Autism Therapy: repetitive

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Clinical Case Studies, by Sigafoos, J., Green VA, Payne D., O’Reilly MF, and Lancioni GE, published in 2009, summarized Oct 28, 2010

Providing leisure activities may distract children with autism from long-terms habits of obsessively rearranging objects.

Many people with autism insist on sameness and do not like change. This case study was aimed at seeing if structured leisure time would help a student (15-year-old boy) with autism to spend less time moving the objects on his desk. This treatment approach was an antecedent intervention that gave the student a chance to do his behavior at a time when it was okay with the teacher. The treatment approach reduced obsessive-compulsive behavior and also caused the child to be more social in the classroom. The authors suggested that this treatment approach may be helpful for children with autism and repetitive behaviors.


J Autism Dev Disorder, by Sokhadze, EM, El-Baz A., Baruth J., Mathai G., Sears L., and Casanova MF, published in 2009, summarized Jun 24, 2010

Repetitive transcranial magnetic stimulation (rTMS) may help to improve the behavior of children with autism.

The authors had studied the brains of people with autism before and found that many people with autism have small changes in their brains. Other research has shown that people with autism have problems using their brains to process what they see and hear, and this problem can be studied using event-related potential (ERP). The main goal of this current study was to see the effects of low frequency rTMS on behavior and social function of people with autism. The authors also looked at electrical readings from the brain (EEG and ERP). The study had only 13 patients.


Child and Adolescent Psychiatric Clinics of North America, by de Martinez-Peraza, F. L., and Carter AS, published in 2009, summarized Feb 12, 2010

Early diagnosis of autism may lead to effective early intervention.

This review article gives an overview of diagnosis, testing, and therapy options for children with autism. Details focus on children with autism or pervasive developmental disorder-not otherwise specified (PDD-NOS). Autism may be diagnosed based on problems with social interactions and communication. A child with autism also may have repetitive behaviors. The Academy of Pediatrics recommends routine autism screening between 18 to 24 months of age. Early intervention therapy may be designed to offer the best chance for learning at each stage of development. The authors suggest that physicians monitor younger brothers and sisters of children with autism for symptoms of autism. Therapists and physicians may also consider that parents face more stress when faced with an autism diagnosis for their child and suggest family therapy for the parents.


Journal of the American Association of Physician Assistants, by Dyke, EM Van, published in 2009, summarized Nov 13, 2009

Physician assistants may be able to help children with autism more if they learn about symptoms and diagnosis of autism.

This article describes the symptoms of autism in infants, children, and young adults. Symptoms include poor social skills, repetitive behaviors, narrow obsessive interests, and poor communication skills. The author suggests that general developmental screening of all children be done at 9-, 18-, 24- and 30-month check-ups at the doctor’s office. Physician assistants can become familiar with the symptoms of autism. They can also become familiar with resources for families in their community to help connect families with the care they need.


Movia Robotics got started helping kids with autism when founder Timothy Gifford’s wife told him schools needed tools to help kids in the classroom. The robots provide social cues to the kids by using external sensors. The robots are predictable and repetitive so that children can learn responses to social situations that involve real people. Gifford explained, “We're trying to improve their quality of life by giving them basic skills," he says, "and through these skills giving them a way to better interact in the world with kids and adults.”

Read original article: Hartford Firm's Robotic System Helps Children Manage Autism


Daniel Thompson didn’t speak until he was four; his autism had been diagnosed when he was three. The now 19-year-old is the subject of a documentary by Act-A-Part titled “Daniel’s Autism – Not Anymore.” Daniel’s father explains that Daniel, who has a driver’s license and bowls a 200, excels because of 80 hours a week of applied behavior analysis (ABA) at the Allegro Autism School in New Jersey. When Daniel was not at school, the family continued with the ABA. The family discovered that Daniel “thinks in pictures and learns in numbers and sequences.” Along with the ABA, Daniel received stimulation to his brain. His parents have found research showing that the stimulation may help form neural connections in his brain. Daniel has held several jobs and prefers those where he can do repetitive work on his own. He may be able to do speaking tours once his documentary is complete; his parents are hopeful that he can learn skills to earn money for independence.

Read original article: Filmmakers Track Teens Life with Autism


Tripp Black an 8 year-old with autism, had lost the ability to speak at age 2. Recently, his parents enrolled him in an experimental therapy program at Beth Israel Deaconess Medical Center that uses singing, movement, and imitation to improve speech skills. After participating in the therapy, Tripp began saying simple words. Gottfried Schlaug, the director of music and neuroimaging at the medical center has found that music combined with motion helped victims of stroke regain speech, and adapted his therapy to children with autism. For 8 weeks, on a daily basis, 10 children participated in the study. The children would hear sung words, be shown a picture of the word, and have their hands guided to tap drums. Schlaug believes that “the combination of sound and movement can activate a network of brain regions that overlap with brain areas thought to be abnormal in children with autism. Researchers think the intensive, repetitive training on sound paired with motion will help strengthen those abnormal areas.”

