Free Mind /Body
Workshops for the Public
8:00 a.m. - 4:30 p.m. at the
PPA is pleased to announce two days of free workshops for everyone interested in feeling better and managing their life more successfully.
Controlling Your Anger: 10 Simple Solutions
Why You Procrastinate . . . & How to Stop
Help! My Child Eats Too Much... or Too Little
Freeing Your Mind from Unwanted Thought Supervise, Don't Supersize: Raising Healthy Kids in a Junk Food World
Got Career Stress? Use Your Strengths to De-Stress
Enhance Parenting by Taking Care of Yourself and Your Committed Relationship
Myths and Realities about the Perfect Body: How to Improve your Body Image
America Runs on Addictive Behaviors
When a Psychologist May Be Helpful
Self-Esteem: Try It. You Might Like You
The Healthy Lifestyle Toolkit: Live Well, Laugh Often
Pennsylvania Psychological Association
416 Forster St. Harrisburg, PA 17102
| Free Speakers for Your Organization|
PPA members are willing to provide free talks for your
business, club or
In recent years psychologists have given public lectures on topics such as:
Stress Motivation Body/Mind Divorce
Of course, there are literally scores of topics that can be chosen for your talk. A typical
presentation may last 30-45 minutes with about 15 minutes for questions and answers. We would request that your audience include at least 10 persons. For more information, please contact Marti Evans at the Pennsylvania Psychological Association.
717-232-3817 This service is being offered as part of the joint mission of the Pennsylvania Psychological Association and theAmerican Psychological Association to advance public knowledge of the field of psychology.
to PA Psychological Association's Summer 2011 Newsletter. Our theme this quarter is Autism in Children. In this issue you will find information and resources about how to recognize and find treatment for this bewildering and lifelong disorder from top researchers and clinicians in the field.
As always, if you find this newsletter helpful, drop a line to firstname.lastname@example.org or the PA Psychological Association office, email@example.com
We welcome your comments.
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The Autism Diagnosis Shuffle
Carla A. Mazefsky, Ph.D.
Is autism being correctly diagnosed? With all of the news about higher and higher rates of autism spectrum disorders (ASD), you might assume that all children are being accurately identified. The unfortunate truth is that many parents are still waiting and searching for the right diagnosis for their child. Even with rapidly increasing awareness about the early signs of ASD, half of children with ASD do not receive their diagnosis until after 5 1/2 years old (Shattuck et al., 2009).
How do we know it's autism? Psychologists use several instruments involving observation of the child and interview with parents and teachers or daycare to identify ASD. They look for a combination of problems the child has with social interaction across situations, difficulties with communication, and repetitive or unusual interests or behaviors.
Along the way to a diagnosis, parents often have to wait on long lists for appointments with specialists. Further, the majority of children with ASD do not receive their ASD diagnosis on their first trip to a mental health professional. Sometimes behavioral problems overshadow the ASD symptoms, resulting in the diagnosis of a behavioral disorder, attention deficit/hyperactivity disorder, or a mood disorder. Often the emotional or behavioral concerns that lead to these diagnoses are part of having the ASD, and it is important that the ASD be identified as the primary diagnosis as early as possible.
Several disorders fall within the ASD umbrella, including:
- Autistic disorder (more commonly called autism
- Asperger's disorder
- Pervasive developmental disorder, not otherwise specified (PDD-NOS) Continued...
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Autism Treatments: What Helps
and What Hurts?
Holly Gastgeb, Ph.D. and
Carla A. Mazefsky, Ph.D.
How can a parent choose from the overwhelming number of treatments for children with an autism spectrum disorder (ASD)? We often hear of new treatments for ASD, sometimes presented as a "miracle cure." While some are effective in treating ASD, many others are "fad treatments" that have not been supported by research and in some cases have even resulted in harm
to people with ASD.
Professionals and family members put a lot of time, money, energy, and hope into helping people with ASD. They need to know that they are pursuing a treatment that has been shown by research to lead to positive changes in the individual's socialization, communication, and/or behaviors, the areas most affected by ASD.
Scientists use specific categories when they evaluate ASD treatments:
- Research Supported - Multiple research studies have shown that the treatment leads to positive changes in socialization, communication, and/or behavior. These treatments are highly recommended by psychologists.
- Some Support - A few research studies have shown that the treatment leads to positive changes in socialization, communication, and/or behavior. These treatments are also recommended by psychologists.
- No Research Support but Not Likely to Harm - Research has not yet shown the treatment to be beneficial, but it is also generally not harmful. Most psychologists will not encourage or discourage parents from seeking these treatments.
- Proven to Have No Benefit but Not Likely to Harm - Research has clearly shown that the treatment has no benefit but is also not harmful. Most psychologists will discourage parents from seeking these treatments.
- Harmful - These treatments may be harmful to the person with ASD. Psychologists strongly discourage these treatments.
Which treatment(s) are OK and which should I avoid? Here are some examples of ASD treatments placed into the above categories.
