![PRACTICE PARAMETERS (2014)
Methods Available for the Delivery of Social Reciprocity/
Pragmatic Language-Oriented Interventions
Developmental Level Methods
Infant/preschool (play based) guided participation, Do-Watch-Listen-Say,
play organizers, buddy skills
School age social stories, social skills groups peer network/circle of friends
Adolescence peer network/circle of friends
visual schedule/verbal rehearsal
social skills group, social thinking
training scripts
[CS]
Speech therapy
Speech therapy + Social skills training
Communication Ix.](https://image.slidesharecdn.com/topicasdfinal-170107175707/75/asd-and-nonmedical-interventions-41-2048.jpg?cb=1672472426)
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ASD and Nonmedical Interventions
- 1. ASD and Nonmedical interventions Topic : January 2017
- 2. Case A Thai boy 11 yo. Known-case: ASD, AR Diagnosed when he was 2 yo.; with mutism, poor eye contact, walking with tiptoe. He came for treatment at the hospital 7 years ago for speech therapy, while also being cared by 3 other hospitals. He was sent to the C & A psychiatric unit for further evaluation 2 years ago. (9 yo.)
- 3. Question If you were a child psychiatrist, what kind of interventions for clinical standard treatment in first visit ? A. Behavioral B. Educational C. Communication D. All of above
- 4. After you assessed all his past history of treatment, you found out he has been being treated with speech therapist, occupational therapist and pediatrician(medications for his behavior). Also he studies in grade 5 of special education program at the boarding school. What else could you do ? His mother said she couldn’t wait for OT service queues at another hospital, she worried about his lack of socialization. He can’t tell what he want to others and he cries every time he was sent to the school.
- 5. What is the level of Evidence for effectiveness of Social skill training ? A. High B. Moderate C. Low D. Insufficient
- 6. Outline • Introduction • Concepts and Goals • Relative factors • Treatment modalities and Interventions (Evidence-based) • Resources and Application
- 7. Timeline of ASD Management 1995 1943 1944 1910 1900 1985 1972 1971 1964 2000 - Present 1967 1996 1987 1979 Introduction Eclectic treatment approach More Evidence-based treatments Research on intervention techniques has been established…
- 10. A developmental model of risk factors, risk processes, and outcome in autism (G dawson, 2008) Introduction
- 11. Concepts • As a lifelong disorder • No curative treatment • Symptomatic approaches • Two developmental periods are especially important : • early preschool • early adolescence • Individual-based; but combination is more effective in most cases Concepts & Goals Developmental Behavioral Educational Communication
- 12. Goals Primary goals; • Maximize functioning • More independent • Improve the quality of life Specific goals; • Improve social functioning and play skills • Improve communication skills • Improve adaptive skills • Decrease negative behaviors • Promote academic functioning and cognition Concepts & Goals
- 13. Relative factors • Age/Developmental Level • Type & Severity of the Communication Disorder • Strengths and Interests • Medical Problems • Family’s Interests and Ability to Participate • Language Uses • Community Resources Relative factors Choice of setting depends on…
- 14. Treatment modalities • Developmental, Behavioral, Educational and Communication Interventions • Complementary and Alternative therapies: CAM • Psychopharmacological Interventions Treatment modalities
- 15. Developmental, Behavioral, Educational and Communication Interventions (Lancet, 2014) • Comprehensive approaches • ABA-based • Structured-teaching • Targeted skill-based intervention • Targeted behavioral intervention for anxiety and aggression • Parent-mediated early intervention - EIBI - EIBI + ESDM, DIR/floortime ⁃ TEACCH - PECS - Social skill training - CBT, ABA - Special Education - Speech therapy - OT, Sensory Integration thrapy - PT Treatment modalities
