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Evidence Based Practices for Mental Health Professionals

By Jim Messina, Ph.D., CCMHC, NCC, DCMHS


Chapter 3 Autism Spectrum Disorder 

LEARNING OBJECTIVES FOR

 AUTISM SPECTRUM DISORDER

After reading this section you will learn the answers to the following questions:

  1. What are the ICD-10-CM Codes for the Austism Spectrum Disorder?
  2. What are the clinical descriptors for the Autism Spectrum Disorder?
  3. What are the symptoms common for Autism Spectrum Disorder?
  4. What are the common populations which are treated for Autism Spectrum Disorder?
  5. What are the common treatment settings for Autism Spectrum Disorder?
  6. What are the Evidence Based Practices for treating Autism Spectrum Disorder?
  7. What area the common psychopharmacological treatments for Autism Spectrum Disorder?
  8. What are some common manuals, guideline books and client workbooks for working with Autism Spectrum Disorder?
  9. What are some good references you can use to learn more in-depth information about Autism Spectrum Disorder?

ICD-10-CM Code for Autism Spectrum Disorder in DSM-5

F84.0 Autism Spectrum Disorder

Specify if Associated with a known medical or genetic condition or environmental factor; Associated with another neurodevelopmental, mental, or behavioral disorder

Specify current severity for Criterion A and Criterion B; Requiring very substantial support, Requiring substantial support, Requiring support

Specify if: With or without accompanying intellectual impairment, With or without accompanying language impairment, With catatonia (use additional code 293.89 (F06.11)

 

American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders (5th ed.) (DSM-5). Washington, DC: Author.

Jeffrey: Autism Spectrum Disorder


Jeffrey’s mother and father are sitting in your office crying as they both describe the shock they felt when Jeffrey’s pediatrician told them he suspected that Jeffrey had autism spectrum disorder (ASD). Mother tells you that when he was only 6 months he did not seem to respond well to his name being called out and he never gave her eye contact. By 9 months he was into self-stimulation and ignored those around him, finally on his first birthday it was clear that something was wrong and that was when they went to his pediatrician who referred them to you due to his suspicion that Jeffery has autism spectrum disorder.


You proceed to get a complete psychosocial history on Jeffrey and his family and find out that there has never been anyone on either side of his parents’ families who was diagnosed with autism spectrum disorder. His parents are college educated and both have stable employment. Jeffrey is their first child and they are not sure what is going to happen to their lives given his diagnosis. They both are blaming themselves for his condition and are confused why he was born with this condition.


After getting a good psychosocial history you spend time with Jeffrey and see that he does not give eye contact even when his name is called. He does not look at you or anyone in the room and seems fixated on the toy he was holding when he and his parents arrived, His developmental milestones are delayed and he still is not walking on his own.


You know he needs to be referred to an early intervention program as soon as possible.  In the program he would receive Discreet Trial Learning (DEL) as part of an Applied Behavioral Analysis (ABA) intervention by a Speech Therapist or Educational Specialist to help him develop his speech and communications skills. He needs sensory integration intervention by an Occupational Therapist to help him coordinate his sensory responses so that he can relax and gain needed fine motor and gross motor skills. He finally needs Developmental, Individual-Difference Relationship (DIR) better known as floor time to grow in relationship building based on growth of emotional and relationship building skills. The parents need to be involve in individual and couple counseling to deal with their grief and loss issues so that they are better able to accept Jeffrey for who he is and so they can adjust their goal setting for him which is reflective of his social, emotional, behavioral, educational and vocational needs. They also need to be referred to support groups which help parents appropriate handle all the issues they will face when dealing with a child who has been diagnosed with Autistic Spectrum Disorder.


Finally give Jeffrey’s parents a homework assignment on handling the response to having a child diagnosed as having a neurodevelopmental disorder and ask them to bring it in for their next appointment with you.

There is a great deal of literature on the Evidence Based Practices for treating Autism (Mesibov and Shea, 2011). However, two treatment approaches for autism have amassed the most scientific and clinical support. The first approach is the behavioral-psychoeducational model of treatment based on the belief that the abnormal behaviors that one exhibits are due to environmental and psychological factors which are characteristics of repetitive behaviors (Boyd, Woodward and Bodfish, 2011) and problems behaviors (Bodfish, 2004). The second is the biomedical treatment approach which is based on the belief in the genetic and neurobiological-medical basis for autism (Cass, Sekaran and Baird, 2006).

