Showing posts with label behaviour therapy. Show all posts
Showing posts with label behaviour therapy. Show all posts

Monday, April 2, 2012

Autism: France's treatment 'shame' - The Mother's at Fault!

In many countries, the standard way of treating autistic children is with behavioural therapy, stimulating and rewarding them to develop the skills they need to function in society, but France still puts its faith in psychoanalysis, and an increasing number of parents are now demanding change.

For autism campaigners, it is one of the most serious health scandals of our times.

How for decades France turned its back on the latest scientific thinking, and treated autism as a form of psychosis.

How, as a result, tens of thousands of children were misdiagnosed, or worse, not diagnosed at all, and consigned to lives of misery.

And how, to this day, in its approach to autism, the French medical establishment continues to believe in the powers of psychiatry and psychoanalysis, long after the rest of the world has switched to alternative methods of treatment.

"It is an out-and-out disgrace," according to Daniel Fasquelle, a member of parliament who campaigns on the issue.

"Every day I am contacted by parents with the same story, how their child's autism was not detected in time, so they never had the treatment that they needed.

"Thousands of children could have been saved. They do it everywhere else. Why not here? It is France's shame."

The row over autism in France has festered unreported for years but recently it has become public.

Independent associations have been created, lobbying for a move away from psychoanalysis and psychiatry, and over to the "behaviourist" treatments that prevail elsewhere.

In early March, these groups scored an important victory - with a ruling from the health ministry that calls into question the use of psychoanalysis as a treatment for autism.

But the psychoanalysts are not taking it lying down. From their point of view, behaviourism is a form of superficial social conditioning that does not address root causes and they resent the way they have been typecast as the villains of the piece, when their aims are as sincere as those of their opponents.

"One thing that never pays in the field of autism is triumphalism," said Lauriane Brunessaux, a child psychiatrist. "Autism is far too complex, and we understand it so badly.

"Today it is the behaviourists who are being triumphalist."

The behaviourist approach to autism was developed in the 1970s and 80s in the US and Canada, and it is now the norm in most of the world.

Under the so-called ABA method (Applied Behavioural Analysis), autism is treated as primarily an educational, rather than a medical, problem.

With a set of rewards (which can be granted or withheld) and with plenty of individual attention, children can learn to function in society, and be much less of a burden on their families.

"If you diagnose early, and then give the right treatment between the ages of two and seven, 70% of autistic children can acquire functional language skills. Here in France, we are way off that figure," says Fasquelle.

"And the same pattern continues later in life. In the UK, there are 17 times more university students with autism than in France. It is unacceptable."

Fasquelle and autism associations argue that the blame lies with a medical establishment that remains fixated with Freud.

"Today everyone knows that autism is a neuro-developmental problem. It is not a psychosis or mental disorder," says Muhamed Sajidi, president of the association Conquer Autism.

"But in France it is the psychiatrists, heavily influenced by Freudian psychoanalysis, who remain in charge and they have shut themselves off from all the changes in our knowledge of autism."

Sajidi set up the association after his life was "destroyed", as he puts it, by the medical establishment's failure to diagnose his son Sami's autism.

For him, as for many others, one of the worst aspects is how blame for autism has been laid at the door of the child's parents, and more especially of the mother.

"The first time I went to see a doctor when my (autistic) son Gael was three and we thought there was a problem, the psychiatrist asked me if I had wanted him - if it had been a wanted pregnancy!" says Candy Lepenuizic, a British woman married to a Frenchman.

"Then she asked what sort of dreams I had had while I was pregnant with him. And suggested the whole family have a course of psychotherapy.

"At that point I got up and walked out. It was only because I had been warned this might happen that I did not burst into tears."

Such horror stories are typical in French families of autistic children.

"The whole idea was that it was la faute à maman (the mother's fault). It was the 'refrigerator mum', or there was some problem with the family dynamic," says Lepenuizic.

"They thought that if the child was failing to communicate with the outside world, it was because of some trauma in the womb or in very early life. There was a family malfunction, and we had to cure it!"

Critics say this emphasis on psychoanalysis and relationships meant that autistic children were not spotted till far too late. And that, in turn, meant that their chances of effective treatment were sharply reduced.

Some 60% of autistic children in Sweden attend school, Sajidi says.

"Today only 20% of autistic children in France are in school, and often only part-time. The rest are either in psychiatric hospitals, or in medico-social centres, or living at home - or in Belgium," says Sajidi.

"Many families are sending their children to Belgium, where it is much easier to set up behaviourist treatment centres.

