One in 68 Children has Autism

QSAC's blog – Clinical » Clinical

Future Focus on Autism Treatment: Biomarkers

January 24, 2017 3:00 pm Published by

asd testThe autism diagnosis has been based on information collected from clinical assessments. These data points include a battery of clinical tests, level of participation in social interaction, communication skills, repetitive behaviors, and parent surveys. However, the advances in the understanding of the genetic architecture of autism spectrum disorders (ASDs) have been shifting the paradigm to a model that integrates unique biological and clinical features of the person and the health problem into clinical management. Therefore, the future focus on autism treatment is to identify biological markers or biomarkers to prevent, diagnose, treat and prognosticate autism. According to Strimbu and Tavel (2010), a biomarker is “a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.”

 

Genetic testing may reveal a genetic susceptibility of an individual to develop Autism Spectrum Disorder. A diagnostic biomarkers may help the earlier detection of autism. A prognostic biomarker may indicate how a condition will be developed in an individual who is already diagnosed. A predictive biomarker helps determine which individuals are most likely to benefit from a specific treatment option.

 

There are several organizations, such as Autism Sequencing Consortium and Autism Biomarkers Consortium for Clinical Trials (ABC-CT) developing more objective knowledge to diagnose and treat autism spectrum disorder. According to Schaerer (2016) “recent advances have demonstrated that specific etiologic factors in autism spectrum disorders can be identified in 30%–40% of cases. Based on early reports newer, emerging genomic technologies are likely to increase this diagnostic yield to over 50%”. Heritability estimates over the past 20 years for ASD have been in the range of 70 to 90%.

 

Emerging biomarkers include genetics (genes susceptibility) and epigenetics findings, electroencephalograms (EEG) and MRI to measure brain function and structure, biochemical measures such as analysis of blood plasma metabolites, proteins, platelet serotonin, lower melatonin secretion/excretion; increased oxidative stress. Other diagnostic tools that can be considered biomarkers include eye tracking technology to measure visual attention, heart rate, pupil response, head circumference, dysmorphology and automated recording techniques to assess behavior and speech.

 

We hope that in the near future, the identification of quantifiable biomarkers related to genetic, biochemical, electrophysiological and behavioral mechanisms improve the diagnosis, prognosis and treatment of Autism Spectrum Disorder.

 

fmonegro-blog

Francisco Monegro currently serves as the residential Clinical Director of adult services programs at QSAC. He is also a consultant on autism for the PSCH clinic and the Shield Institute. Dr. Monegro received his MD/PhD in clinical psychology from the University of Santo Domingo/University of Kansas. In 1988, he received a diploma from the American Board of Medical Psychotherapists, Nashville, and from the International Academy of Behavioral Medicine, Counseling and Psychotherapy, Dallas, TX.

Another area of the brain linked to ASD

January 9, 2017 3:00 pm Published by
Dr. Joshua Henk Balsters and his colleagues performed MRI scans on individuals with ASD, and on a group of age and IQ-matched control subjects. Balsters et al found key differences in the brain activity between the two groups. The part of the brain that was affected plays a complex role in social interaction, affecting emotional intelligence and social cognition. 

Dr Balsters said: “A number of brain regions are activated when something unexpected happens, but there is a special part of the brain called the gyrus of the anterior cingulate cortex – the ACCg – that signals when something surprising happens to other people. We found that individuals with an ASD are less accurate at identifying other people’s expectations, but they also lack the typical response in the ACCg when surprising things happen to other people.”

Their findings were published this month in Brain: A Journal of Neurology. Click to read their abstract, Disrupted prediction errors index social deficits in autism spectrum disorder.

kdumoulin-blog

Kristen DuMoulin, Ph.D., BCBA, SAS, has been a devoted professional to the field of special education and individuals with autism since 1995. She joined Quality Services for the Autism Community (QSAC) in 2002 and is currently the Director of Children’s Clinical Services, where she is responsible for managing the clinical and administrative aspects of the Early Intervention (EI), Special Education Itinerant Teachers (SEIT), Special Education Teacher Support Services (SETSS) as well as the CPSE and OPWDD evaluation programs. She is a permanently certified New York State Special Education Teacher and School Administrator.

