Show:
Facilitated Communication
SIT
Nutritional Therapies
Chelation & O2 Therapy
Auditory Integration Therapy
100
Facilitated Communication
What is a procedure in which a facilitator uses some degree of physical assistance to help a client spell out messages by touching letters on a letter display
100
The types of behaviors exhibited by individuals with ASD that are often referred to as "sensory behaviors"
Individuals with ASD may appear to seek or avoid ordinary auditory, visual, tactile, and oral stimuli •perseverate on objects that have a specific texture or visual pattern •cover their ears when they hear a specific noise (e.g., car horn) •not respond to stimuli that should elicit their attention (e.g., someone calling their name)
100
The GFCF diet
What is a gluten-free casein-free diet (GFCF diet) or gluten-free dairy-free diet (GFDF diet) eliminates dietary intake of the naturally occurring proteins • gluten (found most often in wheat, barley, rye, and commercially available oats) • casein (found most often in milk and dairy products)
100
Chelating agent
What are are molecules that form bonds to specific metals in the body. Thiamine tetrahydrofurfuryl disulfide (TTFD) is hypothesized to act as a chelating agent in children with autism.
100
Auditory integration Therapy
What is a procedure in which accoustically modified music is played to an individual for 10 hours (two 30 – min sessions per day for 10 days within 2 weeks). •Commercial popular music with wide frequency range •Output from a CD player is connected to a box (AIT device; Audiokinetrons) containing electronic circuitry that can modify the signal in two ways: •Modulation (random clipping of frequencies above or below 1000 Hz for random durations) •Narrow-band filtering •Client wears headphones connected to output from AIT device •Alterations in some dimensions of the musical stimuli during the course of treatment
200
Proposed theory that is the basis for FC
What is the following theory: Bilken maintains that individuals with autism suffer from a neurological disorder called dyspraxia which interferes with the production of speech - FC allows individuals with autism to overcome this condition and communicate at a level that suggests that they are not intellectually impaired
200
Ayres (1972, 1974) sensory integration theory and how it translates into practice
What is this theory: •The central nervous system (CNS) has a hierarchical organization such that sensory input must be organized by the lower brain for processing in higher levels of the brain to occur. •All of the sensory systems (i.e., auditory, visual, vestibular, proprioceptive, tactile) interact to receive and organize information. •Once organized, the sensory information can be processed by the CNS to produce end-product skills and abilities. Translation into practice: Difficulty modulating sensory information can result in sensory defensiveness, which will be indicated by an individual’s under- or overresponsiveness to sensory stimuli (Wilbarger, 1984) •abnormal behaviors are caused by a defect in the nervous system in which sensory stimuli are processed and integrated abnormally •SIT is an extension of this hypothesis and further speculates that, given the nervous systems ability to change (neuroplasticity), providing specific forms of sensory stimulation in the appropriate dosage may improve the nervous system’s ability to process sensory stimuli. •Ultimately, the improved nervous system may then result in reductions in problem behaviors and more efficient learning. However, the exact nature of the nervous system’s impairment and the influence of SIT on sensory processing is currently the subject of debate and ongoing research
200
Dohan & Panksepp's proposed ideas that led to the use of a GFCF diet for individuals with autism
•In the 1960s, Dohan speculated that the low incidence of Schizophrenia in certain South Pacific Island societies was a result of a diet low in wheat and milk-based foods. •Dohan proposed a genetic defect wherein individuals are incapable of completely metabolizing gluten and casein as a possible etiology for schizophrenia. •Dohan hypothesized that elevated peptide levels from this incomplete metabolism could be responsible for schizophrenic behaviors. •In 1979, Panksepp proposed a connection between autism and opiates, noting that injections of minute quantities of opiates in young laboratory animals induce symptoms similar to those observed among children with autism.