"Things are changing now, because parents are refusing to be taken for a ride by the professionals. But the real tragedy is with France's autistic adults, many of whom are in a state of total incomprehension or even self-mutilation.

"Seventy-five percent of families with autistic children end in divorce, and normally it is with the mother that the autistic person stays.

"Today these poor elderly women are looking after their adult children with no knowing what will happen when they die."

If Sajidi and other campaigners are beginning to feel the wind turn, it is because the health ministry is finally beginning to fund pilot schemes for behaviourist schools, as well as early diagnosis centres.

In its recent report, the ministry also effectively outlawed a practice known as "packing" where autistic children are wrapped in damp cloths in order to reconnect with their bodies. Campaigners say the treatment is both barbaric and ineffective.

The fundamental problem, campaigners argue, is that the psychiatric profession is resisting calls for change, because the fewer patients there are, the less they earn.

"They have a financial interest in institutionalising autistic children," says Sajidi.

Lepenezuic says: "The state pays. The child doesn't get any better - but who cares? It's being looked after by the state, and the doctors are making a lot of money. Why would they change the system?"

But on the other side of the fence, such charges are deeply resented.

Child psychiatrists like Lauriane Brunessaux believe that the associations have grossly distorted the debate, and are engaged in a battle to "discredit psychoanalysis and the whole notion of the unconscious".

Defenders of the French system argue that the situation was never as one-dimensional as the behaviourists have claimed.

First of all, they say, there have been plenty of success stories emanating from a psychoanalytical treatment of autism. They just have not been so loudly trumpeted.

Secondly, it is not as if the behaviourist approach is itself beyond criticism. In the US and Canada, argues Brunessaux, there have been studies that raise serious questions over its true scientific validity.

"The only real scientific reference for behaviourism is the electric shock experimentation on rats carried out by (US psychologist) Burrhus Skinner in the 1940s.

"Obviously the methods of reward and punishment today are totally different. But that is the background to behaviourism," she says.

For leading French psychoanalyst Eric Laurent, there is a deeper problem.

"Changing behaviour is one thing. But what do you do with the trouble that lies behind it? It is all very well to focus on the skills that can be transmitted via an intensive behaviourist approach, but that leaves a whole dimension out of the picture," he says.

As for the charge that psychoanalysts are responsible for family breakdown, Laurent is equally dismissive.

"The idea that you had to wait for psychoanalysts to come along for there to be hatred inside families is ridiculous. Hatred has always been there.

"Psychoanalysis is being used as a scapegoat - though we should not perhaps mind that, as being a scapegoat is part of the role of psychoanalysis," he says.

What angers people like Brunessaux and Laurent is that while on their side of the debate they are quite prepared to admit the effectiveness of behaviourism - as one of several possible approaches to autism - the behaviourists are dogmatically tied to their system and theirs alone.

Whoever is ultimately in the right, what the autism row perhaps shows most clearly is the changing nature of French society.

Once, families did what they were told. The state was ultimately benevolent, and had massive resources to dispense. If doctors chose institutionalisation, then who was to argue?

Today it is different. Thanks to the spread of knowledge, the internet, consumerism and the decline of the collective spirit - families for the first time feel emboldened to think, and act, for themselves.

Autism: Why Some Children ‘Bloom’ and Overcome Their Disabilities

A new study offers some good news for families with autism. Most children affected by the disorder do not have intellectual disabilities, the study finds, and even among the severely low-functioning, about 10% may improve dramatically over time, with some growing out of their diagnosis by their teens.

The study tracked nearly 7,000 autistic children born in California between 1992 and 2001. The group included most of the children who received an autism diagnosis in the state during that time period.

The kids were followed from diagnosis to age 14 or the oldest age they had reached by the time the data collection was concluded.

The researchers found that 63% of the children did not have intellectual disabilities. Although autism is known to cause cognitive deficits in some children, it is also associated with certain enhanced intellectual abilities, and some affected children have extremely high IQs.

About one-third of the study group were considered low- to low/medium-functioning in terms of communication and social skills, meaning that they may have trouble talking, interacting with others or socializing and making friends with peers.

High-functioning kids with autism, meanwhile, can communicate effectively with others, maintain friendships and are willing to engage in social pursuits.

While the highest-functioning children tended to show the most improvement over time in the California study, about 10% of those who started out in the low-functioning group also moved into the highest group by age 14.

