Sally Rogers and the Early Start Denver Model

Here is short article about Sally Rogers' Early Start Denver Model (ESDM). Children with autism who are not typcially diagnosed until age 2.5 can stagnate and miss fertile developmental opportunities. In fact, we know how to diagnose at much earlier ages (there are at least two methods for making a diagnosis at 6 months) and so have a window of opportunity to work with children at a much earlier age.

Dr. Rogers  and her colleagues have developed an intense program that combines Play, Behavioral Therapy and Relationship Therapy to help children make gains at 18 months. Her team at the Mind Institute in Sacramento is seeing tremendous results that include  speach gains. In fact, 90-95% of children  coming through the Mind Institute's program begin speaking at age 3 - 3.5. 

Here is the transcript of a PBS interview with Dr. Rogers.

Do Weighted Vests Work? Two Studies

Last year, two widely different studies published in AJOT (American Journal of OT) looked at the effectiveness of a weighted vest in increasing the on-task behavior in children with poor attention. One study showed an effective protocol, the other showed a protocol that did not work.  Let's look at the methods used in the studies.

What didn’t work

In study 1, by Collins and Dworkin, children wore a standard commercial vest (based on the size of the child) for 15 or more minutes (the length of an activity). Filming of the child’s behavior was started after a 5 minute adjustment period. The recording was 10 minutes long. A total of 9 sessions were recorded over a period of 3-6 weeks.   To make that clear, each child wore a weighted vest for approximately 15 minutes on each of 9 days. They did not wear a weighted vest at other times. The authors report that their weighted vest protocol did not improve attention to task. By the way, these children were typical children in elementary school. No further information is given about them including whether or not they were known to have sensory issues or had been diagnosed with ADHD.

What appears to work

Study 2, by Fertel-Daly, et. al., had children with autism ages 2-4 in a pre-school program wear similar vests for 2 hours on and then two hours off. Children wore the vests 3 days a week. They were given 3 weeks of this protocol to adjust to the vests prior to filming behaviors. All participants had an increase in attention. The smallest child had the best increase, suggesting that the ratio of the child’s body weight to the weight in the vest made a difference. Teachers noted that the level of aggression and self-stimming behaviors were noticeably reduced at the end of the study. The children's attention skills improved overall by the end of the study and did not return to baseline once the vest was discontinued.

Conclusions that Need Re-Validation

1.       The art of “how much weight to use in a vest” says that 5-10%  of the child's bodyweight works best. In study 2, the smallest girl used weight equal to 4% of her body weight – and it worked. Other students who had less vest weight still had good results, but not as good.

2.       Vests are more effective when used consistently over time. Even 3 days a week is effective, but the gains increase as the weeks go by.

3.       The method of 2 hours on and 2 hours off appears to work. A vest that is worn for 15 minutes (as needed) is not effective.

4.       The weighted vests  appear to help pre-schoolers with autism. Would it help elementary children with autism?

5.   Children with autism tend to have sensory issues. It makes sense that a vest (a sensory solution) was successful for them.  Would it also work for a small child with ADHD?

 

6.  In the second study, the children's attention skills improved - and did not return to baseline. What would happen if the protocol were continued? Would the children lose those symptoms?

So many questions, so few answers. Ah, to have a large group, long term study!

 

References

1.       Collins, A., & Dworkin, R. J. (2011). Pilot study of the effectiveness of weighted vests. American Journal of Occupational Therapy, 65, 688–694.

2.       Fertel-Daly, D., Bedell, G., & Hinojosa, J. (2001). Effects of a weighted vest on attention to task and self-stimulatory behaviors in preschoolers with pervasive developmental disorders. American Journal of Occupational Therapy, 55, 629–640.

In the News ...

Here are a couple of interesting news items you may have missed. I found these on the Science Daily news service over the weekend.

Second-Hand Smoking Affects Neurodevelopment in Babies
How does it affect the baby? ..."poor physiological, sensory, motor and attention responses". Read it - it's an eyeful.

Disorder of Neuronal Circuits in Autism Is Reversible, New Study Suggests
Scientists have found an impaired set of circuitry affecting many symptoms of autism and have reversed the problem in mice. This gives hope that we may be able to do the same in humans once we are better at pinpointing brain chemical therapy to a given small region. A breakthrough in that technique was also reported last week.

You can subscribe to email delivery of ScienceDaily at this site. They also have an RSS Newsfeed.

AJOT Issue on Autism

You might want to check out this month's edition of the American Journal of Occupational Therapy (AJOT) - which is devoted to autism. Here are some highlights from the articles:

• Modifying sound and light in a classroom for students with autism by insulating walls with sound absorbing Owens Corning Basement on Finishing System (TM) and replacing fluorescents with area-based halogen lighting decreased the act-out behaviors of 4 teens (ages 13-20) who use the room.
• Yoga for children with autism is shown to be a good intervention for kids on the spectrum - we already knew that, but it's great to see it verified.
• Also, several articles look at the incidence of sensory issues (oral motor, auditory processing and proprioception) in children with autism as opposed to that in typically developing children.

