1/30/20
1
Co-occurring Physical, Medical, and Mental Health Conditions in Young Children with ASDCesar Ochoa, MDRush University Medical CenterJanuary 31, 2020
1
Email from EITP(eitraining@ illinois.edu)
AFTER the webinar concludes - Includes evaluation survey
Complete surveyCertificate of completion
emailed within 24 hours of survey received
ILLINOIS EI andILLINOIS STATE LICENSURE* credit
*OT, PT, SLP, SW, Nutrition/Dietitian
If you joined as a group, each individual will need to complete the unique survey for credit
2
Today’s Presenter
Cesar Ochoa-Lubinoff, MDHead, Developmental-Behavioral PediatricsAssociate Professor of PediatricsRush University Medical Center
3
Common Co-Occurring Conditions with ASD
General Medical Developmental
Psychiatric
Behavioral issues
4
Medical Co-Occurring Conditions
General Medical
Gastrointestinal
9-70%
Epilepsy
8-30%
Sleep Disorders
50-80%
Immune Dysregulation
<38%
Genetic Conditions
5%
5
Additional Common Medical Issues in ASD
Gurney, et al. National Survey of Children’s Health. Arch Pediatric Adolescent Med. 2006
Dental caries -emphasize dental
care
Allergies – food allergy ↑
Minor injuries
Ear infections Headaches
6
1/30/20
2
Medical Co-occurring ConditionsMedical disorders in children with ASD are widespread and manifest across different areas, such as immunology, neurology and gastroenterology.
The prevalence of medical disturbances in ASD is reported over a wide range, because of the challenges in ascertaining these conditions as well as differences between ASD samples.
Gastrointestinal disorders (GID) and sleep problems increase the risk in ASD patients to have GID, sleep problems and seizures. The presence of seizures doesn’t increase the risk for GID or SD.
The presence of GID, seizures and sleep problems together predicted more severe adaptive behavioral symptoms relevant to their ASD diagnosis.
7
Gastrointestinal Symptoms In Children with ASD
Common symptoms include:• chronic constipation, • abdominal pain, • chronic diarrhea, and• gastro-esophageal reflux
disease
Associated disorders include:• gastritis, • esophagitis, • inflammatory bowel
disease, • celiac disease, • Crohn’s disease, and• colitis
Correlation between certain behavioral problems, such as
anxiety and aggression,
and the increase in GI disorders is now
known
8
STUDY DESIGN FINDINGS140-170 children with ASD – Cross Sectional study
24-63% History of at least one GI symptom: diarrhea, unformed stools, constipation, bloating and/or gastro-esophageal reflux disease
150 children (50 ASD, 50 DD, 50 controls) – Cross sectional study
70% 70% of children with ASD presented GI symptoms compared with 42% of DD children and 28% controls. Abnormal stool pattern and food selectivity were more common in ASD patients. No association between a family history of autoimmune disease and GI symptoms in children with ASD
124 children with ASD and two matched controls for each patient were followed longitudinally for 18years
No increased risk of GI diseases or inflammatory and/or malabsorption compared to typical controls. The only significant difference was feeding issues/food selectivity (24.5% vs 16.1%) and constipation (33.9% vs 17.6%) in ASD people.
Gastrointestinal Symptoms In Children with ASD
9
Feeding Disorders and ASD
Feeding problems are defined as:
a disorder in which the inability or refusal to orally consume adequate nutritional,
hydration or caloric intake in the amounts required to thrive, results in negative nutritional, developmental, social and
psychological consequences.
Earlier studies demonstrated a prevalence ranging from 6 to 33% (1971).
More recent (2004) prevalence rates of
feeding problems range from 13 to 80%
10
Causal Factors Associated With Feeding Problems in ASD
• Sensory processing deficits & food selectivity• 78 to 90% of children with ASD experience and sensory
impairment/defensiveness is frequently noted in the literature as a reason for high prevalence rates of feeding problems in ASD.