- 16. Interventions Target Evidence (GRADE) Framework and Goals Comprehensive: ABA-based • EIBI • EIBI + Developmental and relationship-based approaches <5 years <5 years Low or moderate Moderate or insufficient for ESDM; not established for floortime Discrete trial training, 1:1, intensive ESDM; accelerate development in all domains, ABA + pivotal response training Floortime; functional emotional development, sensory modulation, etc. Comprehensive: structured teaching • TEACCH Children, adolescents, and adults Low Provides structures of the environment and activities Targeted skill-based intervention • PECS • Social skill training • Vocational intervention Non-verbal individuals ≥6 years, adolescents, and adults Adolescents and adults Moderate Low or moderate Insufficient spontaneous social-communication skills Fairly short-term to build social skills interview training and on-the-job support Targeted behavioral intervention for anxiety and aggression • CBT Children, adolescents, and adults Not established Reduce anxiety: practical adaptive skills with concrete instructions Reduce aggression: functional behavior assessment Parent-mediated early intervention • Training for joint attention, parent–child interaction, and communication Young children Insufficient or low increasing parental efficacy in real-life settings Evidence (GRADE)
- 17. EIBI Developmental & Behavioral Ix. Target : Young children (<5 years) Evidence : Low or moderate Goals : improve core symptoms of ASD and maladaptive behaviors Effective characteristics : • highly individualized • up to 40 hours per week • one-to-one direct teaching • initially using discrete trials • Various settings; home, classroom, community
- 18. EIBI Developmental & Behavioral Ix. Resource : คลินิกส่งเสริมพัฒนาการเด็ก, รพ. รามาธิบดี เครือข่าย-หน่วยงานของกรมสุขภาพจิต เช่น สถาบันราชานุกูล สถาบันยุวประ สาทไวโยปถัมภ์ สถาบันสุขภาพจิตเด็กและวัยรุ่นราชนครินทร์ • The most significant improvements within the first 12 months • Pretreatment variables associated with improved outcomes; - presence of joint attention - functional play skills - higher cognitive abilities - decreased severity of autism symptoms
- 19. EIBI + Developmental and relationship-based approaches Developmental & Behavioral Ix. Target : Young children (<5 years) Evidence : Moderate; insufficient for ESDM; not established for floortime Goals : teaching skills that are essential to development; social communication, emotional relationships, cognitive abilities
- 22. EIBI + Developmental and relationship-based approaches Developmental & Behavioral Ix. ESDM : Comprehensive model = Intensive ABA + Developmental and relationship-based approaches • parents as therapists • RCT significant language, cognitive, and adaptive functioning gains in 48 toddlers over a two-year period (sustained in 2 years after) • efficacious in young children, but not clear to be generalized to other specific or combinations of models
- 23. Interventions Target Evidence (GRADE) Framework and Goals Comprehensive: ABA-based • EIBI • EIBI + Developmental and relationship-based approaches <5 years <5 years Low or moderate Moderate or insufficient for ESDM; not established for floortime Discrete trial training, 1:1, intensive ESDM; accelerate development in all domains, ABA + pivotal response training Floortime; functional emotional development, sensory modulation, etc. Comprehensive: structured teaching • TEACCH Children, adolescents, and adults Low Provides structures of the environment and activities Targeted skill-based intervention • PECS • Social skill training • Vocational intervention Non-verbal individuals ≥6 years, adolescents, and adults Adolescents and adults Moderate Low or moderate Insufficient spontaneous social-communication skills Fairly short-term to build social skills interview training and on-the-job support Targeted behavioral intervention for anxiety and aggression • CBT Children, adolescents, and adults Not established Reduce anxiety: practical adaptive skills with concrete instructions Reduce aggression: functional behavior assessment Parent-mediated early intervention • Training for joint attention, parent–child interaction, and communication Young children Insufficient or low increasing parental efficacy in real-life settings
- 24. TEACCH Developmental & Behavioral Ix. Target : Children, adolescents, and adults Evidence : Low Goals : Provides structures of the environment and activities that can be understood by the individual Effective characteristics : • Individualized person • Family-centered plan • Organizing the physical environment • Predictable sequence of activities • Routines with flexibility • Structured work/activity systems • Visual schedules, Visually structured activities
