Friday, June 24, 2011

Best Practice Book Review: Pivotal response treatments for autism: Communication, social, and academic development.

This comprehensive text describes intervention strategies and outcome data related to Pivotal Response Treatments (PRT) for autism. The PRT approach focuses on normalizing child development for children with autism via a delivery model that uses both a developmental approach and applied behavior analysis (ABA). It has demonstrated empirical support in the literature. The chapters are well written and cover a range of topics related to interventions in the general education classroom, parent education programs, communication, social development, and strategies for addressing disruptive behavior. Case examples are also included. The chapter on combining functional assessment and self-management procedures to reduce disruptive behavior should appeal to school-based professionals such as school psychologists, special educators, and other support personnel. Overall, the text succeeds in describing an integrated and comprehensive approach to the treatment of autism. Those without experience or background in autism related research and practice might find some portions of the text to be a challenging read.

Koegel, R. L., & Koegel, L. K. (2006). Pivotal response treatments for autism: Communication, social, and academic development. Baltimore, MD: Paul H. Brookes Publishing.

Thursday, June 16, 2011

Seizure Treatments for Children with Autism

Although the association between autism and seizure disorder is not as yet firmly established, there appears to be a higher incidence of febrile seizures in children with autism compared to the general population. Although a majority of children will have only one febrile seizure in their lifetime, many children will progress to 'status epilepticus' (epilepsy). In fact, 15-20% of children with epilepsy have a history of a previous febrile seizure. Approximately 25 to 35 percent of people with autism will eventually experience full-scale seizures. Many others will have seizure-like brain activity, in which there is no obvious effect on muscles but potential effects on brain functioning, such as temporary loss of attention.

Until recently, little has been known about which traditional treatments for epileptic seizures and commonly used non-traditional alternative treatments are most effective for treating seizures or epilepsy specifically in children and adults with autism. A study provides insight into which treatments are most beneficial in such cases. James Adams, a professor at Arizona State University conducted the research, together with Richard E. Frye, a physician specializing in child and behavioral neurology in the Department of Pediatrics at University of Texas-Houston. The complete study is published in the medical journal BMC Pediatrics.

The researchers surveyed 733 parents whose children with autism experience seizures, epilepsy and/or seizure-like brain activity. They asked parents to rate the effectiveness of 25 traditional and 20 non-traditional medical treatments for seizures. The survey also assessed the effects and side-effects of those treatments. Overall, antiepileptic drugs were reported by parents to reduce the occurrence and severity of seizures but worsened problems with sleep, communication, behavior, attention and mood. Non-antiepileptic drugs were perceived to improve other symptoms but did not reduce occurrence of seizures or make them less severe to the same extent as the anti-epileptic drugs. Four anti-epileptic drugs: valproic acid, lamotrigine, levetiracetam and ethosuximide were reported to most often reduce the number or lessen the severity of seizures, with little positive or negative effect on other symptoms of autism. Certain traditional non-anti-epileptic drug treatments, particularly the ketogenic diet, were perceived to both lessen the number and reduce the severity of seizures and other symptoms. The results of this study should provide physicians with a guide for more effectively managing the treatment of children experiencing seizures related to autism. 

Lee A. Wilkinson, PhD, CCBT, NCSP 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 new Volume in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools.

© Lee A. Wilkinson, PhD

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