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Your Template! UCSF School Department of Family Office of Developmental of Medicine and Community Medicine Primary Care Autism: Matching Therapy to Neurology NJ Autism Center of Excellence January 27, 2021 Clarissa Kripke, MD, FAAFP Clinical Professor, Family and Community Medicine Director, Office of Developmental Primary Care Disclosure I have nothing to disclose. 2 Office of Developmental Primary Care: https://odpc.ucsf.edu/ Learning Objectives . Is autism a disease? . What do we know about sensory and movement differences in autism? . What are the implications? . Is autism better accommodated when understood as a neurological difference? . What are self-advocates telling us? . Why should we listen? 3 Office of Developmental Primary Care: https://odpc.ucsf.edu/ Is Autism a Thing? neuromotor cognition seizures sensory mental health/behavior 4 Office of Developmental Primary Care: https://odpc.ucsf.edu/ Motor control Touch & pressure Taste Concentration, planning, problem solving Body awareness Speech Language Reading Smell Vision Hearing Coordinatio n Facial recognition Office of Developmental Primary Care: https://odpc.ucsf.edu/ The original uploader was Fuzzform at English Wikipedia [GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons Torres, E., Brincker, M., Isenhower, R., Yanovich, P., Stigler, K., Nurnberger, J. I., . Jose, J. (2013). Autism: the micro-movement perspective. Frontiers in Integrative Neuroscience, 7(32). doi:10.3389/fnint.2013.00032 6 Office of Developmental Primary Care: https://odpc.ucsf.edu/ Movement Ranges from Purposeful to Autonomic Conscious Purposeful Intentional Highly practiced Habitual Automatic Reflex Spontaneous Autonomic Unconscious Torres, E. Two Classes of movements in Motor Control. Exp Brain Res. 215:3-4, 2011. 7 Office of Developmental Primary Care: https://odpc.ucsf.edu/ What do we know about sensory and movement issues in autism? . Many of the assumptions which are fundamental to the current paradigm of autism can and should be examined: - Performance does not equal intelligence. You can’t meaningfully test intelligence in people who don’t have a fluent form of expressive communication - Not all behavior is communication—some behavior is an artifact of difficulty organizing and regulating sensation and movement - Intelligence isn’t a fixed trait or capacity 8 Office of Developmental Primary Care: https://odpc.ucsf.edu/ What are the implications of these differences? . Choosing therapeutic approaches needs to be individualized. Use caution when applying “evidence” . Working with sensory and movement differences is more effective than working against them. Everybody needs a fluent form of expressive communication. That needs to be an early, top, priority. Don’t give up. Because of unconscious bias, people are routinely underestimated. 9 Office of Developmental Primary Care: https://odpc.ucsf.edu/ How to apply evidence? . Is my client similar to the subjects of the study? (merely having an “autism” diagnosis isn’t enough) . Are the outcome measures meaningful? . Are the methods used valid? . Is the therapy available? . What are the risks? . Is the treatment consistent with individual and community values? Masic I, Miokovic M, Muhamedagic B. Evidence based medicine - new approaches and challenges. Acta Inform Med. 2008;16(4):219– 225. doi:10.5455/aim.2008.16.219-225 10 Office of Developmental Primary Care: https://odpc.ucsf.edu/ What are self-advocates telling us? Rethinking Autism and Therapeutic Approaches https://www.youtube.com/watch?v=obVvXcwTgtw 11 Office of Developmental Primary Care: https://odpc.ucsf.edu/ Why should we listen? . It leads to better education, opportunities and communication. It reduces burnout of parents and staff. Parents, therapists, schools, and students who are presuming competence and working with sensory and movement issues are getting remarkably good outcomes. See for yourself: - https://unitedforcommunicationchoice.org/documentaries- movies-and-television/ - https://unitedforcommunicationchoice.org/videos-of- advanced-learners/ - https://unitedforcommunicationchoice.org/user-blogs/ 12 Office of Developmental Primary Care: https://odpc.ucsf.edu/ Works Questioning Current Paradigm for Understanding Autism . Leary, Martha R., Donnellan, Anne, M. Autism: Sensory-Movement Differences and Diversity. 2012. Cambridge Book Review Press. Cambridge. Masic I, Miokovic M, Muhamedagic B. Evidence based medicine - new approaches and challenges. Acta Inform Med. 2008;16(4):219–225. doi:10.5455/aim.2008.16.219-225 . Shyman, Eric. Besieged by Behavior Analysis for Autism Spectrum Disorder. 2015. Lexington Books, Lanham. Silberman, Steve. Neurotribes: The Legacy of Autism and the Future of Neurodiversity. 2015. Penguin Random House. New York. Torres, Elizabeth. Autism: The Movement Perspective. 2015. Frontiers in Neuroscience. https://www.frontiersin.org/research-topics/801/autism-the-movement-perspective . Torres, E., Brincker, M., Isenhower, R., Yanovich, P., Stigler, K., Nurnberger, J. I., . Jose, J. (2013). Autism: the micro-movement perspective. Frontiers in Integrative Neuroscience, 7(32). doi:10.3389/fnint.2013.00032 . Torres, E. Two Classes of movements in Motor Control. Exp Brain Res. 215:3-4, 2011. 13 Resources on Rethinking Possibilities for People with Autism and other Complex Disabilities . Autism and Communication Center. California Lutheran University. https://www.callutheran.edu/centers/autism/ . CommunicationFirst. https://communicationfirst.org/. Habib, Dan. Intelligent Lives. https://intelligentlives.org/ . Office of Developmental Primary Care. http://odpc.ucsf.edu, especially Everybody Communicates: Toolkit for Accessing Communication Assessments, Funding, and Accommodations. https://odpc.ucsf.edu/communications-paper . Think College. https://thinkcollege.net/ . United for Communication Choice. https://unitedforcommunicationchoice.org/. 14 Resources by Self-Advocates . Deej. https://www.deejmovie.com/ . Emma’s Hope Book https://emmashopebook.com/. Also, 30 minute film Emma directed and starred in, Unspoken https://www.unspokendoc.com/ . Faith, Hope and Love…With Autism http://faithhopeloveautism.blogspot.com/search?q=communication . Hari’s Blog http://journal4hari.blogspot.com/p/autism.html . Higashida, Naoki. The Reason I Jump: The Inner Voice of a Thirteen-Year- Old Boy with Autism. 2016. Random House Trade Paperback, New York. Kedar, Ido. Ido in Autismland: Climbing Out of Autism’s Silent Prison. 2012. Kedar, Ido. In Two Worlds. 2018. Double Buck Publishing, LLC. Mukhopadhyay, Tito, R. Plankton Dreams: What I Learned in Special-Ed. http://www.openhumanitiespress.org/books/titles/plankton-dreams/ . Wretches and Jabberers. https://www.wretchesandjabberers.org/ 15 Office of Developmental Primary Care 500 Parnassus Avenue, Box 0900 Tel: 415-476-4641 | Fax: 415-476-6051 email: [email protected] web: http://odpc.ucsf.edu 16 Office of Developmental Primary Care: https://odpc.ucsf.edu/.
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