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Intensive Help for Autistic Children
Philip J. Kinney, Ph.D.
By now, you have probably heard about Autism or "Autism Spectrum Disorders" (ASDs). ASDs include autism, Asperger's syndrome, and pervasive developmental disorder. These disorders seem to be increasingly common in America, as more children are diagnosed with them. Other articles in this newsletter will tell you more about the nature of ASDs. Although ASDs are not yet curable, Pennsylvania children with ASDs can be helped a lot with intensive outpatient services.
Intensive Outpatient Services
These services provide ASD children with one, two, and sometimes three mental health professionals. The professionals can help with any need an ASD child has. Needs that can be addressed include:
- Improving communication, speech, and general language skills
- Boosting social and play skills to more typical forms
- Creating better frustration tolerance to reduce outbursts
- Increasing cooperation with parents, other caretakers, and teachers
- Reducing or eliminating behaviors that cause self-harm or harm to others
Who Provides the Intensive Services?
There are mainly three types of professionals that provide these for ASD children:
- Behavior Specialist Consultant (BSC). The BSC has a master's (4 years of college plus 1-2 years of graduate school) or doctorate degree (Ph.D., Ed.D., Psy.D.) in psychology or a related field. A BSC writes up treatment plans with specific strategies for increasing positive behaviors and reducing negative behaviors. The BSC serves as a leader for the treatment team and advises everyone on how to best meet the ASD child's needs.
- Therapeutic Staff Support (TSS) worker. The TSS has a BA (4 years of college) or AA degree (2 years of college). They do much of the actual work with the autistic child, under the direction of the BSC. The TSS teaches the ASD child about playing better with other kids, communicating more effectively, doing things independently, cooperating with adults, and anything else that is needed.
- Mobile Therapist (MT). The MT usually has a master's degree and focuses more on emotional issues affecting ASD children and their families. For example, many parents are very stressed by a child's special issues and need support. Also, some ASD children have many fears and anxieties. The MT can address these more feelings-based issues.
Getting Intensive Outpatient Services
To receive such services for their ASD kids, parents go through the following process:
- An evaluation is performed by a licensed psychologist or licensed psychiatrist. The evaluation must include a diagnosis of an ASD.
- With a report from the psychologist or psychiatrist in hand, parents whose children have health insurance schedule an appointment with an agency that provides intensive outpatient services. The agency then works with the insurance company to get the ball rolling.
- Parents whose children are not insured can file an application with the local Department of Public Welfare office and get a type of insurance coverage called "Medical Assistance."
- In all cases, services for the ASD child must be approved by an insurance company, a process called "authorization."
- Once services are authorized, mental health professionals begin working with the ASD child at home, at school, in the community, or wherever there is a need.
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The Autism Diagnosis Shuffle, continued...
How is Asperger's disorder different from autism? Some children who are bright and verbal may be given the diagnosis Asperger's disorder, or high-functioning autism, or PDD-NOS. The current definition for Asperger's disorder separates it from the other ASDs by requiring normal early speech milestones and average or better intellectual ability. But the line between the disorders becomes fuzzy. In practice, many clinicians make decisions between the two diagnoses based on this framework:
Withdrawn, self-isolates, rigid approaches
Very interested in making friends but awkward and unsuccessful approaches
Verbal but most language for requests with some noticeably unusual uses of language
Overly talkative with monologues on topics of favorite interests and poor conversation skills
Unusual motor movements, rigid, distress with change
Pursuit of information in a specialty area or overly focused interest
The reality is that they are more alike than different. Although debates remain ongoing, most research does not support thinking of high-functioning autism, Asperger's disorder, and PDD-NOS as separate entities. Rather, the current and best information from clinical and neurobiological research suggests that these disorders should be thought of as a single disorder with similar characteristics that vary in severity and presentation. In the updated diagnostic manual for mental health professionals, "autism spectrum disorder" will be the formal diagnostic term replacing the terms autistic disorder, Asperger's disorder, PDD-NOS. (DSM-V)
One name and better diagnosis. Despite the trouble deciding between ASD diagnoses in the current system, clinicians are getting better at determining whether a child has ASD or not. So with the new diagnostic system, hopefully parents of the future will have to come to grips with only one diagnosis, rather than trying to figure out which of the several diagnoses they've been told is the right one for their child. Ideally, the autism diagnosis shuffle will be a thing of the past, and parents, clinicians, and researchers can focus instead on continuing to increase our understanding of the complex disorder and how to promote the best quality of life and outcomes for all who are affected.
Shattuck, P.T., Durkin, M., Maenner, M., Newschaffer, C., Mandell, D.S., Wiggins, L., Lee, L., Rice, C., Giarelli, E., Kirby, R., Baio, J., Pinto-Martin, J., & Cuniff, C. (2009). Timing of identification among children with an autism spectrum disorder: Findings from a population-based surveillance study. Journal of the American Academy of Child and Adolescent Psychiatry, 48, 474-483.