Future Focus on Autism Treatment: Precision Medicine

October 31, 2016 3:00 pm Published by

dna-strain“Personalized Medicine”, “Precision Medicine”, or “Individualized Medicine” is a concept that has modern applications to treatment of malignancies, heart disease, cystic fibrosis, HIV, asthma, hepatitis C, alpha 1 antitrypsin deficiency, among many disease. Jameson and Longo (2015) define precision medicine “as treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations”. In respect to Autism, our advancements in understanding the disorder has not yet translated to our ability to provide precision medicine. We have amassed a wealth of knowledge of the disorder, but have limited therapies to treat it.

According to a report by Sahin and Sur (2015), the heritability of autism has been estimated between 0.7–0.8%, including de novo mutations and epigenetic and environmental factors configuring complex risk architecture (Frye and Rossignol, 2016). Genome analysis has shown association with autism and 15q11–13, 16p11.2, and 22q11.2 copy number variants (CNV) and single nucleotide variants which some of them are de novo (not found in either parent). In addition, several studies, using whole exome sequencing, have estimated between 400-1,000 susceptibility genes associated with autism (Kim and Leventhal, 2015).

Even though the advances in basic neuroscience and human genetics, according to Sahin and Sur (2015), patients with autism spectrum disorder have limited pharmacological options. So far, the FDA has approved only two drugs to treat irritability and not symptoms domain of autism, Risperidone (dopamine antagonist) and Aripiprazole (dopamine agonist). It is imperative to validate a set of measures, indicators or biomarkers (molecular, imaging and behavioral) to develop medications or a particular treatment which target different autistic phenotypes.

Early diagnosis of subtypes of autism would be important in testing which targeted treatment plans are most effective.

 

fmonegro-blog

Francisco Monegro currently serves as the residential Clinical Director of adult services programs at QSAC. He is also a consultant on autism for the PSCH clinic and the Shield Institute. Dr. Monegro received his MD/PhD in clinical psychology from the University of Santo Domingo/University of Kansas. In 1988, he received a diploma from the American Board of Medical Psychotherapists, Nashville, and from the International Academy of Behavioral Medicine, Counseling and Psychotherapy, Dallas, TX.

Instructional Fading – A Path to Increased Productivity

October 3, 2016 3:00 pm Published by

At the QSAC Preschool and Day School, we apply proactive strategies to increase prosocial behavior and decrease or prevent the occurrence of problem behavior. The proactive strategies that we implement are part of a system of Positive Behavior Intervention and Supports (PBIS). PBIS is a decision making framework that improves staff and student behavior through reward systems, careful environmental manipulation, and the use of evidence based practices and ongoing data analysis to monitor staff and student progress. Our PBIS framework includes 13 proactive/preventative strategies for increasing prosocial skills and improving overall behavior. One proactive strategy that we strive to include is instructional fading. Instructional fading allows instructors to systematically increase response requirements for students, so that students can learn to complete work sessions at a level that is as easy for them, before moving on to more difficult and longer work sessions. This blog post offers a synopsis of the research in instructional fading as an antecedent strategy. It is adapted from Maffei-Almodovar & Sturmey (2013).

Instructional fading is typically used to reduce problem behavior that functions for escape from a non-preferred activity (Butler & Luiselli, 2007; Horner, et al., 1991; Pace, Iwata, Cowdery, Andree, & McIntyre, 1993; Weeks & Gaylord-Ross, 1981; Zarcone, Iwata, Smith, Mazaleski & Lermanm, 1994) including SIB maintained by task avoidance (Iwata, et al., 1990; Repp, Felce, & Barton, 1988; Steege, Wacker, Berg, Cigrand, & Cooper, 1989).

Instructional fading consists of drastically decreasing the rate or difficulty of instructions identified as antecedents to escape maintained problem behavior and then systematically increasing the rate or difficulty of instructions to a predetermined acceptable level (Horner, Day, Sprague, O’Brien, & Heathfield, 1991; Pace et al., 1993; Weeks & Gaylord-Ross, 1981; Zarcone, Iwata, Vollmer, Jagtiani, Smith, & Mazauiski, 1993). Instructional fading is one way of possibly decreasing the momentary value of escape for a student.