- 25. TEACCH Developmental & Behavioral Ix. • CCT - comparing TEACCH with no intervention improvements in fine motor skills, gross motor skills, cognitive functioning, social adaptive functioning, and communication skills Resource : Special Education Services, IPD, RICD Pros; • Uses relative strengths in visual skills and interests to supplement weaker skills • Uses special interests to engage for learning • Supports self-initiated use of meaningful communication
- 27. Interventions Target Evidence (GRADE) Framework and Goals Comprehensive: ABA-based • EIBI • EIBI + Developmental and relationship-based approaches <5 years <5 years Low or moderate Moderate or insufficient for ESDM; not established for floortime Discrete trial training, 1:1, intensive ESDM; accelerate development in all domains, ABA + pivotal response training Floortime; functional emotional development, sensory modulation, etc. Comprehensive: structured teaching • TEACCH Children, adolescents, and adults Low Provides structures of the environment and activities Targeted skill-based intervention • PECS • Social skill training • Vocational intervention Non-verbal individuals ≥6 years, adolescents, and adults Adolescents and adults Moderate Low or moderate Insufficient spontaneous social-communication skills Fairly short-term to build social skills interview training and on-the-job support Targeted behavioral intervention for anxiety and aggression • CBT Children, adolescents, and adults Not established Reduce anxiety: practical adaptive skills with concrete instructions Reduce aggression: functional behavior assessment Parent-mediated early intervention • Training for joint attention, parent–child interaction, and communication Young children Insufficient or low increasing parental efficacy in real-life settings
- 28. PECS Pros : • helpful in improving communication initiation • decreasing frustration related to communication deficits • more flexible incorporating photographs, pictures, scene arrays, and video and voice output are available through personal computers and mobile devices Developmental & Behavioral Ix. Target : Non-verbal individuals Evidence : Moderate Goals : Teaches spontaneous social-communication skills through use of symbols or pictures
- 29. PECS Developmental & Behavioral Ix. Resource : RICD
- 30. Interventions Target Evidence (GRADE) Framework and Goals Comprehensive: ABA-based • EIBI • EIBI + Developmental and relationship-based approaches <5 years <5 years Low or moderate Moderate or insufficient for ESDM; not established for floortime Discrete trial training, 1:1, intensive ESDM; accelerate development in all domains, ABA + pivotal response training Floortime; functional emotional development, sensory modulation, etc. Comprehensive: structured teaching • TEACCH Children, adolescents, and adults Low Provides structures of the environment and activities Targeted skill-based intervention • PECS • Social skill training • Vocational intervention Non-verbal individuals ≥6 years, adolescents, and adults Adolescents and adults Moderate Low or moderate Insufficient spontaneous social-communication skills Fairly short-term to build social skills interview training and on-the-job support Targeted behavioral intervention for anxiety and aggression • CBT Children, adolescents, and adults Not established Reduce anxiety: practical adaptive skills with concrete instructions Reduce aggression: functional behavior assessment Parent-mediated early intervention • Training for joint attention, parent–child interaction, and communication Young children Insufficient or low increasing parental efficacy in real-life settings
- 31. Social skills training Developmental & Behavioral Ix. Target : Children aged ≥6 years, adolescents, and adults Evidence : Low or moderate Goals : training sessions to build social skills, usually through a group format Type of therapies : • Joint attention interventions • Modeling • Peer training package • Story-based intervention package/the Socials Stories
- 32. Effective characteristics : • peer training > isolated social skills instruction (more effective) • targeting social behavior (imitation, joint attention, and affect sharing) improving the frequency of socially engaged imitation in toddlers Comorbid : Emotional or behavioral problems may influence outcomes (not in ADHD) Social skills training Developmental & Behavioral Ix.
