Clinical

Clinical (4)

You often don’t give a second thought to biting into an ice cream sandwich, riding a bicycle, or watching a movie. For children who have difficulty with sensory processing these activities, become insurmountable hurdles that result in what most people see as inexplicable and out of control response from their child, including tantrums, anxiety, excessive clumsiness, carelessness, and academic failure.

What’s happening?

The child could very likely be having difficulty integrating information that comes in from their senses, primarily sound, touch, and sight. Commonly known as Sensory Processing Disorder (SPD), the condition affects approximately 1 in 6 children in ways that are significant enough to detrimentally affect daily activities and healthy functioning. For these children, the brain and nervous system encounter a glitch in receiving messages from the senses, interpreting them, and converting them into appropriate motor and behavioral responses. Children can be affected in one sense or across multiple senses. One child may over-respond while another may under-respond to the same sensory stimuli.

There are many theories about the causes of SPD, but no single factor is responsible. While more research is needed, studies to date indicate that a complex interaction of genetics and environment determine how symptoms of SPD develop for any particular child.

What does Bone Conduction have to do with Sensory Processing?

An innovative system for addressing SPD is the Integrative Listening System (iLs), a multi-sensory system that integrates music, movement, and language exercises to help improve brain function. The premise behind iLs is that stimulation of movement, balance, vision, and auditory pathways are vital to the ability to pay attention, process information, coordinate movement, learn and respond. The key components of iLs are air and bone conduction, conveyed through headphones, along with visual and motor input.

Bone conduction and air conduction are the two ways we hear sound. If you’ve ever heard your voice on an audio recording and said, “that doesn’t sound like me” it’s because you’re only hearing the air conduction of your voice. When you speak, your voice is projected over both air and bone conduction, which happens over the mastoid bone just behind your ear. That’s also why, when you have your hearing checked, a vibrator is place on that mastoid bone—it is a test of bone conduction responsiveness and it is crucial in the processing of sensory stimuli.

How does the Integrated Listening System Help a Child?

Integrative Listening Systems uses different frequencies and different levels of sound filtration to selectively train parts of a child’s auditory spectrum. This helps improve learning-related abilities such as sound decoding and auditory memory. The muscles of the inner ear are also trained through a process that triggers patterns of relaxation and response. As the muscle patterns become stronger, the child’s ability for focused listening and attention to tasks can improve.

As lower-level processing tasks strengthen, higher-level processing activities are introduced. These higher-level tasks, such as expressive language training and complex cognitive activities influence the neurological pathways that relay and process sensory information, helping to release the “glitch” that had kept the child entangled in a snare of sensorimotor stimuli.

The results of a successful iLs program for a child with sensory processing challenges can include:

  • accelerating a child’s developmental growth patterns
  • calming a child, which enhances the time spent in therapeutic session
  • behavior improvement at home/school
  • improvement in learning new tasks, regulating emotion, and maintaining focus
  • improvement in body awareness, motor ability, and sleep patterns

Using the iLs program usually begins with intense sessions with a child’s occupational therapist. The program is also easy to use at home and is often recommended to maintain progress.

Resources

“Arousal Study Indicates Integrated Listening Systems Is an Effective Behavioral Solution for Children With Sensory Processing Challenges” Jl of Occupational Therapy, Schools & Early Intervention (2015) 8:3.

Understanding Sensory Processing Issues Understood.org

The Science Underlying Integrated Listening Systems IntegratedListening.com

Wednesday, 31 May 2017 14:53

Physical Activity Benefits Autism

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For children diagnosed with an Autism Spectrum Disorder (ASD), a sedentary lifestyle (including too much time on electronic devices), can worsen ASD symptoms and contribute to additional health problems such as obesity, motor impairment, and isolation. It’s been reported that as many as 40% of children age 10-17, who have autism are overweight or obese. Other studies indicate that among children age 2-19 who have autism, up to 36% are at risk for being overweight. The primary reason for these higher rates among ASD children is insufficient physical activity—the very activity that can enhance their quality of life.

Children on the Spectrum benefit from physical activity just as much, and perhaps more, than typically developing children.

In addition to boosting cardiovascular fitness and strength, children on the Spectrum who participate in regular physical activity and/or organized sports and fitness programs can make great improvement in their

  • balance and coordination
  • fine motor skills
  • overall motor function
  • self-control 
  • ability to focus on a task
  • auditory, visual, and tactile skills

Even beyond these physical benefits, participation in regular sports or fitness programs can enhance the child’s emotional wellbeing, boost self-esteem, and improve social skills. So what’s keeping kids on the Spectrum from being involved in an exercise or sports program?