Four studies have utilized instructional fading to decrease dangerous problem behavior (Butler and Luiselli, 2007; Pace, et al., 1993; Zarcone et al., 1994; Zarcone et al., 1993).  These studies were published in English and in peer-reviewed journals, included participants with identified developmental or intellectual disabilities, utilized a reversal or multiple baseline design to allow for Percentage of All Non-overlapping Data calculations (PAND), and targeted a dangerous problem behavior.  Dangerous problem behavior is defined here as a behavior likely to result in injury to the individual or to others in the immediate environment such as various forms of self-injurious behavior (SIB), aggression, elopement and property destruction.

Participants in the four studies (10 total) included seven females and three males aged two to 40 years.  Nine out of ten participants were diagnosed with moderate to profound intellectual disabilities and one was diagnosed with autism.  Experimental settings included a therapy room, two state residential facilities and one private school for children with developmental disabilities.  All 10 participants engaged in escape maintained SIB and one also engaged in escape maintained aggression.  Instructional fading interventions varied across studies to include instructional fading plus extinction (Pace, et al., 1993; Zarcone et al., 1994), instructional fading plus non-contingent escape (Butler & Luiselli, 2007) and a comparison of instructional fading plus extinction with extinction alone (Zarcone et al., 1993).

There were large effect sizes across all four studies, however, since each study utilized a slightly different variation of the instructional fading intervention, effect sizes will be reported separately for each study. Pace, et al., (1993) applied Instructional fading plus extinction to significantly reduce SIB across 3 participants (PAND = 94%.)  Zarcone, et al. (1993) compared instructional fading plus extinction with extinction alone and found that both interventions significantly reduced SIB.  Zarcone et al. (1993), however, also found that extinction alone produced less reduction in SIB (PAND = 85%) than instructional fading plus extinction (PAND = 94%).  Zarcone et al. (1994) also utilized instructional fading only applying extinction (with the rate of instructions held constant) when SIB remained high across 10 sessions.  Effect sizes for Zarcone et al. (1994) were less robust (PAND =  82%) indicating that instructional fading alone may be less effective than instructional fading plus extinction.  Finally, Butler and Luiselli (2007) implemented non-contingent escape plus instructional fading and reduced problem behavior with the most robust effect size (PAND = 100%.)

Experimenters in all four studies also reported increases in appropriate responses to instructions as instructional difficulty and frequency were faded in during interventions.  In this way, studies also reported increases in participant engagement. Instructional fading shows promise as a component in a treatment package to decrease and possibly prevent dangerous problem behavior when combined with either extinction or non-contingent escape.

At the QSAC schools, instructional fading is often included as a proactive, antecedent strategy and as part of a behavior intervention plan for escape maintained problem behavior after functional behavior assessments have been completed. Instructional fading is a tool that allows us to teach ours students to tolerate increasingly difficult task requirements. The ability to complete ever increasing work requirements is a skill that all working adults ideally possess. This is an important skill for all of our students, especially those that are preparing to enter less restrictive learning environments and work sites. Instructional fading is an avenue to increased independence that can help our students to meet their goals as independent working adults.

 

 

LMaffei-Blog-BubbleLindsay Maffei-Almodovar, MS Ed, MA, BCBA, has worked in the field special education since 2001. She joined Quality Services for the Autism Community (QSAC) in 2011 and is currently the ABA Training & Development Coordinator. She is responsible for designing, evaluating and monitoring staff training initiatives at both the preschool and Day School programs. Lindsay is a certified New York State Early Childhood General & Special Education Teacher and a Licensed Behavior Analyst. Lindsay is also a doctoral student in the Behavior Analysis Training Area of the Psychology Department at Queens College and The Graduate Center City University of New York (CUNY). Her research focuses on efficient methods of training staff members in evidence based behavior analytic procedures.

 

 

 

References

 

Butler, L.R.  & Luiselli, J. K. ( 2007). Escape-maintained problem behavior in a child with

autism: Antecedent functional analysis and intervention evaluation of noncontingent

escape and instructional fading. Journal of Positive Behavior Interventions, 9, 195

202.

 

Maffei-Almodovar, L., & Sturmey, P. (2013). Evidence-based practice and crisis intervention. In

D. D. Reed, F. D. DiGennaro Reed & J. K. Luiselli (Eds.), Handbook of Crisis

Intervention and Developmental Disabilities (pp. 46-69). New York: Springer.

