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Is There Something Off With My Child?

Presentation by: Nikole Hintz-Lyon

Professional Clinical Counselor

Becoming Transformed Counseling LLC.

A straightforward presentation to help parents with A straightforward presentation to help parents with A straightforward presentation to help parents with A straightforward presentation to help parents with the emotionally charged subject of recognizing the emotionally charged subject of recognizing the emotionally charged subject of recognizing the emotionally charged subject of recognizing

developmental delays in their child. developmental delays in their child. developmental delays in their child. developmental delays in their child.

Knowledge is Power !

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What are the signs and symptoms that I should be concerned about in my

child?

• Toe walking

• Climbing- excessive “on the go”

• Clumsy- falls runs into things

• Balance issues- body awareness

• Does not crawl – may scoot

• Walks late

• Hides in spaces - under couch, between cushions

• Bangs head, head butting

• Seeks deep pressure / avoids, sensitive touch

• Hangs upside down

• licks- self, others or items

• Rubs private parts /humping

• Sleep- will not go to sleep

• Chews or bites- people or items

• Unable to handle noises, i.e., vacuum cleaner, blender etc. Covers ears

• Unable to hold eye contact or lack of when spoken to

• Unable to produce 2-3 words together by 18 months/ lack of expressive language skills

• Tantrums or meltdowns-with or without reason or cause

• Aggressive/emotional- constant mood swings , i.e., walk on “egg shells”

• Picky eater- problem eater

• Touch/Smell – refuses to touch things/items, i.e., sticky, cold, hot, too soft too hard, bumpy, or because of how it looks or smells.

• Rigid behaviors- has to have same thing every way, every time, i.e., unable to change routine without meltdown (e.g.

have to take same way home in car rides, same food every day, same cartoon every day, distress in small changes).

• Cries or whines or changes tones when speaking

• Stims- rocks, spins, flaps hands, paces – when upset, or excited

• Perseverates on a topic/event, i.e., will ask the same thing over excessively and may not make sense/odd subject

• Prefers to be alone

• Social- unable to play or initiate play in an age appropriate way both individually or with peers

• Fears people or things-**** anxiety

• Unable to follow commands, i.e., go get the book

• Obsessed with certain things or fixated on item or thing, i.e., carries around an object but does not appropriately use it

or have a purpose for use.

• Lines things or objects up, i.e., takes dinosaurs and lines them up in a straight line on the table shows more interest in

lining the toys up than with imaginative play. Girls fixated on a topic or thing, i.e., applying makeup from tutorials of

other girls on YouTube

• Repetitive- does same thing over and over

• Does not look at you when you are talking or call child’s name.

• Does not look when you talk or point to an object across the room.

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• Scripting

• Transition- unable to transition from one task to next –tornado-

• Unable to regulate body temperature, i.e., too hot or cold all the time

• Echolalia- repeating the same thing just heard minutes ago over and over

What are What are What are What are developmental developmental developmental developmental delays (DDdelays (DDdelays (DDdelays (DD) ?) ?) ?) ?What is What is What is What is Autism Spectrum Disorder (ASDAutism Spectrum Disorder (ASDAutism Spectrum Disorder (ASDAutism Spectrum Disorder (ASD)?)?)?)?

• A child can have a delay in any or all of these following areas:

• Language or speech - Language and speech problems are the most common type of developmental delay. Speech refers to verbal expression, the way words are formed. Language is a system of expressing and receiving information, i.e., understanding gestures.

• Vision/Sensory- hearing, taste, touch, sight - how our brain processes this information

• Movement -- motor skills- both fine and gross

• Social and emotional skills-behaviors *

• Thinking – cognitive intellectual skills

Sometimes, a delay occurs in many or all of these areas. When that happens, it is called “Global Developmental Delay."

What is Autism Spectrum Disorders (ASD)?What is Autism Spectrum Disorders (ASD)?What is Autism Spectrum Disorders (ASD)?What is Autism Spectrum Disorders (ASD)?

A group of neurological disorders that may involve impaired communication as well as impaired social interaction and cognitive skills. Neurological disorders such

as ADHD, OCD, ODD, PDA, PDD-NOS, bipolar, anxiety disorders, sleep disorders, seizure disorders, and more.

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Neuro disorders are not just a “behavioral issue”. It’s a physiological disorder that effects behaviors.

Example people that present with ADHD have a shortage of dopamine (neurotransmitter). Its like the administrative assistant is on vacation making it harder for the CEO to function effectively. “ADHD is no longer viewed strictly as a behavioral issue”(Meyers, 2016).

