Transcript Next Steps into Adolescence

WELCOME
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Next Steps into Adolescence
Who’s here today?
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Parents, Caretakers, Grandparents?
Teachers? Case managers? Other professional
staff?
How old are the children you are here for?
8-12
13 – 17
18 & older
Any younger than 8 years?
This program is designed to help you...
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1. Begin to understand the impact of adolescence on
all individual with and without an ASD diagnosis.
2. Prepare for the physical, and
emotional changes that occur during this time period
3. Consider medical and emotional needs of the
individual with ASD and if meds might be
indicated
4. Consider educational, behavioral needs and if
there need to be changes in the current program
5. Think about accessing resources in your community
to support transitioning needs
Today
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Today we will look at adolescent development for the
teen able to express him/herself with ASD
This is how we will do it ….. ADOLESCENCE IS……
Beginning in 5th or 6th grade; 11 – 14 years
Extending through Middle into High School; 18 – 21
years
Adolescence is the next phase of development
Hear from real kids by video
If, why and when to consider medication
Family Panel Discussion
Adolescence
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It is a time defined by:
physical growth spurts
 mindboggling hormone releases
 ever changing and challenging social relationships
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 Adolescence
is not a regression
 It is the next phase, a developmental progression
Hormones & Behavior
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Some kids’ behaviors improve with the onset of
puberty
Some kids’ behaviors deteriorate with the onset of
puberty
Others have no changes at all……
Adolescence
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Keiran Rump, PhD
Adolescent growth and changes
Cognitive
Behavioral
Physical
Social
Emotional
Cognitive Development
Abstract
Thinking
• Generalization
• Hypothesis Testing
• Thinking about
topics that cannot
be seen
Executive
Functioning
Metacognition
• Higher level cognitive
functions
• Involved in decision
making and
regulation of
behavior
• Thinking about
thinking
• Greater awareness
of what you do and
don’t know
Impact of ASDs on Cognition
Intellectual
Disability
Difficulty with
reading
comprehension
or math
reasoning
ASD
Executive
Functioning
Deficits
Emotional Development
Identity
• “Who am I?”
• Integration of
opinions of
others with own
Autonomy
• Independence
from parents
• Determining own
set of principles
Impact of ASDs on Emotional
Development
Emotional
Awareness
Emotion
Regulation
ASD
Mood &
Anxiety
Social Development
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Julia Video
Social Development
Peers
• Relationships
outside family
• Peer pressure
and conformity
Sexuality
• Developing
sexual urges
• Comfort with
one’s sexuality
Sexuality and ASD
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Eric and Matt Videos
Sexuality and ASD
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Important to teach about sex. If
your children don’t learn from you,
they will learn about it elsewhere.
 Give accurate, age-appropriate
information.
 Give more than the biological facts
about sex. Sexual relationships
involve emotional aspects also.
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Sexuality and ASD
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Need to be explicit and teach specific directions
about what is appropriate behavior
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For example: “it is not OK to touch your crotch in public” or “it is
not OK to touch someone else’s private parts”
Specify who it is appropriate to talk to about sex
For example: “it’s OK to talk to mom & dad and _____ only
 It’s not OK to talk to a younger sibling
 It’s not OK to talk to classmates
 It’s not OK to talk to _________
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Make sure that your teen knows this is a special
conversation
General Guidelines for Tough Topics
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Ten tips
1. Start early
 2. Initiate conversations with your child
 3. …even about sex and relationships
 4. Create an open environment
 5. Communicate your values
 6. Listen to your child
 7. Be honest
 8. Be patient
 9. Use everyday opportunities to talk
 10. Talk about it again and again and again
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Practical Applications
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Jim Connell, PhD
Practical Applications
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Safety
Bullying
Hygiene
Sex, Drugs & Alcohol
Safety
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Safety
 Police
– register with your local precinct (see handout on
CD)
 Fires – practice fire drills – meet outside your home in a
safe location
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Autism ID cards, temporary tattoos, medical alert
bracelets (see safety hand out on CD)
Appropriate vs. inappropriate people (handout Circles curriculum)
Appropriate vs. inappropriate touching
Risky behaviors
Bullying
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Concerns
 To
be bullied
 To be the bully
 To
be recruited by the group to bully someone else
Hygiene
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Health
and Grooming (task analysis)
Shower
regularly
Use deodorant
Shaving
Use feminine health care products
Dress according to age
Video
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Nasaya
Sex, Drugs and Rock & Roll
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 Sex
Education
 Home
 School
 Personal
space and personal privacy
 Drugs – our children are adolescents first and are prone
to experiment.