200
What is the theory proposed for the use of chelation therapy
What is the following theory: After the concerns about the MMR vaccine were raised, parents and some physicians pointed to Thimersol, an ethyl-mercury-based preservative once used in many vaccines in the U.S. including the MMR vaccine, as a possible source of mercury poisoning leading to autism
200
Theory proposed in support of AIT
What was invented in the 1960s by Berard, a French otolaryngologist (medical ear, nose, and throat specialist) -described method as retraining the auditory system
300
The outcomes of the experimental studies examining the effects of FC
What is this outcome: Across three types of evaluation formats (naming pictures, answering questions, and describing activities), results show: •it is rare for the client to produce correct information when the facilitator does not also have access to the information •when the client and facilitator have different information, the information presented to the facilitator is typed during the session
300
Common types of "sensory" activities used in SIT
What is •wearing a weighted vest •being brushed or rubbed with various instruments •riding a scooter board, swinging, sitting on a bouncy ball •being squeezed between exercise pads or pillows •and other similar activities
300
Reichelt's proposed ideas that lead to the use of a GFCF died for individuals with autism
•In 1991, Kalle Reichelt proposed the possibility of a relationship between autism and the consumption of gluten and casein. •Based on studies showing correlation between autism, schizophrenia, and increased peptide levels. Reichelt hypothesized that some of these peptides may have an opiate effect. -Opioid Excess Theory - peptides with opioid activity cross into the bloodstream from the lumen of the intestine, and then into the brain. -These peptides were speculated to arise from incomplete digestion of certain foods, in particular gluten from wheat and certain other cereals and from casein from milk and dairy products. •Reichelt hypothesized that long term exposure to these opiate peptides may have effects on brain maturation and contribute to social awkwardness and isolation. •On this basis, Reichelt and others have proposed a GFCF diet for sufferers of autism to minimize the buildup of opiate peptides.
300
The overall research support for chelation therapy
• A 2002 pilot study administered TTFD rectally to 10 children with ASD, and found beneficial effects. -> Results have not been replicated • •A 2006 review of thiamine by the same author did not mention thiamine’s possible effect on autism. • There is not sufficient evidence to support the use of thiamine to treat autism.
300
Overall research studies for AIT
•Condon analyzed film, frame-by-frame, of movements of children with various diagnoses: Condon concluded that children with autism seemed to respond to discrete sounds more than once, with intraindividually consistent delays of .5 to 1.0 seconds •Condon’s findings have not been replicated •Findings not rediscovered in auditory event-related brain potential studies of persons with autism •Condon did not address hyperacuity, and reported audiometric testing on only 1 of 2 participants •Berard reported of 48 clients with autism who received AIT: -47 experienced disappearance of fear of noise -47 had pronounced modification in behavior -31 experienced progressive restoration or improvement of speech -16 developed speech where it had not existed •Reports claiming beneficial effects: -Rimland & Edelson (1995) -Rimland & Edelson (1994) -Edelson et al. (1999)
400
Biklen's criticisms of the experiment studies of FC
What is the following list: •experimental arrangements cause clients to become anxious or resistant in sessions, impairing their performance •testing destroys the rapport and trusting relationship between the client and facilitator, impairing performance •facilitators were not adequately trained in experimental studies •clients had not been in facilitated communication training long enough to be tested •subjects in experimental studies had word-finding difficulties (aphasia) and, therefore, naming pictures or activities is not a valid way to evaluate facilitated communication
400
The components of SIT
What is •child safety •appropriate levels of participant alertness •opportunities to obtain tactile, vestibular, and/or proprioceptive sensory stimulation to support self-regulation, sensory awareness, or movement •challenge to motor control •novel motor behaviors and efforts to organize movements in time and space •preferences in the choice of activities and materials •activities that are not too easy or too difficult and experiences success •support for intrinsic desire to play •a therapeutic reliance
400
Overall outcomes of the experimental studies examining the effects of the GFCF diet
• A 2008 systematic review of studies examining effects of GFCF diet on the behavior or functioning of individuals with autism concluded -No positive effect on the behavior or functioning of individuals with autism -Research on adverse outcomes lacking • Two randomized trials were included in the review. -One included 10 individuals was single blind (with parents aware of allocation), and reported reduced autistic traits -The second included 15 individuals, was double blind, and found no significant differences in outcomes -The first study criticized for its small sample size and single-blinding; both -factors are associated with positive outcomes bias • A 2009 systematic review, concluded -Evidence in support of the theory is “limited and weak,” -Adverse consequences associated with the diet -Advised against its therapeutic use The review identified 14 studies testing the effects of GFCF diet on autism. -7 reported positive results -4 reported no effect -None of these were longer than 6 weeks • A 2008 study found -Boys with autism had significantly thinner bones than non-autistic boys, starting around age 5–6 years -Boys using casein-free diets had nearly twice the bone thickness deficiency as boys with minimally restricted or unrestricted diets -It is not known which other factors contribute to thin bones in boys with autism, but it appears that a casein-free diet may contribute to calcium and vitamin D deficiencies that lead to decreased bone development and increased risk of broken bones •Only two double-blind studies were identified, and both of these produced negative results • A recent doulbe-blind study was completed at the University of Rochester Medical Center (URMC) with 14 children (without any gastrointestinal issues). -eliminating gluten and casein from the diets of children with autism had no impact on their behavior, sleep or bowel patterns -the researchers acknowledged that children with significant gastrointestinal (GI) symptoms might receive some benefit from dietary changes.