- 33. Interventions Target Evidence (GRADE) Framework and Goals Comprehensive: ABA-based • EIBI • EIBI + Developmental and relationship-based approaches <5 years <5 years Low or moderate Moderate or insufficient for ESDM; not established for floortime Discrete trial training, 1:1, intensive ESDM; accelerate development in all domains, ABA + pivotal response training Floortime; functional emotional development, sensory modulation, etc. Comprehensive: structured teaching • TEACCH Children, adolescents, and adults Low Provides structures of the environment and activities Targeted skill-based intervention • PECS • Social skill training • Vocational intervention Non-verbal individuals ≥6 years, adolescents, and adults Adolescents and adults Moderate Low or moderate Insufficient spontaneous social-communication skills Fairly short-term to build social skills interview training and on-the-job support Targeted behavioral intervention for anxiety and aggression • CBT, ABA Children, adolescents, and adults Not established Reduce anxiety: practical adaptive skills with concrete instructions Reduce aggression: functional behavior assessment Parent-mediated early intervention • Training for joint attention, parent–child interaction, and communication Young children Insufficient or low increasing parental efficacy in real-life settings
- 34. CBT Developmental & Behavioral Ix. Target : Children, adolescents, and adults Evidence : Not established Goals : reduce anxiety Concepts : • modifies dysfunctional • teaching of practical adaptive skills with concrete instructions • often combined with social skill training • systematic desensitisation is useful particularly for individuals with ID
- 35. ABA Developmental & Behavioral Ix. Target : Children, adolescents, and adults Evidence : Not established Goals : reduce aggression Concepts : • apply functional behavior assessment • teach alternative behaviors and skills; • antecedent manipulations • changes in instructional context • reinforcement-based strategies • behavior reduction strategies
- 36. Special Education Effective characteristics : • intensive, individualized, staff-to-student = 1: 1-2 • experienced, interdisciplinary team of providers • family involvement Educational Ix. Target : Young children (<5 years) Evidence : Low or moderate Goals : enhancing verbal and nonverbal communication, academic skills, social, motor, and behavioral capabilities
- 37. Special Education • Min. of 25 hrs/wk • Functional analysis of behavior problems • Ongoing program evaluation and adjustment • Close monitoring and modification as the child's needs change • Curriculum emphasizing attention, imitation, communication, play, and social interaction • Highly supportive teaching environment • Predictability and structure Educational Ix.
- 38. Special Education Educational Ix. What to evaluate ? • chronologic age • developmental level • specific strengths and weaknesses • family needs Resource : Special Education Services
- 39. Communication Ix. Speech therapy (Traditional) Target : Any, Evidence : - Goals : • improve core deficits in social and functional communication skills • promote communication skills to improve in overall functioning • specific goals may vary depending upon the level of function
- 40. Communication Ix. Speech therapy For individuals who do not yet use words; use of alternative communication modalities e.g. sign language, communication boards, visual supports, picture exchange, and other forms of augmentative communication For individuals with fluent speech, the focus should be on pragmatic language skills training
- 41. PRACTICE PARAMETERS (2014) Methods Available for the Delivery of Social Reciprocity/ Pragmatic Language-Oriented Interventions Developmental Level Methods Infant/preschool (play based) guided participation, Do-Watch-Listen-Say, play organizers, buddy skills School age social stories, social skills groups peer network/circle of friends Adolescence peer network/circle of friends visual schedule/verbal rehearsal social skills group, social thinking training scripts [CS] Speech therapy Speech therapy + Social skills training Communication Ix.
- 43. Communication Ix. Speech therapy หน่วยแก้ไขการพูด รพ. รามาธิบดีและโรงเรียนแพทย์ทุกแห่ง สถาบันราชานุกูล, สถาบันสุขภาพเด็กแห่งชาติฯ สถาบันประสาทวิทยา, สถาบันสุขภาพจิตเด็ก และวัยรุ่นราชนครินทร์, โรงพยาบาลเจริญกรุง ประชารักษ์, โรงพยาบาลสมเด็จพระปิ่นเกล้า ฯลฯ Resource :
- 44. Sensory Integration therapy, Traditional OT Target : Young children to adolescent Evidence : -/inconsistent Goals : • young children focuses on enhancing sensory processing, sensorimotor and social-behavioral performance, self-care and participation in play • older children may include social and behavioral performance and transition to work and independence in the community Developmental-based Ix.
- 45. Traditional OT Developmental-based Ix. Concepts: • associated ASD features : motor delays atypical features • Motor delays effect ability to mimic another’s actions as well as to participate in goal-directed behavior, • provide means for learning other skills (social and academics)
- 46. Sensory Integration therapy (SIT) Concepts: • clinical-based • child- directed • uses play activities to engage child participation and challenge sensory processing and motor planning skills • daily routine (home, school) Areas of Possible Sensory Intervention Developmental-based Ix.