 

Pace, G. A.,  Iwata, B. A., Cowdery, G. E.,  Andree, P.J., & McIntyre, T. (1993). Stimulus

(instructional) fading during extinction of self-injurious escape behavior. Journal of

Applied Behavior Analysis, 26, 205-212.

 

Zarcone, J. R., Iwata, B. A., Smith, R. G., Mazaleski, J. L., & Lerman, D. C. (1994).

Reemergence and extinction of self-injurious escape behavior during stimulus

(instructional) fading. Journal of Applied Behavior Analysis 27, 307-316.

 

Zarcone, J. R.,  Iwata, B. A., Vollmer, T. R., Jagtiani, S., Smith, R. G. & Mazauiski, J. L.(1993).

Extinction of self-injurious escape behavior with and without instructional fading.

Journal of Applied Behavior Analysis, 26, 353-360.

Co-morbid Disorders in Autism Spectrum Disorder

July 11, 2016 3:00 pm Published by

brainwavesAutism Spectrum Disorder is a neurodevelopmental disorder which is associated with multiple co-morbid disorders.

These co-morbid disorders include genetic disorders such as fragile X syndrome, tuberous sclerosis, 15q duplications, and untreated phenylketonuria; electroencephalographic abnormalities which is seen in 20–50% of cases such as in epilepsy; intellectual disability which is seen in approximately 70-75% of cases; medical conditions that are noted in 15–37% of cases such as sleep disturbance, gastrointestinal symptoms, obesity, asthma, allergies; autoimmune diseases such as hypothyroidism, hyperthyroidism; sensory issues; and psychiatric disorders such as major depression, bipolar disorder, anxiety disorder, schizophrenia, and OCD.

Mannion and Leader (2013, 2015) explain that one of the most researched topic, and not fully understood, has been the relationship between autism and epilepsy. The risk of autism is greater with epilepsy associated with tuberous sclerosis complex (TSC), and epilepsy associated with neurofibromatosis (NF-1). When we compare idiopathic autistic disorder and epilepsy, epidemiological studies have found that they co-occur in approximately 30% of individuals with either autism or epilepsy. The prevalence of autism is significantly higher than in the general population where 2% has been diagnosed with epilepsy (Tuchman, et al. 2010).

According to a research by Christelle, et al. (2015), all seizure types have been reported associated with autism. However, the most common type of seizures found in individuals with autism and epilepsy is complex partial and generalized seizures, where the activities are more frequent in temporal and parietal areas of the brain. In addition, there are shared genetic risk factors for autism and epilepsy. There are several copy number variants (CNVs) which are linked to both autism and epilepsy [e.g. 1q21.1 deletions, 7q11.23 duplications, 15q11.1-q13.3 duplications, 16p11.2 deletions, 18q12.1 duplications, and 22q11.2 deletions.]

The challenging behaviors such as repetitive behaviors, self-injurious behaviors, psychomotor agitation with disruptive behaviors and aggression in individuals with autism and epilepsy represent a difficult task in term of understanding and treatment options because some of these behaviors may be considered also part of the epilepsy phenotype.

Often we see that parents, educators, clinicians and custodians become frustrated at the challenging behaviors of this patient population. We believe that the best approach to developing a comprehensive treatment plan involves an interdisciplinary team that includes geneticists, psychiatrists, pharmacists, neurologists and psychologists.

 

 

fmonegro-blog

Francisco Monegro currently serves as the residential Clinical Director of adult services programs at QSAC. He is also a consultant on autism for the PSCH clinic and the Shield Institute. Dr. Monegro received his MD/PhD in clinical psychology from the University of Santo Domingo/University of Kansas. In 1988, he received a diploma from the American Board of Medical Psychotherapists, Nashville, and from the International Academy of Behavioral Medicine, Counseling and Psychotherapy, Dallas, TX.

Positive Behavior Intervention and Supports

June 6, 2016 3:00 pm Published by

As we continue to review the essential components of Positive Behavior Intervention and Supports (PBIS), this post is dedicated to the review of Functional Communication Training (FCT). In order to understand the importance of FCT, a quick review of PBIS is outlined below.

What is PBIS and why do the QSAC Day School and Preschool programs use it?