Read original article: When Language is Blocked, Music May Offer Detour


Stephanie Bruno Dowling, a speech therapist in Pennsylvania, uses warm weather and summer activities can help improve communication with a child with autism. She advocates as much outdoor activity as possible: walking, swinging, and riding bikes. These activities provide good opportunities to communicate with the child. Dowling says, "When I have a child on a swing, we practice saying repetitive phrases, such as "1, 2, 3!" and "Ready, set, go!". In addition, the child needs to either say or sign "more please" in order for me to give another push. I have also found that they will say "stop" and "all done" more readily when they have had enough."

Read original article.



Please comment on this autism topic.

PDD-NOS Repetitive Behavior

Aug 28, 2011 by Claudia Cella

I'm looking for guidance. In case of a child with PDD-NOS that shows repetitive behaviours - such as playing the very same scene of a movie over and over - is it advisable to make him stop by using a distractor or negotiation or whatever works with him, or is it better to just let him watch the movie the way he likes?

The boy I have in mind is 7. He has been working with a neurologist, a psychopedagogist and a neurologist since he was diagnosed at 2 and has developed good social skills. He attends school, has friends, is a very calm, loving boy. He´s a happy kid. He usually has some repetitive behaviours but there are days that for no reason at all - at least to my knowledge - the intensity of the repetitive behaviours increases. Instead of playing with his brothers like he usually does, he may spend a whole afternoon watching the same 10 seconds of a movie, normally a funny part that makes him laugh.

So, is it ok to let him do that or should I find the way to make him stop?


Responding to repetitive

Feb 12, 2011 by ricky wilson

Gabapentin help with sleep and repetitive motions on children with austim.


Ayurveda for Autism Spectrum Disorder

Jan 4, 2011 by sunethriayurved...

Hi everybody,

I am Dr.Prasad M, MD (Ay.), working with autistic kids from 2002 onwards. I went through the article mentioned. Let me share with you an unbiased information on the scope of Ayurveda, the age-old Indian system of Vedic medicine, in the treatment of ASD. This is based 100% on my personal experiences. Kindly see the following passages. Comments and criticisms are welcomed whole-heatedly. 

Scope of Ayurveda in Autism Spectrum Disorder

Trials with Ayurvedic medicines and treatments for their efficacy in ASD are going on at various centres in India and abroad.   The main advantage of ayurvedic medicine is that it has got a magazine of safe therapeutic preparations of various forms which are developed by continuous trials and rectifications over thousands of years.  There are many preparations like kwatha (decoction), churna (powder), arishta (self-fermented beverage), gudika (pill), ghrtha (medicated ghee), thyla (medicated vegetable fats) etc.  In recent times, many of the herbs used in Ayurveda are proven to have excellent detoxifying effect as well as free radical- scavenging potential.  The therapeutic preparations like kwatha are combinations of many herbs.  These combinations are originally developed on the basis of ayurvedic principles.  Till recent times these formulations were not given due consideration by the western scientists.  But now the picture has changed. More and more ayurvedic preparations are under their evaluation.  In Ayurveda, the compounds as well as single herbs are used for different purposes of health care like pacifying vitiated functional units called doshas, eliminating excessive toxic accumulations, providing targeted nutrients to tissues, tuning the mind-body coordination, sharpening the efficacy of sense-organs, and so on.  These prescriptions are based on personalised evaluation of different aspects like body constitution, doshik status, power of digestion and assimilation, status of bowel evacuation, physical strength, mental constitution, and etc which is done by experienced physicians.  Mind is an important factor in the healing of any ailment.  It is assumed that mind is like ghee which is held inside a pot called body.  If the ghee is hot the pot also gets warmed and if the pot is hot definitely the ghee also will be hot.  You cannot expect warm ghee in a cool pot and wise versa.  Similarly, food is given the supreme role in the healing process as well as in the maintenance of health.  It is a basic concept in Ayurveda that there is no use for any medicine if one stick on to pathya (wholesome) food (as it brings about health spontaneously) and there is no use for any medicine if one stick on to apathya (nasty) food (as there is no scope for functioning of the medicine).   In the context of autism, these assumptions are extremely important and seen exceptionally beneficial. 

