Autism - Beyond core therapies. 2nd Annual NICE Conference Summary

Autism or Autism Spectrum Disorder (ASD) presents with wide range of challenges in Social interaction, communication combined with restricted and repetitive behaviors. Professionals from different disciplines are involved in assessment and treatment of children with Autism. These professionals include Developmental Pediatrician, Psychologist, Psychiatrist, Speech language Pathologist, Occupational Therapist, Special educator, Nutritionist, etc. When all these professionals work as a team in assessing and treating children with Autism, improvement is evident in all the domains.

 Nishta center of excellence (NICE) has provided a common platform to help all the professionals from different disciplines to learn about Autism and the myths surrounded it, evidence based intervention strategies, etc. As a health care professional it is very important to know the facts and myths that surround Autism. NICE has organised a 1 day conference at St. Isabel's Hospital, Chennai with the theme "Autism - Beyond Core Therapies" on 4th March 2018. Below I would like to share my learnings from the Conference. 

The first presentation was "Follow up ASD Learn, Unlearn and relearn" by Dr. J. Meenakshi, Pediatrician, NICE. ASD tends to occur more often in people who have certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis. Artificial reproduction treatment methods may also contribute to ASD. Role of  "Epigenetics and environment" as one of the possible causes for ASD has been explained. To explain in brief, it appears that autism often results from a combination of genetic susceptibility and environmental triggers. Autism symptoms manifest before 18 months and by monitoring child's developmental patterns it can be identified early. The checklists and questionnaire for different age groups that helps in early identification were listed out in this presentation.

The Second presentation was "Growing up with Autism Spectrum Disorder - a Timeline" by Ms. Devi, Speech language Pathologist. In this presentation, speaker shared information about history of Autism diagnosis, Co-morbid problems, timeline for intervention from the day of identification till adolescence, data about autistic adults in terms of independent living and outcomes, and Cynefin Framework. Speaker also shared about the elements that act as strong predictors of vocabulary development.

The third presentation was "Teen with ASD" by Ms. Priya. G, Psychologist. The Third speaker explained about the challenges that an Autistic teen encounters every day in terms of executive functioning skills, hygiene, sleep disturbances, schooling, Sexuality and also shared few strategies that help them cope with these issues. Areas of concerns in low functioning and high functioning Autism were explained.  

 The fourth Presentation was "Struggles for adults with ASD" by Dr. Kannan, Child Psychiatrist. Dr. Kannan shared data regarding prevalence and incidence of ASD in India, that ASD is the fastest growing developmental disorder, 1 in 110 children are having ASD, 7,500 children on average are likely to be diagnosed as ASD every year. Factors that affect outcomes in persons with ASD were shared.

The fifth presentation was"Psychiatric disorders in ASD and the management strategies" by Dr.Poongodi Bala. A number of medical and behavioral issues frequently occur with autism spectrum disorder (ASD). These “co-morbid conditions” include anxiety, depression,attention-deficit/hyperactivity disorder (ADHD), Intellectual disability (ID), gastrointestinal (GI) problems,sleep disturbances, inappropriate sexual behavior, OCD, Schizophrenia, Tics, Tourettes's syndrome, catatonia, epilepsy, Trichotillomania, enuresis or encropresis. Statistics reveal that 3/4 of ASD children have co-morbid conditions. 70% to 92%  have atleast one Co-morbid conditions. 40% have 2 co-morbid conditions. 10% of Intellectual diability have Autism. 38% of the children with ASD  have Intellectual disability as co-morbid condition. Analysis and intervention strategies were briefed.

In the next presentation, "Autism and ADHD" by Dr.Vimal Doshi Veerappan, Psychiatrist. Information regarding the relationship and differential diagnosis between Autism and ADHD, comorbidity, causes, symptoms, identification methods, importance of medication in reducing inattention and impulsivity were discussed. Intellectual disability and global developmental delay are the first co-morbid conditions in ASD and  ADHD is the second co-morbid condition in ASD.  For children who are already diagnosed with ADHD, the diagnosis of Autism is delayed by 3 years. 85% of ASD will have ADHD and 67% of Autism symptoms are reported in ADHD. 

The next Presentation was about "AAC (Alternative Augmentative Communication) by Ms. Amruthavarshini, Speech Language pathologist. Topics like candidacy, Social stigam in using AAC, strategies, different types of AAC devices along with pros and cons of each type of AAC were discussed. Few apps which provide AAC like Aavaz app were also listed out. 

The next topic was about "Social communication development in ASD" by Mr. Perumal, Reader, Speech Language Pathologist which had information about importance of social communication in ASD, diffrent components of pragmatics, assessment tools, intervention of pragmatic skills, activties for group therapy. 

Dr. Subramanian, Pediatrician spoke about medical management of Autism clearing the myths and misconceptions around relation between Vaccination and Autism, insufficient evidence of clear benefits with Gluten and Ceasin free diets, consequences of malnutrition on congnition in ASD due to these diets. He has also mentioned some of the medical conditions associated with Autism like pica, obesity, anorexia,GI tract related issues, gastritis etc. He has also shared that 1 in 4 autistic children develops seizures before 5 years or during adolesecnce. Mangament strategies for few medical conditions like chronic constipation were discussed.

 Dr. Vidhubala, Psychologist, shared information about "Evidence Based practices in Intervention". She has mentioned treatment approaches that has significant scientific evidence like ABA, DTT, PECS, FCT, Pivotal response training  etc., treatment approaches that has limited scientific evidence like sensory integration, auditory integration therapy, Play therapy, electro convulsive therapy, parent counselling etc., treatment approaches not recommended such as holding therapy, Secretin, Chelation for neurotoxicity. She has also highlighted the need of reasearch and data collection in ASD from different professionals in India.

 Ms. Ida, Occupational therapist explained about "Strategies towards management of meltdown", which focused on meltdown triggers, catastrophic reactions, types of meltdown, difference between meltdown and tantrums, management strategies such as NAPPI, SCARED. 

The last presentation was about "Literacy in ASD" by Mr. Rajesh Ramachandran, Special education, focused on Cognitive-Linguistic model, pre academic skill development strategies, NIOS curriculum. 

A parent of 21 years old autistic male, has also shared about her experiences throughout the journey till date. She has also shared that how her son became independent after the birth of sibling which made her realize that she has never created a situation for transition of learnt skills into independent living. 

Finally, my takeaways from this conference were 

1. Environmental epigenetics - How environmental factors can control gene expression?  

2. Co-morbid disorders and its management, 

3. Intervention of lifeskills through childhood till adolesence, 

4. Activities to target social communication development, 

5. Treatment approaches with significant scientific evidence, 

6. Management of meltdown, 

7. Myths and misconceptions about medications, vaccination, GFCF diet.

Dated: 06/03/18

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