400
The potential side effects/risks of chelation therapy
•Some chelation agents cannot remove heavy metals that are bound in some tissues, and some agents remove beneficial minerals needed by cells for healthy function, which requires that the prescribing physician must use several of them and provide supplements to replace needed minerals. •In 2005, an incorrect form of EDTA used for chelation therapy resulted in hypocalcemia, causing cardiac arrest that killed a five-year-old boy with autism (Baxter & Krenzeloki, 2008).
400
Criticisms of AIT
•Findings not always replicated across their own studies •Measures were often psychometrically invalid •Employed unconventional statistical methods that, by chance or design, maximized the likelihood of positive but chance findings supportive of AIT •No scientific evidence for the type of peripheral hearing abnormalities in autism that Berard reported •AIT is theoretically inconsistent with knowledge about structures and mechanisms of the ear •No audiometric measurement sufficiently valid and reliable to discriminate 5 or 10 dB peaks of hypersensitivity, especially in children with autism •Only weak, irrelevant or insignificant “evidence” for AIT’s claimed positive effects •Sound pressure levels produced by some AIT devices were potentially unsafe •Cost to parents was $1000 to $2000 for 10-hr treatment
500
This is how researchers have addressed Biklen's criticisms of experimental studies of FC
What is: Montee et al. (1995) evaluated further the possibility of facilitator influence during facilitated communication while addressing a number of the issues raised by Biklen •Used client-facilitator pairs, referred by a local service provider, who were reported to be their most accomplished facilitated communication users. •Baseline condition to establish successful communication through facilitated communication and to rule out word-finding problems. •In activity condition, clients did not have to name an object, but rather described an activity - word finding was not an issue in this evaluation format. •Measured anxiety behaviors and escape behaviors in every experimental session. If any client exhibited anxiety or escape behaviors, the experimental trial was terminated and data were not used from that session. •All sessions conducted in their usual locations, at the usual times, with the established facilitators. •Any time the facilitator was not comfortable for any reason, the facilitator could terminate an experimental trial. Results of Montee et al. (1995) showed the client: •typed the correct answer only when the facilitator had access to the same information •never typed the correct answer when the facilitator had no information or false information •typed the picture or activity presented to the facilitator when it was different from the one experienced by the client *These results provide unequivocal evidence for facilitator control of typing during facilitated communication.
