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AUGUST 2016

QUESTION 1

QUESTION:
Working with a 6-year-old boy in preschool who bites everything he comes across. He does it regardless of mood or environment. Diagnosis is autism and hyperactivity, along with overall low development level. How can we help him with this?

ANSWER:
1. Map out what he likes to do. Commend him clearly for the things he likes to do (that do not include putting things in his mouth or biting). Use simple sentences, speak in a positive (straightforward) manner and maintain a pleasant tone. If he is unable to speak or understand spoken language, immediately stop him from biting things, calmly but firmly.
2. Don’t give him positive (or strongly negative) attention when he’s biting things. However, calmly and clearly show him that it is forbidden to bite things. Don’t say anything positive and don’t show any positive attitude in conjunction with the biting.
3. Try to understand what the biting means to him. Often it’s a case of either attention-seeking or demand avoidance. Try to find a different, positive behaviour that can substitute for the biting.
4. Give him a positive prompt rather than an admonishment.
5. Make sure to be with him during activities that he likes, use large toys. These are more difficult to put in one’s mouth.
6. If he is playing with other children, position yourselves so that you are able to actively instruct or interrupt him before he bites anything, in the manner detailed under item 4, but also by actively offering fun activities (as outlined in item 1).

Remember to be fun and nice adults, don’t nag, talk less! Use physical support to model (show) the behaviour you want the child to learn, as well as to help them gain desired skills.

BY BIRGITTA SPJUT/CHRISTOPHER GILLBERG


QUESTION 2

QUESTION:
I wonder whether it may be concluded that the ESSENCE concept is an important platform for organizing services for young children with complex neurodevelopmental/psychiatric disorders, i.e. that services should rather be developed on the basis of age groups rather than diagnostic labels?

ANSWER:
This is not an easy question, and any more concrete answer would have to be quite wordy. However, in summary, I believe that the ESSENCE concept is a good basis for suggesting that services need to organized in a primary care framework across the life span with GPs, child psychiatrists, pediatricians, child neurologists, child psychologists, speech and language therapists, education specialists, nurses, adult psychiatrists, adult psychologists, and social workers all working together, and, at least in the cities, under the same roof. The point is that the 10 per cent (at least) of the whole population who are affected by ADHD, ASD, LD, SLI etc. (i.e. any kind of ESSENCE) need to be able to access and avail themselves of services aimed at reducing stigma, academic failure, social exclusion, drug abuse, criminality and mental health problems more generally (that are the consequences of ESSENCE).

BY CHRISTOPHER GILLBERG


QUESTION 3

QUESTION:
My son J is diagnosed with ADHD/autism spectrum disorder. He is 28 years old and works in the food industry where he finds great use in his fantastic memory and thoroughness. He has had certain “themes” throughout his entire life. However, the latest one, which has gone on for a bit over a year, is the most dangerous theme yet. He has become fixated on the scale and isn’t eating or drinking enough. He is 160 cm (5’3) tall and now weighs 52 kilograms (114 pounds). A number of somatic problems have appeared now that he rather than drinking spends time exercising and bathing in the sauna every day in order to drop his weight further.

He is plagued by excessive hair growth, numbness, urological problems etc.

I helped him make a personal application to the Eating Disorder Unit at Malmö Hospital but we’ve received the reply that they do not treat people with autism!

As a result, we’re wondering where to turn next? With the support of his employer he has now been convinced that he needs medical care.

Is it a hopeless case, having both an eating disorder and autism?

ANSWER:
It’s fantastic that your son has a workplace where they recognise his strengths. However, these traits can also cause problems in other areas. What you’re describing is a major problem. Most counties don’t know who should take care of people with different so-called “double diagnoses”. The physical symptoms are common upon weight loss and must, as you say, be treated. Eating disorder units around the country have varying attitudes as to who they should treat and units for people with autism/ADHD are often unequipped to treat eating disorders. This is a growing problem as we learn more and more about these overlapping difficulties. Unfortunately the organisational structure within healthcare services is not adapting quickly enough to keep up, and it is easy to end up being caught in between and not getting the help you need. Again, conditions and standards vary throughout the country, but if the eating disorder clinic in your area is unable to help, you can turn to e.g. adult habilitation services or similar facilities. As for your specific case, these days one can freely choose where to be treated, so you could inquire whether you can get any help from the Eating Disorder Unit in Lund. In cases like these the person needs help in breaking their pattern of behaviour and perhaps finding a different “theme” or interest, and this goes for both people with eating disorders and people with autism/ADHD. Judging from your question, the fixation concerning food, exercise and weight seems to be the most urgent, which might after all indicate that an eating disorder clinic should be the right place to go for help. The ideal situation would be if for example the eating disorder clinic and habilitation services could collaborate in order to combine their knowledge of both conditions and thereby help your son and others in similar situations in the best way possible.