Why Autism Spectrum Disorder?Why Autism Spectrum Disorder?Why Autism Spectrum Disorder?Why Autism Spectrum Disorder?

Diagnostic & Statistical Manual Of Mental Disorders (DSM-V)

• DSM IV (Old)- V (Current) Autism vs Asperger’s Syndrome-

• DSM IV Old Diagnostic Criteria: one of the main components that differentiated Autistic Disorder vs Asperger’s in previous criteria in order for Autism Dx: (299.00) was one had to have a speech delay or onset before age 2.

• DSM V (2013-Present)- Diagnostic Criteria:

• A: Diagnostic criteria can meet deficits in social communication and social interaction deficits across multiple context.

• Deficits in social- emotional reciprocity, ranging for abnormal approach and failure of normal back and forth conversation or failure to respond or initiate social interaction.

• Deficits in nonverbal communication behaviors used for social interaction ranges from poor communication skills verbal to non-verbal, abnormal eye contact and body language, understanding use of gestures to lack of facial expressions and non-verbal communication.

• Deficits in developing, maintain, understanding relationships. Ranging from difficulty in adjusting behaviors to suit various social contexts; to difficulties in imaginative play or in making friends; to absence of interest in peers.

• B: Restricted, repetitive patterns of behavior, interests, or activities as manifested in at least two (2) of the following:

• Stereotyped or repetitive motor movements, use of objects, speech (e.g., lining up toys of flipping objects echolalia, idiosyncratic phrases).

• Insistence on sameness, inflexible adheres to routine, or ritualized patterns of verbal or non-verbal behavior. (Rigid thinking patterns, need for same things every day).

• Highly restricted, fixated interests, perseverated interests preoccupied with unusual objects.

• Hyper- or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature adverse response to certain sounds or touch of objects fascination with lights or movement).

• C. Symptoms must be present in early development period (but may not become fully manifested until social demands exceed limited capacities, or may be masked by learned strategies in later life).

• D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning

• *** Guidelines for redetermination for DDD 6 and older must be at a level 2-3 severity (DSM) criteria. (Autism 101 class) in order to keep services***

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It is projected that by the year 2030203020302030, if the incidence of autism continues to rise as it has

been for the past several years, “ 1 in 1 in 1 in 1 in every every every every 2 2 2 2 male children will be diagnosed male children will be diagnosed male children will be diagnosed male children will be diagnosed autistic”.autistic”.autistic”.autistic”.

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Girls vs. BoysGirls vs. BoysGirls vs. BoysGirls vs. Boys

4 to 1 Ratio• Boys out number girls in 4 to one ratio specifically in “high functioning diagnosis”

• Autistic behaviors are different in boys than girls

• Differences are as early as preschool years

• Girls present with anxiety able to camouflage

• Behaviors such as obsessing about one particular friendship or fixated on 1-2 like minded friends.

• Autistic behaviors are different in boys than girls

• Pretending trying to “blend in” socially

• Studies show girls pay close attention to eye contact when watching anything media related. Trying to figure out facial expressions and social cues to mask and hide.

• Presents with less repetitive obsessive behaviors such as hand flapping -gray matter study in brain ( cerebellum) Girls had less gray which is responsible for repetitive behaviors in boys-. Girls are able to camouflage or it is socially acceptable than males especially throughout adulthood (Psych, 2015). (Dinosaurs vs. Makeup analogy)

• Girls present with more brain abnormalities than males in neurological brain scans and testing

• Most girls are misdiagnosed or fly under radar specifically at school girls tend to “withdrawal” (anxiety) and boys are “disruptive”. Teachers tend to focus more on the hyperactivity components boys present with and problem behaviors in the classroom. Studies conclude teachers miss more autistic symptoms in girls than boys.

• Studies show that teachers label them as “model students”.

• Girls tend to have more emotional outbursts meltdowns studies show more irritability and lethargy than boys.

• The 4’ O’clock Explosion

• “For many kids with ASD – but especially girls – parents say that their child manages to hold it together at school, but then comes home and has to release the pressure built up during a day of pretending to be someone else. Nonetheless girls with autism were just as impaired, or more impaired, than males in their social and communication skills, according to some studies” (Sarris, 2015).

