National Conference on ASD 2020 – Scientific Session 4 – Alternative & Native Medicine and Gender Issues

Hi All,

this post is in continuation of “National Conference on ASD 2020” series, in this post you would find the details of fourth and the last Scientific Session happened on day two. The chairperson was Prof. S. Sudhakar, below were the speakers who are part of this Scientific Session:
1) Dr. Partheeban – Native Medicine & Alternative Approaches for Autism
2) Dr. Amrita Panda – Handling Gender Issues in Persons with Autism
3) Ms. Kavitha Krishnamurthy – Art Based Therapies
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Understanding and Unravelling the Autism – Scope of Ayush System of Medicine by Dr.Partheeban Kanagasabai.

Dr. Dr.Partheeban Kanagasabai is a Siddha practitioner and Director of “Swabhimaan- Holistic Solutions for Autism” which is based on Indian system of medicines including where Siddha, Ayurveda and Yoga. Few points from his presentation are given below:

1) Due to raising cost in Allopathy (Western) medicines, people are moving towards alternate medicines. The cost is expected to get doubled in less than 10 years time frame.

2) Autism does not exist in Isolation, it will always have one or more co-morbid conditions with it. They could be:

• ADD
• ODD
• Specific Learning Disabilities
• ADHD
• Anxiety
• Tourette
• OCD
• Developmental Co-ordination Disorder
• Gifted / Savant
• Sensory Integration Disorder
• Auditory Processing
• Depression

When we focus on the co-morbidities and manage it along with autism, it becomes easier for the child’s development.

3) One third of the Autistic population has Epilepsy.

4) The reason why ASD should be approached with holistic intervention is due to its :

• The biological profile of Autism is complex
• Multi-factorial (not restricted to single cause) , involving many causes
• Multi-Systemic , involving many parts of the body, not just brain

5) Comorbid Conditions

• Medical comorbidities are much more prevalent in people with ASD than in the general population.
• Eczema, allergies, asthma, ear and respiratory infections, gastrointestinal problems, severe headaches, migraines, and seizures.
• Individuals with autism appear to be at increased risk for developing common chronic diseases including: diabetes, coronary heart disease, cancer, and osteoporosis

Some behaviour issues are triggered due to the above mentioned comorbid conditions as well.

6) An autistic Individual is same as any other individual, he can get all medical illness which is faced by any other individual. It is a misconception, that once a person is diagnosed with autism he is excluded from all other illnesses which are applicable to any individual. Even this state is extended to the health /Medical insurance companies, most of the policies exclude people with Autism in it. For policies where Autism individuals are covered, they are only covered for treatments related to Autism and not for other medical conditions which any individual can get.

7) Mortality is significantly increased in autism, with death rates being more than three times higher than the general population.  Premature deaths in autism are mostly the result of co-occurring medical conditions such as epilepsy, respiratory, gastrointestinal and cardiovascular disease. Risk of both epilepsy and premature death increases with the severity of autism

8) He shared a slide containing chart which indicated, the medical and psychiatric conditions faced by Adults with ASD. It contained medical conditions like:
Gastro-Intestinal Disorders, Hyper Tension, Diabetes, Obesity, Sleep Disorders. And the psychiatric conditions are: Anxiety, Depression and Suicide Attempts, where the % is more for psychiatric conditions.

9) Behaviors which may indicate an underlying comorbid illness include:

• Sudden change in behaviour
• Loss of previously acquired skills
• Irritability and low mood
• Tantrums and oppositional behaviour
• Frequent night-waking or general sleep disturbance
• Teeth grinding
• Change to appetite or dietary preferences Heightened anxiety and/or avoidance behaviors
• Repetitive rocking or other new repetitive movement
• Walking on toes
• Posturing or seeking pressure to specific area
• Sensory hyper-responsitivity: hyperacusis (e.g. covering ears with hands)
• Tactile defensiveness
• Sensitivity to light
• Behaviour around evacuation
• Aggression: onset of, or increase in, aggressive behaviour Self-injurious behaviour: biting, hits/slaps face, head-banging, unexplained increase in self-injury
• Constant eating/drinking/ swallowing (‘grazing’ behavior)
• Frequent clearing of throat, swallowing Mouthing

10) “ Sudden and unexplained behavioral change can be the hallmark of underlying pain or discomfort. Behavioral treatment may be initiated as the possible concurrent medical illness is being investigated, diagnosed (or excluded), and treated, but the behavioral treatment should not substitute for medical investigation.

