Help: Stimming in Autism

Tonyia Posts:

DEAR ERI COMMUNITY: I’m looking for any advice regarding a current student I work with. He is a 9 y/o boy with severe Autism, hard of hearing, and cognitive delay. His stims have been increasing lately, approximately the last 6-8 weeks, we’ve seen new stims including drawing on himself and in the air, arm flapping, running in circles, can not stand still longer than 2 sec (I know these are “typical” stims). His normal stims are drawing on white board over and over, looking at his drawings with his peripheral vision, and rocking. The stimming is constant throughout his day and nights, compared to previously a handful of times throughout the day. We are a residential school, so he is here 5 days/nights a week. He has also started touching other boys in their genitals, repetitively. He has developed an unhealthy relationship with another classmate, who he needs to be next to at all times, is constantly touching him, if the other child leaves the room, he begins to cry and perseverates on that boy until he returns. The teacher and aides have them separated in the classroom so there is no touching that can happen, unless this boy runs over and grabs the other boy. The other boy does not encourage these behaviors. He is caring toward the other student, but often wants a lot of separation between the two of them.

I know that stims change, come and go, intensify at times, one needs to be replaced with another. We have always been able to redirct him in the past, we’ve worked with increasing his sensory diet and he communicates his needs most of the time now. He is never denyed sensory when we feel he needs it or when he requests it.

So, the real question is: does anyone have any ideas what can be causing the increase in stimming and behavior, plus treatment ideas please. Our behavior specialist is helping with the changes as well, but hasn’t come up with anything effective yet.

Thank you,
TLF, PTA

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Worried about how the New Definition of Autism and ASD Will Affect your Therapy Practice?

Are parents asking you about how this new definition will affect their child’s therapy?

As you know, revisions in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders, set for publication spring 2013 has changed the definition of autism and will categorize Aspergers, PDD-NOS and Autism into one lump category of ASD (Autism Spectrum Disorders). 

One pro of this revised definition is that there will be fewer misdiagnosed patients. “Better diagnosis can help give better numbers on those affected, causes, potential diagnosis and effectiveness in interventions” according to the Center for Autism. 

One major concern is that some who may need occupational therapy, may not get the health care coverage needed to afford it. Many therapists believe that there will be a rise in high functioning children with autism that will become ineligible for health insurance coverage for their therapy treatments. 

Another worry is that these patients that may be high functioning ASD cases will not be referred to therapists because they don’t fit the new definition. 

At this point there is speculation as to what the new definition will include. The New York Times posted an article that showed the proposed Autism definition’s changes this past January. However we will not know for sure until the new version is released to the public next spring. 

As a therapist what do you think of the new definition of Autism? Is your center doing anything to promote a grass roots effort to challenge the definition and educate the public?

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Child Won't Chew: Any Tips

Beth Posts:

DEAR ERI COMMUNITY: I have a client right now that I am having trouble teaching how to chew. He was on stage 2 baby foods at 14 months old when I first started working with him. He is now eating mashed table foods, but often needs pudding or appleasuce on the spoon with the foods to tolerate. His mother has done the Therapressure Protocol with him in the past and we saw great improvements with tolerating touching foods, diaper changes, etc. I have asked his mother to start the Therapressure Protocol again. Now that we are gradually making his food chunkier, we have noticed that he does not chew. I gave his mom a NUK brush and gave her suggestions on working on tongue lateralization to improve oral motor skills. He will briefly hold something between his front teeth, but he pushes the chewy tube forward with his tongue when I place it on his back molars. I have his mother inserting the spoon to the sides of his mouth so the food is placed on his molars and she said she thinks he chewed one time over the past week. Any tips or suggestions would be appreciated! Thanks!

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Demystifying CEUs (Continuing Education Units) for physical therapists: State Requirements

Did you know that the APTA does not have an approval process for CEUs for continuing education courses? What this means is that it is up to each Board of Registration in Physical Therapy to set (and sometimes administer) its own requirements for re-licensure. At last count, while 12 states have no CEU requirements for re-licensure, 38 others were left to figure out whether or not they needed a pre-approval process for their CEU requirements. In addition, some states have chosen to require “continuing competency”, and thus they include giving credit for writing and publishing research quality papers, giving in-services, and the like.

Education Resources keeps up with each state’s requirements and any changes. We apply for approval to either the Board or to the state chapter of the APTA for pre-approval in the state where our live courses are being held. In addition, we are pre-approved in certain states (Texas, New York, California, North Carolina) and some other states will accept another state’s approval, (Rhode Island, South Carolina and Virginia).

What does this mean?

If you are licensed in: TX, NY, CA, NC, RI, SC or VA you may take any of our courses no matter where they are, and receive CEU credits.

Stay tuned for more specifics about each state and how to tell if the course you are taking will provide you with the CEUs you need for re-licensure. As always, feel free to call us (508-359-6533) or blog with any questions you may have about CEUs and we will try to answer them.

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Down's Syndrome: Case Question

Jennifer Posts

DEAR ERI COMMUNITY: I am a new pediatric occupational therapist and I can’t wait to hear some suggestions. A fellow physical therapist and I have been struggling with a patient: 16 month old female, Dx with Down’s syndrome. I have been seeing this pt. for around 5 months. The physical therapist and I whom are working with this little one feel as if we have hit a wall for about the last month. The patient was making excellent progress, including independence with sitting balance and improvement with functional transitions. The patient now begins to cry the second she leaves her Mother’s arms. We have tried having the mother observe unseen through a one way mirror, using the mother as a distracter, and even utilizing Mom for much of the handling. The other therapist and I have begun testing a variety of sensory strategies along with private rooms, large treatment gym, natural lighting, low lighting, music, etc. We have backed off with handling and tried moving off of the floor to platform swings, swiss ball, & even mother’s lap to no avail. The patient immediately closes her eyes, throws herself into extension, begins to cry, and is unable to be calmed by Mom or therapist. The patient has been cleared by her MD for GI, cardiac, and any other factors we could think of. Mom and Dad report the Pt does not demonstrate any difficulties at home. Any suggestions would be greatly appreciated!

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