Wednesday, August 24, 2016

Transitioning Back to School: Tips for Parents of Children with Autism

Transitioning Back to School: Tips for Parents of Children with Autism

Students throughout the country will soon be making the transition to a new school year or a new grade. This includes an increasing number of special needs children identified with autism spectrum disorder (ASD). Since Congress added autism as a disability category to the Individuals with Disabilities Education Act (IDEA) in 1990, there has been a dramatic increase in the number of students receiving special education services under this category. 

The beginning of a new school year is an exciting yet anxious time for both parents and
children. It typically brings a change in the daily routine established over the summer months. This transition can be especially challenging for families with children on the autism spectrum. While change can be difficult, the following tips will help prepare a child with ASD for the new school year and make the transition back to school easier.
1. Prepare and reintroduce routines.
  • Familiarize and reintroduce your child to the school setting. This may mean bringing your child to the school or classroom, showing your child a picture of their teacher and any classmates, or meeting the teacher before the first day of school. If possible, arrange to visit the teacher or the school a week or two before the first day. If this isn’t feasible, visit the school building or spend some time on the playground. Driving by the school several times is another good idea. You may also want to drive your child on the first day as well if they ride a bus to school. For many children with ASD, riding a bus to school on the first day can result in a sensory “overload.” Gradually easing them into the transportation routine will be helpful for everyone.
2. Expect the unexpected.
  • Parents cannot anticipate everything that might happen during the school day. Allow more time for all activities during the first week of school. Prepare your child for situations that may not go as planned. Discuss a plan of action for free time, such as lunch and recess. Use social stories to familiarize your child with routines and how to behave when an unexpected event occurs. Anticipate sensory overload. The activity, noise and chaos of a typical classroom can sometimes be difficult to manage. Establish a plan of action for this situation, possibly a quiet room where the child can take a short break. If your child has dietary issues, determine in advance how this will be managed so as to avoid any miscommunication.
3. Review and teach social expectations.
  • Although many children may transition easily between the social demands of summer activities and those required in the classroom, children on the autism spectrum may need more clear-cut (and literal) reminders. Review the “dos and don’ts” of acceptable school behavior. You can also create a schedule of a typical school day by using pictures and talk about how the school day will progress. Create a social story or picture schedule for school routines. Start reviewing and practicing early. If possible, meet with teachers and administrators to discuss your child’s strengths and challenges. Remember, you are your child’s best advocate. Establish communication early to develop positive relationships with your child’s teacher and school. Rehearse new activities. Ask the teacher what new activities are planned for the first week. Then, prepare your child by performing, practicing, and discussing them. This rehearsal will reduce anxiety when new activities take place during the beginning of school.
In summary, do everything possible to help reduce the stress level for your child and family during this transition time. Don’t forget to prepare yourself! A calm and collected parent is better able to help their child make a successful transition back to school.

Wednesday, August 10, 2016

Autistic Traits and Sensory Experiences in Adults

Autistic Traits and Sensory Experiences in Adults

Unusual sensory processing experiences are common among individuals with autism spectrum disorder (ASD), and are now part of the Diagnostic and Statistical Manual 5th Edition (DSM-5) diagnostic criteria. Although previous research indicates that ASD traits are associated with sensory scores in the general population, it is unclear whether they characterize the “broader phenotype” of ASD which includes individuals with mild impairments in social and communication skills that are similar to those shown by individuals with ASD, but exhibited to a lesser degree. 

Research

A study published in the
Journal of Autism and Developmental Disorders sought to replicate the reported relationship between ASD traits and sensory traits across the entire range of symptom severity, and to investigate its specificity in a large sample of adults both with and without ASD. Adults (n = 772) with and without an ASD were administered the Autism Spectrum Quotient (AQ) together with the Adult/Adolescent Sensory Profile (AASP), the Cardiff Anomalous Perceptions Scale (CAPS), and the Glasgow Sensory Questionnaire (GSQ), all questionnaire measures of abnormal sensory responsivity. Of the 772 participants, 23 reported having autism and 55 reported a first-degree relative with the disorder. Another 147 participants indicated having another psychiatric condition, such as depression, and 85 reported having migraine headaches on a regular basis.
The results indicated that self-reported atypical sensory experiences were positively correlated with ASD trait scores on all three sensory questionnaires. The more autistic traits, the more sensory problems he or she reported. Individuals with the most autism traits, such as narrow interests or social difficulties, showed high levels of atypical sensory behavior on all three questionnaires. Although the study’s sample was predominantly (72 %) female, the investigators found that the relationship between sensory symptoms and ASD traits was very similar for both genders. They also found that ASD traits were correlated with levels of anxiety symptoms. Participants who reported being anxious had both more autism traits and more unusual sensory responses than those who were not anxious. This suggests that  sensory processing issues and anxiety symptoms are related, yet separate, phenomena.
Implications

These results have implications for the integration of sensory processing issues into the diagnosis and assessment of ASD. For example, the study confirms the association between sensory experiences and autism across the entire autism spectrum, suggesting that sensory traits might serve as a dimensional measure of the severity of ASD. It should be noted, however, that unusual sensory experiences are not unique to ASD. The researchers found that trait anxiety, a history of psychiatric conditions, and a history of migraines were all associated with higher sensory scores, even after controlling for ASD traits. Thus, individuals with these conditions may report high levels of unusual sensory experiences, which could potentially lead to a misdiagnosis of ASD. It also appears unlikely that atypical sensory experiences underpin all ASD symptoms. Even so, it does appear that if sensory symptoms were treated successfully, then some core ASD symptoms, such as stereotypies, might also be reduced (or vice versa). Further research is needed to examine this issue. Finally, the cognitive/biological basis of the relationship between autistic traits and sensory problems is unknown, and further work is required to determine whether improving sensory processing could effectively reduce the severity of ASD symptoms.
Reference