11) Other areas to be aware of are:

• Heavy metal toxicity (Lead)
• Dietary allergy / sensitivity
• Immune system dysfunction
• Nutritional deficiency (Picky Eaters)
• Sensory integration issues

12) Ayush Treatment protocol: We are not substitute of any of the existing medications and treatments child is undergoing, we do not suggest in stopping any of the medications that are being followed. Our therapies are in addition to it:

• Yoga therapy
• Siddha medicines
• Ayurvedic External therapies including abhyangam, kizhi, shirodhara, podithimiral and applications/patru (It is efficient for sensory issues on child , it is non evasive)
• Customised healing diet
• Varma therapy (Non evasive)
• Sports/arts activities

Ayush stands for Ayurveda, Yoga, Unnani, Siddha and Homeopathy.

YOGA

13) Resistance to the word “yoga”

• Some people think it is cult
• Associating religion with yoga
• Associating language restriction
• Western countries are the first to adopt yoga in treating children with special needs

14) Initial challenges in introducing Yoga to children with ASD

• Response: fight, flight, or freeze modes that divert blood from the digestive organs to the skeletal muscles.
• Some of the kids don’t speak—don’t have language
• Some children also have trouble engaging
• They don’t have the kind of motor planning skills like going from point A to point B to point C
• Their self stimulatory behaviors

15) Benefits of Yoga for Autism and special needs

• Strength
• self esteem
• communication
• body awareness
• self regulation
• flexibility
• Motor skills
• balance

16) The child is more co-operative and calm after a yoga session

SIDDHA

17) Autism concept in Siddha:

• Maantham
• Kanam
• valippu
• sanni
• Kirigai- 18 types
• Kalleri kirigai (throwing things)
• Neerkudi kirigai ( repeatetive behaviors)

18) There is a Gut brain relationship and Extra-esophageal symptoms of GERD (Gastroesophageal reflux disease) in Children like:

• Dental erosions
• Chronic sore throat
• Chronic cough
• Apnea / bradycardia
• Wheezing / asthma
• Otitis / Sinusitis
• Hoarseness

19) Following are the few Siddha Medicines that are currently being prescribed:

• Improves enzyme flora in the gut (Korosanai maathirai)
• Tridhosha samanam (Metabolic regulators)
• Anti geno-toxic effects ( Tulasi)
• Enhances chelation in the body (kaatu puliyaranai, karumpullanchi)
• Immuno-modulators boosts the child’s immunity
• Kayakalpa drugs acts as anti-oxidants and promotes rejuvenation of the nerve cells (Karisalai)
• Valuluvai- celastrus paniculatus
• Podudhalai- Lippia nodiflora
• Kirkman – Curcurmin / Turmeric Root Extract capsules

VARMAM

20) Varmam- what not to do

• No group practices
• Read the sensory profile ( Preparation is very important in this practice)
• Connect with the child before going therapeutic
• Focus on “great beginnings”
• Do not stop other treatments
• Gentle enhancement
• Can also be part of Abhyangam
• customize as per the needs of the child

21) Following are the varmam techniques that might provide to be effective for children on ASD:

• Agathaarai thadaval
• Purathaarai thadaval
• Mundasu adangal
• Uchi adangal
• Kothanda adangal
• Pirai adangal
• Thanduvada pinnal
• Mudichugal
• Chau kalam
• Kauli kalam
• Komberi varmam
• Viruthi kalam
• Ullangai chakkara adangal
• Patha chakkara adangal

22) Healing effects of siddha external therapies in ASD

• Epileptic attacks reduced
• Aggression/violence has reduced
• Stomach disturbances has come down
• Better sleep
• Attention-concentration improved

23) Siddha external therapies

• Includes Thokkanam, kizhi, thaarai sikitchai, podi thimiral, Thalam, nasyam
• Elimination of toxins
• Rejuvenation of nervous system
• Helps balancing of the three bio-energetic forces
• Remedies insomnia

24) WHY DIET SHOULD BE THE MATTER OF REAL CONCERN FOR THE CHILDREN WITH AUTISM !

• Low hydrochloric acid/ lack of digestive enzymes (Big reason for behavioural issues)
• Low pancreatic functions (Healthy food will not be absorbed by the system)
• Chronic candidiasis (Fungal infection, which mimics autism like behaviours, it can be identified with help of a stool test. It takes few months to heal after diagnosis.
• Leaky gut syndrome/ gluten caesin intolerance
• Constipation (Due to lack of physical activities)
• Imbalance in essential fatty acids (Omega 3, 7, 9 . Autism children needs more omega supplement that a neurotypical child due to their over thinking abilities)

25) Sports therapy – benefits

• Intensive sports activity decreases stereotypic (self-stimulatory) behavior
• Sports activities reduces stress, anxiety and depression
• Improves sleep, reaction time and memory
• A good p.ed program should have a place in child’s IEP.

