Vol 3 • Issue 2 • Mar 2012

Autism Awareness: The Importance of Meaningful Work

Over the last twenty years, the prevalence of Autism Spectrum Disorders (ASD) in the United States has increased more than 600 percent, bringing us to the now familiar statistic 1 in 110 children. Approximately 67 million people worldwide are affected by ASD. With rates of the disorder on the rise, it is more important than ever that people understand what Autism is, how to spot it and what to do to ensure that any person diagnosed with it can lead a meaningful and good life.

Organizations such as Autism Society and Autism Speaks have worked very hard to advance the dialogue, informing parents, practitioners and lawmakers. There is an urgent demand to address the many needs associated with ASDs. Individuals and families continue to struggle to address unmet needs across the lifespan of individuals with ASD.

April is Autism Awareness Month. In 2007, April 2 was also declared World Autism Awareness Day by the United Nations General Assembly. There is no better time, therefore, to educate people about this complex neurological disorder that is more prevalent among children than cancer, diabetes and AIDS combined.

There is no cure for Autism: it is a lifelong condition that impacts how an individual interacts with the world around them. However, research indicates that two years of early behavioral intervention at preschool age can result in significant improvements in IQ and language ability for many children with ASDs. It is important, therefore, for parents to be on the lookout for “red flags” that can act as early indicators of autism. These red flags may indicate a child is at risk for atypical development, and is in need of an immediate evaluation. In clinical terms, there are a few “absolute indicators,” often referred to as “red flags,” that indicate that a child should be evaluated.

For a parent, these are the “red flags” that your child should be screened to ensure that he/she is on the right developmental path.

• No big smiles or other warm, joyful expressions by six months or thereafter
• No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter
• No babbling by 12 months
• No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
• No words by 16 months
• No two-word meaningful phrases (without imitating or repeating) by 24 months
• Any loss of speech or babbling or social skills at any age

If your child shows any of these early indicators, it is important to get an immediate evaluation from a pediatrician or family practitioner to ensure that they are on the right path. With the correct treatment and support, people with Autism can lead a rich, fulfilling life. While it is an enduring disorder, individuals with Autism like Vanessa who you will read about later in this newsletter, can learn real-life skills and become a productive and contributing member of society.

In observance of Autism Awareness Month, I urge you to seek out information on the disorder. Resources are readily available. Education is the key to strengthening our community and will help to advance the lives of those living with Autism.
For more information about the continuum of services offered at GIHN, please contact the admissions office at admissions@grafton.org.

Success Story

Vanessa’s Story

ASSESSMENT:
Vanessa* is a 16 year old young lady who loves Disney movies and reportedly has a great sense of humor. Prior to her admission, Vanessa engaged in serious destructive behaviors at home and school including self-injurious behavior (biting self, banging head), pica (eating non-edible materials), and aggression (hitting, scratching others). She exhibited poor impulse control and experienced difficulties accepting rules and. Her behavioral outbursts were frequent and severe when preferred items or activities were not immediately made available to her.

Each member of her multidisciplinary team sought to understand Vanessa across different treatment specialties through functional behavior, academic, vocational and speech language assessments.

INITIAL PRESENTATION:
When Vanessa was admitted to Grafton Integrated Health Network, she was diagnosed with Autistic Disorder, Attention Deficit Hyperactivity Disorder, Mood Disorder and an intellectual disability.

Most notable behaviors of concern included self-injurious behaviors (head banging) and biting, putting her and others at risk. At the time of admission, Vanessa was exhibiting multiple forms of destructive and disruptive behaviors that put her and others at risk for injury. The primary triggers for Vanessa’s target behaviors stemmed from being denied her way and/or being asked to delay gratification. This was particularly evident when she has been denied access to the computer or additional food.

Another behavior that placed Vanessa’s safety at risk was elopement. Although this occurred intermittently, when it did occur, it placed Vanessa’s safety at risk as she was not able to let others know where “home” was nor was she able to discern safe and unsafe situations.

Vanessa frequently resorts to idiosyncratic gestures, self injurious behaviors and aggression to regulate and express her emotions.

THERAPEUTIC INTERVENTIONS:
In developing a customized treatment plan, Vanessa’s multidisciplinary team took into account her communication needs, strengths, preferences and abilities. It was critically important to identify things that were important and meaningful for Vanessa. Like most teenagers, Vanessa enjoys listening to music and spending time surfing the internet. She also had a keen interest in completing word puzzles. These activities were made available to her during the school day as well as in the evenings to encourage task completion and to develop greater impulse control and delay gratification.