 Peer
pressure
 Experimentation, prescription meds, huffing, markers, etc.
 Alcohol
 Peer
pressure
 Experimentation
Medical
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Eron Friedlander, MD
Medical System
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Primary care doctor
Developmental pediatrician
Neurologist
Psychiatrist
Gynecologist
Gastroenterologist
Medical Discussion
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Psychopharmacology
 Why
start medication?
 When should meds be stopped?
 When should medications be changed?
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When and why involve medical community
 General
Health
 Gynecology
 Sleep
 Seizures
Pharmacotherapy of ASD
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No effective treatment for core deficits
Compliment to standard behavioral and
educational interventions
Aimed at temporizing symptoms of comorbid
conditions
 Hyperactivity,
impulsivity
 Self-injurious behavior, aggression, irritability
 Affective disorders: depression, anxiety
 Sleep disturbance
 Seizures
Medication Summary
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Aggression
Antipsychotics
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X
Anxiolytics
Dopamine reuptake
blockers
Stereotypies
Sleep
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X
X
X
X
Stimulants
Alpha-adrenergic
agonists
ADHD
X
Antidepressants
Mood stabilizers/
AED
Depression
Anxiety
X
X
X
X
X
X
X
Seizures
X
Sleep Disturbance
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Diphenhydramine (Benadryl)
Antihistamine
 Over the counter
 Side effects: nervousness, anxiety, confusion, disturbed
coordination, tremor
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Melatonin
Hormone secreted by pinela gland
 Not yet empirically studied
 Side effects: headache, nausea, nightmares, enuresis, next
day irritability
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Benzodiazepines
Seizures
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Transient, involuntary
Altered consciousness, behavior, motor activity,
sensation, autonomic function
Excessive discharges from cerebral neurons
Most common neurological disorder of childhood (410% general population)
Epilepsy: 2 or more unprovoked seizures
(2-3% general population)
Seizures and ASD
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6% of children with ASD have a seizure
20-33% of children with ASD develop epilepsy
 Bimodal
age of onset
 1-5
years of age
 Early adolescence (most present after age 10)
 Occurs
in autism far above chance co-occurance
 Evidence
that autism is a neurologic rather than psychogenic
disorder
 Shared genetic basis for autism and epilepsy
Seizures and ASD Risk factors
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Associated intellectual disability
Birth injury / underlying neurologic disorder
Family history of epilepsy
Severe receptive-expressive language disorder
(verbal auditory agnosia)
Seizures and ASD
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All seizure types have been associated with ASD
Clinical recognition of seizures is complicated
Social detachment
 Stereotyped movements
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Manifestations of seizure activity
Sustained deterioration in behavior or level of functioning
without explanation
 Discrete periods of irritability, aggression, rage
 Staring spells +/- loss of memory for events
 Transitory cognitive impairment: brief interruptions in
memory, language, academic performance
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Gynecologic concerns
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Common complaints
 Irregular
bleeding
 Hygeine
 Menorrhagia,
dysmenorrhea
 Cyclical mood and behavioral changes
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Management
 NSAIDS
 Oral
 SSRI
contraceptives
Gastrointestinal Concerns
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17-85% individuals with ASD report
 Diarrhea
 Constipation
 Abdominal
pain
 Food intolerance
 Feeding selectivity
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No clear evidence of increased GI disease in ASD
Specific treatment only with validated disease
Parent Panel
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Self-advocacy
 Self- disclosure
 Self-reliance
 Independence
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Thank you
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Thank you for coming to Next Steps into
Adolescence.
 Consolidation
of a full day presentation.
 To learn more about ASD Research please go to
http://www.centerforautismresearch.com