Why aren’t Children with Autism More Physically Active?

Ironically, many of the benefits of physical activity tie into the reasons why caregivers are hesitant to enroll a Spectrum child in a fitness program or to allow them to play outdoors regularly. It’s true, there are challenges:  Spectrum children can have limitations in motor skills. They may not be able to plan ahead, anticipate, and respond in ways that allow for success at a task. Children with autism can become overwhelmed by the increased auditory, visual, and sensory stimuli in a sports or fitness setting. However, if a program is planned and executed properly, all of these challenges can be managed and physical activity can be an appropriate intervention activity that helps kids on the Spectrum thrive.

How to Help a Child with Autism be More Physically Active

First, speak with your child’s care team—psychologist, physical therapist, or physician—to assess your child’s level of readiness and to customize a program. Some children may begin with visits to a playground at a quiet time when they can be slowly introduced to appropriate equipment. Also, daily walks for increasing lengths of time and over different terrain (hills, wooded, city streets) can be a great beginning on the path to physical fitness. Others might join a small fitness class with children who have similar abilities/limits. For some children, the best first step may be learning at home by exploring different size balls from different types of sports, learning about the sports, and over time exploring the skills for a particular sport or activity of interest.

Swimming is a wonderful activity for children who do not have a sensory issue with water. Many towns and private aquatic facilities offer swim lessons for special needs children. Local yoga studios offer programs specifically designed for differing abilities. There is even a special certification for working with children who have autism and other special developmental needs. Another avenue to introduce fitness to your child is to bring her/him to observe other children involved in sports programs. Discuss how the children follow the coach’s instruction and work together toward a goal. Point out how the children are of different sizes and abilities. Your healthcare team can guide you to the right first steps or to organized programs that best suit your child’s needs.

What to Look for in a Physical Fitness Program for Children with Autism

Ask your child’s healthcare providers for referrals. Your child’s behavior specialist may even teach programs at their facility. Inquire with support groups, YMCA or JCC, and non-profit organizations that provide services for special needs children.

Once you’ve made a list of possible programs: Visit facilities and meet with instructors to discuss your child’s needs. Be sure to observe classes. Ask for a trial class or a trial week.

Instructors should be trained to understand and teach to the needs of children with ASD. They may have degrees in adaptive physical education or exercise science with a specialization in developmental disorders. The instructor should demonstrate understanding of the physical, emotional, and sensory needs of your child. By observing a class, you should be able to see how the instructor breaks down specific exercises/physical tasks, helps children set goals, and provides positive behavior support as well as appropriate correction. 

By getting your child involved with a regular program of physical activity, you are giving them an opportunity to challenge themself within appropriate boundaries, enhance their physical and emotional well being, and to move beyond the perceptions of what children with ASD can or cannot do.

Autism Friendly Fitness Centers in Connecticut:

The ASD Fitness Center

Autism Speaks List of Recreation Activities (provides a searchable database by state) 

Yoga Movement Therapy in Central Connecticut

Resources

Obesity takes heavy toll on children with autism. SpectrumNews.org (10 Sept 2015). post by Jessica Wright. Accessed 8 May 2017: https://spectrumnews.org/news/obesity-takes-heavy-toll-on-children-with-autism/ 

AutismFitness.com (website and book by Eric Chessen). http://autismfitness.com (free e-book available)

Sports, Exercise, and the Benefits of PHsyical Acitivitty for Individuals with Autism. (9 Feb 2009) AutismSpeaks.org : https://www.autismspeaks.org/science/science-news/sports-exercise-and-benefits-physical-activity-individuals-autism 

Autism and Swimming:  children with Autism can Benefit from Physical Activity. SuperSwimmersFoundation.org: http://superswimmersfoundation.org/Autism-and-Swimming.htm  

Physical Exercise and Autism. Edelson, Stephen. Autism Research Institute: https://www.autism.com/treating_exercise 

Jones, R. A., Downing, K., Rinehart, N. J., Barnett, L. M., et. al., (2017). Physical activity, sedentary behavior and their correlates in children with Autism Spectrum Disorder: A systematic review. PLoS ONE, 12(2), e0172482. http://doi.org/10.1371/journal.pone.0172482 

PDF: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330469/ 

Dillon, S. R., Adams, D., Goudy, L., Bittner, M., & McNamara, S. (2016). Evaluating Exercise as Evidence-Based Practice for Individuals with Autism Spectrum Disorder. Frontiers in Public Health, 4, 290. http://doi.org/10.3389/fpubh.2016.00290

