)• Social Responsiveness Scale (SRS)
![Page 30: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/30.jpg)
PSYCHOLOGICAL TESTING
Autism Diagnostic Observation Schedule
(ADOS)
“Gold standard” for assessing behaviors of
ASD
New versions of IQ testing
Profiles for individuals with
autism.
![Page 31: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/31.jpg)
LOOKING BEYOND IQ
• University of Montreal found intelligence tests (WISC, WAIS) in ASD over-diagnosing ID
• None of the children scored in the high average range and a 1/3 scored in the ID range
• Nonverbal IQ test, a 1/3 scored in the high average range, and only 5% scored as ID
• Newer intelligence tests have profiles for ASD to explain such conflicting results
![Page 32: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/32.jpg)
KIM PEEK’S STORY
• Inspired by movie Rain Man• Read two pages at once• Memorized 12,000 books• Low average IQ
![Page 33: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/33.jpg)
NEUROPSYCHOLOGICAL TESTING
• Stroop• Continuous Performance• Trail Making• Shifting Attention• Symbol-digit coding• Finger Tapping• Verbal/Visual memory
Neuropsychological testing:
• Cognitive flexibility/switching• Organization, planning• Visual-working memory• Verbal fluency• Complex attention
Executive functioning deficits in ASD:
![Page 34: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/34.jpg)
READING THE MIND’S EYE TEST
• Visual-perceptual processing
• Problems with facial recognition, and social-emotional processing.
• Social cognitive test for empathy or “Theory of Mind”.
• Best way to evaluate social issues is through observations.
![Page 35: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/35.jpg)
OCCUPATIONAL/SPEECH ASSESSMENT
• Special education ASD evaluations include speech and occupational evaluations when identifying ASD.
• CMH provides contractual support for OT and Speech when physician has ordered interventions for ASD in the home.
![Page 36: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/36.jpg)
NEED FOR MEDICAL EVALUATIONS• Gastroenterologist- problems with intestines
and stomach including issues like constipation• Neurologist- brain imaging like CT scans and
brain function with EEG• Immunologist/allergist- identify potential
environmental allergies influencing behaviors• Dietitian- identify health habits• Psychiatrist- medications for behavior and
mood
![Page 37: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/37.jpg)
E V I D E N C E D -B A S E D P RAC T I C E S F O R A S D
AUTISM INTERVENTIONS
![Page 38: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/38.jpg)
OPTIMIZING LIFE PURSUITS IN ASD
Grandin wrote, “I think the same principle applies to autistic children-work with them instead of against them. Discover their hidden talents and develop them”.
![Page 39: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/39.jpg)
PERSON-CENTERED• Assist parents and individuals with ASD:
• Understanding procedures, aid in documents, ease transition in services, respect, be flexible.
• PC seeks collaboration with natural supports and community.
• Empathy, unconditional positive regard:• Individuals with autism are often on a one way street-walk with them for a while!
![Page 40: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/40.jpg)
![Page 41: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/41.jpg)
MDCH ASD BEHAVIORAL SERVICES
• Provided to age 18 months-5 y/o• Applied Behavior Analysis (ABA)
• Science of the principles of behavior• Two levels of service intensity for ABA
• Early Intensive Behavioral Intervention (EIBI)• Children with a diagnosis of autistic disorder• Average of 10-20 hours per week
• Applied Behavioral Intervention (ABI)• Children with a diagnosis of Aspergers, PDD, etc• Average of 5-15 hours per week
![Page 42: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/42.jpg)
• Structured applied behavior analysis program that relies upon discrete trial training (DTT) methods and incidental teaching opportunities
• Administered in a child’s home or a clinic setting.
HOW SERVICES WILL BE CONDUCTED
![Page 43: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/43.jpg)
DISCRETE TRIAL TRAINING• Comprehensive structured behavioral
intervention or discrete trial training (Lovaas, 1987)
• Operant conditioning (Skinner): rewarding specific behaviors to increase the likelihood of the behavior occurring again
• Learning environment is structured• Target behaviors are broken down into
discrete subskills• Initiated and selected by adult• Child’s response is prompted• Reinforcers are unrelated to the target
response (e.g. toy)• Rewards for correct response or successive
approximations
![Page 44: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/44.jpg)
![Page 45: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/45.jpg)
DIR FLOOR-TIME
• Developmental, Individual Difference, Relationship-Based (DIR) Floortime Model (Greenspan, 2000)
• Infants to preschoolers improve social-emotional cognition
• Motive, planning, and sequencing• http://www.youtube.com/watch?v=jrXGh9bT0Sw
![Page 46: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/46.jpg)
PIVOTAL RESPONSE TRAINING• Pivotal response training: teaching core or
pivotal skills makes it easier for children with autism to learn basics (Koegel et al., 2001)
• Increasing motivation to engage in social communication• Motivation• Self-regulate behaviors• Initiate social interactions• Response to multiple social cues
![Page 47: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/47.jpg)
COGNITIVE-BEHAVIORAL THERAPY•Social skills training•Anger management•Rethinking perspective•Regulate emotions•Social skills training•Social Autopsies•Social Stories
![Page 48: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/48.jpg)
ASD PSYCHOPHARMACOLOGY IASD 2nd Generation
Neuroleptics:• FDA (2006) approved
risperidone as the first medication to treat irritability and aggression in children and adolescents with autism.
