Sensory Processing Disorder and ASD

According to a policy statement from the section on Complementary and Integrative Medicine of the American Academy of Pediatrics Sensory Processing Disorder should not be used as a medical diagnosis. They express concern with it's overuse, and the application of sensory based therapies for which there is little if any evidence of effectiveness. Regretfully, even with a diagnosis of Autism Spectrum Disorder or Asleger's Syndrome many school district produce IEPs (Individual Education Plans) that rely heavily on these unproven treatment- while they avoid the use of validated behavioural treatments. Often the reason for this is that sensory based treatments are easier to implement with untrained staff, and there is simply a lack of trained professionals in the field of behavioural interventions (or classroom management). Click http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/33018 for the full story The statement says, "Pediatricians should not use sensory processing disorder as a diagnosis, according to a policy statement from the American Academy of Pediatrics. Although there are standardized measures of a child's sensory processing abilities, there is not a widely accepted framework for diagnosing the disorder, members of the AAP's Section on Complementary and Integrative Medicine wrote in the June issue of Pediatrics." The reort notes, "that the committee developing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has called for further research before officially recognizing sensory processing disorder." In addition, the authors wrote, "it is unclear whether children who present with sensory-based problems have an actual 'disorder' of the sensory pathways of the brain or whether these deficits are characteristics associated with other developmental and behavioral disorders." The report suggests that instead of diagnosing sensory processing disorder, pediatricians should perform a thorough evaluation -- usually with appropriate referral to a developmental and behavioral pediatrician, child psychiatrist, or child psychologist. The report continues, "consideration should be given to other developmental and behavioral disorders that may be associated with difficulty tolerating or processing sensory information, including autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorders, and childhood anxiety disorders." "Pediatricians should inform families that occupational therapy is a limited resource, particularly the number of sessions available through schools and through insurance coverage," the authors wrote. "The family, pediatrician, and other clinicians should work together to prioritize treatment on the basis of the effects the sensory problems have on a child's ability to perform daily functions of childhood." Here in Bc there has been tremendous growth in school based "sensory rooms." Often children with ADHD, Autism Spectrum Disorder or Asperger's Syndrome are removed from class and sent to the "sensory rooms" in an effort to calm them down, rather than the school completing an appropriate Functional Behavioral Assessment and developing a behavior based intervention plan that either teaches new skills or uses behavioural techniques (long known about and familiar to experts in the field) such as controlled exposure, relaxation and thought stopping interventions to teach the child appropriate ways to deal with unwanted sensory input. Little effort is made to help the child develop coping skills, self-southing skills or other alternative behavioural skills to deal with the sensory issues. Many parents feel that the over use of sensory rooms and removal from the teaching environment do little more than reinforce inappropriate and unwanted behaviours. A second look at the over use of the "sensory Processing Disorder" diagnosis seems like an appropriate place to start. While here in BC excessive removal from a classroom (Time Out / Time Away) due to behavioural issues seems acceptable. In the United States such removal would be considered a "change in educational placement" and would require approval by both the school special education team and parents. An excellent source of information on how behaviours that interfere with learning should be addressed in the classroom through well know and scientifically supported educational and behavioural techniques can be found at this web page: http://www.pent.ca.gov The PENT website offers free materials which any school district could use to address problematic behaviours which interfere with learning. An appropriate Functional Behavioural Assessment (FBA) is the place to start when addressing these kinds of issues. I have used the PENT training materials to implement training programs in completing and writing Functional Behavioural Assessments for almost 10 years and it is really unmatched ....and FREE. All of these training materials are....FREE. Rather than providing easy interventions that are not supported by science. I would hope that every school instead provides science based assessment and intervention programs that directly assess the behaviours of concern and use interventions techniques we know work. The problem comes down to this: If your child has a serious behavioural problem at school, you should expect that the school would implement strong, science based interventions that are designed to directly address the problem AND teach new adaptive behaviours. Changing the child's environment, and removing them from the classroom, is not a plan. Sensory room or not. If your having such problems with your child in school I would suggest contacting an expert in the field, a psychologist or professional educator, to visit the school, observe the situation and complete an FBA (Functional Behavioural Assessment)

What Treatments are there for Adults with Asperger's Syndrome or Disorder?

I am often asked: "What Treatments Are Available for Adults with Asperger Syndrome?" Many adults who have been having low level but continuous problems socially, at college, work or in their own family go on line and seek out a diagnosis. Often they complete a check list somewhere and it tells them they MAY have Asperger's Syndrome or Asperger's Disorder. Of course, one of the problems is the short check list was designed to do nothing more than search out signs and symptoms of Aspeger's, and honestly, there are a lot of people who you see most of those signs or symptoms in. A real diagnosis would have taken a broader view, and looked at alternative causes for these symptoms. This process is called "differential diagnosis" and a licensed psychologist or medical doctor familiar with Asperger's would have ruled in or out several very similar disorders. But, at any rate, you have completed the checklist, it says Asperger's and your symptoms are of concern. Many people wonder why someone would even go through an examination to get a diagnosis, because they aren't sure what "therapies" are even available. For children with Asperger Syndrome (AS) and other forms of autism usually there is a fairly common set of treatment interventions available through the school district. This might include physical, occupational and speech therapy along with some kind of social skills (social reciprocity) training and behaviour support. But for adults it's a very different matter. Most people start treatment because of some event that is currently going on in their lives. They may have had difficulty at school with more complex subjects, and their difficulty is related to Asperger's tendency to limit cognitive flexibility. This can be addressed through psychoeducation, practice and feedback. Others may be having problems at work. They could be similar to those just mentioned, or include time management issues, focus and attention problems very similar to ADHD, or social interaction issues. All of these are addressed through fairly common techniques, and the issue of social interactions, or social cognition, is usually addressed through psychoeducation (readings and discussions about how the brain works in social interactions) and modelling, then practice in using social cognition skills. For the individual with Asperger's this is a very different issue than "social skills training," which many people are pointed to by therapists who are not familiar with the complexity of Asperger's Syndrome or Disorder. As I always do, let me mention the work of Michelle Garcia Winner here. Here web page, www.socialthinking.com explains this issue really well. When adults come to my offices in Burnaby or Vancouver for treatment of aspects of their Asperger Syndrome I often recommend trying to look over Michelle's materials to get a firm grip on what exactly is going on when they have difficulty in social settings. Family issues is another point that often brings individuals with Asperger's Syndrome to the office. Sometimes we work together one-to-one on understanding and improving communications, sometimes we work on things as simple as arranging appropriate schedules and interaction times. Couples often need relationship counselling as well. And of course, educating your spouse can make a big difference. This is another place where a trained professional comes in handy. Finally, many individuals come in for the same symptoms and problems anyone might come to a therapist or psychologist for. They may have anxiety issues, phobias or depression. For these issues we often use an adapted form of CBT - Cognitive Behavioural Therapy to address the thoughts and feelings of loneliness, depression and isolation. Of course others come in because of legal issues after work place incidents, or to help get social services and so on. Some individuals need help with daily living skills like keeping a bank account, eating properly, exercising and finding a job. Others with Asperger's have anxiety because of their limited ability reading social cues at work where they may be a department head, director of research or university faculty. Asperger's is a spectrum disorder and individuals come in with a spectrum of issues they can use support and help with. These are just a few of the reasons individuals come to my office seeking help with Asperger Syndrome symptoms. For more information on the services I provide please feel free to contact me, or check out the information on my web page at www.relatedminds.com