- 47. Sensory Integration therapy, OT Resource : หน่วยงานกิจกรรมบาบัดของสถาบัน ในสังกัดกรมสุขภาพจิต เช่น สถาบัน ราชานุกูล, สถาบันสุขภาพจิตเด็ก และวัยรุ่นราชนครินทร์, ยุวประสาท ไวโยปถัมภ์ Developmental-based Ix.
- 48. Physical therapy (PT) Target : Any ages Evidence : -/inconsistent Goals: • Improve participation in activities of daily living • Acquire new motor skills, motor strength • Develop better coordination • Improve reciprocal play skills (throw & catch a ball) • Develop motor imitation skills Developmental-based Ix.
- 49. Physical therapy (PT) Developmental-based Ix. Resource : หน่วยงานกายภาพบาบัดของ สถาบันในสังกัดกรมสุขภาพจิต เช่น สถาบันราชานุกูล, สถาบัน สุขภาพจิตเด็กและวัยรุ่นราช นครินทร์, ยุวประสาทไวโยปถัมภ์
- 50. Physical therapy (PT) : Vojta therapy Developmental-based Ix. Reflex Locomotion • Reflex Creeping • Reflex Rolling
- 51. Complementary and Alternative therapies • Hippo therapy/ Therapeutic horseback riding • Art therapy • Music therapy • Drama therapy • Auditory Integration Therapy (AIT) • HEG, Neurofeedback • Hyperbaric oxygen therapy (HBOT) • Hydrotherapy • Acupuncture • Nutritional supplements and diets (e.g. Omega-3 fatty acids, Casein- and Gluten-free, Vit. B6, 12, Mg, Melatonin, etc.) And many more… Treatment modalities : CAM
- 52. Complementary and Alternative therapies Treatment modalities : CAM
- 53. Complementary and Alternative therapies Treatment modalities : CAM
- 54. Complementary and Alternative therapies Treatment modalities : CAM Nutritional supplements and diets; • Possible benefit, potential risk - Gluten-free, casein-free diet (2C) • Unknown benefit, potential risk - Vitamin B6 and magnesium • Possible benefit, low risk - Melatonin - Oxytocin - Sulforaphane • Unknown benefit, low risk - Omega-3 fatty acids - Probiotics
- 55. Clinical Application • Ramathibodi hospital • Child Development Unit : Early Intervention Clinic อาคารสิริกิติ์ ชั้น 3 • Speech and Language Clinic/ ภาควิชาวิทยาศาสตร์สื่อความหมายและความผิดปกติของการสื่อ ความหมาย : Speech therapy อาคาร 4 ชั้น 4 • Others services; - Speech : หน่วยแก้ไขการพูด โรงเรียนแพทย์ทุกแห่ง, สถาบันราชานุกูล, สถาบันสุขภาพเด็กแห่งชาติฯ สถาบันประสาทวิทยา, สถาบันสุขภาพจิตเด็กและวัยรุ่นราชนครินทร์, โรงพยาบาลเจริญกรุงประชารักษ์, โรงพยาบาล สมเด็จพระปิ่นเกล้า ฯลฯ - OT,PT : หน่วยงานกิจกรรมบาบัดและกายภาพบาบัดของสถาบันในสังกัดกรมสุขภาพจิต เช่น สถาบันราชานุกูล, สถาบันสุขภาพจิตเด็กและวัยรุ่นราชนครินทร์, ยุวประสาทไวโยปถัมภ์ เป็นต้น Resources and Application
- 56. National Resources (For Parents) • สถาบันสุขภาพจิตเด็กและวัยรุ่นราชนครินทร์ : http://www.smartteen.net/main • สถาบันราชานุกูล : http://www.rajanukul.go.th • โรงพยาบาลยุวประสาทไวทโยปถัมภ์ : http://ycap.go.th • สถาบันสุขภาพจิตเด็กและวัยรุ่นภาคตะวันออกเฉียงเหนือ : http://www.necam.go.th • Center for Autism Recovery and Education - CARE Thailand : www.carethaiautism.com • http://rajanukul.go.th/main/ebook.php (free social stories) Resources and Application
- 57. International Resources(For Parents) Autism Today: largest autism-related information online; multilingual Action for Autism: worldwide links to autism organization, resources in about 100 different countries www.autism-india.org/worldorgs.com Center for the Study of Autism www.autism.org Autistic Living: site developed by parents for parents www.autisticliving.com Autism Speaks: world's largest autism advocacy organization http://www.autismspeaks.org/ Autism Resources: over 16 languages www.autism-resources/links/nonenglish.html Autism Society of America (ASA) www.autism-society.org Autism Research Institute www.autism.com/ Resources and Application
- 58. What is the level of Evidence for effectiveness of Social skill training ? A. High B. Moderate C. Low D. Insufficient Case (continue) Continue Sensory integration therapy with Occupational therapist and Speech therapy sessions…..