Carla Mazefsky, Ph.D., is a licensed psychologist and Research Assistant Professor in the Department of Psychiatry at the University of Pittsburgh. Her research is part of the Center for Excellence in Autism Research (CeFAR) funded by the National Institutes of Health. For more information about the autism research programs available at CeFAR or Dr. Mazefsky, see www.pittautismresearch.org.
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|Autism Treatments, continued...
Research Supported - Highly Recommended
- Early Intensive Behavioral Intervention (EIBI) is the only treatment for ASD that has been well researched and consistently found to work. It involves the use of one-on-one behavioral techniques to address social skills, communication, and challenging behaviors. EIBI approaches draw from applied behavior analysis (ABA), discrete trials training, or pivotal response therapy (PRT).
Some Support - Recommended
- Comprehensive Developmental Programs utilize a range of developmental approaches to foster social and communication skills, with the most famous models including Training and Education of Autistic and Related Communication Handicapped Children (TEACCH), Floortime, Relationship Development Intervention, and the Denver Model.
- Cognitive Behavioral Therapy (CBT) is used in individual or group talk therapy to challenge negative thoughts, change unhealthy behavior, and build skills. It is a well-supported treatment for disorders such as depression and anxiety. A small but growing body of research suggests that it may also be an effective approach for treating mood, anxiety, and social skills in high functioning people with ASD.
No Research Support but Not Likely to Harm
- Gluten-Casein Free (GF/CF) Diet excludes the proteins gluten (found most often in wheat, barley, rye, and commercially available oats) and casein (found most often in milk). Many special foods need to be bought and it can be quite expensive.
- Omega-3 Fatty Acids is a vitamin supplement.
- Vitamin B-6 is another vitamin supplement.
- Auditory Integration Training (AIT) is a technique developed by Dr. Berard, an ear, nose and throat physician in France. He believes that distortions in hearing or auditory processing contribute to many behavioral or learning disorders such as ASD. AIT is designed to normalize these hearing distortions.
- Animal Therapy is a type of therapy that typically involves horses or some other animal as a part of therapy.
Proven to Have No Benefit but Not Likely to Harm - Discouraged
- Facilitated Communication involves the use of a facilitator who supports the hand/arm of the individual with ASD in order to assist them in using a keyboard or other device to communicate.
- Secretin is a hormone related to digestion. One theory of ASD suggests the difficulties that people with ASD experience is linked to their gastrointestinal difficulties.
No Benefit and Harmful - Avoid
- Chelation involves chemicals that are used to remove metals from the body. In the process of removing harmful metals, it also removes important metals and can lead to death.
- Anti-infective drugs (e.g. antifungal, antivirals, antibiotics) are sometimes purposely avoided or used long-term in ASD. They should be used in ASD, but only short-term to treat identified infections (e.g. ear infections) or other specific medical concerns.
- Hyperbaric Oxygen Chamber involves the use of an increased concentration of oxygen under pressurized conditions. The side effects can be severe and life threatening.
- Le Packing involves wrapping a naked child in towels soaked in very cold water followed by wrapping them in blankets. It is considered unethical.
For more information about ASD treatments and systems of care available in Pennsylvania to receive some of the recommended services, see:
Reichow, B., Doehring, P., Cicchetti, D.V., & Volkar, F.R. (Eds.) (2011). Evidence-based Practices and Treatments for Children with Autism. NY: Springer.
Holly Gastgeb, Ph.D., is a Postdoctoral Research Associate in the Department of Psychiatry at the University of Pittsburgh. Carla Mazefsky, Ph.D., is a licensed psychologist and Research Assistant Professor in the Department of Psychiatry at the University of Pittsburgh. Their research is part of the Center for Excellence in Autism Research (CeFAR) funded by the National Institutes of Health. For more information about the autism research programs available at CeFAR or Drs. Gastgeb and Mazefsky, click here.
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Paying for Services
One of the best pieces of news is that intensive outpatient services for ASD children who qualify are FREE in Pennsylvania. Yes, both private insurers (like Aetna, Highmark, etc.) and public forms of insurance (Medical Assistance) must pay for such services. And, the services are free regardless of household income!
Patience Will be a Virtue
You will be dealing with an insurance company or government bureaucracy and the process takes time. Usually, at least a month goes by between having an evaluation and starting services. The vast majority of parents find that intensive outpatient services are well worth the wait!
For More Information
Department of Public Welfare - Children's Resources
PA Department of Public Welfare - Adult Resources
Lehigh County Department of Human Services
Dr. Phil Kinney is a clinical psychologist in Behavioral Health Services at the Carbon Lehigh Intermediate Unit, where he provides evaluations, therapy, and supervision, and presents workshops on children's mental health issues. In addition, he maintains a private practice in Allentown, PA, specializing in ASDs, anger, anxiety, depression, and child custody matters.
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