Wednesday, August 19, 2015

National Indicators Report on Autism & Adolescent Transitions




Young adults with autism are facing significant challenges as they transition to adulthood, a national report suggests, with many on the spectrum finding themselves unemployed, isolated, and lacking services. The "National Autism Indicators Report: Transition into Young Adulthood" from Drexel University’s A.J. Drexel Autism Institute is a comprehensive report (available free online) that presents new findings about a wide range of experiences and outcomes of youth on the autism spectrum between high school and their early 20s. The report is a collection of indicators that focuses national attention on outcomes which are almost universally lower for those on the autism spectrum compared to their peers with other types of disabilities and serves as a call to action to fill the remaining large gaps in knowledge. Key findings include:
  • Over one-third (37 percent) of young adults were disconnected during their early 20s, meaning they never got a job or continued education after high school. In comparison, less than eight percent of young adults with other types of disabilities were disconnected.
  • Approximately 26 percent of young adults and 28 percent of those unemployed and not in school received no services which could help them with employment, continue their education, or live more independently.
  • Just 58 percent of young adults worked for pay outside the home between high school and their early 20s, a rate far lower than young adults with other types of disabilities. Those with jobs generally worked part-time for relatively low wages.
  • Approximately one in four young adults were socially isolated, meaning they never saw or talked with friends and were never invited to social activities within the past year.
  • Only about one in five ended up living independently (without parental supervision) in the period between high school and their early 20s.
  • Sixty percent of youth had at least two health or mental health conditions in addition to autism spectrum disorder. Over half of youth had co-occurring ADD/ADHD and anxiety issues in adolescence. Three-quarters of youth took at least one kind of medication on a regular basis for any health or mental health issue.
  • Nearly 50% of youth experienced threats and bullying during high school. Over one-quarter (27 percent) of adolescents engaged in some type of wandering behavior in which they impulsively left a supervised situation, increasing their risk of becoming lost and going missing
  • Transition Planning, a key process for helping youth build skills and access services as they enter adulthood, was frequently delayed. Just 58 percent of youth had a transition plan by the federally required age.
The creation of effective and affordable programming tailored to meet the needs of the 50,000 individuals with autism who leave high school each year - each with unique strengths, interests, and challenges - is an urgent task facing our society. It is clear that we are not succeeding as a nation in helping autistic adults to thrive to the best of their abilities and attain a high quality of life. It is time for new approaches.
“This is the most comprehensive report to date describing what we know about young adults with autism as a whole and across the various parts of their lives. Yet, it represents only a fraction of what we need to know. Huge gaps remain,” said Anne M. Roux, MPH, research scientist at the A.J. Drexel Autism Institute in the Life Course Outcomes Research Program and lead author of the report. Although these indicators don’t tell us why outcomes are worse for those with autism compared to youth with other disabilities, this report is an important first step toward addressing the gaps in what we know, as we work to build an evidence base about how to help achieve better outcomes.
The link to the report download page is http://drexe.lu/autismindicators.
Roux, Anne M., Shattuck, Paul T., Rast, Jessica E., Rava, Julianna A., and Anderson, Kristy, A. National Autism Indicators Report: Transition into Young Adulthood. Philadelphia, PA: Life Course Outcomes Research Program, A.J. Drexel Autism Institute, Drexel University, 2015.
Lee A. Wilkinson, PhD, NCSP, CPsychol, AFBPsS is a licensed and nationally certified school psychologist, chartered psychologist, registered psychologist, and certified cognitive-behavioral therapist. Dr. Wilkinson is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a text in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Ed.).