- 59. References • Reichow B, Barton EE, Boyd BA, Hume K. Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database Syst Rev 2012; 10:CD009260 • Howlin P, Magiati I, Charman T. Systematic review of early intensive behavioral interventions for children with autism. Am J Intellect Dev Disabil 2009; 114:23. • Dawson G, Rogers S, Munson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics 2010; 125:e17. • Autism(Seminar). Lancet 2014; 383: 896–910. Published Online September 26, 2013 • Practice Parameter for the Assessment and Treatment of Children and Adolescents With Autism Spectrum Disorder. JAACAP, Feb. 2014 • Reichow B, Steiner AM, Volkmar F. Social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Cochrane Database Syst Rev 2012; :CD008511. • A National clinical guideline- SIGN145 : assessment, diagnosis and interventions for ASD. June 2016 (Healthcare Improvement Scotland) • Management of autism in children and young people: summary of NICE and SCIE guidance. BMJ 2013;347:f4865 doi: 10.1136/bmj.f4865 (Published 28 August 2013) • LeBlanc & Gillis. Behavioral Interventions for Children with Autism Spectrum Disorders. Pediatr Clin N Am 59 (2012) 147–164.
Notas do Editor
- Show resource some form of brain injury. It includes the Doman-Delecato or Glenn Doman programme, autism rehabilitation therapy, psychomotor patterning and developmental reflexive rehabilitation Patterning therapy involves a series of bodily exercises and other activities designed to “rewire” the brain in individuals with autism and other disorders.
- Therapies and Special Education
- EIBI = Based on ABA principles; usually home-based or school-based teaching in simplified and structured steps); 1:1 adult-to-child ratio; intensive teaching for 20–40 h/week for 1–4 years Early intensive behavioural intervention + developmental and relationship-based approaches (eg, ESDM and floortime [DIR-based model]) *Early Start Denver Model (ESDM) ([developmental individual- difference, relationship-based model]) ) suggested by available systematic reviews and meta-analyses, with criteria directly following or similar to the Grading of Recommendations Assessment Development and Evaluation Working Group recommendation; different ratings for the same model or agent are from different reports.