“The critical finding is that when you look at those children that this study refers to as ‘bloomers’, the children who seemed very low-functioning at the beginning and then did extremely well, they [tend not to] have any intellectual disabilities,” says Rahil Briggs, assistant professor of pediatrics at Albert Einstein College of Medicine, she was not associated with the research.

Low-functioning children without intellectual disabilities were twice as likely to “bloom” as those who had cognitive deficits.

Briggs adds that another “very key” factor is that the mothers of the kids who bloomed tended to be more educated and not minorities.

This suggests that low-income immigrant or minority families may not be receiving the services and support for their children that educated, affluent parents are able to access more easily.

With developmental disorders, the earlier a child receives help, the more likely he or she is to overcome disabilities.

Early intervention matters because the brain is remarkably vulnerable early in life, built to shape itself to the environment it initially faces. “The young brain is disproportionately receptive to input, whether positive or negative,” says Briggs.

“That’s why young children can learn a second language easily and why early exposure to domestic violence and toxic stress are so incredibly damaging.”

If autistic children receive intervention before such coping mechanisms as repetitive behaviours and extreme social withdrawal are firmly entrenched, for example, their innate oversensitivity to their environment is far less likely to become or remain disabling, and their other abilities and gifts can flourish.

If these children are reached early enough, “we can actually start to change brain functioning if we provide the right kind of repetitive and focused intervention,” Briggs says.

Parents Need to be Aggressive Champions
The American Academy of Pediatrics currently recommends that doctors screen children for autism at their 18-month well-child visit. Briggs adds that parents must become aggressive champions for their children.

“So much can depend on how good that parent is at advocating for the child,” says Briggs, noting that parents need to be aware not only of what services are available, but also which ones are best, which are not helpful and how to get the best care.

“That puts an incredible burden on parents,” she acknowledges. With the Centers for Disease Control and Prevention reporting last week that autism now affects 1 in 88 children, it is becoming a burden shared by more and more American families.

Briggs says that the findings in the new study reflect the types of developmental trajectories she sees in children in her practice as director of the Healthy Steps program at Montefiore Hospital in the Bronx (NY), which helps disadvantaged families access numerous services, including autism therapies, through their pediatricians’ office visits.

She describes working with a 5-year-old autistic boy and his family. The family said he would come home from kindergarten crying, but they couldn’t figure out what was wrong.

Finally, he described how he felt while he waited for his mother to pick him up in the school’s cafeteria:
“There were so many echoes bouncing off the walls that it felt like people were having a party in my head and they wouldn’t turn down the music,” he said.

Identifying the problem led Briggs to enroll the boy in listening therapy, which helped him cope with his sensitivity to sounds.

When such sensory issues, which are common in autism, can be mitigated, children become far less stressed and far better able to learn other skills like social interaction and communication.

Most children from disadvantaged backgrounds aren’t able to get these kinds of services, however. “If we still see these huge differences in children with autism based on socioeconomic factors, we clearly don’t have enough programs or haven’t made them available enough,” Briggs says.

The research was published in Pediatrics.

Wednesday, October 26, 2011

ADHD: Training and Support for Clinicians


Aims
The ADHD website aims to give information to clinicians including general practitioners, GPWsi's, community paediatricians and CAMHS staff on:
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a) ADHD and related neurodevelopmental disorders;
b) Identifying the signs and symptoms of ADHD including consideration of the differential diagnoses, co-morbid disorders and associated functional difficulties;
c) Management options for children with ADHD and their families including behavioural strategies and prescribing options;
d) How to manage ongoing care and support for children with ADHD and their families including medication monitoring.
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The information provided on the website could be used as :
  1. an introductory training package for GP's with a special interest (GPWsi's) in children's mental health, in particular in ADHD, who wish to take a lead on this topic within their practice area;
  2. an introductory training package for non consultant clinical staff who work in ADHD clinics run by either by Child and Adolescent Mental Health Services (CAMHS) or paediatric departments e.g. GP clinical assistants, senior nurse practitioners and junior/ middle grade medical staff. It is advised that this information is complemented by on site clinical supervision from a consultant with special expertise in ADHD.
  3. training materials about ADHD for all GP's who have children and young people on their lists with this disorder and to act as a pointer to websites which may be useful to clinicians and parents. The site may be of particular interest to GP's providing ADHD monitoring enhanced services.
  4. an aid for a seamless transfer of specific aspects of patient treatment from the secondary sector to general practice. Information is provided on the nature of the condition treated, the medications in question, the monitoring required and the responsibilities of the parties involved.
This website can also be utilised as a part of a PG Cert Course (30 credits at Masters Level, ‘subject to validation’) with the University of Wales, Newport. Please contact amanda.kirby@newport.ac.uk for further information.
.
The course aims are as follows:
The module will provide student knowledge in the following areas
  • An understanding of the signs and symptoms of ADHD in children, adolescents and adults
  • An understanding of the assessment and diagnosis of ADHD in children and adolescents
  • The principles of a multi-modal treatment package for ADHD.
  • The knowledge of non pharmacological interventions for ADHD
  • An understanding of the pharmacological interventions for ADHD
  • The understanding of issues of medication including
    • Starting medication
    • Switching medication and polypharmacy
    • Medication monitoring
    • The issues of the management of the ADHD- follow up clinics
  • Consideration of ADHD in relationship to other co-morbid disorders
The Learning Outcomes are as follows:

