Autism
Behavioural
syndrome characterised by impairment in reciprocal social interaction,
impaired communication skills, restricted range of interests and
activities. Prevalence of 5-15/10 000. Incidence appear to be increasing.
M 4x>F.
Symptoms:
appear ‘aloof’, self absorbed and remote; do not point
to objects; avoidance of eye-to-eye contact; lacks facial expressions;
lacks make believe play; ‘unavailable’ emotionally;
do not seek shared enjoyment; have poor language development; attention
focusing problems; overly repetitive mannerisms; resistant to change;
may have multiple allergies; oversensitive to light, sound and touch;
outbursts and tantrums; self abusive behaviour
Controversy
– MMR vaccine and autism
Toe walking is common
Asperger’s syndrome
Could
be variant of autism continuum.
Have
strong interest in repetitive activities and a strong desire to
avoid changes in the environment.
Difficulty in initiating and maintaining a two way conversation.
Paucity of emotional expression and facial gestures.
Often
become intensely interested in unusual subjects.
Attention deficit/hyperactivity disorder (ADD/ADHD)
Most
common neuropsychological disorder in children. Boys up to 8x>
girls; affects 6-9% of children;
Unknown
aetiology, but theories involving neuronal pathway dysregulation,
especially involving the monoamine neurotransmitters (norepinephrine,
serotonin, dopamine) – drugs used to treat act by promoting
the release of these neurotransmitters.
Clinical
features:
Usually starts between ages 3 to 7; child is fidgety; has problems
concentrating; impatient; impulsive; excessively switches from one
activity to another; very often does not complete tasks;
Management:
Many strategies:
• family therapy; behavioural/cognitive approaches
• methylphenidate (Ritalin™) ? usually respond rapidly
and dramatically
Advice
to parents of the child with ADHD (Lessen, 2001):
• ADHD is a real disease with a real treatment – it
is not personal failure
• Consistency is one of the keys to effective treatment
• Make it easier for your child to succeed rather than punish
failure
• Celebrate your child’s strengths – work with
your child’s weaknesses
• Use behaviour techniques, such as enforcing time out, setting
limits, and remaining claim
• Minimise negativity – it will destroy your child’s
self-esteem
• Pay positive attention
• Feedback must be immediate and more powerful with ADHD children
• Do it – don’t talk about doing it
• Home environments should be as structured and orderly as
possible
• Give clear, powerful instructions, and ask your child to
repeat tem to you
• Concrete reward systems are helpful, particularly with younger
children
Sensory Integration Dysfunction/Sensory
Modulation Dysfunction
Sensory
integration is the ability of the brain to organise and process
sensory information from the visual, auditory, vestibular, tactile
and proprioceptive sensory systems. A sensory integration dysfunction
occurs when there is an inability to adequately interpret these
sensations. Based on initial work by Jean Ayres (1972) as a theoretical
framework for occupational therapy that has practical implications
(Smith-Roley et al, 2001; Bundy et al, 2002). It provides an alternative
explanation for deviations in function, learning and behaviour
Sensory
integration is a natural part of development and occurs dynamically
throughout development. Children are typically sensory seeking –
they seek out sensory information. It appears that sensory input
is capable of enhancing neural connectivity.
The
three major postulates of sensory integrative theory are (Bundy
et al, 2002)
1) Learning is dependant on the ability to take in and process sensation
from movement and the environment and use it to plan and organise
behaviour
2) Individuals who have decreased ability to process sensation also
may have difficulty producing appropriate actions, which, in turn,
may interfere with learning and behaviour
3) Enhanced sensation, as a part of meaningful activity hat yields
an adaptive interaction, improves the ability to process sensation,
thereby enhancing learning and behaviour
Sensory
integrative approaches are used in a number of developmental disabilities
such as autism, cerebral palsy, fragile X syndrome, premature birth,
prenatal drug exposure and hearing impairment.
Identification
of defects in sensory processing (adapted from Blanche & Nakasuji,
2001):
Tactile defensiveness/hyper-responsiveness to tactile input:
• Object to being handled when not wearing clothes
• Struggle against being held
• Object to light touch
• Startle easily when being touched lightly or unexpectedly
• Push the clinicians hand away
• Rub or scratch the part of the body that has been touched
• avoids touching certain textures or surfaces
• unwilling to wear foot orthoses
• avoids barefoot on grass or sand
• dislikes finger/toe nails being cut
• walking on tip toes to minimise contact with ground
Proprioception
processing:
• fails to adjust the body in response to changes in position
• bumps or crashes into objects
• grinding of teeth
• likes shoes or buckles tightly fastened
• has difficulty going up or down stairs
• leans into clinicians hands when being examined
• can’t stand on one foot
Vestibular
Dysfunction:
• objects to having feet leave the ground
• fearful of swinging, spinning and sliding
• overreact when moved in space
• dislikes sudden or quick movements
• sits in ‘W’ position to stabilise self
• unable to catch self from falling
• poor gross motor skills – frequently trips
• difficulty moving hands and feet together such as jumping
or catching
Management:
Occupational Therapy
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