• Skill deficits, such oral-motor delays which affect the child’s ability to swallow, chew and suck
• Gastrointestinal disorders• High prevalence of GI symptoms of children with feeding
problems• Gastroesophageal reflux disease has been found to be the most
common condition associated to feeding disorders • Constipation and diarrhea are also often associated with feeding
disorders
11
Symptoms Or Issues Associated To Feeding Disorders
Food selectivity
Disruptive mealtime behaviors
Food refusal
Limited food repertoire
Restricted intake
Most common DSM-5 feeding disorders in ASD: • Avoidant/Restrictive Food Intake Disorder
• Pica/Rumination Disorder
12
1/30/20
3
Food SelectivitySelective ("picky") eaters• Most show aversions to
specific food colors, texture, smells or other foods’ characteristics
Adversely effects:• diet quality, • nutritional deficiency and, • gut microbiota
composition
Many ASD/co-occurrent GI disorders influenced by dietary habits that may
exacerbate ASD symptomatology
Currently, it is difficult to precisely decipher the physiological processes that link together food selectivity and GI problems
13
PICA
• The eating of non-nutritive, non-food substances that is persistent over a period of at least 1 month.
• It is inappropriate to the developmental level of the individual and is not part of a culturally supported or socially normative practice.
14
PICA• Poorly understood and considered multifactorial:
• An association with micronutrient deficiencies, including iron, calcium and zinc• Higher incidence in children with neurodevelopmental disabilities, including ASD, was
traditionally believed to result from an inability to differentiate between food and non-food items.
However, current thinking suggests that this is more likely to be secondary to learned behaviors.
• Pica in children has also been associated with deprivation, parental neglect and malnutrition.• It may present in the presence of a coexisting psychiatric disorder• Increasing evidence that it may be associated with conditions leading to malabsorption, poor
nutritional status or anemia.
15
PICA
Evaluation: Look for anemia, iron deficiency,
blood lead level, infections and parasites, bowel and dental problems
Multidisciplinary approach: The team may include physicians, social
workers, dieticians, psychologists and dentists.
When devising a treatment plan, consider the symptoms and complications that the child is
experiencing.
16
Nutritional & Medical Risks Associated With Feeding Disorders
Malnutrition
Vitamin and mineral deficiencies:• Lower calcium intake, rickets
and/or poor bone health • Iron deficiency
Preference for sugary/fatty foods• supports the emerging
evidence for greater risks of obesity in this population
Invasive medical procedures,
such as the insertion of feeding tubes with ASD
who present w ith feeding problem s
17
Dietary Interventions In ASD
1. GLUTE-FREE CASEIN-FREE DIET
2. KETOGENIC DIET
3. THE SPECIFIC CARBOHYDRATE DIET
4. THE MEDITERRANEAN DIET
18
1/30/20
4
Gluten-free Casein-free Diet
• Exclusion of all gluten-containing food items including:• wheat, oats, barley or rye, which are, all flours, bread, rusks,
pasta, pastries, and other bakery products made with these cereals,
• Elimination of casein means no intake of dairy products: • milk, including breast milk, yogurt, cheese, butter, cream, or ice
cream among others
• In all patients, this diet could be recommended when allergies or allergic intolerance is diagnosed
• Conflicting results have been recorded on ASD cohorts: • some evidence supports the use of this diet in the amelioration
of ASD symptoms showing that the GF/CF diet decreases urine peptides, improves behavior and decreases GI symptoms;
• Other studies highlighted that the adoption of this elimination diet could decrease fiber intake, thus probably aggravating the GI symptoms.
• To date evidence to support or refute the GC/CF diet is limited an inadequate in terms of quantity and quality.
19
The Gut-brain Axis Hypothesis
• Many ASD children have also been shown to carry abnormalities in GI physiology, including: • increased intestinal permeability, • overall microbiota alterations, and • gut infection with cresol-producing Clostridium difficile
• Recent evidence in human gut microbiota studies highlighted the existence of a close connection between gut and brain functions, the so called “gut-brain axis”, including neural, hormonal, immune, and metabolic pathways.