Speech therapy sessions focused on encouraging Vanessa to use pictures, sign language and verbal phrases to communicate. Through repetition, modeling and consistent reinforcement from team members, Vanessa has been able to gradually increase her repertoire of spoken language. She now uses a combination of verbal and nonverbal communication to express her needs. In addition to a few basic signs such as “please”, “eat” and “thank you”, she relies on picture icons to let her desires and wishes be known.

Picture schedules have proved to be an effective tool in preparing Vanessa for upcoming activities within her daily routine. Picture icons have promoted choice and developed a sense of autonomy. These communication tools have provided Vanessa with additional means to communicate. She is able to use sign language as well and has learnt certain verbal phrases to communicate what she needs. Her willingness to use her verbal skills is heavily reinforced by her team members who make it a point to honor her requests when she chooses to use words.

Through the use of cognitive behavior strategies, modeling and structured repetition, Vanessa has steadily learned to request things that she wants. Recently, she has been making independent requests for medicine when she experiences headaches or migraines.

PROGRESS:
As the multidisciplinary team began to better understand Vanessa, it became apparent that “meaningful work” was important to Vanessa’s sense of self and her overall self-concept. Vocational assessments administered on an annual basis suggested that Vanessa selected the same types of tasks as meaningful and rewarding. Her job placements were selected directly as a result from what she identified as meaningful. Currently, Vanessa works at three work sites including Chadwick & Son Orchid’s, Pocahontas State Park and James River Park system. Her job duties consist of cleaning and stocking clay pots as well as cleaning bathrooms and maintaining park grounds by picking up litter. She is able to complete tasks at all three job sites with minimal to no prompts from staff. Many of the job tasks at her work sites requires up to fifteen steps to complete the task. In fact, when other clients fail to complete the task at hand using all the “required” steps, Vanessa steps in to assist them!

Recently, Vanessa had a successful visit home. She actually returned from a home visit and began using the phrase, “I love you” towards staff. It is believed that Vanessa’s mother actually taught her this phrase and used it frequently with her.

Vanessa’s mother shares, “Vanessa has learned to communicate her wants and needs and this has made a world of difference. She also enjoys her jobs within the community and I am just so pleased with how she is doing. I think that her Case Manager at Grafton is the best of the best and really knows Vanessa and responds to her in such a positive manner.”

Overall, Vanessa has made significant progress. Amazing, creative, lovable and intelligent are just a few words that team members use to describe Vanessa.

There has been a significant decrease in self-injurious behaviors, elopement and incidents of disruption. She has developed coping skills to help manage her behavioral difficulties, become a strong advocate for herself and most importantly, use tools available to articulate what she wants and needs.

*Client’s name has been changed to protect her privacy

• GIHN wins the 2012 Negley President’s Award for excellence in risk management practices. The award submission focused on the “Safety Seven”, a program designed to keep clients and employees safe. The Negley award was presented at the Mental Health Corporations of America (MHCA) conference on February 23, 2012. The paper will also be presented at the 42nd National Council conference in Chicago, Illinois scheduled in April 2012.
• “Improving Goal Mastery through Data-Based Decision Making” was presented at the 2012 Virginia Transition Forum by Lisa Marshall, director of clinical services, in Roanoke on March 12th through March 14th. Roger Styron, career and technical education (CTE) teacher also presented, CTE Assessment for Intellectually and Behaviorally Challenged Individuals at this conference.

• Shamsi Sadeghzadeh, director of outreach services will present “Functional Behavior Assessments and Innovative and Proactive Treatment Strategies”, a webinar for the National Association of Dually Diagnosed (NADD) webinar series on April 10th.
• Shweta Adyanthaya, director of communications and Kim Sanders will present “Promoting Trauma Informed Treatment Practices” at the American Association of Children’s Residential Centers (AACRC) 56th Annual Conference. In addition, “ABA in a Trauma Informed Program of Care” will be presented by assistant education administrator, Jason Craig and Shamsi Sadeghzadeh. The conference will be in New Orleans on April 23rd through April 27th.
• Teachers, Robert Johnson, Laura Mills and Jessica Wine will present “IPad vs. SMART Boards” at the 2012 spring Virginia Association of Independent Specialized Education Facilities conference on April 26th.