On completion of the PG Cert module the student would:

  1. Have an understanding of current knowledge and theory relating to the aetiology underpinning ADHD and related co-morbid disorders.
  2. Be able to critically reflect upon the management and intervention options for supporting an individual with ADHD.
  3. Demonstrate knowledge of current practices in the management of the individual with ADHD in the context of common health and educational practices and through a consideration of research undertaken in this area.
  4. Demonstrate an understanding of the choices for treatment both pharmacological and non pharmacological.
  5. Critically reflect upon the different factors that may impact on the individual’s difficulties at home and at school and in further education.
  6. The student will gain knowledge of the management principles of running a follow up ADHD clinic.
These aims are informed by the following philosophy:

Improving access to knowledge on ADHD for the groups of clinicians above will help to combine the best of primary and secondary care for the benefit of these patients and their families.

Shared care arrangements between primary and secondary care are thought to be essential for safe, effective and efficient treatment with complex drugs such as those used in the medical treatment of ADHD.

Entry into a shared care arrangement is voluntary for all parties involved. It should be noted that clinical responsibility lies with the prescribing doctor.

GPs and other clinicians should therefore familiarise themselves with the drug treatments they are prescribing, ensure an acceptable monitoring arrangement is in place and feel confident that they can obtain appropriate specialist support when required.

Glossary of Abbreviations
  • ADHD = Attention Deficit HyperactivityDisorder
  • ASD = Autistic Spectrum Disorder
  • CBT = Cognitive Behaviour Therapy
  • CD = Conduct Disorder
  • DCD = Developmental Co-ordination Disorder
  • DSM-1V= Diagnostic and Statistical Manual of Mental Disorders (4th Edition)
  • HKD = Hyperkinetic Disorder
  • ICD-10 = International Classification of Diseases (10th version)
  • IEP = Individual Education Plan
  • LSA = Learning Support Assistant
  • LEA = Local Education Authority
  • ODD = Oppositional Defiant Disorder
  • SDQ = Strengths and Difficulties Questionnaire
  • SEN = Special Educational Need
  • SENCO= Special Educational Needs Co-ordinator
  • TCA = Tricylic antidepressant
  • WISC = Wechsler Intelligence Scale for Children 

    Saturday, March 5, 2011

    Distance Learning: Play Therapy from Counsellor Training

    For more information visit the Counsellor Training website; Play Therapy



    NB: This is not a reccomendation to buy this product, it is suplied for information only. We encourage you to make your own checks and research on the provider before committing to the course.

    Friday, May 7, 2010

    Meta-cognitive Therapy (MCT) for Adult ADHD

    Meta-cognitive Therapy (MCT) for Adult ADHD | Psych Central News

    A new study suggests meta-cognitive therapy (MCT), a method of skills teaching that uses cognitive-behavioral principles, improves outcomes among adults with attention deficit hyperactivity disorder (ADHD).

    Mary Solanto, Ph.D., Associate Professor in the Department of Psychiatry and Director of the Attention Deficit/Hyperactivity Disorder Center at The Mount Sinai Medical Center examined the effectiveness of a 12-week meta-cognitive therapy group.

    The intervention was intended to enhance time management, organisational, and planning skills and abilities in adults with ADHD.

    “We observed adults with ADHD who were assigned randomly to receive either meta-cognitive therapy or a support group,” said Dr. Solanto.

    “This is the first time we have demonstrated efficacy of a non-medication treatment for adult ADHD in a study that compared the active treatment against a control group that was equivalent in therapist time, attention, and support.”

    The study observed 88 adults with rigorously diagnosed ADHD, who were selected following structured diagnostic interviews and standardized questionnaires.