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mental illness in children

The Rise of Mental Illness in Children

 

 

The Journal of Pediatrics published a recent article that childhood developmental conditions including ADHD and Autism are increasing at a rate of 16% from 2001 to 2011 (Read a review of this article on the CNN blog, The Chart, here). Although this might sound astounding and like this should be an area of concern, the researchers have posited that this actually might be a positive.

In all likelihood, these rates were probably the same. What we have now is an increased awareness of a variety of developmental disabilities as well as increased acceptance of such conditions. Having increased acceptance is extremely positive in that now we are able to provide support and services to help these children that otherwise would not be available.

Here are some tips for parents for children who might have a neurodevelopmental condition like ADHD or Autism:

  1. Seek out a good, comprehensive evaluation in order to first help identify the specific condition that the child might present with.
  2. Identify your treatment team. Your team will consist of multiple individuals including teachers, therapists, administration, and special education teachers. Make sure the team is all on the same page and aware of the specifics that the child presents with.
  3. Seek out resources and information to help support you and your family. There are multiple, empirically supported organizations that provide parents and family members with not only support but also resources to help the child out.

Although the rates of a variety of neurodevelopmental conditions are on the rise, it is likely that these conditions have always been as prevalent as they are today. The social stigma associated with the conditions is no longer as strong, and these children are now able to receive specific services and interventions that would be beneficial for them.




physical therapy for autism

Physical Therapy for Children with Autism

 

 

 

Autism Spectrum Disorders (ASD) is a diagnosis that describes kids with significant social, communicative, and behavioral challenges. While the diagnosis is mostly associated with difficulty with communication, there are also common physical issues experienced by children with ASD.

Some children with autism are not diagnosed until they are older, though retrospective studies have shown gross motor discrepancies in babies and toddlers who were later diagnosed to be on the spectrum. With so much treatment emphasis placed on their social and language impairments, physical limitations only become more amplified in these children as they age. Children with ASD can have trouble with a number of large postural tasks, such as sitting, walking, running, jumping, and balance. Studies have shown the prevalence of low muscle tone (hypotonia), toe-walking, ankle stiffness, motor apraxia, and increased motor stereotypes in children with autism. Hypotonia is the most common motor symptom, affecting up to 51% of these children.

How can physical therapists help children on the autism spectrum?

  1. Collaboration: Having a child on the autism spectrum (click here to view our autism infographic) can be challenging for parents. Limited social, behavioral, speech, and motor skills can lead to difficulties both at home and at school. With balance, coordination, and poor motor control at play, it is important for physical therapists to collaborate with other professionals involved in a child’s care. It is also important for physical therapists to contribute to the conversations involving parents and therapists. Physical therapists can address a child’s balance and postural control to encourage improved endurance and attention with school time activities. Knowing a child’s sensory processing needs and behavioral tendencies helps physical therapists make effective goals to make the most gains for a child with ASD associated gross motor delay.
  2. Education/Resources: Parents may not understand the link between physical performance and behavioral responses. A child with gait changes due to sensory-seeking behaviors or a child with poor balance due to decreased motor control will have a hard time participating in play and social skills. As some children are diagnosed years after gait deviations or musculoskeletal compensations are in place, parents also rely on physical therapists to provide information and resources for their child’s orthopedic or developmental needs. Physical therapists can direct parents to orthotists, equipment, or community sports programs specialized for their child with ASD.
  3. Therapeutic Play/Socialization: A huge focus of therapeutic exercises for children with ASD is to encourage large quality movements and age-appropriate play. For example, a child who walks on his toes will need exercises to increase ankle mobility and calf flexibility. A child who has a hard time holding his trunk upright during school will need exercises for postural control. Some children may have a hard time coordinating their limbs to participate in age-appropriate skills, such as hopping on one foot or skipping. Physical therapists help these kids gain more confidence in the skills they need in the future to navigate different environments and perform challenging tasks in the community as adults. Pediatric physical therapists often design treatment sessions where movements that hinder social participation are reduced and movements that lead to independence are encouraged.

New research on toddlers and preschoolers with autism found that children with better motor skills are more proficient at socialization and communication than those who have physical deficits. In addition, autism spectrum disorder has a wide range of presentations and physical involvements, with impairments varying from mild to severe. Physical therapists are becoming much more involved in the lives of children with ASD, in order to help these kids improve their day to day functioning from early childhood well into adulthood.

References:

Oregon State University. Autistic children with better motor skills more adept at socializing. Available at: http://oregonstate.edu/ua/ncs/archives/2013/sep/autistic-children-better-motor-skills-more-adept-socializing. Accessed on July 7th, 2014.

Bullen, D. More than just playtime. Advance: Physical Therapy and Rehab Medicine. Vol.24 No.21. Available at http://physical-therapy.advanceweb.com/Features/Articles/More-than-Just-Playtime.aspx. Accessed on July 7th, 2014.