PBIS is implemented in school settings as a decision-making framework, not a curriculum. As a decision-making framework, PBIS defines expectations for both student and staff behavior and conduct. The goals of PBIS are to ensure that all students have access to the most effective and accurately implemented instructional and behavioral practices and interventions possible in order to improve academic and behavioral outcomes. Some of the outcomes associated with schools that utilize PBIS are less reactive, aversive, dangerous, and exclusionary situations for both staff and students. Management issues can be addressed in the classroom as well as improving supports for students whose behaviors require more specialized assistance (e.g., FBA, BIP), thereby maximizing student academic engagement and achievement (Horner, Sugai, Todd, & Lewis-Palmer, 2005) How is this done? Prevention is where it all begins. For many of our students prevention begins with FCT.

FCT is required to replace problem behavior that has a communicative intent. In order to decrease the use of problem behavior as a means to communicate, replacement behaviors that serve the same communicative function as the problem behavior are needed (Carr & Durand, 1985). For example, a student may engage in problem behavior to get access to an item he/she wants, leave an activity, gain attention, or tell us about discomfort or illness. /\We present this to families and instructional staff by asking: can your student(s)/child make his/her most basic wants and needs known to anyone who is “listening,” in the absence of problem behavior? If the answer is no, then we will work on FCT. In our schools, FCT consists of of intensive mand/request training (Greer & Ross, 2004; Sundberg & Partington, 1994). Depending on the student, his/her abilities, and the manner (topography) in which he/she communicates, our goal is to offer many (even hundreds) of opportunities a day to practice asking for items/activities/access. What does this have to do with PBIS?

In PBIS students can be provided with 3 levels of support: Primary (school/class wide supports), secondary (for smaller, at risk groups of students) and tertiary (specialized individual supports). FCT would fall within the secondary and certainly tertiary supports. Based on assessment and data, students in our schools have instructional goals to increase their ability to communicate more effectively and efficiently. As we know from the behavior analytic literature on FCT, the ability to communicate decreases problem behavior (Carr & Durand, 1985). Some of our students require that a large portion of their daily instruction be FCT. By increasing our students’ abilities to ask for what they want and need, we are better preparing our students to receive and benefit from learning opportunities. Think about how motivated you would be to come to work if you couldn’t ask for a day off, find out when your pay check was arriving, or even order your lunch.

In both QSAC schools, FCT is used as a secondary and tertiary support and is an essential part of daily instruction. By spending more time teaching functional communication, we strive to spend less time managing problem behavior; this falls in line with the definition of PBIS.

 

GFelicianoBlogGina Feliciano is the Senior Director of Education Services; prior to that Gina served as the Director of the Preschool. Gina is responsible for the overall operation of the preschool and day school. She is a Board Certified Behavior Analyst (Doctoral level) as well as a certified New York State Special Education Teacher and School Administrator.

Gina received her Doctorate from Columbia University in Special Education and Behavior Disorders in 2006.

Her previous professional experience includes being appointed as Director of Clinical Services, Director of ABA services and years training staff and education professionals as a Behavioral Consultant.

Gina has held academic positions as an adjunct professor at Hunter College, Pace University and Queens College teaching courses on behavior management, classroom management and education psychology.

 

 

References

Carr, E. G., & Durand, V. M. (1985). Reducing behavior problems through functional communication training. Journal of Applied Behavior Analysis, 18(2), 111-126. doi: http://dx.doi.org/10.1901/jaba.1985.18-111

Greer, R. D. (1987). A manual of teaching operations for verbal behavior. Yonkers, NY: CABAS and The Fred S. Keller School.

Greer, R. D., & Ross, D. E. (2004). Verbal behavior analysis: A program of research in the induction and expansion of complex verbal behavior. Journal of Early and Intensive Behavior Intervention1(2), 141.

Horner, R.H., Sugai, G., Todd, A.W., & Lewis-Palmer, T. (2005). School-wide positive behavior support. In L. Bambara & L. Kern (Eds.) Individualized supports for students with problem behaviors: Designing positive behavior plans. (pp. 359-390) New York: Guilford Press.

Sundberg, M. L., & Partington, J.W. (1998). Teaching language to children with autism or other developmental disabilities. Danville, CA: Behavior Analysts, Inc.