 

Behavioral-psychological approaches which have been shown to be evidenced based practices are based on four components: 1) Operational definition of the observed target’s undesirable behaviors such as repetitive behaviors (Boyd, McDonough and Bodfish, 2012); 2) Identification of the triggers for the unwanted behaviors and development of the treatment environment which controls or eliminate such triggers; 3) Task analysis which clearly explains the involved treatment procedures; and 4) Measurement which quantifies acquisition, maintenance and generalizes the targeted behaviors ( Bodfish, 2004). The behavioral-psychoeducational models include the classroom program called TEACCH, Applied Behavioral Analysis/Discrete Trial Training, Pivotal Response Training, and Incidental Teaching (Bodfish, 2004; Simpson, 2005). Behavioral-psychological models have been proven successful in teaching autistic children mathematical concepts in grade school (Chihak and Foust, 2008). Communications based interventions with children with Autism Spectrum Disorder which include applied behavior analysis, naturalistic behavioral, developmental, classroom based, video modeling, computer-assisted instruction (Pennington, 2010), social skills and augmentative and alternative communication models of interventions have been effective in building communication skills within school classroom interventions (Brunner and Seung, 2009).

 

Analysis of behavioral-psychological approaches to intervening with children on the autism spectrum has resulted in the following: 1) adult-directed teaching and peer-mediated intervention (inclusion in typical classrooms); 2) use of visual supports (signs and symbols), self-monitoring and family member involvement in the intervention (Odom, Brown, Frey, Karasu, Smith-Canter and Strain, 2003) and 3) positive behavioral support, videotaped role modeling; giving children choices for preferences for learning tasks (Sansosti and Powell Smith) and web-based coaching (Ruble, McGrew, Toland, Dalrymple and Jung, 2013).

 

Another factor in treating individuals with the Diagnosis of Autism Spectrum is using early intervention in group and classroom settings (Drahota, Aarons and Stahmer, 2012). This allows for peer interaction to help build skills in individuals with autism (Sisco, Chung and Stanton, 2010). Research has shown that when individuals receive early intervention, they will develop more long lasting behavioral, language, social and communications skills (Boulware, 2006). Research has demonstrated that the earlier classroom teachers receive training in the behavioral-psychological approaches in working with autistic students, the more impactful their work and intervention with these autistic spectrum children is (Lerman, Vorndran, Addison and Kuhn, 2004; Schwartz, Sandall, McBride and Boulware, 2004; Odom and Brock, 2013).

 

Research findings indicate that intensive behavior therapy known as applied behavioral analysis, or ABA, represents an effective treatment for autistic spectrum disorders. However, expanded research has demonstrated that psychoedcuational approaches with the parents and caregivers of autistic children is necessary and effective in helping parents learn necessary information about EBPs for treating autism. They require information on how to overcome barriers to gaining intensive treatment for their children and gaining peer support for family members in order to learn how to cope with the realities involved in having an autistic child in the family (Hillman, 2006).

 

Whatever EBP a clinician uses with autism spectrum children, it is important for him/her to identify the goals of such work first and then pinpoint the appropriate EBP which will address that goal best. Such goals include: social skills (Reichow and Volkmar, 2010); academic achievement; modified behaviors; improved communication; healthy play; and ability to handle natural transitions which happen on a daily basis in a child’s life (Odom, Collet-Klingenberg, Rogers and Hatton, 2010).

Jeffrey’s Parents’ First Homework Assignment


Please answer the following questions in each of your personal journal about how you individually have reacted to the diagnosis of a child having a neurodevelopmental disorder. Once you both have answered these questions then meet together and discuss your answers. Finally bring this assignment in to your next session with your counselor who is going to help you learn how to live you lives with a child with a neurodevelopmental disorder.

 

Do you remember how you immediately felt after you were told what type of neurodevelopmental disorder your child had?

Where were you?

How were you told?

How did you react?

Well consider the following questions that parents ask after their children have been diagnosed as having a neurodevelopmental disorder and see how many you had and still have:

  • What is the cause of our child's neurodevelopmental disorder?
  • Could this neurodevelopmental disorder have been prevented?
  • Did something go wrong during the pregnancy or delivery to cause this problem?
  • Did the doctors do something to cause this problem? Did they leave something undone?
  • Which of us parents was responsible for this problem?
  • Was it one of our faults?
  • Are we responsible for our child having this problem?
  • What did we do wrong to deserve this?
  • Can this neurodevelopmental disorder be ''cured''?
  • Will my child grow out of it?
  • Why did this have to happen to us?
  • How severely handicapped will my child be?
  • Is it safe to have another child?
  • Does genetics contribute to a child having this neurodevelopmental disorder?
  • Does the genetic background of one parent contribute more than that of the other?
  • I cannot help but pity my child. Is this wrong?
  • If our child with this disorder lives at home, how will it affect our future children?
  • How can we explain the disorder to our future children?
  • How can we explain our child's disorder to relatives, friends, and neighbors?
  • How can I deal with others' reactions to my child's disorder?
  • Should we belong to some organization?
  • What are the advantages of belonging to a parent group?
  • Are there parent organizations that address our concerns?
  • Will I always have to be so involved in my child's care?
  • Do I have to change my goals in life because of my child's disorder?
  • What are the chances of my child going to college or getting a job later on in life?
  • What programs, schools, specialists are available to help my child?
  • Will we ever be able to have a normal life again?
  • What happens if we precede our child in death? Who will care for our child?

