Tonight’s Autism 200 Series presentation, Autism …...Restricted Interests and Repetitive...
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Tonight’s Autism 200 Series presentation, Autism 209: Autism Care Planning, will begin at 7 p.m.
Transcript of Tonight’s Autism 200 Series presentation, Autism …...Restricted Interests and Repetitive...
Tonight’s Autism 200 Series presentation, Autism 209: Autism Care Planning, will begin at 7 p.m.
Autism 209: Autism Care Planning -Recommended Interventions, Resources and Support
Autism Center ARNP teamOctober 17, 2019
Introductions
Objectives for this evening
• Understand “Care Planning” at the Autism Center
• Review the essential components of “Care Planning”
• Provide families with guidance to evaluate their child’s treatment needs
• Know where to find helpful resources
Presenter
Presentation Notes
DH
Autism Spectrum Disorder (DSM-5)
Restricted Interests and Repetitive Behaviors
Social Communication and Social Interaction
Impairment
Autism Spectrum Disorder
Presenter
Presentation Notes
DH DSM-5 Criteria: Social Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text) Deficits in social-emotional reciprocity Deficits in nonverbal communicative behaviors used for social interaction Deficits in developing, maintaining, and understanding relationships Must have all 3 social symptoms DSM-5 Criteria: Restricted/Repetitive Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text): Stereotyped or repetitive motor movements, use of objects, or speech Insistence on sameness, inflexible adherence to routines Highly restricted, fixated interests that are abnormal in intensity or focus Hyper-or hyporeactivity to sensory input
Social Communication Impairment
• Social-Emotional Reciprocity
• Non-verbal Behaviors
• Developing Relationships
Presenter
Presentation Notes
DH Difficulty with back-and-forth conversations Difficulty sharing enjoyment & interests with others Difficulty relating to others, taking another’s perspective, and empathy Difficulty using/interpreting eye gaze, gestures, body language, etc. Lacking facial expression, over exaggerated facial expression Lacking interest in peers Difficulty developing and/or maintaining friendships Challenges with cooperative/imaginative play with others Examples of what you might see – You might see less looking at faces, or lower response to name. Might be less likely to see a range of facial expressions, or they might not be directed to other people (e.g. returning a smile). May not point out things to you – showing you things, or directing your attention in an appropriate way. Generally less likely to start an exchange – e.g. smiling at you to engage with you, trying to get your attention. Lack of interest in other children. Perceived lack of interest or atypical interest in others Very attached to certain adults, but no interest in peers. Wants friends, but doesn’t “get it.” Lack of joint attention. Lack of understanding of or misinterpreting facial expression or social cues. Behavior problems related to lack of interest in social praise or social consequences. Depends from child to child – much variability within autism spectrum!! Social/emotional reciprocity: reading social cues, taking the perspective of others, two-sided interactions, modifying behavior based on others’ cues, showing empathy
• “Stereotyped” (repetitive) behaviors
• Rigid/ inflexible behaviors
• Abnormally obsessive interests
• Sensory differences (e.g., sight, sound, touch, smell, taste)
Restricted/Repetitive/Atypical Behaviors
Presenter
Presentation Notes
DH Hand flapping, rocking, spinning, pacing Repetitive and/or odd use of language (e.g., “echolalia”, overly formal, scripts, unusual prosody) Distress with transitions, changes in routine Rituals Objects, activities, topics Parts of objects Sensory seeking Sensory aversions
Reason for Care Planning Visit
• Concerns and questions related to autism
Suggestion: bring a list
• Overall goals and plan for the future.
• Not the time to question the diagnosis of autism.
Presenter
Presentation Notes
ST While you need to collect information we will talk about below, taking the time at the start of the visit to write down the list of concerns or questions the family has helps everyone get what they need from the time spent together. For families listening, I would encourage them to write down or spend some time before the visit thinking what they want to ask about.
