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WELCOME 1 Next Steps into Adolescence Who’s here today? 2 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... 3 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 4 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 5 It is a time defined by: physical growth spurts mindboggling hormone releases ever changing and challenging social relationships Adolescence is not a regression It is the next phase, a developmental progression Hormones & Behavior 6 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 7 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 13 Julia Video Social Development Peers • Relationships outside family • Peer pressure and conformity Sexuality • Developing sexual urges • Comfort with one’s sexuality Sexuality and ASD 15 Eric and Matt Videos Sexuality and ASD 16 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. Sexuality and ASD 17 Need to be explicit and teach specific directions about what is appropriate behavior 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 _________ Make sure that your teen knows this is a special conversation General Guidelines for Tough Topics 18 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 Practical Applications 19 Jim Connell, PhD Practical Applications 20 Safety Bullying Hygiene Sex, Drugs & Alcohol Safety 21 Safety Police – register with your local precinct (see handout on CD) Fires – practice fire drills – meet outside your home in a safe location 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 22 Concerns To be bullied To be the bully To be recruited by the group to bully someone else Hygiene 23 Health and Grooming (task analysis) Shower regularly Use deodorant Shaving Use feminine health care products Dress according to age Video 24 Nasaya Sex, Drugs and Rock & Roll 25 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 26 Eron Friedlander, MD Medical System 27 Primary care doctor Developmental pediatrician Neurologist Psychiatrist Gynecologist Gastroenterologist Medical Discussion 28 Psychopharmacology Why start medication? When should meds be stopped? When should medications be changed? When and why involve medical community General Health Gynecology Sleep Seizures Pharmacotherapy of ASD 29 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 30 Aggression Antipsychotics X X Anxiolytics Dopamine reuptake blockers Stereotypies Sleep X 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 31 Diphenhydramine (Benadryl) Antihistamine Over the counter Side effects: nervousness, anxiety, confusion, disturbed coordination, tremor Melatonin Hormone secreted by pinela gland Not yet empirically studied Side effects: headache, nausea, nightmares, enuresis, next day irritability Benzodiazepines Seizures 32 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 33 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 34 Associated intellectual disability Birth injury / underlying neurologic disorder Family history of epilepsy Severe receptive-expressive language disorder (verbal auditory agnosia) Seizures and ASD 35 All seizure types have been associated with ASD Clinical recognition of seizures is complicated Social detachment Stereotyped movements 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 Gynecologic concerns 36 Common complaints Irregular bleeding Hygeine Menorrhagia, dysmenorrhea Cyclical mood and behavioral changes Management NSAIDS Oral SSRI contraceptives Gastrointestinal Concerns 37 17-85% individuals with ASD report Diarrhea Constipation Abdominal pain Food intolerance Feeding selectivity No clear evidence of increased GI disease in ASD Specific treatment only with validated disease Parent Panel 38 Self-advocacy Self- disclosure Self-reliance Independence Thank you 39 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