BY LOUISE KARJALAINEN


QUESTION 4

QUESTION:
Do you perform examinations of children as well? I have a daughter diagnosed with autism but there seem to be many other things that aren’t quite clear. Sometimes she starts stuttering and loses the ability to speak, and then I know she has contracted a cold or an infection that will break out within a few days. She is 5 years old now. We are operating under a biomedical approach and have had her on a gfcf diet for over 1.5 years.

ANSWER:
Regarding your daughter with autism: write a self-referral to CNC (BNK), Otterhällegatan 12A, 411 18 Gothenburg with a more detailed description of problems and previous examination, and we will try to help you from there.

BY MATS JOHNSON


QUESTION 5 & 6

QUESTION:
How much is currently known about IBT?

QUESTION:
I am the mother of Matheo in this article  http://www.gp.se/nyheter/g%C3%B6teborg/politikern-om-problemet-ingen-aning-1.1469960

I wonder what you think about the article on what the situation is like for autistic children in Gothenburg? A study from last year shows that intensive training is not the best method. Of course it is not, given the fact that Region Västra Götaland is using a “light version” of what has come to be called the Lövås method, and the fact that autistic people differ more than neurotypical people. Now many preschool directors are using that study as justification for not providing any intervention measures at all for our children. I would therefore very much like to know which methods and approaches you find to be best and how to customise them individually? What do you think about the work being conducted by habilitation services in the greater Gothenburg area? Are they knowledgeable enough? Should not we here in Sweden and especially we in Gothenburg be at the cutting edge given all the research you are conducting? Are there any researchers interested in conducting research on methods that may help our children reach their full capacity and facilitate our daily lives? If so, my family and I, along with many others I know, would like to take part.

ANSWER:
All clinical experience indicates that early intervention is helpful for children with autism (autism spectrum disorders). There are different kinds of intervention and these can be implemented with varying intensity, but must always be adjusted according to the individual child’s general development level, language level and other concurrent disorders/disabilities. Today interventions are often based on so-called applied behaviour analysis (ABA), a method based on a structured way of helping the child with learning, using the child’s own motivation in learning situations and reinforcing positive behaviours. There are also intervention types based on so-called TEACCH (Treatment and Education of Autistic and related Communication handicapped Children), i.e. on methods emphasising visual support in learning, positive routines and a structured approach to learning situations. Both ABA and TEACCH involve both parents and preschool staff in the treatment.

Intervention based on ABA can be implemented intensively – this is often defined as intervention measures taking place a certain number of hours per week – or non-intensively, meaning not as many hours but fundamentally built on the same learning principles.

The intensive measures are a frequent topic of discussion today, and many studies have compared children with autism receiving different measures – those receiving intensive measures with those receiving other types of measures (non-intensive), with follow-up of the children’s development and function. The majority of these studies have shown greater improvements for children receiving intensive measures compared to those not receiving such measures, but the studies have been small, and included around 20-40 children.

In one of the largest follow-up studies including some 200 children, about half of whom had received intensive interventions and half of whom had received non-intensive, but so called riktade insatser during a two-year period, we could not show that children with autism generally improved more from intensive than non-intensive interventions. As intervention commenced, parents of the children in both groups received an education programme on autism; about the children’s fundamental difficulties, how to treat and interact with them and how to approach problem situations. In this study we were unable to show that the most intensive measures gave better results compared to non-intensive measures. The study showed that the children’s intellectual ability, more so than the intervention type used, was most important to the child’s development during the study period.

There are studies indicating that intensive measures may be good for certain children with autism. However, clinical experience tells us that these measures are likely the most important ones for children: all-round examination, early diagnosis and information to parents and preschool staff about the individual child’s fundamental cognitive difficulties and strengths, as well as intervention measures, including increased adult support for the child to aid in learning, interactive and problem situations, and finally, creating an “autism-friendly environment”.

It is also important for every child with autism (autism spectrum disorder) to get a medical evaluation regarding such aspects as causal factors, problems with food/food intake and sleep, and follow-up over time.

BY ELISABETH FERNELL


We will reply to more of your questions next month!

Regards from the GNC researchers.

 

Page Manager: Anna Spyrou|Last update: 8/17/2016
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