National Conference on ASD 2020 – Scientific Session 2 – Therapeutic Advancements in Handling persons with Autism

Hi All,

this post is in continuation of “National Conference on ASD 2020” series, in this post you would find the details of Second Scientific Session happned on day one. The chairperson was Dr. Neeradha Chandramohan, below are the speakers who were part of this Scientific Session:
1) Dr. Pratiba Karanth – Recent Strategies in Communication Development
2) Dr.Jamuna Rajeswaran – Neuropsychological Interventions
3) Dr.Amitabh Dwivedi – Updates of Sensory Integration Therapy

********************************************************************************** Recent Strategies in Communication development for children with Autism Spectrum Disorders by Dr.Prathibha Karanth Ph. D

Dr. Prathibha Karanth is the Founder Director and Managing Trustee of The Communication DEALL Trust located in Bangalore and a Speech Language Pathologist with over 40 years of experience (She was the first one to speak post lunch, honestly my senses were not in sync at that time, but luckily her presentation was not related to medical terminologies, so was able to focus then and there.)

Few pointers from her presentation are given below:

1) She spoke about SCD i.e. Social Communication Disorder which mimics ASD in all other expects except the RRB’s (Restricted or Repetitive behaviors)

2) There is a difference between people who do not want to communicate and who have genuine difficulties in communication.

3) Following are the communication Interventions that were developed during the period range (1980’s to 2000’s):

• ABA/VBA – The strongest point is that it shall demonstrate changes, it can be quantified, documented and measured. The biggest criticism is that due to reinforcer model children will become prompt driven. She also referred about other terminologies which shares the ABA principles like Discrete Trial Training (DTT), “Lovaas therapy”, Functional Communication Training (FCT) , Pivotal Response Training (PRT) etc.
• TEACHH (Treatment and Education of Autistic and related Communication-handicapped children) – It focuses on the strengths of the child and follows structured teaching, it is a fading method now.
• PECS (Picture Exchange Communication System) – For Non Verbal children.
• DIR/Floor time (Developmental, Individual Difference, Relationship)
• RDI (Relationship Development Intervention)

4) Following are the communication Interventions that were invented and being followed after 2000’s:

• SCERTs (Social Communication, Emotional Regulation, and Transactional Support) – It is family centered approach focussing on enhancing communication and socioemotional Abilities of Children.
• Hanen – It is developed in Canada, where access to speech therapists were at scarce. The program was created to focus on communication delay and not a dedicated tool for Autism. The parents are trained by therapists on how to communicate with the child. Couple of programs offered by them are i) More Than Words® Program ii) TalkAbility Program
• PACT/PASS (Preschool Autism Communication Trial / Parent-mediated intervention for Autism Spectrum disorder in South Asia) – They focus on low-income and middle-income countries (LMICs).
• ESDM (Early Start Denver Model) has become very popular in recent times

5) The Communication DEALL program: functions within a developmental framework beginning with a focus on pre-linguistic skills such as eye contact, sitting tolerance etc followed by developmental skills across domains. Speech therapists, occupational therapists, psychologists are part of this program.

6) Few of the Communication Aids that are being used are:

• Oro-motor & Sensory Kit Set I & Set II
• Pragmatic Kit (Basic)
• Pragmatic Kit (Advanced)
• Stories of Everyday Social Skills
• Stories of Everyday Social Skills (Set – II)
• Proto-vocabulary Kit (My Proto-Vocabulary Book & My Verb Book)
• Assessment of Oro-motor skills in toddlers: A manual (with score sheets)
• Parallel Talk
• Communication Ring
•  Pre – DEALL Manual
• Visual Kit
• Teaching Independent Toileting Skills for Children with ASD
• Independent Activity Manual
• Gesture Manual
• Social Stories Set-3 (Scooter / Car ride & Sleep Book)

7) The proportion of non verbal autism children used to be 70:30 ratio i.e.one third (where out of 100, 30 may remain non verbal), whereas in recent times we have a seen an increase in this, where the ratio is now 60:40 (where out of 100, 40 may remain non verbal) . For such children we use AAC (Alternate & Augmentative Communication) such as Signaling, typing, Flash cards, Electronic talkers, Pointing out words etc ..

She is reachable through prathibha.karanth@comdeall.org

I found her speech informative, she did her best given that the timelines were short.