 

A Work in Progress: Ensuring Procedural Integrity within the QSAC School Programs

May 16, 2016 3:00 pm Published by

Procedural integrity is the extent to which an intervention is implemented as intended (e.g., Cooper, Heron, & Heward, 2007). There are a few other terms that have been used interchangeably with procedural integrity including treatment fidelity, treatment integrity and procedural fidelity. All of the above terms relate to the same basic theme: evidence based interventions should be applied as written to the greatest extent possible in order to achieve desired outcomes.

At the QSAC Day School and Preschool we prioritize the procedural integrity of our teaching procedures as part of our schoolwide Positive Behavior Intervention and Supports (PBIS). Our PBIS framework includes 13 evidence based proactive/preventative strategies for increasing our students’ prosocial skills and improving overall behavior. Procedural integrity of teaching procedures may be the most important of these strategies. In order for our teaching procedures to be effective, they must be implemented correctly. In order to ensure this, we employ Behavioral Skills Training (BST).

BST is an evidence based practice for disseminating behavior analytic skills to caregivers of varying backgrounds and experience levels (Dib and Sturmey, 2007; Ryan, Hemmes, Sturmey, Jacobs, & Grommet, 2007; Sarokoff and Sturmey, 2004; Seiverling, Pantelides, Ruiz, & Sturmey, 2010; Ward-Horner & Sturmey, 2008). BST packages generally consist of four components: 1) instructions, 2) modeling, 3) rehearsal, 4) feedback. At the QSAC schools, we are continually in the process of creating BST packages in order to effectively train our staff members to implement teaching procedures correctly. This process involves two basic steps. First, we break down each of our teaching procedures into multi-step behavior chains. The process of breaking down chains of behavior into their component steps is called task analysis. The task analyses developed make up the “instructions” component of the BST package. The next step in the creation of our BST packages involves the creation of a model for each teaching procedure. We typically create video models by recording experienced staff members implementing procedures correctly with our students. We then edit these recordings by adding freeze frames and embedded text to highlight important aspects of the models and make it easier for staff members to match what they see in the model with the task analyzed instructions. These recordings make up the “model” component of the BST package.

Once the necessary materials for the BST package are complete, training for a targeted teaching procedure can begin. At the QSAC Day School, our Director and our ABA coordinators train all new staff members to implement our teaching procedures using BST packages. At the QSAC Preschool, our teachers use BST to train their new teaching assistants to implement these procedures, while our Director and ABA coordinators train only new teachers. Training begins when the trainer provides the trainee with the task analysis for the targeted teaching procedure. The trainer then provides the trainee with a model of the procedure either by presenting a video model, or by performing a live model. The trainee checks off the steps of the teaching procedure on his/her task analysis as they watch the model. The trainer then observes the trainee rehearse the teaching procedure several times and provides the trainee with immediate feedback on their performance errors. These rehearsal and feedback sessions continue until the trainee meets a predetermined competency level and is able to implement the procedure independently. At both QSAC school programs, we manage an extensive database of each staff member’s training and his/her competency levels in implementing our teaching procedures. Staff competence is an important measure of school program quality. At the QSAC schools we strive to maintain a high quality program by ensuring the procedural integrity of all of our teaching procedures as part of our schoolwide PBIS system.

 

LMaffei-Blog-BubbleLindsay Maffei-Almodovar, MS Ed, MA, BCBA, has worked in the field special education since 2001. She joined Quality Services for the Autism Community (QSAC) in 2011 and is currently the ABA Training & Development Coordinator. She is responsible for designing, evaluating and monitoring staff training initiatives at both the preschool and Day School programs. Lindsay is a certified New York State Early Childhood General & Special Education Teacher and a Licensed Behavior Analyst. Lindsay is also a doctoral student in the Behavior Analysis Training Area of the Psychology Department at Queens College and The Graduate Center City University of New York (CUNY). Her research focuses on efficient methods of training staff members in evidence based behavior analytic procedures.

 

References

Cooper, J.O., Heron, T.E, and Heward, W.L. (2007). Applied Behavior Analysis (2nd Edition). Upper Saddle River, NJ: Pearson Merrill Prentice Hall.
Dib, N., & Sturmey, P. (2007). Reducing student stereotypy by improving instructors’
implementation of discrete-trial teaching. Journal of Applied Behavior Analysis, 40, 339-343.