26) Our responsibilities

• Unconditional acceptance
• Optimistic
• Energetic and enthusiastic
• Consistent
• Willing to learn new things
• Always be in charge

He session ended very quickly, he covered points crisply. I have consulted him personally for my child a year back, hence i was aware of his practices and approach.

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Handling Gender Issues in Persons with Autism by Dr. Amrita Panda PhD, Rehabilitation Psychology Program Head Pradip Centre for Autism Management Kolkata

She has been talking on this topic for past 9 years. She is part of Pradip Center for autism in Kolkatta which has been catering to the needs of autism children for 19 years. Below are the few points shared by her:

1) Concept of Sexuality

• Human sexuality is the way people experience and express themselves sexually.
• It’s the way they express their identity.
• Sexuality is NOT just about Sexual Act.
• It’s Physiological Need and also Expression/Way of communication of a person with the world around

2) Human sexual drive is a primary drive; it is not optional.

3) Sexual awareness is normal. Sexual feelings are normal, and there are many ways of expressing them.

4) The Sexual Dichotomy

• Pleasure
• Pain
  • Physical
  • Psychological (Love, Fear, Abuse, Discrimination, Prejudice, rape)

5) Sexuality & Developmental Disability – If a person has a disability, it does not change any of this.

6) People often falsely believe that people with ASD are, sexually immature or do not experience sexual attraction (Konstantareas & Lunsky, 1997), are unaware of their sexuality and are uninterested in intimacy (Sullivan & Caterino, 2008).

7) Adolescence in ASD

• Individuals with ASD mature physically and sexually according to normal developmental stages; however
• A young with ASD can develop normally in some areas of social and emotional understanding and have difficulties in others.
• What often changes is the socialization that provides the foundation for sexual identity.

8) Challenges of GENDER ISSUES in ASD are due to Individual, Family and Society

9) Challenges of GENDER ISSUES in ASD are : Shame, Guilt, Inhibition, Embarrassment and Lack of knowledge

10) Concerns

Families and caregivers are often concerned about the growing sexual behaviour in young people with disability because it is generally not accompanied by a corresponding growth in the field of social know-how which often leads to socially embarrassing behaviour.

11) Common Sexual Behaviors During Transitions IN ASD

• Touching private body parts
• Removing clothes in public
• Masturbating in public areas
• Touching others inappropriately
• Discussing inappropriate sexual subjects
• Obscene gestures
• Non-consensual hugging consensual hugging
• Inappropriate remarks and suggestions that have sexual connotations
• Echolalic repetition of sexual terms
• Perseveration on sexual topics

12) The Impairments of ASD Related to Sexual Behavior

a) Challenges with Socialization Skill

The impairments in social awareness and reciprocal social interaction, necessary for learning and understanding appropriate sexual interaction leads to errors in social judgment.

b) Concept of Privacy
These errors in social judgment can interfere with the ability to assess whether they should perform certain behaviors in public or private places and how and why they should practice personal hygiene

c) Communication Difficulties

Difficulty learning how to interact with others, recognizing subtle cues, communicating with others and considering their own and others’ viewpoints.

13) PURPOSE OF Sex Education

• Awareness about own sexuality
• Awareness about other’s sexuality
• Eradicating the stigma
• Concept of privacy
• Ensuring safety
• Ensuring happiness

14) Sexuality Education for ASD: The Difference

Typical sexuality education programs for people with disabilities alone may lack components that address the unique social skill needs of people with ASD
Teaching should be less about “what erections are and why they occur” and more about what to do when they have one.

15) Sexuality Education

Before teaching social/sexual skills, the person’s individual preferences, strengths and communication skills should be assessed. It is recommended that a thorough functional behavioural assessment (FBA) is undertaken as part of this individualized approach.

16) When to Start Sex Education

Sexuality education for individuals with ID is usually taught when inappropriate behaviors are first seen (e.g. public masturbation) and when the intervention leads to a behaviour change considered meaningful to others (e.g. menstrual hygiene)
BUT Privacy training should start from childhood

17) Adolescence Training is as Important as Any Other Management Process for Individuals with ASD

18) Components of Adolescence Training are: Safety, Privacy and Hygiene.

19) Naming Body Parts

In the early years, we give children information on being a boy or a girl. It is also helpful to give them correct names for their body parts including penis, vagina, and anus. These terms should be taught using relaxed and open language.

20) Toilet Training should focus on Independent toileting and Fading out prompts, so that child knows the privacy and has independance

21) Bath Time training should teach the following:

• Bath time is also a good time to teach body awareness including the need to treat one’s body with respect.
• This can be taught, regardless of the identified level of disability.
• Independent bathing
• Independent use of soap
• Independent drying

The purpose is for the kid to feel the privacy, Functional Independence and Pleasure.