Tuesday, August 11, 2015

Autism and Improvisational Music Therapy



Music therapy has become an integral part of many programs for children with autism. The broad category of music therapy is generally described as interventions that seek to teach individual skills or goals through music. Music therapists use their training as musicians, clinicians, and researchers to effect changes in cognitive, physical, communication, social, and emotional skills.  According to the National Autistic Society, “Music therapy aims to encourage increased self-awareness/self-other awareness, leading to more overt social interactions. The therapy stimulates and develops the communicative use of voice and pre-verbal dialogue with another, establishing meaning and relationship to underpin language development. The client may also benefit from increased tolerance of sound, tolerance of and capacity for two-way communication.” 
Research Autism reports strong positive evidence from peer-reviewed journals that support the effectiveness of music therapy for individuals with autism spectrum disorders (ASD). Based on the literature to date, music therapy has shown good effects in influencing joint attention, social interaction, verbal and gestural communication and behavior. It is considered to be a useful intervention, particularly with young children, and where language acquisition is either delayed or disordered to a severe degree. Currently, music therapy is identified as an emerging intervention by the National Autism Center (2015) and incorporates many of the identified ASD-specific evidence-based practices.Supporters of music therapy emphasize that it can be used to develop social engagement, joint attention, communication abilities, while also addressing emotional needs and quality of life.
A study published in the journal Autism provides further support for the effectiveness of music therapy with ASD. This study investigated the social-motivational aspects of musical interaction between the child and the therapist in improvisational music therapy by measuring emotional, motivational and interpersonal responsiveness in children with autism during joint engagement episodes. Improvisational music therapy is an individualized intervention that facilitates moment-by-moment motivational and interpersonal responses in children with autism. Compared with other therapeutic interventions utilizing music as a background or contingent stimulus, improvisational music therapy involves the interactive use of live music for engaging clients to meet their therapeutic needs. It is gaining growing recognition as an effective intervention addressing fundamental levels of spontaneous self-expression, emotional communication and social engagement for individuals with a wide range of developmental disorders.
Design
This randomized controlled exploratory study employed a single subject comparison design in two different conditions (improvisational music therapy versus toy play sessions) and two different parts of a session (an undirected/child-led part versus a more directed/therapist-led part) in each condition. The objective was to compare the effects of these two different media (music versus toys) and to determine how children respond in a musical context with or without direction, compared with a non-musical context such as play activities with toys with or without direction.
Participants and Procedure
Participants were children aged between 3 and 5 who were not previously treated with either music therapy or play therapy. A total of ten children (all male) completed the clinical trials. Five children were non-verbal while the other five were verbal with varying degrees of language skills. Eight children were in preschool special education, and two were in mainstream preschool programs that included additional therapeutic supports, such as speech language therapy. The children were randomly assigned either to have the music therapy sessions first and the toy play sessions later (group 1), or vice versa (group 2). In order to differentiate the media used in these two conditions, the therapists in music therapy were instructed to interact with the child mainly through music, whereas the therapists in the toy play condition were instructed to engage the child by any means, but to avoid any musical media, such as singing or rhythmic playing.
Observed behaviors were recorded in terms of both their frequency and their duration for two broad categories. The first category concerned the participant’s emotional and motivational responsiveness (joy, emotional synchronicity, initiation of engagement) towards different types of attunement promoted by the therapist in these two conditions. The second category concerned two different types of responsiveness towards the therapist’s initiation of interaction (social invitation and interpersonal demands). Joy referred to an event when the child either smiled (facial expression duration only), or laughed (facial expression with vocal sound) during the interaction with the therapist. Emotional synchronicity referred to an event when the child and the therapist shared a moment of emotional affect duration (happiness or sadness) while engaged with each other. Initiation of engagement referred to an event where the child spontaneously initiated interaction with the therapist, or initiated a change during ongoing interaction, and then expected the therapist to follow.
Results and Discussion
Improvisational music therapy produced markedly more and longer events of joy, emotional synchronicity and initiation of engagement behaviors in the children than toy play sessions. In response to the therapist’s interpersonal demands, ‘compliant (positive) responses’ were observed more in music therapy than in toy play sessions, and ‘no responses’ were twice as frequent in toy play sessions as in music therapy. In the music therapy condition, there were more joy, emotional synchronicity and initiation of engagement events in the undirected part than the directed part, suggesting that children were happier, more able to express their happy emotions and more able to share their affects with the therapist when leading. These results suggest that musical attunement enhances musical-emotional communication together with joy and emotional synchronicity, which results in children’s spontaneous willingness to respond, initiate and engage further.
According to the authors, “The temporal structure of music and the specific use of musical attunement in improvisational music therapy suggests that we can help children with autism experience and develop affective skills in a social context.”  Creating music relates to the child’s expression, interest and focus of attention may evoke responses from the child to a therapist creating such relational music for them. Moreover, improvising music together is an emotionally engaging process. Music can be an attractive medium, allowing the child his/her own space and the choice of objects, at the same time engaging the child with different objects of the therapist’s choice.
Of course, this “exploratory” study has limitations.  For example, the small sample makes any generalizable conclusion premature. The test power is low and should be considered when interpreting the results. Likewise, the small sample limits the relevance of subgroup analyses (language, age, severity) as well as therapists’ effects which would be helpful to understanding how children with different developmental needs respond to this type of intervention different therapists.
Conclusion
In conclusion, the results of this exploratory study found significant evidence supporting the value of music therapy in promoting social, emotional and motivational development in children with autism. The findings highlight the importance of social-motivational aspects of musical interaction between the child and the therapist, the therapeutic potential of such aspects in improvisational music therapy, and the relative value of less directed and more child centered approaches for children with autism. The authors conclude, “Both previous and the current study indicate that we should use music within the child’s focus of attention, behavioral cue and interests, whether it is improvised or precomposed. A future study should perhaps look at the differential effect on response of improvised and precomposed music with young children with autism.”