Ryan, C. S., Hemmes, N. S., Sturmey, P., Jacobs, J. D., & Grommet, E. K. (2007). Effects of a
brief staff training procedure on instructors’ use of incidental teaching and students’ frequency of initiation toward instructors. Research in Autism Spectrum Disorders, 2,28–45.

Sarokoff, R. A., & Sturmey, P. (2004). The effects of behavioral skills training on staff implementation of discrete-trial teaching. Journal of Applied Behavior Analysis, 37, 535-538.

Seiverling, L., Pantelides, M., Ruiz, H. H., & Sturmey, P. (2010). The effect of behavioral skills
training with general-case training on staff chaining of child vocalizations within natural language paradigm. Behavioral Interventions, 25, 53–75.

Ward-Horner, J., & Sturmey, P. (2008). The effects of general-case training and behavioral skills
training on the generalization of parents’ use of discrete-trial teaching, child correct responses, and child maladaptive behavior. Behavioral Interventions, 23, 271–284.

Pharmacological Therapy that May Reduce Autistic Behaviors

April 11, 2016 3:00 pm Published by

monegroarticleThere is a hypothesis that the autistic disorder may result from an imbalance between excitatory glutamatergic and inhibitory GABAergic pathways. Some studies have investigated the potential role of Gamma-Aminobutyric Acid (GABA) modulators such as valproate (Depakote), Acamprosate (Campral), and Arbaclofen (Brondine et.al 2016); Memantine (Namenda) and Minocycline (Minocin) (Kumar & Sharma, 2016).

Depakote is an anticonvulsant medication. Acamprosate (Campral) is a GABA analog indicated for maintenance of alcohol abstinence. Arbaclofen is a derivate of Baclofen, a skeletal muscle relaxant. Bumetanide (Burnex) is a chloride co-transporter NKCC1 antagonist diuretic which can reduce intracellular concentration of chloride in neurons. Dipeptide L-carnosine acts by reducing zinc and copper influx near GABA receptors. Riluzole (Rilutex) is used for the treatment of amyotrophic lateral sclerosis (ALS).

Kumar and Sharma (2016) have studied the role of Minocycline and Memantine to reduce maladaptive behaviors. Minocycline is a tetracycline indicated to treat inflammatory lesions. Memantine is used for the treatment of moderate to severe dementia. While the authors did not study its effect specifically in Autistic subjects, they were able to demonstrate that Minocycline and Memantine reduced locomotion, anxiety, brain oxidative and nitrosative stress, inflammation, calcium and blood brain barrier permeability when these symptoms were induced by Valproic acid.

All of the above medications are not yet approved by the FDA for treatment of autism, although they may have potential off label use for autistic individuals.

 

fmonegro-blog

 

Francisco Monegro MD., PhD., currently serves as the residential Clinical Director of adult services programs at QSAC. He is also a consultant on autism for the PSCH clinic and the Shield Institute. Dr. Monegro received his MD/PhD in clinical psychology from the University of Santo Domingo/University of Kansas. In 1988, he received a diploma from the American Board of Medical Psychotherapists, Nashville, and from the International Academy of Behavioral Medicine, Counseling and Psychotherapy, Dallas, TX.

April 2nd – World Autism Awareness Day

April 1, 2016 9:00 am Published by

WAAdayTomorrow, April 2nd is the eighth annual World Autism Awareness Day.
This years theme is “Autism and the 2030 Agenda: Inclusion and Neurodiversity”

Autism and other forms of disability are part of the human experience that contributes to human diversity. As such, the United Nations has emphasized the need to mainstream disability in the Organization’s development agenda. Mainstreaming disability requires an integral approach in the design, implementation, monitoring and evaluation of policies and programmes in all political, economic and societal spheres, so that inequality is not perpetuated.

Disability and persons with disabilities are explicitly referenced in the following goals: 4) Quality Education; 8) Decent Work and Economic Growth; 10) Reduced Inequalities; 11) Sustainable Cities and Communities; and 17) Partnerships for the Goals.

QSAC pursues this mission through direct services that provide a supportive and individualized setting for children and adults with autism to improve their communication, socialization, academic, and functional skills.