- (simple to more complex skills) The most significant improvements generally are seen within the first 12 months of treatment Pretreatment variables that are associated with improved outcomes include the presence of joint attention, functional play skills, higher cognitive abilities, and decreased severity of autism symptoms
- (simple to more complex skills) it is unclear whether one type of intensive behavioral intervention is better than another,
- There are very few studies comparing ABA with other treatment models, and those studies have methodologic limitations. Those performed comparing ABA with a Developmental Individual Difference Relationship-based Model (Floortime) and TEACCH found no difference in efficacy (ABA/ DIR/TEACCH)
- However, the current evidence is inconclusive
- However, the current evidence is inconclusive - Milieu therapy was associated with improvement in cognitive skills, overall course, and communication and play skills [46,47]. ●Responsive teaching was associated with improvements in quality of social communication and expressive language [48]. ● The More Than Words program was associated with positive outcomes in facilitative strategies and vocabulary
- Treatment and Education of Autistic and related Communication-handicapped Children
- EIBI = Based on ABA principles; usually home-based or school-based teaching in simplified and structured steps); 1:1 adult-to-child ratio; intensive teaching for 20–40 h/week for 1–4 years Early intensive behavioural intervention + developmental and relationship-based approaches (eg, ESDM and floortime [DIR-based model]) *Early Start Denver Model (ESDM) ([developmental individual- difference, relationship-based model]) )
- Picture Exchange Communication System Targeted skill-based intervention
- EIBI = Based on ABA principles; usually home-based or school-based teaching in simplified and structured steps); 1:1 adult-to-child ratio; intensive teaching for 20–40 h/week for 1–4 years Early intensive behavioural intervention + developmental and relationship-based approaches (eg, ESDM and floortime [DIR-based model]) *Early Start Denver Model (ESDM) ([developmental individual- difference, relationship-based model]) )
- 2012 meta-analysis of five randomized trials (196 participants) found some evidence that participation in social skills groups improved overall social competence and friendship quality in the short term 1. (eg, pointing to objects, showing, etc) Joint attention Interventions teach the child to respond to the nonverbal social bids of others or to initiate joint attention interactions (eg, pointing, showing, following eye gaze) 2. Modeling (both real-life and video-based modeling) Interventions involve imitation of target behaviors that are demonstrated by an adult or peer 3. (including, but not limited to peer networks, peer initiation training, and peer-mediated social interventions) 4. (including the Socials Stories approach) Conversational skills. Basic social skills
- (imitation paired with eye contact)
- EIBI = Based on ABA principles; usually home-based or school-based teaching in simplified and structured steps); 1:1 adult-to-child ratio; intensive teaching for 20–40 h/week for 1–4 years Early intensive behavioural intervention + developmental and relationship-based approaches (eg, ESDM and floortime [DIR-based model]) *Early Start Denver Model (ESDM) ([developmental individual- difference, relationship-based model]) )
- compared with ordinary cognitive behavioural therapy, therapy modified for autism relies less on introspection and more on teaching of practical adaptive skills with concrete instructions
- compared with ordinary cognitive behavioural therapy, therapy modified for autism relies less on introspection and more on teaching of practical adaptive skills with concrete instructions
- social, cognitive development, Adaptive skills Core features of successful autism educational programs identified in observational studies and systematic reviews include….(cont’)
- language interventions that span settings and are incorporated into their daily routines will be most beneficial Not include** Augmentative communication strategies (eg, picture exchange system, gestures, sign language, electronic communication systems) + Visual supports (eg, visual schedules, choice boards)
- Empirical evidence suggests that sensory and motor difficulties are present for many children with ASD, especially during early development. However, empirical studies in this area are limited and primarily rely on parental report. Emerging evidence from retrospective video studies and clinical evaluations suggest differences in sensory & motor features for individuals with ASD and individuals with other developmental disabilities. These patterns may relate to core features of ASD, the development of other behaviors, and later prognosis for individuals with ASD meta-analysis of motor coordination in ASD to provide evidence for motor deficits as a core feature.
- Empirical evidence suggests that sensory and motor difficulties are present for many children with ASD, especially during early development. However, empirical studies in this area are limited and primarily rely on parental report. Emerging evidence from retrospective video studies and clinical evaluations suggest differences in sensory & motor features for individuals with ASD and individuals with other developmental disabilities. These patterns may relate to core features of ASD, the development of other behaviors, and later prognosis for individuals with ASD meta-analysis of motor coordination in ASD to provide evidence for motor deficits as a core feature. Motor delays tend to become more pronounced with age. Motor skills provide means for learning other important skills. Motor planning deficits effect ability to mimic another’s actions as well as to participate in goal-directed behavior. Low muscle tone Repetitive motor movements Oral-motor problems Dyspraxia Social Skills Academics
- A well organized system integrates multiple sources of input
- Exercise, gaming, swimming, toewalking Exergames combine play and exercise. Exercise has been shown to support improvements in executive functioning (EF) in children.
