행동치료의 의학적 처방

Hyun S. Park, MDDevelopmental and Behavioral PediatricianNeurodevelopmental Center, For OC Kids

Assistant Clinical Professor of Pediatrics, UCI SOM

Autism

• Qualitative Social Interaction Impairments• Qualitative Communication Impairments• Repetitive and Restricted Stereotyped

Patterns of Behavior, Activities and Interest

Incidence

• 1 child in 150 has autism spectrum disorder

Characteristic of behaviors

• Dangerous• Hurt self and/or others• Annoying• disturbing

Common Behavior Problems

• Aggression to self and others• Tantrums• Agitation• Obsessions and compulsions• Rocking, spinning, wandering around

• Hyperactivity, jumping, climbing • Inattention, immobility, low energy• Echolalia, non verbal• Excessive talking, screaming, shouting• MELTDOWNS

• moodiness• Fearful, fearless• Pain reaction: too much- too little• Sensory processing difficulties: auditory,

visual, tactile, oral, vestibular.

What to do with behavior problem

• Identify the problem• Understand what is going on with them• Children with autism learn by repetition

Brain learning circuitry

• Reflex• Associative

Children with autism learn by repetition of behaviors

• Routine in daily activities, schedules, environment

• Learned skill not able to generalize to different settings and situations

• Re-learn the skill in a different setting and situation

• Visual learners• Concrete thinkers

• Focus your energy in teaching simple new skills such as praying, singing, greeting, sharing

• Reinforced with repetition

• Lack of common sense• Gradual introduction of change• Ignoring negative behaviors

Medical consultations

• Primary physician – check for absence of illness

• Developmental and Behavioral Pediatrician- developmental and behavioral problem

• OT, PT, Speech therapist

• Psychiatrist -mental and behavioral problem

• Behaviorist- behavioral modification

• Neurologist –possible seizure

• Gastroenterologist-diarrhea, food malabsorption, GER

Medications

• Stimulants• Antidepressants• Atypical neuroleptics • Antiseizure

Psychostimulants

• Hyperactivity,inattention, impulsivity

Ritalin, Metadate, ConcertaDexedrine, Adderall, Vyvanse

Strattera

• Hyperactivity,inattention, impulsivity

Antidepressants, anxiolytics

• Fluoxetine• Paroxetine• Citalopram• Others SSRIs

Atypical neuroleptics

• Risperdal – Aggressive behavior, irritability, insomnia,

mood swing

What can I do for these children

Be loving, caring, PATIENT, provide warm environment.

Be understanding of the child and familyGuide and encourage families to seek help

Referrals to….• Early intervention programs • Referral to Early Start Programs, • Regional Center in California• Public Schools Special Education programs

Education and information

• Mental health • Community centers• Medical specialist

You see them for short time, family lives with child 24/7.