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Why the “wait and see approach” is not beneficial Why the “wait and see approach” is not beneficial Why the “wait and see approach” is not beneficial Why the “wait and see approach” is not beneficial

to your child’s overall to your child’s overall to your child’s overall to your child’s overall

Decades of rigorous research show that children’s earliest experiences play a critical role in brain development. The Center on the Developing Child at Harvard University has summarized this research:

• Neural circuits, which create the foundation for learning, behavior and health, are most flexible or “plastic” during the first three years of life. Over time, they become increasingly difficult to change.

• Contributing Factors:

• Persistent “toxic” stress, such as extreme poverty, abuse and neglect, or severe maternal depression can damage the developing brain, leading to lifelong problems in learning, behavior, and physical and mental health.

• The brain is strengthened by positive early experiences, especially stable relationships with caring and responsive adults, safe and supportive environments, and appropriate nutrition.

• Early social/ emotional development and physical health provide the foundation upon which cognitive and language skills develop.

• High quality early intervention services can change a child’s developmental trajectory and improve outcomes for children, families, and communities.

• Intervention is likely to be more effective and less costly when it is provided earlier in life rather than later.

Last to develop is the Prefrontal Cortex

This section is specifically responsible for Executive Functioning

-Common among Autism, ADHD

• Emotions, Self regulation, and setting goals- thinking ahead

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The Developing Brain

The Dog Brain

3-11 years of age

The Boy Brian

11-25 years of age

Prefrontal Cortex

Executive Functioning

The amygdala gets priority

in the brain. Sensory input

reaches hits the amygdala

first, triggering a fear (or

pleasure) reaction long

before that same data gets a

chance to reach the slower,

more reasonable portion of

your brain, called your

frontal lobe.

The Lizard Brain

Birth – 3

“Fight or Flight”

The ACC…Anterior Cingulate of the Cortex(Sensory)

• One of the important information systems of the body

• Acts as an environmental filtering system, assessing threat in the immediate environment based on sensory input from the body

• Studying the environment in real time when the body is calm and relaxed

• Extremely sensitive to dysregulation.

Most behavior considered pathological is an adaptive reaction to this over utilized system

Every major

system in the

body is

activated

through the

Poly-vagal

system

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Vagus Nerve- Parasympathetic nervous system extends from Brain stem to abdomen regulates heart rate, breathing, digestion, “Rest and digest”. Critical for calming function and safety.

The Threat Response SystemThe Threat Response SystemThe Threat Response SystemThe Threat Response System(Activation of the ACC)(Activation of the ACC)(Activation of the ACC)(Activation of the ACC)

COOL (respond)(Parasympathetic Nervous System)

A system that supports:

1.Making conscious choices

2.Feeling connected in Communication

3.Emotional balance and regulation

4.Flexibility in response (pause before reacting)

5.Fear modulation

6.Empathy

7.Insight/judgment

8.Moral awareness

9.Intuition

10.Identity

HOT (React)

(Sympathetic Nervous System)

A system that has the primary functions:

1.Fight- Physical or Verbal

2.Flight- Avoid or Run

3.Freeze

So what is happening?So what is happening?So what is happening?So what is happening?

• The physical and neurobiological systems are reacting to the environment.

• Patterns are developing around (perception, relationships, emotional regulation, physical and mental health)

• Patterns are emerging and becoming dominate templates/schemas.

• Family culture is being created or being reinforced

• ACC and the Vagus systems are in over-demand and usage begins to rewire physiology and behavior potentials

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Early intervention, programs and the different type of therapies

• Occupational Therapy

• Speech Therapy

• Feeding Therapy

• Physical Therapy

• Early Intervention Preschool Screenings ( Through public school district)

• ECM/ECH program – ABA based program

• *At risk or Autism dx before the age of 4*

• Mental and Behavioral counseling using EBM’s- ABA approaches CBT methods, and Exposure therapy

- Dealing with self-regulation, internal components emotions and feelings- CBT, REBT, Exposure

• Music therapy

• Equine therapy

• Play & Art therapy

• Aquatic therapy

• Cryotherapy (Cold resets your CNS)

Where do I start, what does this look Where do I start, what does this look Where do I start, what does this look Where do I start, what does this look like and who do I like and who do I like and who do I like and who do I

seek in starting this journey ?seek in starting this journey ?seek in starting this journey ?seek in starting this journey ?Evaluations/Diagnosis

• Developmental Pediatrician

• Licensed Clinical Psychologist

• Psychiatrist

• ( DDD/ALTCS will only recognize the diagnosis from the above 3 in order to get ALTCS services and programs needed such as ECM/ECH programs for at risk or Autism Dx).*Autism 101 class*

• DD-epilepsy, cerebral palsy, cognitive disability* or autism. In order for a child to be found eligible for DDD services, they must show substantial functional limitations in three of seven areas in addition to having a qualifying diagnosis. The life areas assessed are self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living and economic self-sufficiency.

