BOOK
Acute Management of Autism Spectrum Disorders, An Issue of Child and Adolescent Psychiatric Clinics of North America, E-Book
Matthew Siegel | Bryan H. King
(2014)
Additional Information
Book Details
Abstract
The “spectrum” in this disorder is Autistic Disorder, Asperger Syndrome, and Pervasive Developmental Disorder. This issue specifically addresses acute management of the extreme behaviors that accompany this disorder spectrum: extreme behaviors, complete lack of communication, inability to learn or express language, etc, and covers in-hospital or residential therapies as well as in-home family involvement. Medical treatment for this disorder is the main focus of discussion in topics such as: Emotional Regulation: Concepts and Practice in ASD; Specialized Inpatient Treatment of ASD; Residential Treatment of Severe Behavioral Disturbance in ASD; Treatment of ASD in General Child Psychiatry Units; Behavioral Approaches to Acute Problems; Communication Strategies for Behavioral Challenges in ASD, along with topics covering Psychiatric Assessment of Acute Presentations in ASD; Sensory Regulation and its Relationship to Acute Problems in ASD; Family Dysfunction, Assessment and Treatment in the context of Severe Behavioral Disturbance in ASD; and Self Injurious Behavior in ASD.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Acute Management of Autism Spectrum Disorders \r | i | ||
| Copyright\r | ii | ||
| Contributors | iii | ||
| Contents | vii | ||
| Child And Adolescent\rPsychiatric Clinics\r | xi | ||
| Preface\r | xiii | ||
| Psychiatric Assessment of Severe Presentations in Autism Spectrum Disorders and Intellectual Disability | 1 | ||
| Key points | 1 | ||
| Introduction | 1 | ||
| Prevalence of psychiatric illness | 2 | ||
| Reasons for referral for psychiatric assessment | 3 | ||
| General assessment issues | 4 | ||
| Language Skills and Communication Development | 4 | ||
| Accommodations Made by Caregivers | 4 | ||
| Clinician Questions | 4 | ||
| Comorbidities | 5 | ||
| Diagnostic considerations | 5 | ||
| Medical considerations | 6 | ||
| Developmental considerations | 8 | ||
| Environmental considerations | 9 | ||
| Summary and future directions in ASD/ID | 10 | ||
| References | 11 | ||
| Emotion Regulation | 15 | ||
| Key points | 15 | ||
| Introduction | 15 | ||
| Emotion Regulation Concepts | 15 | ||
| Role of ER in Autism Spectrum Disorder | 16 | ||
| ASD-Related Factors that Impede Effective ER | 16 | ||
| Illustrative case example | 18 | ||
| Current approaches to practice | 18 | ||
| Summary | 20 | ||
| References | 21 | ||
| Behavioral Approaches to Managing Severe Problem Behaviors in Children with Autism Spectrum and Related Developmental Disorders | 25 | ||
| Key points | 25 | ||
| Introduction | 26 | ||
| Method | 28 | ||
| Study-Selection Criteria | 28 | ||
| Search Methods and Study Selection | 28 | ||
| Variable Definitions and Coding | 29 | ||
| Participants | 29 | ||
| Behavior | 29 | ||
| Interventions | 29 | ||
| Other study characteristics | 29 | ||
| Results | 31 | ||
| General Study Characteristics | 31 | ||
| Settings | 31 | ||
| Periodical | 31 | ||
| Fidelity | 31 | ||
| Assessment | 31 | ||
| Participants | 32 | ||
| Age and gender | 32 | ||
| ASD and ID | 32 | ||
| Behavior Targets, Interventions, and Outcomes | 32 | ||
| Behavioral targets | 32 | ||
| Evidence that problem behavior was severe | 32 | ||
| Behavioral function | 32 | ||
| Response to treatment | 32 | ||
| Type of interventions | 33 | ||
| Interactions Between Behavior Interventions and Other Factors | 33 | ||
| Combinations of interventions | 33 | ||
| Interactions with behavioral targets | 33 | ||
| Interactions with behavior functions | 34 | ||
| Interactions between response to treatment and interventions | 34 | ||