• Other medications like aripiprazole (second generation antipsychotics) are being approved for autism.
• Improve both dopamine and serotonin regulation.
• Decrease aggression, self-injuries, irritability, and improve mood stability.
ASD Antidepressants:• Research for 20 years
including clomipramine, desipramine, fluoxetine, citalopram, sertraline, and venlafaxine.• improve stereotypic and
obsessive behaviors.• Medscape (2010) SSRIs are not
recommended for just ASD because of limited research.
• Sertraline, fluoxetine, and fluvoxomine are approved for OCD, and fluoxetine and escitalopram approved for depression.
• Symptoms of anxiety and depression that are comorbid with ASD.
![Page 49: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/49.jpg)
ASD PSYCHOPHARMACOLOGY II
• decrease hyperarousal, agitation, improve dental visitsAnxiolytic:
• decrease seizures and stabilize moodsAnticonvulsant:
• Decrease aggression1st generation neuroleptic:
• improve attention, concentration, and impulsivityNeurostimulant:
• improve sleep and attention and decrease aggressionAntihypertensive:
![Page 50: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/50.jpg)
DIETARY AND VITAMINS
• Ketogenic diets (used in seizure disorders) and gluten-casein free diets (used in schizophrenia)
• Melatonin for initiating sleep• Fish Oil (EFA) improves cognition• Vitamin D to improve mood, sleep, cognition• Vitamin B6 and B12 to improve cognition• Oxytocin improve social affect and social cues• Recommendations come from physicians• Dietitians may provide nutrition consultation
![Page 51: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/51.jpg)
OCCUPATIONAL THERAPY
• OT provides critical interventions that might offset need for medication or other therapy
• Assists in skills like in improving hand writing• Sensory diets regulate the environment and structure daily activities to prevent overload• Schedules are very important in ordering the
day’s sensory input!
![Page 52: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/52.jpg)
SPEECH THERAPY
• Speech therapy teaches effective ways to communicate in areas like pragmatics
• Improve speech production such as voice modulation
• Picture Exchange Communication System (PEC)• PECS are helpful for improving
communication and schedule• Easily recognizable• Exchange the picture for a desired activity
or item
![Page 53: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/53.jpg)
ABUSE IN CHILDREN WITH AUTISM
![Page 54: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/54.jpg)
ABUSE IN CHILDREN WITH DD• A child with any type of developmental disability
was 4xs more likely to be sexually abused than a child without (Sullivan & Knutson, 2000).
• 50% of children with autism are nonverbal and unable to participate in usual means for verbal interviews that require reciprocal communication.
![Page 55: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/55.jpg)
AT RISK
• Struggle with interpreting caution and picking up deceptive emotions in facial affect
• Perpetrators may target children with nonverbal autism because inability to disclose
• Issues with sequencing of events and misinterpreting them
• 50% of offenders of individuals with developmental disabilities had contact with them through their disability services
![Page 56: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/56.jpg)
FORENSIC INTERVIEWING
• Need to provide multiple interviews in order to gain rapport and short sessions vs. long sessions
• “Referential communication” ability to know what another person is asking and refer to• Question: “Did John Doe touch you”• Answer: “No” (answering for today, but abuse
happened in past). • Children with autism struggle with responding
to questions appropriately or accurate information
![Page 57: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/57.jpg)
SIGNS AND SYMPTOMS
• Often simply noticing change of behaviors is most important
• Increased self-stimulation
• Self-injurious behaviors• More meltdowns• New Behaviors not
present before
![Page 58: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/58.jpg)
INTERVENTION
• Trauma focused therapies such as play therapy or cognitive therapies if verbal
• Sex education and education regarding appropriate and inappropriate touch
• Difference between public and private behaviors
• Providing social stories as a means of communication
![Page 59: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/59.jpg)
JASON “J-MAC” MCELWAIN’S STORY
In his first-ever high school game, he scored 20 points and tied the school record with six 3-pointers in 4 minutes
![Page 60: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/60.jpg)
In a book on autism, a mother describing her son and others with autism said,
“From their deep sense and connection to the universe and our planet they feel what a leaf feels, they can smell cold, they are truly in the moment. These special beings can teach us many things through their gifts that they have to offer.”
![Page 61: Michael J. Lucido, PhD Charlevoix Center Supervisor Christine Lennon, MA, LPC](https://reader035.vdocument.in/reader035/viewer/2022062521/5681672b550346895ddbc6b9/html5/thumbnails/61.jpg)
Thank you!!!
ANY THOUGHTS OR QUESTIONS?