행동치료의 의학적 처방 hyun s. park, md developmental and behavioral pediatrician...

행동치료의 의학적 처방

Hyun S. Park, MDDevelopmental and Behavioral PediatricianNeurodevelopmental Center, For OC Kids

Assistant Clinical Professor of Pediatrics, UCI SOM

Autism

• Qualitative Social Interaction Impairments• Qualitative Communication Impairments• Repetitive and Restricted Stereotyped

Patterns of Behavior, Activities and Interest

Incidence

• 1 child in 150 has autism spectrum disorder

Characteristic of behaviors

• Dangerous• Hurt self and/or others• Annoying• disturbing

Common Behavior Problems

• Aggression to self and others• Tantrums• Agitation• Obsessions and compulsions• Rocking, spinning, wandering around

• Hyperactivity, jumping, climbing • Inattention, immobility, low energy• Echolalia, non verbal• Excessive talking, screaming, shouting• MELTDOWNS

• moodiness• Fearful, fearless• Pain reaction: too much- too little• Sensory processing difficulties: auditory,

visual, tactile, oral, vestibular.

What to do with behavior problem

• Identify the problem• Understand what is going on with them• Children with autism learn by repetition

Brain learning circuitry

• Reflex• Associative

Children with autism learn by repetition of behaviors

• Routine in daily activities, schedules, environment

• Learned skill not able to generalize to different settings and situations

• Re-learn the skill in a different setting and situation

• Visual learners• Concrete thinkers

• Focus your energy in teaching simple new skills such as praying, singing, greeting, sharing

• Reinforced with repetition

• Lack of common sense• Gradual introduction of change• Ignoring negative behaviors

Medical consultations

• Primary physician – check for absence of illness

• Developmental and Behavioral Pediatrician- developmental and behavioral problem

• OT, PT, Speech therapist

• Psychiatrist -mental and behavioral problem

• Behaviorist- behavioral modification

• Neurologist –possible seizure

• Gastroenterologist-diarrhea, food malabsorption, GER

Medications

• Stimulants• Antidepressants• Atypical neuroleptics • Antiseizure

Psychostimulants

• Hyperactivity,inattention, impulsivity

Ritalin, Metadate, ConcertaDexedrine, Adderall, Vyvanse

Strattera

• Hyperactivity,inattention, impulsivity

Antidepressants, anxiolytics

• Fluoxetine• Paroxetine• Citalopram• Others SSRIs

Atypical neuroleptics

• Risperdal – Aggressive behavior, irritability, insomnia,

mood swing

What can I do for these children

Be loving, caring, PATIENT, provide warm environment.

Be understanding of the child and familyGuide and encourage families to seek help

Referrals to….• Early intervention programs • Referral to Early Start Programs, • Regional Center in California• Public Schools Special Education programs

Education and information

• Mental health • Community centers• Medical specialist

You see them for short time, family lives with child 24/7.