Reason for Care Planning Visit
• Making sure child in the right therapies or school program to support their development
• Are there any other medical tests to consider given the diagnosis of autism
• Help addressing activities of daily living such as diet/feeding, sleep, toileting
• Behavior concerns including aggression, self-injury, safety
• Questions about other mental health issues like ADHD, anxiety, depression
• Questions about medications or supplements
• Help accessing resources or support groups
• Questions about FMLA
Concerns and questions may include:
Presenter
Presentation Notes
ST
Usual Components of the Visit
(But not every visit is the same!)
Health History
• Differentiate issues related to ASD from issues related to other medical history
• Guidance for recommendations
• Identify gaps in care
• Future monitoring of related health concerns
Why do we gather health history?
Presenter
Presentation Notes
KC Health history includes: Birth history, hospitalizations, significant illness, injuries, prior evaluations and diagnostic studies, current medications/medication history, allergies Why do we gather health history? Helps prioritize recommendations any gap in f/u’s with specialists Holistic understanding of the patient Past medical issues working against patient’s development
Health History
• Complications during pregnancy and/or birth
• Prenatal exposures to alcohol, drugs, tobacco, medications
• Gestational age: premature infants may have developmental delays
• Birth weight
• Neonate period: History of infections, failure to thrive
• Medical issues contributing to behaviors
Birth History
Hospitalizations, significant illnesses, injuries
Presenter
Presentation Notes
KC Associated issues attributed to prenatal exposures (fetal alcohol syndrome, NAS) Premature infants: may have developmental delays that are not attributed to ASD, expected to need catch-up time for milestones Hospitalizations, significant illnesses, injuries What issues may be contributing to behavior Medical diagnoses may be compounding symptoms of ASD Prolonged hospitalizations may cause regression in development Broken bones/head injuries/infections
Health History
• Where and when was the child diagnosed with autism and by whom?
• Medical specialists: neurology, genetics, gastroenterology, psychiatry, sleep
• Prior developmental assessments (speech evaluation, OT, PT)
• Educational assessments: review IEP, cognitive testing
• Psychiatric assessments: diagnoses such as anxiety, depression, ADHD
• Hearing assessment
• Diagnostic imaging
• Genetic testing
Prior evaluations and diagnostic studies
Current medications and/or medication history
Presenter
Presentation Notes
KC Specialists Common issues often seen with ASD may lead patient’s to be followed by other various specialists Knowing other specialists helps us coordinate care and make appropriate medical recommendations/referrals Prior developmental assessments Review these records, may have already been given recommendations Helps us to best utilize apt time Educational assessments Helpful to review IEP, review services/supports to guide our recommendations/know what areas to advocate for Hearing impairments may limit social interactions and speech development, rule out dual diagnosis Diagnostic imaging that may have been done such as brain MRI and results Genetic testing Review results and guides what genetic recommendations we may make next
Review of Systems
• Determine if any current medical concerns are contributing to the overall picture
• Focus on common medical issues seen in ASD and any concerns family may have
Presenter
Presentation Notes
DH PLUG: Sara’s class and AUT 200 Highlight that we may spent the visit on a single topic
Review of Systems
• Any concerns for weight gain/loss, growth curve, head size
• Difficulty falling/staying asleep, restlessness, snoring
• Constipation, Diarrhea, Stomach Pain
• Picky eater, rigidity/rituals around food, food seeking
General Growth
Sleep
GI
Eating Habits
Hearing/VisionSeizures/Staring Spells
Presenter
Presentation Notes
DH
Observations
• Height/weight/head circumference, possibly blood pressure
• Looking at facial features
• How are they moving/manipulating objects
• How are they playing
• How do they communicate
• Other ASD features
Transitions
Repetitive movements
Interactions
Presenter
Presentation Notes
KS Not a PCP physical exam
Current Development
• Social skills (conversation skills, asking for help, building friendships, interactions with family)
• Repetitive behaviors (difficulty with change/transitions, literal thinking, restricted interests)
• Current Development – Determining current functioning and where support is most needed
ASD symptoms that interfere with daily tasks
Presenter
Presentation Notes
ST
Current Development
• Life skills – bathing, dressing, feeding, problem solving, making choices, safety awareness, academics Medical specialists: neurology, genetics, gastroenterology, psychiatry, sleep
• Triggers• Management attempts and response• Goals for behavior
Adaptive skills
Behavior
Presenter
Presentation Notes
ST
Mental Health
• Skills
• Learning
• Motivation
• Behavior
Determining what, if any, mental health problems may be affecting:
Presenter
Presentation Notes
ST
Mental Health
• Is the child currently being treated for mental health concerns (anxiety, depression, mood disorder, behavior challenges, ADHD)?