• Any Master Level Clinician Mental Health – LPC, or LCSW Dx, assess, and treat

• Important to get assessments from an Occupational therapist, Speech therapist, and Physical therapist. Include this in your application to DDD/ALTCS

The importance of parents seeking selfThe importance of parents seeking selfThe importance of parents seeking selfThe importance of parents seeking self----care for themselves and care for themselves and care for themselves and care for themselves and the family unit as a wholethe family unit as a wholethe family unit as a wholethe family unit as a whole

• Parents you play the most vital role in your child’s success

• You must take care of YOU before you can take care of them!

• You must act from your “cool” system not your “hot”.

• You must be able to go through the proper grieving stages. Don’t

feel guilty it is necessary in order to be healthy. There is no

particular order and some repeat a particular one often!

o Denial and Isolation

o Anger

o Bargaining

o Depression

o Acceptance

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• Coping skills for yourself /family unit

- counseling both individual and family – (Family System Therapy)

• Having a child or family member with autism can positively, negatively or neutrally impact family function. There are eight (8) main family functions: affection, self-esteem, spirituality, economics, daily care, socialization, recreation and education. Stress can be caused by a family not being able to meet their needs in one or more of these areas.

Study of University of Wisconsin and also in the August 2010 study in the Journal of Family Psychology showed marriages that had children with Autism had a 24% higher divorce rate than the other group that did not present with a child with a disability. Each group comprised of 341 participants (Ghose, 2010).

Find ways to deFind ways to deFind ways to deFind ways to de----stressstressstressstress

• Communicate with others

• Journal

• Exercise

• Yoga/meditation

• Support systems/ groups such as -AZ Autism of the West Valley etc.

• Self-regulation- REGULATE YOURSELF breathing techniques grounding skills

• Educate yourself

• Spiritual Support

• Respite Care – USE IT that is what it is there for!...

Recent studies showRecent studies showRecent studies showRecent studies show

• Parents- (Mothers) of children with Autism were reported to show low levels of hormones that are directly related to their chronic daily stress. Studies show that these are the same levels that have been reported and identified to be seen in combat soldiers suffering with chronic stress levels and PTSD.

• Parents of those with autism reported spending at least two hours more each day caregiving than mothers of children without disabilities. On any given day these moms were also twice as likely to be tired and three timesas likely to have experienced a stressful event.

• Parents were also interrupted at work on 1 out of every 4 days compared to less than 1 in 10 days for other moms (Diament, 2009).

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ResourcesResourcesResourcesResourcesWest Valley ProvidersWest Valley ProvidersWest Valley ProvidersWest Valley Providers

Psychologists

Dr. Jenny Baumgardner, Ph.D.

3000 N. Litchfield RdSuite 120Goodyear, AZ 85395Phone: 623-262-8915

email:Dr.JenniferBaumgardner@gmail.com

The Serin Group- Psychologists

10184 W. Happy Valley Road, Suite 190Peoria, AZ 85383

(623) 824-5051

Ronic Psychological Services LLC.

13128 N 94th Dr, Suite 203 Peoria, AZ 85381

(623) 977-1869

ronicpsych.com

Dr Karlson Roth

2211 E. Highland Ave Suite 108 in Phoenix, AZ.

602) 863-0101

Neurological/ Developmental Pediatrician

Dr. Roblin Blitz -Director of Autism Clinic / Michelle McDowell CNP

Phoenix Children’s Hospital Neuro Developmental Pediatrician

1919 E. Thomas Road Phoenix, AZ 85016

602) 546-1000

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• Clinical Therapies

Team 4 Kids- OT, Speech, Feeding, and Physical therapies

13601 N. Litchfield Rd Suite 124 Surprise, AZ 85379

1(800)-376-3440

WEE Care Corporation-Speech, Occupational Therapy, Feeding, Hab Masters Rehabilitation, Respite, Attendant Care

4870 N. Litchfield Road, Suite 101, Litchfield Park, AZ 85340

623-935-6040

Therapy Tree PLLC

9150 W Indian School Rd

(623) 500-2401

AZOPT Kids Place West

Physical Therapy Clinic

(623) 242-6908

14557 W Indian School Rd

Eat, Talk, and Play Therapy LLC

Speech Pathologist

3013 N 67th Pl #101

(480) 247-9190

HOPE GROUP- BCBA’s ECH/ECM program

4530 E Muirwood Dr Ste 103,

Phoenix, AZ 85048

(480) 610-6981

AZA United- BCBA’s ECH/ECM programs

5025 E Washington St Ste 212,

Phoenix, AZ 85034

(480) 820-2924

Mental & Behavioral Health Services- Private Practice

Becoming Transformed LLC.