Ming, Xue, Michael Brimacombe, and George C. Wagner. “Prevalence of motor impairment in autism spectrum disorders.” Brain and Development 29.9 (2007): 565-570.

Autism ribbon

The Diagnostic Transformation of Autism

 

 

 

The Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-V) brought about many changes in psychiatric diagnosis.  Among them, the criteria used to diagnose Autism underwent a number of alterations.  To begin, the previous manual (DSM-IV TR) outlined three Autism diagnoses: Autistic Disorder, Asperger’s Disorder, and Pervasive Developmental Disorder Not Otherwise Specified.  With the most recent edition, there now exists only one Autism diagnosis: Autism Spectrum Disorder.  The “spectrum” has certainly widened and is supposed to be used to describe those who are nonverbal to those with only mild Autism ribbonsymptoms.

Now more than ever, a thorough and careful evaluation is needed to determine whether a child meets criteria.  This begins with an extensive interview including the child’s history (medical, developmental, social, language, play, and behavior), a detailed description of current concerns, observations across a minimum of two sessions, and a collection of objective data (testing, parent questionnaires, teacher surveys).  Consideration of alternative explanations for a child’s presenting concerns is also done, including cultural and social factors.

A year after its inception, the consequences of the diagnostic changes are still taking shape.  From a personal clinical experience, the new criteria makes diagnosis more specific.  Where before, criteria may have been liable to greater subjectivity, attempts to resolve this in the new edition have been made and we are defining Autism with ever greater clarity.

 

What is a Pediatric Neuropsychologist?

Pediatric neuropsychologists are clinical psychologists who focus on completing comprehensive evaluations to ascertain the most appropriate diagnosis in order to lead to the most effective treatment outcome. All neuropsychologists have their Ph.D. or Psy.D. in Clinical Psychology and also have several years of training with brain based behaviors, neurodevelopmental conditions, as well as effective interventions and accommodations.

The typical questions that parents will bring forth in a neuropsychology clinic are related to the child’s academic performance, behavioral regulation, social interaction, and/or emotional functioning. It is the goal of the neuropsychologist to help identify what is causing the negative behavior and what would be an effective course of action.

Conditions and diagnoses that pediatric neuropsychologists often work with include the following:

Often, it is found that a child may have multiple conditions. One of the goals of the neuropsychologist is to help determine what the main condition(s) to address are and the most effective interventions.

The interventions that are determined by a pediatric neuropsychologist are often found in the following places:

8 Great Apps for Kids with Autism

Parents often ask me if I have suggestions for applications to download on their iPads, iPhones or other devices for their children.  I do!  I have TONS of apps that I use in my work with children with Autism daily.

My 8 favorite apps to use with kids diagnosed with Autism for iPhone/iPad users are the following:

  1. 123 Token Me– This app is a visual token board that can be used for one child (free version) or unlimited children and unlimited behaviors ($9.99).  This app gives you the versatility to choose background color, various token choices, and graphs and visually displays data for you. This is the most motivating token board I have used with my kids because it is interactive.  Also, one of the token options shows a picture of the child, which they all love!
  2. First Then Visual Schedule HD– This app is 2 applications put into one; it is both a visual schedule and a choice board.  It allows you to show the child “first ___, then ____.” with the ability to make choices from a visual field.  It also allows you to make more complex, multiple-step, visual schedules.  It is a bit on the pricey side at $14.99 but totally worth it if your child struggles to make choices verbally or would benefit from a visual schedule.  It is much easier to carry around than a paper schedule or choice board, because you can update it on the fly using the camera function or Google images.
  3. Duck Duck Moose, Inc.- (includes Wheels on the Bus, The Itsy Bitsy Spider, Old MacDonald and many more).  All of the Duck Duck Moose apps are a big hit with all the kiddos I work with as they are interactive, the characters move, jump and dance, and they all play familiar kid’s songs.  The apps range in price from free versions up to $3.99 each. Read more

What is Verbal Behavior?

Verbal Behavior (VB) is an Applied Behavior Analytic approach to teaching all skills, including language, to children withautism Autism Spectrum Disorders or other related disorders.  Language is treated as a behavior that can be shaped and reinforced.  This is done with careful attention given to why and how the child is using language.  Verbal Behavior uses similar discrete trial teaching (DTT) techniques such as “SD-response-consequence,” but the approach is slightly different.  VB programming focuses on “manding” (requesting preferred items).  If a child can request what he wants, his world is a better place.  Pairing is also used.  Pairing the table, instructors, and work areas/materials with reinforcement is important to a VB program.

Another key aspect of the VB approach is the idea of “teaching across the operants.” In Verbal Behavior, teaching the child the word “ball” would require several steps.