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Neuropsychological Interventions in Autism Spectrum Disorder by Dr.Jamuna Rajeswaran

She is a Professor & Head Clinical Neuropsychological and Cognitive Neuroscience Centre, Faculty In-charge Advanced Functional Neuroimaging at Centre for Cognitive Neurosciences, Department of Clinical Psychology NIMHANS, Adjunct Faculty, National Institute of Advanced Science, Indian Institute of Science, BANGALORE.

Few pointers from her presentation are given below:

1) People with autism needs Acceptance, Understanding, Tolerance, Inclusion, Satisfaction and Meaning as a part of their everyday life

2) Brain parts involved in Autism are:

• Inferior Frontal Gyrus (speech and language)
• Right inferior frontal gyrus (executive control /response inhibition)
• Anterior Cingulate Cortex ( reward anticipation, decision-making, ethics and morality, impulse control and emotion)
• Angular Gyrus (complex language functions )
• Insula (compassion and empathy, perception, motor control, self-awareness, cognitive functioning, and interpersonal experience)

3) Various other parts of the brain that are affected by Autism are:

• Amygdala
• Cerebral Cortex
• Basal Ganglia
• Corpus Callosum
• Cerebellum
• Brain Stem
• Hippocampus

4) Research on neuroanatomical models provides the following information:

• Autistic individuals have enlarged brains and heads.
• Cellular changes in the hippocampus and the amygdala increased cell packing has been seen in the amygdala
• Reduced cerebellar size
• The severe deficits in language and communication that characterize autistic disorder suggested the possibility of left cortical involvement.
• Prosody and language pragmatics are also affected which is right-hemisphere related, hence a left hemisphere hypothesis cannot account for all deficits
• Abnormalities in cortical and subcortical region, neostratium, sensory processing systems, and the cerebellum.
• A role for the medial temporal lobe was suggested by dilatation of the temporal horn in the left lateral ventricle observed

5) Unfortunately, like most clinically validated therapeutic approaches for ASD, behavioral therapy is time-consuming, not cost effective and low-potential benefit.

NEUROPSYCHOLOGICAL REHABILITATION

6) Neuropsychological rehabilitation is defined as a systematic functionally-oriented service of therapeutic cognitive activities, based on an assessment and understanding of the person’s brain-behaviour deficits. Services are directed to achieve changes by

• reinforcing, strengthening or re-establishing previously learned patterns of behaviour or
• establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems

7) Cognitive Retraining involves remediation of cognitive dysfunctions and Cognitive Adaption training improves adaptation and functions

8) Cognitive Tasks and Mediation:

• The tasks selected should be capable of being given at a) graded level of difficulty, b) able to score objectively c) able to modify and make it flexible etc
• Focus should be on basic functions such as ( attention, information processing speed )and higher cognitive functions such as (concept formation, planning, learning and memory). The improvement in basic functions will automatically facilitate the improvement in the higher cognitive functions as the program moves further ahead.

9) She also mentioned that neuropsychological intervention/therapy also is time-consuming, not cost effective and no empirical evidence.

EEG NEUROFEEDBACK

10) Neurofeedback (NFB), also called neurotherapy or neurobiofeedback, is a type of biofeedback that uses real-time displays of brain activity in an attempt to teach self-regulation of brain function. The research evidence on EEG neurofeedback suggests that it can capitalize on the implicit plasticity of the brain to induce neural, functional, and ultimately behavioral changes. By using quantitative electroencephalography (qEEG) and specific NF protocols (e.g., amplitude and coherence training) for individual subjects, NF can be targeted to fit the heterogeneity of autistic symptoms.

11) A Dysfunctional brain may have Unstable brainwaves, Too much of brainwaves over others or an impaired ability to shift from one mental state to another. It can be retrained through Neurofeedback.

12) Neurofeedback uses EEG which is used for measuring electrical activity in the brain. EEG captures electrical signals in microvolts which are then amplified to millivolt signals which are then stored in computer for analyzing the brain wave frequencies and provides us information in an usable form.

13) Based on the frequency bandwidth, brainwaves are classified.