- กระตุ้นให้เด็กเกิดการเรียนรู้การเคลื่อนไหวของร่างกายแบบอัตโนมัติโดยใช้กลไกลที่เรียกว่า “การเคลื่อนไหวแบบรีเฟล็กซ์ (Reflex Locomotion)” เพื่อนำไปใช้ในการเคลื่อนไหวพื้นฐานของมนุษย์ เช่น การกำมือ การเอื้อม การพลิกตัว การคืบ การคลาน การยืน และการเดิน เป็นต้น โดยไม่ต้องฝึกฝน สามารถกระตุ้นให้เกิดขึ้นได้โดยไม่ต้องอาศัยความตั้งใจของผู้ถูกกระตุ้น แต่ต้องอาศัยสิ่งเร้าที่ถูกต้องตรงตามเทคนิคการกระตุ้น ประกอบไปด้วยชุดการเคลื่อนไหวอยู่ 2 ชุด เรียกว่า “การคืบแบบรีเฟล็กซ์ (Reflex Creeping)” และ “การพลิกตัวแบบรีเฟล็กซ์ (Reflex Rolling)”
- exercise interventions consisting individually of jogging, horseback riding, martial arts, swimming or yoga/dance can result in improvements to numerous behavioral outcomes including stereotypic behaviors, social-emotional functioning, cognition and attention Music therapy - horseback riding + pet therapy = Possible benefit, low risk AIT, Acupuncture = Unknown benefit, low risk discourage CAM therapies with unknown benefits and potential risks in the treatment of ASD. do not actively encourage CAM therapies with possible/unknown benefit and low risk
- exercise interventions consisting individually of jogging, horseback riding, martial arts, swimming or yoga/dance can result in improvements to numerous behavioral outcomes including stereotypic behaviors, social-emotional functioning, cognition and attention
- Neurofeedback is direct exercise of the brain. As the brain continues to get rewarded through visual and/or auditory feedback, neural networks on the area where the electrodes are located are being activated. With repeated neurofeedback sessions, these newly formed neural networks become more permanent and the dysfunctional symptoms of the client undertaking the training are steadily being reduced (based on the idea that human beings can consciously alter their brain function through training sessions in which they attempt to change the signal generated by their brain and measured via some neurological feedback mechanism.) HEG - near infrared and passive infrared, are indirect measures of neural activity based on neurovascular coupling Possible benefit, low risk HBOT- Low-evidence, one RCT, systemic review 2016, there is no evidence that hyperbaric oxygen therapy improves core symptoms and associated symptoms of ASD. It is important to note that adverse effects (minor-grade ear barotrauma events) can occur. Unknown benefit, potential risk
- no evidence based recommendations for Nutritional therapy Concept = treat a variety of symptoms, including the core symptoms of ASD (eg, deficits in social communication and interaction and restricted, repetitive patterns of behavior, interests, and activities), inattention, gastrointestinal symptoms, and sleep disturbance - Gastrointestinal abnormalities, such as dysbiosis (abnormalities of microflora) or "leaky gut," prompting the use of secretin, antifungal agents, probiotics, etc (see 'Secretin' below and 'Antimicrobial agents' below and 'Probiotics' below) ●Food sensitivities and allergies, prompting the use of special diets, such as the gluten-free and/or casein-free diet (see 'Gluten-free casein-free diet' below) ●Autoimmunity, prompting the use of immunotherapy (see 'Intravenous immunoglobulin' below) ●Metabolic abnormalities (eg, in glutathione synthesis, sulfation, folate metabolism), prompting the use of antioxidants [10-12] (see 'Sulforaphane' below and 'Other interventions' below) ●Heavy metal toxicity, especially mercury, prompting the use of chelation therapy (see 'Chelation' below) ●Nutritional imbalances, prompting the use of nutritional supplements (eg, omega-3 fatty acids, vitamins) (see 'Omega-3 fatty acids' below and 'Vitamin B6 and magnesium' below and 'Other interventions' below) ●Inflammation [13] (see 'Sulforaphane' below) ตามระบบ NICE, AAP, Scottish Intercollegiate Guidelines**