Steps to teach a Child the Word “Ball” Using Verbal Behavior:

  • The child can “mand” for the ball if they want it.
  • The child can receptively identify the ball (listener responding).
  • The child can expressively identify or label it (tact).
  • The child can match the ball to another ball (matching to sample).
  • The child can perform a motor movement using the ball (motor imitation).
  • The child can answer a question about the ball (intraverbal).
  • The child can repeat the word ball (echoic).
  • The child can identify the ball by it’s feature, function, or class. Read more

5 Chicago Performing Arts Programs to Encourage Speech and Language Development in Children

Performing Arts programs provide an excellent avenue to encourage speech and language skills in children.  LearningChicago performing arts happens best during fun and engaging multisensory experiences, such as acting out a story, dancing to music, or singing a new song.  Through performing arts programs, children gain opportunities to socialize with other children, follow directions, engage in pretend-play, further develop creativity and imagination, build narrative language skills and cultivate expressive language skills.  This blog highlights 5 top performing arts programs in the Chicago area for children of all ages, including a program designed for children on the Autism spectrum.

5 Top Performing Arts Programs in Chicago for Speech and Language Development:

  1. Dream Big Performing Arts Workshop: Dream Big offers a variety of performing arts camps and classes for children ages 2 through 18.  Classes encourage children to explore dramatic play, creative movement, music, team-work, self-expression and creativity while having fun singing, dancing, and playing games.  Classes are separated by ages: “Spotlighters” (2 years), “Mini Showstoppers” (3-5 and 4-6 years), “Moving Stories” and “Creative Drama” (3-5, 5-7 years).  Programs also include customized, age-appropriate parties that include singing, dancing, theatre games and other drama fun! Read more

DSM-5 Changes in Autism

With publication of the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013, DSM-V Changeschanges to diagnostic labels, symptom criteria, and specifiers of Autism have been put into action.  Perhaps the most obvious change is the exclusion of Asperger’s Disorder in the latest manual.  Not to say the syndrome no longer exists, rather the nosology has been altered.  Asperger’s is now subsumed under the broad diagnosis of Autism Spectrum Disorder.  Apparently, the “spectrum” is now greater than ever, but thanks to a variety of specifiers, the child’s strengths and weaknesses can be easily communicated.

Other Changes to the DSM-5:

  • The creation of a single category for communication and social interaction symptoms.  The focus is less on the actual language impairment, per se, but more on the qualitative social aspect of impairment.
  • Diagnosis now requires at least two restricted and repetitive behaviors, with the old manual requiring only one.
  • Criteria have been clarified to reflect the variations in behaviors, interests, and sensory experiences.

What this means for rates of diagnosis of Autism Spectrum Disorder in the future remains to be seen.  Criticism has abounded, with some predicting inflation in diagnosis while others fear the many costs associated with potential under-diagnosis.  Nonetheless, it is important to realize that with the changing in terminology, treatment of Autism has remained stable and continues to be evidence-driven.

For more on Autism read When to Screen Children for Autism and Other Pervasive Developmental Disorders and Potty Training and Autism: The Complete Guide.  To learn more about the Chicago Autism Clinic, click below or call us at 877-486-4140.


Tips to Integrate Children with Autism into Day Camp

Camp should be a fun summer experience that all kids can enjoy.  Sending your child to summer camp with new peopleautism and a new routine can be a scary thought for most kids.  The difficulty of this transition is much more pronounced for kids with autism.  There are ways to make this transition easier on kids with autism, so they don’t miss out on this fun, childhood experience.

Tips to transition to a camp setting for kids with autism:

  • Meet the counselors, staff and new teachers before the program begins.
  • Let the counselors, staff and new teachers know to what your child best responds, for example, first/then sentences, praise, or certain words.
  • Explain any “triggers” that may cause your child with autism to have a tantrum.
  • Take a tour of the facilities with your child before you send him for his first day.
  • Show your child a schedule of what his day will look like at camp so he is not surprised.
  • Read your child a social story about camp, following directions, and making friends. Read more

Does Your Child Need Feeding Therapy?

There are a variety of reasons why a child may need feeding therapy. To many of us, it would seem like eating should be a basic instinct. However, eating is one of the most complex activities we do, especially for the developing, young child. Eating involves several processes in the body, including sensory, oral-motor, muscular, neurological, digestive, and behavioral systems. Feeding problems can arise involving any one of these systems, and often more than one of these is implicated.

The following are reasons why a child may have a feeding problem:

  • Sensory processing issuesFeeding Therapy
  • Food allergies or severe reflux
  • Autism
  • Developmental delays
  • Complex post-op recovery course
  • Transition from feeding tube to oral nutrition

Feeding therapy is usually done with one or more clinicians. Depending on the type of feeding problem, therapy may involve a speech language pathologist, an occupational therapist, a registered dietitian, a social worker or behavior therapist, and/or a physician. Read more