PDF:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293813/ 

Bandini, L. G., Gleason, J., Curtin, C., Lividini, K., Anderson, S. E., Cermak, S. A., Maslin, M., & Must, A. (2013). Comparison of physical activity between children with autism spectrum disorders and typically developing children. Autism, 17(1), 44–54. doi:10.1177/1362361312437416

Broder-Fingert, S., Brazauskas, K., Lindgren, K., Iannuzzi, D., & Van Cleave, J. (2014). Prevalence of overweight and obesity in a large clinical sample of children with autism. Academic Pediatrics, 14(4), 408–414. doi:10.1016/j.acap.2014.04.004

Monday, 13 February 2017 14:09

Interfering or Inappropriate Behaviors in Autism

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We all have behaviors that can get in the way of being our best self at home, school or at work. We might lose our cool and want to scream at a co-worker. We can get stressed and want to hit something. But, we don’t. The executive thinking center of the brain doesn’t let us exhibit a behavior that will, ultimately interfere with our well-being. And that ability—to not scream, to not hit—is not easy for children on the Autism spectrum. 

Some behaviors displayed by children on the Autism spectrum would challenge the patience of angels. (Perhaps this is why parents of ASD children are often referred to as angels!) These challenging behaviors are often referred to as interfering behavior. In essence, these behaviors disrupt positive interactions with others and within certain settings such as home, school, or public places. When not managed effectively, Interfering Behavior (IB) has a detrimental effect on the social, emotional, and/or physical wellbeing of the child, his or her family, and peers.

What are Interfering Behaviors?

Interfering behavior varies among children with Autism and can range from mild, periodic vocal outbursts to inappropriate sexual touching. These behaviors disrupt the child’s day-to-day activities and prevent positive interactions with other people.

Interfering Behaviors commonly seen in Autism include, but are not limited to:

  • A tantrum that appears uncontrollable
  • Refusal to cooperate to perform a task (eat, get dressed, play a game, do homework)
  • Running from the authority figure at home, in public, at school
  • Hiding under the table
  • Eating non-edible items such as paper, erasers, soap
  • Making loud noises when quiet is expected
  • Laughing at inappropriate social times (e.g., at a funeral)
  • Destroying property
  • Being aggressive or threatening aggression
  • Banging one’s head on a wall, desk, etc. and other self-harming actions

What Causes Interfering Behavior in Autism?

Deficiencies in verbal and written communication skills, deficits in interpersonal interaction, sensory sensitivity, and difficulties with higher-level thinking and judgment are factors that underlie IB. The inappropriate behavior can result from the deficit in the skill needed to communicate feelings, needs and wants, or to successfully complete a task.

Here are a few examples:

Suri does not have language skills to communicate she wants to go outside. She throws a doll at the window to indicate this. She doesn’t know what else to do. 

Ian has limitations with hand coordination that may make playing a game hard for him. Out of frustration he throws a temper tantrum. 

A big part of healthy social functioning is linked to understanding the rules of social behavior. We listen to others when they speak. We shake hands or wave good-bye at appropriate times. Most children with Autism don’t understand the basic rules that govern how to develop friendships, how to ask for help, or when they should or shouldn’t share their private thoughts or physical bodies with others. 

John pushes a child in class because he wants to play but they aren’t paying attention to him. Pushing gets the other child’s attention, just not in a way desired or socially accepted.

Children with autism expect routine in order to feel secure in their surroundings. When routine is broken, they may have an outburst. The outburst disrupts their activity and the activity of those around them, but that is not the reason for the outburst. The outburst is their way of expressing the stress they feel and a lack of a healthy way to cope. 

Keep in mind that a behavior is a learned process. The first time a child learns that throwing the toy (rather than going to to the adult to indicate help is needed) gets attention and gets the problem resolved, the behavior is reinforced; the child will use it again and again. While behavior is typically learned over time, it can be reinforced in as little as one instance.

  • Behavior is performed to serve a need or a purpose.
  • When a child’s behavior results in a need being met, the behavior is reinforced. 
  • A behavior that is reinforced (achieves the desired outcome) will be repeated.

It’s also very important to remember that there is no one purpose or set of reasons why a given behavior develops. Two children who both have Autism may use the same IB for very different purposes.

How are Interfering Behaviors Managed?

Understanding how behavior is learned (a.k.a. the learning process) and the need it meets helps clinicians and parents identify how to manage the IB.  