Nikole Hintz-Lyon- Clinical Counselor

Individuals, Families, Children

11327 W Bell Rd Suite 300

Surprise, AZ 85378

623-640-2088

Mental Health Services-Counseling

Agencies -

Touchstone Behavioral Health – Valley wide locations

AZ Children’s Association- Valley wide locations

Jewish Children and Family Services- Valley wide locations

Trumpet Behavioral Health- Valley wide locations

Oasis- Valley wide locations

Books

A Parent's Guide to Developmental Delays: Recognizing and Coping with Missed Milestones in Speech, Movement, Learning, and Other Areas - Laurie-Fivozinsky-

Pervasive Developmental Disorder: An Altered Perspective by Barbara Quinn, Anthony Malone

The Out of Sync Child: Recognizing and Copying with Sensory Process Disorder- Carol Stock Kranowitz

The Ultimate Guide to Sensory Processing Disorder-Ostovar, Roya, Ph.d.

Healing ADHD- Dr. Daniel Amen

Six Subtypes of ADHD- Dr. Daniel Amen

What is Autism?: Understanding life with Autism or Asperger’s- Chantal Sicile-Kira

41 Things to Know About Autismby Chantal Sicile-Kira

Autism Aspergers: Solving the Relationship Puzzle--A New Developmental Program that Opens the Door to Lifelong Social and Emotional Growthby Steven E. Gutstein

Autism and Asperger Syndrome: Busting the Mythsby Lynn Adams, PhD

Autism: Advancing on the Spectrum: From Inclusion in School to Participation in Lifeby Melissa Niemann and Danuta Highet

The Autism Book: Answers to Your Most Pressing Questionsby S. Jhoanna Robledo, Dawn Ham-Kucharski

The Autism Sourcebook: Everything You Need to Know About Diagnosis, Treatment, Coping, and Healing--from a Mother Whose Child Recoveredby Karen Siff Exkorn

Autism Spectrum Disorders: The Complete Guide to Understanding Autism, Asperger's Syndrome, Pervasive Developmental Disorder, and Other ASDsby Chantal Sicile-Kira

Autism Spectrum Disorders from A to Z: Assessment, Diagnosis... & More!by Emily Doyle Iland, Barbara T. Doyle

Autism Spectrum Disorders: What Every Parent Needs to Know

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Autism Spectrum Realitiesby Gary W. Studebaker, Ed.D.

The Age of Autism: Mercury, Medicine, and a Man-Made Epidemicby Dan Olmsted, Mark Blaxill

Autism's False Prophets: Bad Science, Risky Medicine, and the Search for a Cureby Paul A. Offit, MD

Deadly Choices: How the Anti-Vaccine Movement Threatens Us Allby Paul A. Offit, MD

Overcoming Autism: Finding the Answers, Strategies, and Hope That Can Transform a Child's Lifeby Lynn Koegel, Claire LaZebnik

The Snowflake Children of Autism: Unleash Their Potentialby Irene L. Schulz, Ph.D. & Margaret S. Texidor, Ph.D

Thinking Person's Guide to Autismedited by Shannon Des Roches Rosa, Jennifer Byde Myers, Liz Ditz, Emily Willingham, & Carol Greenburg

Understanding Autism For Dummiesby Stephen M. Shore, MA and Linda G. Rastelli, MA

The Autistic Brain- Dr. Temple Grandin

Support Groups

Raising Special Kids - Phoenix Office

5025 E. Washington St. #204Phoenix, AZ 85034602-242-4366Toll Free: 800-237-3007Fax 602-242-4306info@raisingspecialkids.org

Autism Speaks- http://www.autismspeaks.org

Autism Society of Greater Phoenix- http://www.phxautism.org

Autism Society of America Greater Phoenix Chapter- http://www.phoenixchildrens.org/health-information/the-emily-center/child-health-topics/support-groups/autism-society-of-america

AZ Autism Network of the West Valley (AZANOW)-http://www.azanow.org/