22) Privacy is a Basic Human Right

23) With respect to Hygiene, one should take personal care of themselves such as Brushing, Nails, Shaving, Soap. Also the same extends to Menstruation and
Masturbation.

24) Caregiver’s Role

• Give our children a loving understanding of sexuality.
• If we give them the message that their sexuality is precious and wonderful, then they will have some information with which to balance the rather conflicting messages they will likely receive from the dominant culture.
• When they are old enough to be aware of others around them, saying to them: “I know that feels good and it is supposed to feel good, but it is also something that is special and private.” This type of explanation would help them understand their sexuality.
• Whatever words you choose, they will best serve a child by imparting the notion that sexual feelings are wonderful and very personal.

25) Behavior Modification Strategies

• Ensure the person can engage in a variety of non-sexual pleasurable activities
• Identify and reduce environmental causes of anxiety
• Ensure the person has the ability to communicate their needs, seek attention and express emotions
• Respect the privacy of bedrooms (private space)
• Eliminate the use of mechanical restraints such as bodysuits which restrict the person’s access to their body
• Ensure the person has access to their private space whenever they choose.
• Make available a number of sensory-specific activities based on individual assessment of preferences
• Allow private time when bathing (if safe to do so)
• Provide access to water-based lubricants and/or sexual aids, if it’s necessary
• ‘Shape’ behaviour according to the environment (e.g. help to redirect the person to their room if they are found to be masturbating in the lounge room)
• Use appropriate interventions such as social stories and social scripts for HF ASD
• Obtain a medical review for persistent anal touching/ scratching/ picking

26) The best Sex Education is a full awareness of: social skills, boundaries, sexual expression, and expectations.
27) Let’s Not FIX Sexual Issues of ASD Assuming Sense of Superiority. They Need Empathy, Love, Understanding To Understand & Explore Sexuality Their Own Way

28) Your sexiest body part is your MIND

She is reachable in Email: pradip_autism@yahoo.com and musicsocial@gmail.com

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Arts-Based Practices with persons with autism by Ms. Kavitha Krishnamurthy 

She has been working in the art based practices field for around 8 years. She began the session with a Tamborine, interacting with the Audience without any words expressing music as a means of communication.

1) Arts-based practices means using the Creative Arts to accomplish planned goals within a purposeful relationship

2) Creative Arts include

• Music
• Movement
• Visual arts – painting, sculpture, print making, drawing etc
• Play
• Weaving
• Theatre
• Photography
• Poetry

3) The Goal can be either a planned goal or based on the explicit and implied needs of the individual in the areas of: Sensory-motor, Relatedness, Communication and expression and Emotional regulation

4) Purposeful relationship

• Contained within the safe space provided by the facilitator
  • not ‘splashing paint on the walls’ or putting music and getting everyone to dance
  • Not ‘anything goes’
• Facilitator intervenes to gently nudge the person towards meeting the planned goal; is purposeful.
• Not teaching an artistic skill – but using the arts for a specified outcome
• Work with where the individual or group is

IMPACT

5) Connectedness and relatedness

• Art is often the first connection with the external world
• Indicators of connectedness
  • Eye contact
  • Smile
  • Sense that they are ‘present’

6) Emotional regulation: Reducing anxiety, increasing sense of calm Over time, “settles” them

7) Sensory need fulfillment

• Sensory art
  • Tactile
    • finger painting
    • sand
    • slurry
    • clay
  • Kinesthetic
    • movement,
    • stamping, mono printing
  • Auditory – music

8) Social skills improvement such as Turn taking and Group skills – sense of group

9) Self-expression

• Arts – a voice, a means of self-expression
• Reflection of personality, of who an individual is

10) Communication

• Spontaneous initiation – high motivation
• Skills of communication
  • Repeating sounds (last sound of line of song)
  • Artistic Communication (through music, rhythm, movement – through art)

11) Why does art seem to work for people with autism

• Innate connection with the Arts
• Duality and complexity in the Arts – appealing
  • Pattern lovers – a certain repetitiveness, predictability, structure
  • Is spontaneous, creative, free flowing – expresses a hidden, invisible part of their selves

12) Caveat here is

• Arts – not a magic potion, a panacea
• Has its place, alongside other interventions aimed at skill building
• Inter-disciplinary approach works best
• Art opens windows, that need to be built upon, with all professionals working together

13) Thank You

Acknowledging with gratitude, students, parents,
colleagues and mentors from

She is part of the below organization

Kilikili
Bubbles Centre for Autism
Sampoorna Music Therapy Centre
A Brush with Art
The CanBridge Academy

Regards,

Saranya and Karthik

karthiksaranyaparents@gmail.com