PRIORITIZING THERAPIES FOR CHILDREN WITH

AUTISM SPECTRUM DISORDERS

NAA- NY Metro ChapterNovember, 2008

Patricia S. Lemer, M.Ed., NCCExecutive Director

Developmental Delay Resources (DDR)www.devdelay.org

devdelay@mindspring.com 800- 497- 0944

AUTISM SPECTRUM DISORDERS (ASD)

AD(H)D LD ASPERGER’S PDD AUTISM

………………………..…………………………..

Least severe More severe Most severe

ALPHABET SOUP

• AUTISM LD• ASPERGER’S NLD• PDD GTLD• PDD-NOS SPD• ADD OCD• ADHD

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• 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

• Parents with immune system dysfunction

• Chronic fatigue, fibromyalgia, familial allergies

• Nutritional/endocrine deficiencies, including thyroid and EFA

• Environmental toxic exposure prenatally

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”

• List possible genetic load factors in your family

• List possible environmental insults your child(ren) may have had

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

• 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 Lay the Foundations

• STRUCTURAL

• BIOLOGICAL

– Dietary

– Nutritional

• DETOXIFICATION

STRUCTURAL SYSTEM

• WHAT GOES WRONGOrgans, 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

• Chiropractic

• Osteopathy

• Cranio – Sacral therapy

• Massage

• Other “Bodyworks” therapies

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

• 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

• 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

• 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

• Artificial colors, flavors and preservatives

• Dairy products• Corn• Wheat• Eggs

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

• 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

• 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

• 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

• 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

• Use non-toxic cleaners• Use natural fiber clothing and

household items• Eliminate pesticides• Drink filtered water• Watch art materials• Eliminate passive smoking

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

• Urine, hair and blood tests for recent exposure

• Immune system testing and observation for past exposures

• “Challenge”tests • Stop all ongoing exposures

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

• 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 • 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

• Helps elimination, sleep, executive function and concentration

• Boosts serotonin levels

• Vestibular stimulation

• Walking

• Relaxation and meditation, yoga

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

Reflex Timetable

CONSEQUENCES OF REFLEX ABNORMALITIES

• Aberrant motor development

• Poor lateralization

• Hyper- or hypotonic muscles

• Vestibular dysfunction

• Poor binocularity

• Eye motor difficulties

• Perceptual problems

SENSORY INTEGRATIONNear senses

• Touch

• Movement

• Muscles and joints (proprioception)

Far senses

• Vision

• Audition

All must work together!!

VESTIBULAR SYSTEM Balance system Located in the inner ear Key to well-integrated sensory function Connected to:

Language center of the brainDigestive tractEye muscles

Requires suspended equipment

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

• 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• Different from eyesight• Eye movements• Binocularity• Focus, convergence• Visual-motor integration• Visual perception• Visualization

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

• 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

• 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

• 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• 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

• 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• 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

• 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

• 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• 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• 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

• 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

• Vision Therapy (VT)• Binocularity, Focus• Perception

• Academics

• Psychological Development• Social-emotional skills• Pragmatic language

• Vocational Training

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!