In Autism research, a variety of Applied Behavior Analytic (ABA) methods have been shown to be effective for managing IB. Some of these methods/strategies are: Functional Communication Training (FCT), Visual Supports, Extinction, and Differential Reinforcement. 

Managing IB involves a variety of steps that will be unique to each child and family, and perhaps even to different settings in which the behavior can occur. The strategies used to change IB aim to 

  • nurture respect for the child and the situations in which they live, learn, and play;
  • provide a positive approach to prevent the behavior from occurring in the first place; and
  • identify ways to change the IB or replace it with appropriate behavior.

These strategies can result in significant improvement in the child’s behavior and enhance quality of life at home, school, and in the community.

Resources

Boyd, B. A., McDonough, S. G., & Bodfish, J. W. (2012). Evidence-Based Behavioral Interventions for Repetitive Behaviors in Autism. Journal of Autism and Developmental Disorders, 42(6), 1236–1248. http://doi.org/10.1007/s10803-011-1284-z

Dunlap G. and Phil Strain.  Challenging Behaviors, Autism Spectrum Disorders, and Prevent- Teach-Reinforce.  Presentation Accessed 7 Feb 2017: http://challengingbehavior.fmhi.usf.edu/explore/presentation_docs/10.10_challenging_behaviors.pdf 

AutismSpeaks.org  “Family Services: Challenging Behavior Toolkit.” Accessed 7 Feb 2017: http://www.autismspeaks.org/sites/default/files/challenging_behaviors_tool_kit.pdf 

Virginia Commonwealth University Autism Center for Excellence. “Behaviors and ASD” Accessed 7 Feb 2017:  https://vcuautismcenter.org/resources/behavior.cfm 

Did you know there is a brain training technique that is effective for improving movement and behavior patterns in people with ADHD that is also used by world-class athletes and military veterans? It’s called Interactive Metronome®.

Interactive Metronome is a treatment that can be used alone or in conjunction with other therapies for a variety of learning, behavior, and movement disorders.

The aim of Interactive Metronome (IM) is to restore essential brain pathways that are responsible for coordinated movement and timely processing of information—also called “temporal processing” or “neural timing.” Timing of movement, coordination, and rhythm are orchestrated through the brain and are crucial to daily tasks such as getting dressed, walking, writing, and basic thinking, organization and planning. Poor rhythm and timing is associated with difficulties in attention, motor coordination, balance and gait, language processing, and impulsivity. 

Developed in the 1990’s, Interactive Metronome has been shown to improve timing and coordination of movement in people with ADD/ADHD, Autism Spectrum and other behavior disorders. It has also been successful for those with impaired motor skills, dyslexia and other learning disorders, as well as movement disorders such as cerebral palsy.

What is Interactive Metronome Training Like For a Child? 

IM uses a game-like auditory and visual platform that engages a child and reinforces the target behavior/movement pattern with high-speed, easy-to-understand feedback. The technology challenges the child to synchronize movements to a precise computer-generated reference tone that they hear through headphones. The goal is to match the rhythmic beat of the tone with the behavior/movement pattern they are trying to learn.

Movements that are trained with IM can be as simple as hand and/or foot patterns, as well as complex motor movements that involve intricate decision-making.

Research on IM shows that the approach helps children with learning, behavior and developmental disorders:

  • Improve planning and sequencing
  • Improve focus and attention 
  • Improve motor control
  • Enhance mind-to-muscle communication 
  • Enhance their ability to focus for longer periods
  • Enhance their ability to filter out internal and external distractions

IM is a way to retrain the brain using interactive auditory and visual games or cues that kids respond to.

Is Interactive Metronome Treatment Right For My Child?

Compared to other therapies, IM is still considered a new approach in treatment. Clinical research is addressing questions such as how IM can be effective for different people and for different health conditions. No two people with the same illness or disorder experience it in the same way. This is why treatments for one person might not work as well for another person. Your child’s clinician is the best person to talk with about how Interactive Metronome may benefit your child. 

Learn more with these articles & videos:

  1. IM Training in sports (general overview), Learn More
  2. Research Studies with Outcomes Described for General Audience, Learn More
  3. Shaffer, R.J., Jocokes, L.E., et al., “Effect of Interactive Metronome Training on Children with ADHD” Amer Jnl Occupational Therapy (Mar/Apr 2001), 55:2, 155-162. Accessed Nov 14, 2016, Learn More 
  4. National Resource Center on ADHD, Learn More 
  5. Medical Citations on IM and ADHD, Learn More 
  6. Video Demo of IM, Watch Video 
  7. Interactive Metronome at Talcott Center for Child Development, Learn More

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