The care of autism, as per ayurvedic principles, is based on the protocol of a three-step intervention

  1. detoxifying the body by regulating the agni
  2. Cleansing the dhatus (body tissues) by medicines and therapies
  3. Enhancing the mental abilities like comprehension, memory etc. by promoting the Agni.

Again, though the stages are generalised the execution will be personalised. 

The first stage is based on medicines almost completely.  Medicinal preparations like purgatives, specific formulations for de-worming, for enhancing the functions of the liver and pancreas, for enhancing the digestive fire (Agni), and for regulating the intestinal motility are used in this stage.  Certain preparations meant for squeezing out heavy metals from the tissues are also used.  Turmeric, garlic, curry leaves, etc are having this advantage. 

Second phase is mainly comprised of massages.  Traditional methods like abhyanga (hot-oil massages), udwarthana (dry powder massages), pindasweda of various types, thalapothichilpizhichil, etc are used here.  These manoeuvres improve the muscle tone, reduce hyperactivity, create better motor coordination, and normalize most of the obsessive repetitive movements.  Child sleeps well.  The bowels become more regular at this stage.  He/she will be more receptive to commands or suggestions.  The demand for sensory stimulation slows down considerably and the symptoms like increased sensitivity to certain sounds (hyperacusis) slowly disappear.  There will be oral medications parallel to the therapies and a few of these medications will be carried over to the next phase as well.  

Third stage is very specific and sold not be started before the proper completion of the first two.  This is an important point as there is a general tendency to mark the condition as mental retardation and to prescribe brain tonics and memory boosters to all autistic kids indiscriminately.

The major therapies in this stage are shirodhara (pouring of liquids like oils on the head), shirovasthi (holding of medicated oils on the head inside specially designed leather-rims), shiropichu (wetting the scalp with oil bandages), dhoopanam (fumigation with specific medicines) etc along with specific medications like kallyanakam kashayam, indukantham kashayam, gorochanadi gudika,balakanakapathradi kashayam, sidharthakam gudika etc.  Certain specific herbs like sahadevi, sankhapushpi, vacha, vishnukranthietc are also used.  Follow up is done with ghee preparations like mahakallyanaka, mahapaisachika, brahmighrtha, saraswathaghrtha, etc. 

Conclusion

It is seen that the classical ayurvedic treatment done systematically give promising results in kids diagnosed with ASD.  But it should be emphasised that the level of improvements is different from child to child.  Another important point is that these interventions are made in a corrective manner.   The child gets relieved of a lot of physical problems and tantrums.  But this will not make him/her a normal child.  Intensive training and special education are needed to put him on track and to catch up the peers.  This requires the dedicated involvement of parents, special educators, and skilled professional like occupational therapists.


Citalopram: No Effect in Autism

Dec 3, 2009 by Anonymous

Does citalopram help children with autism? A Citalopram (Cilexa®) study made a big splash in the autism community this month. Citalopram is an antidepressant that has been prescribed off-label for children with autism. Doctors thought it might reduce repetitive behaviors (rocking, hand flapping, etc.) in children with autism. A new study suggests that it probably won’t make a difference.  

Citalopram is a selective serotonin reuptake inhibitor (SSRI) which is a class of drugs that are FDA-approved for depression. SSRIs are said to be widely prescribed off-label for children with autism, but hard numbers are not known because of the off-label use. They are prescribed off-label for other conditions, including obsessive compulsive disorder (OCD) in children.  

King et al (2009) reported results of a large randomized, placebo-controlled, double-blind study of citalopram with 149 children (5-17 years old). The children had autism, Asperger syndrome, or pervasive developmental disorder not otherwise specified (PDD-NOS). All of the children had moderate to severe compulsive or repetitive behaviors. They received citalopram therapy (10-20 mg/day) or placebo for 12 weeks. 

Citalopram therapy did not reduce repetitive behaviors or improve any other behaviors that they measured more than placebo. The authors tested more than 11 behaviors and skills using 3 different standard clinical tests.  

Why is this important? For one thing, citalopram may be commonly prescribed for children with autism, though it is tough to know just how often. Pair that tidbit with the solid design study. The design is quite solid for this kind of study. They had 149 children in the study, placebo controls, double-blinded design, 12 weeks of drug therapy, and 3 standardized tests for 11 different behaviors. And they found no effect.  

The second reason it is important is that this study also showed a noticeable “placebo effect.” The placebo effect is when people who take placebo in the study report having a response (either better or worse). In this study, 34% of children taking placebo showed improvement in the behavioral test scores. The patients and the researchers didn’t know which they were receiving (hence the term “double-blind”). So about 1/3 of the patients showed improvements, whether they took the placebo or the drug



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