| Interactions with other participant and setting variables | 34 | ||
| Discussion | 34 | ||
| References | 37 | ||
| Using Communication to Reduce Challenging Behaviors in Individuals with Autism Spectrum Disorders and Intellectual Disability | 41 | ||
| Key points | 41 | ||
| Introduction | 41 | ||
| Communication challenges in ASD/ID | 42 | ||
| Epidemiology of challenging behavior in ASD/ID | 43 | ||
| Using communication to address behavioral challenges | 43 | ||
| Functional Communication Training | 44 | ||
| Interpretive Strategies | 44 | ||
| The PECS and AAC Strategies | 45 | ||
| PRT | 46 | ||
| Review of current evidence | 48 | ||
| FCT | 48 | ||
| Interpretive Strategies | 48 | ||
| PECS and AAC | 49 | ||
| PRT | 49 | ||
| Discussion | 49 | ||
| Summary and future directions | 50 | ||
| References | 50 | ||
| Appendix | 55 | ||
| Kevin’s Social Story | 55 | ||
| Examination of Aggression and Self-injury in Children with Autism Spectrum Disorders and Serious Behavioral Problems | 57 | ||
| Key points | 58 | ||
| Introduction | 58 | ||
| Methods | 59 | ||
| Setting and Subjects | 59 | ||
| Measures | 60 | ||
| Parent target problems | 60 | ||
| Intellectual functioning | 60 | ||
| Clinical Global Impressions scale | 60 | ||
| Autism Diagnostic Interview-Revised | 61 | ||
| Vineland Adaptive Behavior Scales | 61 | ||
| ABC | 61 | ||
| Children’s Yale-Brown Obsessive-Compulsive Scale for PDDs | 61 | ||
| Procedures | 61 | ||
| Classification of parent target problems | 61 | ||
| Analytical Strategy | 62 | ||
| Results | 63 | ||
| Sample Characteristics | 63 | ||
| Discussion | 65 | ||
| Limitations | 68 | ||
| Summary | 68 | ||
| Acknowledgments | 69 | ||
| References | 69 | ||
| Psychopharmacologic Management of Serious Behavioral Disturbance in ASD | 73 | ||
| Key points | 73 | ||
| Introduction | 73 | ||
| Epidemiology of ASD | 74 | ||
| Current evidence | 74 | ||
| Atypical Antipsychotics | 74 | ||
| Clozapine | 74 | ||
| Risperidone | 74 | ||
| Olanzapine | 75 | ||
| Quetiapine | 76 | ||
| Ziprasidone | 76 | ||
| Aripiprazole | 77 | ||
| Paliperidone | 77 | ||
| Alpha2 Adrenergic Agonists | 77 | ||
| Clonidine | 77 | ||
| Guanfacine | 78 | ||
| Mood Stabilizers and Anticonvulsants | 78 | ||
| Lithium | 78 | ||
| Divalproex sodium | 78 | ||
| Lamotrigine | 78 | ||
| Levetiracetam | 79 | ||
| Discussion | 79 | ||
| Conclusion and future directions | 79 | ||
| References | 79 | ||
| Management of Agitation in Individuals with Autism Spectrum Disorders in the Emergency Department | 83 | ||
| Key points | 83 | ||
| Overview | 83 | ||
| Introduction | 84 | ||
| Symptoms of ASD | 84 | ||
| Rapid assessment of crisis behaviors in individuals with ASD | 85 | ||
| Initial Assessment Interview | 86 | ||
| Medical Issues | 86 | ||
| Psychiatric Issues | 86 | ||
| Sensory and Self-regulation Issues | 86 | ||
| Communication Issues | 86 | ||
| Social Skills Deficit | 87 | ||
| Motor Skills Deficit | 87 | ||
| Academic/Cognitive/Adaptive Skill Deficit | 87 | ||
| Family/Community Environment | 87 | ||
| Initial medical evaluation of patients with ASD with acute agitation | 87 | ||
| Medical Causes of Agitation in Patients with Autism | 88 | ||
| Use of psychotropic medications in ED | 88 | ||
| Management of patients with acute agitation | 89 | ||
| Rapid Assessment of Acute Agitation | 89 | ||
| Environmental Adaptations (Stimulation, Lighting, Number of People) | 89 | ||
| Communication | 90 | ||
| Behavioral approaches | 91 | ||
| Somatosensory interventions | 91 | ||
| Restraint and Seclusion for Agitated Patients with ASD in the ED | 91 | ||
| Caution When Using Restraint and Seclusion in Patients with ASD | 91 | ||
| Discussion | 92 | ||
| Summary | 92 | ||
| References | 93 | ||