Who is treating?
Response?
• Usual mood
• Predictability
• Change in behavior or adaptive skills
• Recent changes to routine or environment
Presenter
Presentation Notes
ST
Autism Center Care Plan Visit
• Education – Child Specific
• 504-Plan
Accommodations
• Individualized Education Program (IEP)
Goals and Services – speech therapy, social skills, OT/PT, other
• Classroom-Type
Presenter
Presentation Notes
KS To get an IEP, there are two requirements: A child has one or more of the 13 disabilities listed in IDEA. The law lists specific challenges, like learning disabilities, ADHD, autism, and others. The disability must affect the child’s educational performance and/or ability to learn and benefit from the general education curriculum. The child must need specialized instruction to make progress in school. To get a 504 plan, there are two requirements: A child has any disability. Section 504 covers a wide range of different struggles in school. The disability must interfere with the child’s ability to learn in a general education classroom. Section 504 has a broader definition of a disability than IDEA. (It says a disability must substantially limit one or more basic life activities. This can include learning, reading, communicating, and thinking.) That’s why a child who doesn’t qualify for an IEP might still be able to get a 504 plan.
Recommendations/Plan
• Based on issues identified in the visit and may include:
Health recommendations (e.g. sleep, constipation, physical activity)
Outside therapy referrals, medical referrals (at Children’s or back to PCP)
Possible recommendations for lab work (orders or refer back to PCP)
Recommendations for education resources
Social skills resources
• Resources
Autism Speaks
The Autism Blog, Autism 200 series, Autism Center Website
State & Federal supports (DDA, SSI, DVR)
Presenter
Presentation Notes
KS Care planning and recommendations change through age and development
Autism Family Support and Resources
Patient and
Family
Education: School Services
Applied Behavior Analysis
(ABA)
Speech Therapy
Social Skills
Sibling and Family Support
State and Federal Disability Services
Mental Health Services
Research Opportunites
Basic Needs
Legal Supports
Medication Management
Safety/Wandering
Insurance:Medicaid or Private
Parent Education:Understanding
Autism
Seattle Children’s Autism Center
Presenter
Presentation Notes
KS
Autism Family Support and Resources
Adult Population
Transition and Adulthood:Pathway to a meaningful Life
-Developmental Disabilities Admin-Services and supports for non DDA population-Supplemental Security Admin-Medicaid Insurance-Guardianship or Power of Attorney -Therapy (ABA, Speech, OT, Life skills, Social skills)
-Education-Housing-Employment-Community Participation-Relationships/Sexuality-Finances/Special Needs Trust-Advocacy (for parents and for autistic adults)-Legal Resources
Presenter
Presentation Notes
KS
Take-home Points
• Care planning is a process and it is collaborative with your child’s whole team
Not every visit is the same
We may not address every concern in one visit
Keep in touch with your PCP
Our role is to partner with families and provide support as needed over time
Work through challenges
Celebrate successes!
Presenter
Presentation Notes
KS
Any Questions?
Olivia
Presenter
Presentation Notes
FYI only: We will take questions from those in the room and then questions from those watching through Facebook Live