Monday, August 3, 2015

Reclassification May Account for Rise in Autism



The dramatic increase in the rate of autism among children enrolled in special education programs in the United States between 2000 and 2010 may be due in large part to the reclassification of students who previously would have been given other disability labels, according to new research. In a paper published online in the American Journal of Medical Genetics, scientists at Penn State reported their analysis of 11 years of data from the United States Individuals with Disabilities Education Act (IDEA) for students enrolled in special education programs. Under IDEA, individuals are classified into one of 13 disability categories including autism, intellectual disability, emotional disturbance, other health impairment and specific learning disability.
The researchers found that between 2000 and 2010, the number of children in the autism category more than tripled from 93,624 in 2000 to 419,647 a decade later. Yet nearly 65 percent of this increase was significantly associated with a corresponding decline in the number of students classified under the intellectual disability category in the IDEA data. The researchers estimate that, for 8 year-olds, approximately 59 percent of the observed increase in autism is accounted for by reclassification, but by age 15, reclassification accounts for as much as 97 percent of the increase in autism. Likewise, the researchers found the category of specific learning disability as another potential contributor to diagnostic reclassification. They also note that the relationship between autism cases and disability categories varied state-by-state, suggesting that state-specific health policy may be a significant factor in estimates of autism prevalence.
Although a broadening of diagnostic criteria, improved assessment practices, increased awareness of autism, and strategic use of diagnosis to gain access to services have all had a significant effect on the prevalence of autism, this new research provides the first direct evidence that much of the increase may be attributable to a reclassification of children with related disorders (or diagnostic substitution) rather than to an actual increase in the rate of new cases of autism. The researchers conclude that the large increase in the prevalence of autism is likely the result of students being moved from one category to another and is complicated by the variability of autism and its overlap with other related disorders. Current prevalence estimates are based on specific clinical features of autism and do not consider co-occurring disorders that may confound diagnosis and classification. "Because features of neurodevelopmental disorders co-occur at such a high rate and there is so much individual variation in autism, diagnosis is greatly complicated, which affects the perceived prevalence of autism and related disorders," said Santhosh Girirajan, assistant professor of biochemistry and molecular biology and of anthropology at Penn State and the leader of the research team. "For quite some time, researchers have been struggling to sort disorders into categories based on observable clinical features, but it gets complicated with autism because every individual can show a different combination of features. The tricky part is how to deal with individuals who have multiple diagnoses, because the set of features that define autism is commonly found in individuals with other cognitive or neurological deficits."
Polyak A, Kubina RM, Girirajan S. 2015. Comorbidity of intellectual disability confounds ascertainment of autism: implications for genetic diagnosis. Am J Med Genet Part B 9999:1–9.
Lee A. Wilkinson, PhD, CPsychol, AFBPsS is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers. He is also editor of a recent volume in the American Psychological Association (APA) School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools and author of the new book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT.

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