| Systems of Care for Individuals with Autism Spectrum Disorder and Serious Behavioral Disturbance Through the Lifespan | 97 | ||
| Key points | 97 | ||
| Introduction | 97 | ||
| Systems of care in ASD across the country | 98 | ||
| The mental health system | 101 | ||
| Family support services | 101 | ||
| The medical system and allied health professionals | 102 | ||
| Illustrative autism program example | 102 | ||
| Early childhood service systems | 105 | ||
| The education system | 105 | ||
| Transition services to adult systems | 106 | ||
| Housing options | 107 | ||
| Summary and future directions | 108 | ||
| References | 108 | ||
| Residential Treatment of Serious Behavioral Disturbance in Autism Spectrum Disorder and Intellectual Disability | 111 | ||
| Key points | 111 | ||
| Introduction | 111 | ||
| Epidemiology | 113 | ||
| RTF beginnings and later trends | 113 | ||
| Answering concerns about the effectiveness of RTF treatment | 114 | ||
| Advantages of an RTF for Children with ASD/ID and SBD | 114 | ||
| Evidence-Based Interventions and Practices | 115 | ||
| Best-Practice Strategies | 116 | ||
| The use of ABA instructional methods | 116 | ||
| Environmental milieu expectations | 116 | ||
| Predictable and structured routines with high engagement levels | 117 | ||
| Functional communication and social skills training | 117 | ||
| Use of visual supports | 117 | ||
| Errorless learning | 117 | ||
| Community-based instruction | 117 | ||
| Essential Program Components | 117 | ||
| Family inclusion, engagement, and training | 117 | ||
| Individualized positive behavior support processes | 118 | ||
| Staff training and supervision | 118 | ||
| Intensive treatment services | 118 | ||
| Comprehensive discharge planning | 118 | ||
| Summary and future directions | 119 | ||
| Funding | 120 | ||
| Intensive Case-Management Services | 120 | ||
| Family Intervention | 120 | ||
| Community Involvement | 121 | ||
| References | 121 | ||
| Psychiatric Hospital Treatment of Children with Autism and Serious Behavioral Disturbance | 125 | ||
| Key points | 125 | ||
| Introduction | 125 | ||
| Epidemiology, costs, and access | 126 | ||
| Recent developments in psychiatric hospital care for children with ASD | 127 | ||
| General considerations for psychiatric hospital care of children with ASD | 128 | ||
| Assessment of Presenting Crisis Behaviors | 128 | ||
| Psychiatric Comorbidity | 130 | ||
| Verifying ASD Diagnosis and Cognitive Ability | 131 | ||
| Considering Communication | 131 | ||
| Receptive communication | 131 | ||
| Expressive communication | 132 | ||
| Hospital Environment | 132 | ||
| Staff Training | 132 | ||
| Evidence base for treatment of children with ASD in general psychiatric hospital units | 133 | ||
| Evidence base for specialized psychiatric hospital treatment of children with ASD | 133 | ||
| Adult Studies | 133 | ||
| Child and Adolescent Studies | 134 | ||
| Specialized psychiatric hospital treatment models | 134 | ||
| Model 1: Specialized Inpatient Treatment Unit | 134 | ||
| Model 2: Specialized Inpatient Treatment with Integrated Step-down Model | 137 | ||
| Improving care for all psychiatrically hospitalized individuals with ASD | 138 | ||
| Summary and future directions | 139 | ||
| Acknowledgments | 139 | ||
| References | 139 | ||
| The Family Context of Autism Spectrum Disorders | 143 | ||
| Key points | 143 | ||
| Introduction | 143 | ||
| Expressed emotion and behavioral difficulties | 144 | ||
| Families of adolescents and adults with autism | 145 | ||
| The Transitioning Together Program | 148 | ||
| Composite case of a family who completed the Transitioning Together program | 150 | ||
| Summary and future directions | 151 | ||
| Acknowledgments | 152 | ||
| References | 152 | ||
| Index | 157 |