 

kdumoulin-blogKristen DuMoulin, Ph.D., BCBA, SAS, has been a devoted professional to the field of special education and individuals with autism since 1995. She joined Quality Services for the Autism Community (QSAC) in 2002 and is currently the Director of Children’s Clinical Services, where she is responsible for managing the clinical and administrative aspects of the Early Intervention (EI), Special Education Itinerant Teachers (SEIT), Special Education Teacher Support Services (SETSS) as well as the CPSE and OPWDD evaluation programs. She is a permanently certified New York State Special Education Teacher and School Administrator.

People First Language

March 29, 2016 3:00 pm Published by

People First Language is an alternative way of talking about individuals with disabilities; it focuses on the person themselves, and not just their disability. People First Language was developed to promote and foster positive communication when speaking to, and about, people with disabilities. It puts the person before their disability, and describes what a person has, not who a person is.

For example, someone who wears glasses does not say “I have a problem seeing”; they say “I wear/need glasses.” The same can be said for someone that utilizes a wheelchair; instead of saying “I have a problem walking”, they say “I use/need a wheelchair.” As it pertains to autism, when we use the term “autistic”, it does not describe that person as a whole. For example, if I say “Bob is autistic”, I am only describing his diagnosis, which does not define who he is as a person. Instead, I can say something along the lines of “Bob is 15 years old, has brown hair and blue eyes, likes music and movies, has autism, and is caring and compassionate.” Having autism is only a part of who Bob is. When referring to someone as “autistic”, we are only referring to a part of them, and may be missing out on the many different aspects of what makes them special and unique outside of their diagnosis.

It is also important to keep People First Language in mind when discussing “high” and “low” functioning individuals. For individuals with developmental disabilities, the areas in which they need support may differ, and using the terms high and low functioning does not give us enough information as to where they need support. Here is a fictional story of two sisters:

Mary lives with her sister, Beth. She uses full sentences to communicate with others, and can travel independently. However, Mary needs assistance with cooking, making her bed, and cleaning her apartment.

Beth does not communicate using verbal language. She needs assistance and supervision while out in the community. However, Beth is able to independently cook, make her bed, and clean her apartment.

In that story, which is high and low functioning? Mary’s deficits are Beth’s strengths, and vice versa. Each woman is “high functioning” in some areas, and “low functioning” in others. Also, although it is nice to hear that your child is “high functioning”, referring to someone as “low functioning” can make an autism diagnosis even more challenging for a family to cope with. Instead, we can say that someone needs more or less support, which does not place them in a high or low category. It is important to be clear about where the individual needs support, instead of giving a general functioning label.

I also find it to be important to limit the usage of “unable to” or “cannot”. These words have a permanent, and oftentimes negative connotation. Even if it is unlikely that someone will be able to complete a certain task, if it is not impossible for them do so, we should not limit them with these terms. Instead, we can utilize terms such as “not yet able to”, which suggest that the individual has the ability to learn a certain skill with the proper supports.

The importance of being “people first” is more about the mindset involved, as it promotes a positive environment for individuals with disabilities and their loved ones. It gives individuals and their families encouragement, and ensures that the individual’s specific wants and needs are addressed, instead of being generalized. Most importantly, it gives us a better understanding of who the person is, outside of their disability. Having a diagnosis of autism, or any other disability, does not define people. We are all people first, and it is important to utilize the language that reflects this.

Kathie Snow has written a great article about People First Language, which is where I generated the information used for this blog. You can click here to see a copy of the article, if you would like to read more on the topic. By being mindful of how we communicate, we are also being mindful of the way that we treat and respect those with disabilities.

SGiangiobbeBlog
Sara Giangiobbe, MAT serves as a Medicaid Service Coordination Supervisor in QSAC’s MSC Department. She has been serving in a multitude of roles with QSAC since 2004. In addition to her professional role in the field of autism and developmental disabilities, she has a younger brother who is diagnosed with autism. She is a proud sibling and professional, and is also a regular contributor to onQ, QSAC’s blog.

ABOUT US

QSAC is a New York City and Long Island based nonprofit that supports children and adults with autism, together with their families, in achieving greater independence, realizing their future potential, and contributing to their communities in a meaningful way by offering person-centered services.

QSAC pursues this mission through direct services that provide a supportive and individualized setting for children and adults with autism to improve their communication, socialization, academic, and functional skills.