500
Overall outcomes of the experimental studies examining the effects of SIT
Watling, Deitz, Kanny, and McLaughlin (1999) •surveyed 72 occupational therapists (OT) working with children with autism and found that 99% regularly implemented SIT Case-Smith and Miller (1999) •contacted 292 OTs and found SIT to be the most frequent intervention utilized by OTs with children with ASD Green et al. (2006) •surveyed 552 parents of children with autism and reported that 38.2% of parents said their child currently receives SIT and an additional 33.2% reported that their child has received SIT at some point in the past. Lang et al. (2012) systematically identified and analyzed intervention studies involving the use of SIT Twenty-five studies described in terms of: •participant characteristics •assessments used to identify sensory deficits or behavioral functions •dependent variables •intervention procedures •intervention outcomes •certainty of evidence •3 of the reviewed studies suggested that SIT was effective •8 studies found mixed results •14 studies reported no benefits related to SIT *Many of the reviewed studies, including the 3 studies reporting positive results, had serious methodological flaws
500
Dietary supplements used to treat behavior symptoms in individuals with autism and overall research support and potential side effects for each
Vitamin B6 in combination with magnesium at high doses (B6-Mg): Scientific evidence: •Rossignol (2009) systematic review: •some low-quality evidence to support its •evidence was equivocal and the review noted the possible •Nye & Brice (2005) systematic review: •due to the small number of studies, the methodological quality of studies, and small sample sizes, no recommendation can be advanced regarding the use of B6-Mg as a treatment for autism Potential side effects: •fatal hypermagnesemia Dimethyiglycine (DMG): Scientific evidence: •Two double-blind, placebo-controlled studies found no statistically significant effect on autistic behaviors, and Potential side effects: •Few side effects reported Vitamin C: Scientific evidence: •Decreased stereotyped behavior in a small 1993 study. -The study has not been replicated, and vitamin C has limited popularity as an autism treatment. Potential side effects: •High doses might cause kidney stones or gastrointestinal upset such as diarrhea. Probiotics containing potentially beneficial bacteria: hypothesized to relieve some symptoms of autism by minimizing yeast overgrowth in the colon. Scientific evidence: •The hypothesized yeast overgrowth has not been confirmed by endoscopy, the mechanism connecting yeast overgrowth to autism is only hypothetical •No clinical trials to date have been published in the peer-reviewed literature. Potential side effects: •No negative side effects have been reported. Melatonin: sometimes used to manage sleep problems in developmental disorders. Scientific evidence: •A 2008 open trial found that melatonin appears to be a safe and well-tolerated treatment for insomnia in children with ASD, and suggested controlled trials to determine efficacy •A small 2009 retrospective study had similar results for adults. Potential side effects: •generally reported to be mild, including drowsiness, headache, dizziness, and nausea •however, an increase in seizure frequency is reported among susceptible children. Omega-3 fatty acids, which are polyunsaturated fatty acids (PUFA): Scientific evidence: •little scientific evidence supporting their effectiveness Potential side effects: •No negative side effects have been reported.
500
Hyperbaric oxygen therapy and it's overall research support
Hyperbaric oxygen therapy (HBOT) can compensate for decreased blood flow by increasing the oxygen content in the body. •HBOT is approved by the Undersea and Hyperbaric Medical Society (UHMS) and the Food and Drug Administration for conditions ranging from carbon monoxide poisoning to compromised skin grafts. •It has been postulated that HBOT might relieve some of the core symptoms of autism. HBOT can cost up to $150 per hour with individual’s using anywhere from 40 to 120 hours as a part of their integrated treatment programs •Rossignol et al. (2009): double-blind study of autistic children found that 40 hourly treatments of 24% oxygen at 1.3 atmospheres -provided significant improvement in the children's behavior immediately after treatment sessions -this study has not been independently confirmed •More recent, relatively large-scale controlled studies have also investigated HBOT using treatments of 24% oxygen at 1.3 atmospheres -found less promising results Granpeesheh et al. (2010): double-blind study compared HBOT to a placebo treatment in children with ASD. -Both direct observational measures of behavioral symptoms and standardized psychological assessments were used to evaluate the treatment. -No differences were found between the HBOT group and the placebo group on any of the outcome measures. o Jepson et al. (2011): single-subject design study also investigated the effects of 40 HBOT treatments of 24% oxygen at 1.3 atmospheres on directly observed behaviors using multiple baselines across 16 participants. -No consistent outcomes were observed across any group -No significant improvements were observed within any individual participant
500
The factors that contribute to parents adopting unproven treatments
Nature of the disorder: •comorbidities are pervasive and aversive •desperation to find treatments are that helpful •avoidance of guilt – “What if I later find out that I could have done something?” Lack of knowledge: •Most parents are new to the diagnosis – although increased prevalence, still uncommon •Few parents have been trained in the principles of scientific inquiry – scientific training is also uncommon, widely recognized scientific illiteracy in the general population Nature of the systems with which parents must interact: •There are also relatively few professionals who are well-educated about autism •Professionals may provide different, even conflicting information -Systems with which parents have to interact may have different, even competing, interests, perspectives, and considerations (e.g., school vs. health care professionals