Horder, J., Wilson, C. E., Mendez, M. A., & Murphy, D. J. (2014). Autistic traits and abnormal sensory experiences in adults. Journal of Autism and Developmental Disorders, 44, 1461-1469. doi:10.1007/s10803-013-2012-7
Lee A. Wilkinson, PhD, NCSP is a licensed and nationally certified school psychologist, chartered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)

Tuesday, August 9, 2016

New Book Giveaway - Self-Help for Adults on the Autism Spectrum


Enter for a chance to win a Kindle copy of award winning author Dr Lee A. Wilkinson’s book, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT. This self-help guide presents strategies derived from cognitive-behavioral therapy (CBT), adapted specifically for adults on the higher end of the autism spectrum, to help them overcome anxiety and depression, and improve their psychological well-being. It is written for individuals in the early and middle years of adulthood, with and without a formal diagnosis, who share features associated with autism spectrum conditions. It is also appropriate for adults who recognize their autistic traits, even though they may not have experienced major social difficulties and clinical impairment, but who want to improve their emotional well-being.
Used alone or in combination with therapy, Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBT is an essential self-help book for adults on the higher end of the spectrum looking for ways to understand and cope with their emotional challenges and improve their psychological well-being. Family members, friends, and others touched by autism will also find this self-help book a valuable resource.
Enter the giveaway at: https://giveaway.amazon.com/p/b349e373778fbfb7 . NO PURCHASE NECESSARY. Ends the earlier of September 28, 2016 11:59 PM PDT, or when all prizes are claimed.

This giveaway has ended and all prizes claimed. Please download the free sample of my book and watch for the release of the second edition of my award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, in November, 2016.

Saturday, August 6, 2016

Self-Help for Adults on the Autism Spectrum



The dramatic increase in the prevalence of autism spectrum conditions among children and adolescents and the correspondingly large number of youth transitioning into adulthood has created an urgent need to address the problems faced by many adults on the autism spectrum. Nearly a half million youth with autism will enter adulthood over the next decade and most will continue to need some type of services or supports. In addition, there is a large and diverse group of adults whose autistic traits were not identified in childhood and have not received the appropriate interventions and supports. 
Although autism symptoms may improve with age, mental health issues may worsen in adolescence or adulthood. As a result, there are a significant number of adults on the spectrum who are now seeking help to deal with feelings of social isolation, interpersonal difficulties, anxiety, depressed mood, and coping problems. Unfortunately, co-occurring mental health issues such as anxiety and depression and even the diagnosis of an autism spectrum condition itself often go unrecognized. Although the rate of mental health issues for adults on the spectrum is high, accessing services to address these symptoms is frequently difficult and the extent of the problem will only increase as more and more youth transition to adulthood.
Evidence is beginning to emerge for interventions targeting this growing and underserved group of adults, including cognitive-behavioral therapy (CBT). CBT has direct applicability to adults on the autism spectrum who often have difficulty understanding, managing, and expressing emotions. It has been shown to be effective in changing the way a person thinks about and responds to feelings such as anxiety and depression. With CBT, the individual learns skills to modify thoughts and beliefs through a variety of strategies which improve interaction with others in helpful and appropriate ways, thereby promoting self-regulation and mental health. It is a goal oriented approach and primarily emphasizes here-and-now problems, regardless of one’s past history, traits, or diagnosis. CBT also provides a more structured approach than other types of psychotherapy, relies less on insight and judgment than other models, and focuses on practical problem-solving. Moreover, because individuals learn self-help in treatment they are often able to maintain their improvement after therapy has been completed. Evidence-based CBT holds considerable promise as an effective intervention for improving the quality of life and psychological well-being of adults on the autism spectrum. Nevertheless, it should not be assumed that CBT interventions will universally produce positive outcomes for all individuals on the spectrum. Research findings are only one component of evidence-based practice. Intervention selection is complicated and must take into consideration not only the best available research, but each individual’s unique presentation including specific strengths and needs, individual and family values and preferences, and available family and community resources.
Despite the availability of effective psychological treatments for anxiety and depression, a substantial number of adults on the autism spectrum do not seek professional help. Common barriers to mental health care access include limited availability and affordability of services, confidentiality issues, lack of insurance coverage, frequent delays and long waiting periods, and social stigma. Moreover, many service providers do not have the experience or expertise to work with individuals on the autism spectrum, particularly those with co-occurring mental health issues. Self-help interventions represent an increasingly popular alternative to therapist-delivered psychological therapies, offering the potential of increased access to cost-effective treatment for a range of different mental health issues. They provide an opportunity for the individual to gain some useful insights and begin to work through their problems with limited guidance from a therapist or mental health professional. Research has clearly shown that self-help strategies are effective, practical, and acceptable for many individuals in reducing mental health problems such as mild to moderate anxiety and depression. As a result, self-help interventions have the potential to play an important role in providing effective treatment to the large proportion of adults on the spectrum who are experiencing mental health issues. Of course, the use of self-help strategies alone are not appropriate for all individuals on the spectrum. Some adults will need the ongoing supportive assistance and direct services of a qualified mental health professional.

Wednesday, August 3, 2016

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 may be due in large part to the reclassification of students who previously would have been given other disability labels. 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 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, NCSP is a licensed and nationally certified school psychologist, registered psychologist, and certified cognitive-behavioral therapist. He provides consultation services and best practice guidance to school systems, agencies, advocacy groups, and professionals on a wide variety of topics related to children and youth with autism spectrum disorders. Dr. Wilkinson is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a best-selling text in the APA School Psychology Book Series,  Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

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