EFT Post Update

Here is an update to the original EFT post of a few weeks ago.

The Emotional Freedom Technique is an easy way to deprogram the brain of emotional garbage. The basic idea is that you tap on acupressure meridians while bringing up difficult emotions or memories followed by saying positive things (affirmations) about yourself. The claim is that the emotions disappear and the memories become neutral. The evidence says that it is effective and my own quick experimentation with it has sold me on it. Bad memories were indeed neutralized. It felt a bit like magic.

There are a number of YouTubes that demonstrate the method, including how to do this with a child. You will want to read The EFT Manual by Gary Craig before you try it. And by all means, don't do it on others if you are not professionally capable of handling the situations you could get into. There are lots of workshops out there that can give you a hands-on approach to learning it.

Here are the basic steps:

1. Name an emotion you are feeling.

2. Create an affirmation:

      But even though I am (emotion), I deeply and completely accept myself.

      Example: Even though I am angry, I deeply and completely accept myself.

3. Tap side of palm while saying affirmation.

4. Tap head, face and other points while saying emotion.

5. As you move to the wrists, say the affirmation again. 

6. Do steps 3-5 for several rounds until the emotion eases.


Doing EFT on the memory of an emotional incident
1. Name the memory (i.e. “fight with Sarah on the playground”).

2. Create an affirmation (as before).

3. Tap through the name of the memory until the child can say it without emotional reaction.

Now very slowly begin to play a part of the memory. Stop and tap until you are comfortable with it, then continue on with each section of the memory in the same fashion. You do not have to do the entire memory in one setting – break it up and do what is comfortable for you. Long or highly emotional memories will take a while. 

Older memories may have layers and layers of thoughts and emotions connected to them. Perhaps the child gets through one aspect (embarrassment of the situation) only for another aspect (fear of Sarah) to show up next.

 There is so much more to learn, but this is enough to experiment with. Remember – read the book, watch the YouTubes, practice on yourself and see how it works for you.

Using Ease for Behavior & Flight/Fright

Here is a way to help a child with poor self-regulation (think of a wiggly, inattentive sensory child with or without autism or of a child who is alarmed by loud noise). The type of therapy I'm describing is a lite-version of sound therapy and can be done at home or at school over a period of several weeks. The product is called EASE and is modulated music on a CD (there are a variety of CDs). It is available to parents and therapists at Vision-Audio.com.

Protocol
As a protocol, the child listens to music 2x/day for 20-30 minutes, 5-7 days per week. Separate the 2 daily sessions by 3 hours or more. The volume should be set low - that is, no higher than what is needed for the child to comfortably hear the music.

Try not to use the disks too close to bedtime as the music may be alerting. Use each disk for about 2 weeks. You can rotate the disks in and out of a long-term schedule, or do a few weeks of music and then more later as needed.
 Always do a 5-minute test before starting a program. Have the child listen to music for 5 minutes, then wait 24 hours before doing any more. If there are any emotional outbursts, mood changes, or unusual behaviors during that time, do not continue therapy unless you are well-versed in sound therapy and know your way around this.  

Do not do sound therapy if the child has a history of seizures, depression, mania, bipolar disorder, or some type of psychosis – including hearing voices.

Purchasing Equipment

Purchase Ease 1 or 2 for starters and then if it appears to be working, purchase additional disks. Ease 3 is typically used for children with attachment issues. Ease 4 has especially good 3-D auditory enhancement properties. There are many disks available.

You will want to buy good headphones. Do not use Bose - they filter out the modulated music sounds. Two good choices are Sony 7506 (about $100) and the relatively childproof Sennheiser HD 500A (about $150). Both are available from on-line sources. Get a good CD Player with random-access play. I like the Sony's that are available for about $25. Putting the player in random-access mode will help keep the music from getting boring. Make sure that Mega Bass is OFF. It is harmful to ears.

By the way, Vision-Audio also has 3-D video games which can help with auditory and visual sensory integration.  There is also a very powerful iPod app available to therapists to use with clients.

ADHD Alternative to Meds

Here is some infromation for parents looking for alternatives to ADHD meds.

Dr. Weil, the alternative medicine guru cites a study in Australia (1) that compares the results of taking methylphenidates such as Ritalen and Concerta versus a supplement of omega-3 fish oil and omega-6 in the form of evening primrose oil. The omega-3 and omega-6 supplements showed the best results. Dr. Weil's blog post is here.

There is a recent book on the topic by Dr. Sandy Newman: ADHD Without Drugs. Dr. Newman recommends that the child also take a multivitamin and a probiotic daily to help keep the gut healthy.

Dr. Weil also says to "be sure to rule out hearing or vision problems, allergies, thyroid disorders, depression, or even boredom in a gifted child" before resorting to medication. Here is a link to his blog on ADHD.  

1. Sinn, N. & Bryan, J. Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems Associated with Child ADHD. Journal of Developmental & Behavioral Pediatrics: April 2007 - Volume 28 - Issue 2 - pp 82-91