How well have you been able to get your questions answered?

It is important for you to fully explore these questions with the professionals involved in your child’s care.

Do not stop asking questions until you have a full understanding of what your child’s neurodevelopmental disorder is and what needs to be done to assist your child reach his or her optimal potential.

We agree to this plan of action

Signed                                                               Date

 

Adapted from: Chapter 1 Handling the Shock of Diagnosis in: Messina, J.J. (2013). Tools for Parent with Children with Special Needs, retrieved at: www.coping.us

The biological and neurological oriented assessment and treatment approaches have focused on the use of a variety of medications: 1) Clinicians have used stimulant medications such as methylphenidate (Ritalin) with autistic individuals who have problems with hyperactivity, inattention, restlessness and impulsivity (Volker and Lopata, 2008). 2) Clinicians have used atypical antipsychotics with younger individuals to treat behavioral problems (Posey, Stigler, Erikson and McDougle, 2008). 3) Some clinicians have found serotonin reuptake inhibitors (SRIs) useful with older individuals in treating repetitive behaviors including stereotyped motor behaviors and compulsions (Bodfish, 2004). 4) Complementary and alternative medications such as melatonin have been successful in treating sleep problems in children with autism spectrum disorder (Whitehouse, 2013).

 

Workbooks for Parents with Children with Autism Spectrum


Knapp, S.E. (2005). Parenting skills homework planner. Hoboken, NJ: John Wiley & Sons, Inc.

 

Knapp, S.E. and Jongsma, A.E. (2005). The parenting skills treatment planner. Hoboken, NJ: John Wiley & Sons.

 

Messina, J.J. (2013). Pathfinder parenting: Tools for raising responsible children. Retrieved at: http://coping.us

 

Messina, J.J. (2013). Tools for parents with children with special needs, retrieved at: www.coping.us

 

Miltenberger, R.G. (2008). Behavior modification-principles and procedures, fourth edition. Belmont, CA: Thomson Higher Education.

 

Sailor, W., Dunlap, G., Sugai, G. and Horner, R. (2009). Handbook for positive behavior support. New York: Springer

 

Wells, K.C., Lochman, J.E. and Lenhart, L.S. (2008). Coping power-parent group program. New York: Oxford University Press.

References on Autism Spectrum Disorder

 

Bodfish, J. (2004).. Treating the core features of autism: Are we there yet? Mental Retardation

and Disabilities Research Reviews, 10(4), 318-326. doi: 10.1002/mrdd.20045 

 

Boulware, G., McBride, B., Sandall, S. and Schwartz, I. (2006).. Project DATA for toddlers: An

inclusive approach to very young children with autism spectrum disorder.Topics in Early Childhood Special Education, 26(2), 94-105. 

 

Boyd, B.A., McDonough, S.G. and Bodfish, J.W. (2011). Feasibility of exposure response

prevention to treat repetitive behaviors of children with autism and an intellectual disability: A brief report. Autism, 17(2) 196-204. DOI: 10.1177/1362361311414066

 

Boyd, B.A., McDonough, S.G. and Bodfish, J.W. (2012). Evidence-based behavioral

intervention for repetitive behaviors in autism. Journal of Autism and Developmental Disorders, 42, 1236-1248.

 

Brunner, D.L. and Seung, H. (2009). Evaluation of the efficacy of communication-based

treatments for autism spectrum disorders. Communications Disorders Quarterly, 31(1), 15-41. DOI: 10.1177/1525740108324097

 

Carter, E.W., Sisco, L.G., Chung, Y. and Stanton-Chapman, T.L. (2010). Peer interactions of

students with intellectual disabilities and/or autism: A map of the Intervention literature. Research and Practice for Persons with Severe Disabilities, 35(3-4), 63-79.