• Delta: 0-4 Hz (It is a deep sleep wave Eg. Dominant in Infants)
• Theta: 4-7 Hz (It is a Light Sleep wave Eg. Creative thoughts, Internal Focus)
• Alpha: 8-12 Hz (It is a Relaxation Wave Eg. Meditation, peacefulness,Superior Intellgience)
• Beta: 12-30 Hz (Problem Solving, Focused, Thinking)
• Gamma: >30 Hz (It is rare brainwave Eg. Peak Concentration, Fastest Brainwaves, High level of cognitive function)

14) There are no risks associated with Neurofeedback, as it only measures the electrical activity in the brain. Doesn’t send anything else.

15) EEG is used as therapeutic tool where Brainwaves are Translated to Feedback in Real Time. Users get feedback based on their current mental state and try to improve it instantly.

16) EEG Neurofeedback can be used as therapy/training for Neurological, Psychiatric and General Medical conditions such as Autism, ADHD, Anxiety, Depression, Head Injury, Memory etc.

17) It works on the concept of Self-Regulation. Slowly, the brain learns to engage in a new way as feedback teaches it to self-regulate and correct a specific mental activity.

18) A minimum of 20 sessions needs to be provided on alternate days and a typical session time would be around 30-40 mins

19) Post NFT she was witnessed the following:

• I Q assessment showed significant improvement (96)
• Improvement in socialization
• Speech significant improvement
• Parents report 75-80% improvement

20) She concludes stating EEGNFT (Electroencephalogram Neurofeedback Therapy) is emerging hope in ASD however Empirical studies need to be carried out keeping Cultural aspects. She showed a video of a child who is being treated by her, with the changes / improvements attained through EEGNFT. She is reachable through drjamunarajan@gmail.com

I have personally heard EEG as a tool for diagnosing Fits/ Seizues and nothing more, looks like an experimental therapy.

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Recent Trends in the Interventional approaches of Autism Spectrum Disorder by Dr. Amitabh Kishor Dwivedi

He is an Occupational therapist and Dean of Jaipur Maharaj Vinayak Global University which is a college for Occupational therapy in Jaipur. (He was literally pressed for time, the host/chairperson were pushing him to wrap up asap.)

Few pointers from his presentation are given below:

1) The theory of mind is the ability to represent the mental states of others.It includes, knowing and anticipating what others think,  Joint attention and Cognitive and emotional empathy

2) The theory of weak central coherence states that people with ASD first focus on specific details of images or objectives rather than on their entirety. This can be assessed using the Navon Test

3) The theory of Executive Functions refers to cognitive skills to organize, be flexible, anticipate, plan & control our impulses. Key areas are:

• Response Control – Skill to inhibit immediate responses.
• Working memory – Storing information as a pre-requisite or tool to solve future problems
• Self-regulation of alertness, emotions and motivations – Modulating responses to situations.

4) From Neurobiological perspective, he mentioned Mirror Neurons and their functions such as:

• the part of the brain that is activated when making a facial gesture is the same part of the brain that is working when observing others’ facial expressions.
• when people look at faces, they react according to whether expressions are positive or negative by sending signals to emotional systems in the brain, mirror neurons also help facilitate and translate the emotions of others
• For example, sports fans tense with the action of the game, grimace and jump up and down; when you know the game, then your neurons are firing as if you’re playing the game

5) Recent Interventions in Autism:

• Dance and Movement Therapy
• Music Therapy – Helps overcome sensory aversions to certain sounds
• Play Therapy
• Floor Time
• Lego Therapy – Helps in turn taking, sharing, listening, team work, shared attention, etc.
• Behavioral Interventions such as ABA, DTT etc
• Relationship Interventions such as RDI
• Sensory Integration Therapy Help children learn to use all their senses together
• Social Skills Program – PEERS (Program for the Education and Enrichment of Relational Skills)
• PECS – Picture Exchange Communication System

6) Role of Genes:

• DNA sequencing, has advanced the study of genetics. whole exome sequencing (WES) and whole genome sequencing (WGS), are increasingly used in healthcare and research to identify genetic variations termed as next-generation sequencing
• A wide range of genetic variation is involved in ASD, with interplays of gene-gene and gene-environment interactions.
• Large-scale investigations combining NGS technology and accumulated clinical data will facilitate the genetic study of ASD from diagnoses to targeted treatments in the future.

Considering that occupational therapy plays a major role in children with special needs, i was disappointed with this particular presentation. It had very little takeaways or i must have had over expectations !

Regards,
Saranya and Karthikeyan
karthiksaranyaparents@gmail.com