Week 10: Autism Treatment Flashcards Preview

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Flashcards in Week 10: Autism Treatment Deck (12)
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1
Q

“Biomedical” Treatments

A
Vitamins and diet
 Vitament supplements
 E.g., C, B6,magnesium
 Diet
 Gluten-free
 Secretin - in the gut used as atreatment for ulcers
No use in autism
2
Q

Secretin

A

Hormone produced in the intestinal glands
-Used to treat peptic ulcers
-Three children with autism received it for unrelated conditions and
improvement in symptoms of autism noted
-Since that time ….
-Several well-designed studies showing no effect
-Meta-analysis of 7 large studies concludes secretin is not effective
-Other than secretin, there is limited research
-No strong evidence for efficacy

3
Q

Goals of Treatment for Children with Autism

A

Minimize core challenges

Maximize independence and quality of life

4
Q

Overview of Treatment Strategies

A

Engaging children in treatment

Decreasing disruptive behaviors (like agression)

Teaching appropriate social behavior

Increasing functional, spontaneous communication

Promoting cognitive skills including language

Teaching adaptive skills to increase responsibility and
independence
-brush teeth/get dressed

Very diverse spectrum of issues

5
Q

Treatment Strategies: Applied Behavior Analysis (ABA)

A

(1) Discrete Trial Training
- Structured behavioral approach
- Therapist begins with a prompt that should elicit the desired skill/behavior (show me the 2! Show me the pretzel!)
- Prompt the behavior
- Positively reinforce the desired behavior
- Shaping

Praising a good behavior so it is repeated then moving along - can lead to complex behavior patterns

(2) Reinforcing naturally occurring behaviors
- Read a story and reinforce use of language
- Video glossary at autismnavigator.com
- Treatment, Behavioral, Discrete Trial Training and Lovaas Method of Applied Behavior Analysis

6
Q

Evidence Base for Treatments with Autism

A

Journal of Clinical Child and Adolescent Psychology commissions reviews in which experts review the evidence base for different
treatment approaches
-2015 review of treatments for autism identified two well-established treatments
-Individual, Comprehensive ABA
-Teacher-Implemented, Focused ABA + DSP

7
Q

Individual Comprehensive ABA

A

Intensive interventions consisting of 20 to 40 hours per week for 2 to 3
years
-Start prior to the age of 5 years
-Communication, social skills, cognition, behavior management, preacademic skills
-Research has shown this treatment is associated with improvements
in IQ and adaptive behavior
-Research has suggested that these gains can be achieved with 6 to
28 hours per week of treatment (can be done with less)
-Note that there are limitations in this literature
-RCTS enrolled a small number of participants

Evidence atm suggests good

8
Q

Teacher-Implemented, Focused ABA + DSP

A

Delivered in a classroom

  • Less intensive than comprehensive interventions
  • Combines ABA and DSP techniques
  • Research has found that this approach is associated with greater joint engagement in play activities with caregivers and teachers
9
Q

Controversy around ABA

A

-Many advocates in the autism community do not think ABA should
be used with children with autism
-At least two concerns:
-Historically, punishment used to shape behaviors
NOT done now but still resonates
-Can be used to shape behaviors that are atypical but not harmful
-Engaging in repetitive, self stimulating behaviors such as handflapping
-Not making eye contact

Just because we can change something, does not mean we should

Autism people sometimes say they had change who they were cos of this

Might be good to get autistic adults to advocate for the kids

-Can also be used to shape behaviors that may help the child to increase independence and be more successful at school and with peers and to decrease harmful behaviors such as aggression

Many adults wish they had more of it (some wish they had less)

Language and communication skills

10
Q

Medication

A

-Currently used primarily to treat other psychiatric symptoms that may be present, rather than core features of autism
-SSRIs for anxiety/obsessive-compulsive behavior
-Stimulants for ADHD symptoms
-Antipsychotics for aggression and agitation
-There is some research evidence suggesting these medications are effective for reducing these symptoms in youth with autism
-In general, the risks and benefits of using these medications must
be carefully evaluated

11
Q

What about Oxytocin?

A

Oxytocin is a neuropeptide hormone implicated in social bonding and social behaviors
-Will administering oxytocin improve social functioning in individuals
with autism?
-Approximately 12 RCTs have looked at this question
-Many demonstrated improvements

For example:
-16 adolescents randomly assigned to receive oxytocin (nasal spray) or a
placebo (Guastella et al. 2010)
-Participants who received intranasal oxytocin showed significant improvement in the ‘Reading the Mind in the Eyes’ task
-Small trials so far, but big trials (100s of participants) have been funded

Caution warranted

  • Work with animals suggests may be long-term consequences
  • Not a panacea (will not restore magically people to the same level as non autistic children)
12
Q

Summary

A

-ABA and DSP are evidence-based approaches that may improve
the cognitive and adaptive functioning of youth with autism
-Medication may be used to manage other psychiatric symptom

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