 

Drahota, A., Aarons, G.A. and Stahmer, A.C. (2012). Developing the autism model of 

implementation for autism spectrum disorder community providers: Study protocol. Implementation Science, 2012(7), 85-95. doi:10.1186/1748-5908-7-85

 

Hillman, J. (2006). Supporting and treating families with children on the autistic spectrum: The

unique role of the general psychologist. Psychotherapy: Theory, Research, Practice, Training, 43(3), 349-358. doi: 10.1037/0033-3204.43.3.349 

 

Mesibov, G.B. and Shea, V. (2011). Evidence-based practices and autism. Autism, 15(1), 114-

133. DOI: 348070 1362-3613(2011)

 

Moore, T.R. and Symons, F.J. (2009). Adherence to behavioral and medical treatment

recommendations by parents. Journal of Autism and Developmental Disorders, 39(8), 1173-1184. doi: 10.1007/s10803-009-0729-0   

 

Odom, S.L., Brown, W. H., Frey, T., Karasu, N., Smith-Canter, L. L., and Strain, P.S. (2003).

Evidence-based practices for young children with autism: Contributions for single-subject design research. Focus on Autism and Other Developmental Disabilities, 18(3)166-175. 

 

Odom, S.L., Collet-Klingenberg, L., Rogers, S. J. and Hatton, D.D. (2010). Evidence-based

practices in interventions for children and youth with autism spectrum disorders. Preventing School Failure54(4), 275-282. doi: 10.1080/10459881003785506


Odom, S.L., Cox, A.W. and Brock, ME. (2013). Implementation Science, Professional

Development, and Autism Spectrum Disorders. Exceptional Children, 79(2), 233-251.

 

Pennington, R.C. (2010). Computer-assisted instruction for teaching academic skills to

students with autism spectrum disorders: A review of literature. Focus on Autism and Other Developmental Disabilities, 25(4), 239-248. DOI: 10.1177/1088357610378291

 

Reichow, B. and Volkmer, F.R. (2010). Social skills interventions for individuals with autism:

Evaluation for evidence-based practices within a best evidence synthesis framework. Journal of Autism and Developmental Disorders, 40(1), 149-166. DOI 10.1007/s10803-009-0842-0

 

Reichow, B. and Wolery, M. (2009). Comprehensive synthesis of early intensive behavioral

interventions for young children with autism based on the UCLA young autism project model. Journal of Autism and Developmental Disorders, 39(1), 23-41.doi:10.1007/s10803-008-0596-0 

 

Rogers, S.J. and Vismar, L.A. (2008). Evidence-based comprehensive treatments for early

autism. Journal of Clinical Child and Adolescent Psychology, 37(1), 8-39. doi: 10.1080/15374410701817808 

 

Ruble, L.A., McGrew, J.H., Toland, M.D., Dalrymple, N.J. and Jung, L.A. (2013). A

randomized controlled trial of COMPASS web-based and face to face teacher coaching in autism. Journal of Consulting and Clinical Psychology, 81(3), 566-572. DOI: 10.1037/a0032003

 

Sansosti, F.J. and Powell-Smith, K. A. (2008). Using computer-presented social stories and

video models to increase the social communication skills of children with high-functioning autism spectrum disorders. Journal of Positive Behavior Interventions, 10(3), 162-178. doi: 10.1177/1098300708316259 

 

Schwartz, I. S., Sandall, S. R., McBride, B. J. and Boulware, G. L. (2004). Project DATA

(developmentally appropriate treatment for autism): An inclusive school-based approach to educating young children with autism. Topics in Early Childhood Special Education, 24, 156-168. 

 

Simpson, R. (2005). Evidence-based practices and students with autism spectrum

disorders. Focus on Autism and Other Developmental Disabilities, 20(3), 140-149

 

Volker, M. and Lopata, C. (2008). Autism: A review of biological bases, assessment, and

intervention. School Psychology Quarterly, 23(2), 258-270. doi: 10.1037/1045-3830.23.2.258 

 

Whitehouse, A. J. (2013). Complementary and alternative medicine for autism spectrum

disorders: Rational, safety and efficacy. Journal of Paediatrics and Child Health, 49, E438-E442. doi:10.1111/jpc.12242

WHERE DO I GO FROM HERE?

CONCERNING AUTISM SPECTRUM DISORDER

Now that you have read this section, in “My Mental Health Professional Practitioner Journal” record your answers and reactions to the following questions:

  1. How will this information help me as a Mental Health Professional?
  2. How interested am I in implementing Evidence Based Practices concerning Autism Spectrum Disorder in my clinical practice?
  3. Why is it important that I learn more about Autism Spectrum Disorder?
  4. What more do I need to know about this Autism Spectrum Disorder?
  5. Where can I go to obtain more information about Autism Spectrum Disorder?
  6. Where can I go to obtain the journal articles, manuals, workbooks or guidebooks on Autism Spectrum Disorder?