• Neuro-immune pathways can contribute to ASD symptomatology via the gut–brain axis. It has been proposed that cytokines associated with ASD, due to an inflamed gastrointestinal tract, may cross the blood-brain barrier and help an immune response in the brain, thus influencing behavior.
20
Epilepsy and ASD
• The estimated prevalence of epilepsy in ASD is 12.1%
• Factors such as • genetic and chromosomal abnormalities, • metabolic conditions, • environmental factors, e.g., maternal rubella during pregnancy, and • brain damage via neonatal jaundice,
are examples that have been recognized as predisposing to both epilepsy and autism.
21
Epilepsy and ASD
There is increased frequency of epilepsy in individuals with ASD & intellectual disability or genetic syndromes
Females (34.5%) with autism had a higher prevalence of epilepsy compared to males with autism (18.5%).
Two age peaks of onset: early childhood and adolescence
It has been found that symptoms of autism can be minimized when epilepsy is treated in patients with both conditions
22
Sleep disorders and ASD
Sleep problem s in children with ASDD is
one of the prim ary concerns and one of the m ajor reason parents seek m edical
help
The prevalence of sleep disorders m ay be
as high as 60–86%, which is 2-3 tim es
greater than typically developing (TD) children
Sleep is critical for typical synaptic
developm ent and brain m aturation, and poor sleep can have detrim ental effects on
children’s cognition in the dom ains of attention, m em ory, m ood regulation, and
behavior.
23
Sleep Disorders and ASD
Children with ASD often have difficulties with falling and staying asleep, with night waking having a strong association with daytime behavior problems.
Studies utilizing actigraphy and polysomnography with children with ASD have found shorter sleep time, longer sleep latency, and decreased sleep efficiency as compared to TD control groups
24
1/30/20
5
Sleep Problems In ASD Are Multifactorial
Neurobiological, medical, behavioral, and cultural mechanisms
However, the underlying biological and behavioral rhythms of ASD predisposes children to both extrinsic and intrinsic stressors that threaten sleep, making children with ASD uniquely vulnerable to sleep problems
25
Sleep Disorders and ASD
Hypotheses regarding intrinsic causes of insomnia in children with ASD
include:
• Brain wave organizational and maturational differences
• Circadian-relevant genes• Abnormal melatonin production• Arousal and sensory dysregulation.
Intrinsic hypotheses• Co-occurring psychiatry disorders
(ADHD, Anxiety) that are associated with high arousal
Behavioral insomnias of childhood (BIC) are the most common extrinsic
causes of insomnia in children, including those with ASD.
• Extrinsic causes of insomnia in children with ASD include• Behavioral Insomnias • Sleep-onset association type• Behavioral Insomnias – Limit
setting type• Predisposing factors• Precipitating factors• Perpetuating factors
26
Sleep Interventions For MedicalPractitioners
• All children should be screened for sleep problems
• Discuss parental concerns
• Underlying medical conditions that may be contributing to sleep problems should be screened and treated
• Determine the willingness and capacity of the family to implement a sleep intervention.
• The first-line approach is parent education about environmental modification, positive bedtime routines, and behavioral strategies.
• Introduce the ATN Sleep Tool Kit and educational materials with visual schedule.
• If the family is unable or unwilling to follow environmental and behavioral strategies, consider consultation to a sleep specialist.
• Pharmacological interventions may be considered, start with melatonin.• Timely follow-up in 2–4 weeks for all interventions
• Annual reassessment for all children with ASD is important
27
Medical Conditions That May Contribute To Sleep Problems
Medical Conditions
Gastrointestinal disorders
• Reflux• Constipation Pain
Respiratory disorders• Sleep-disordered breathing
• Allergies• Asthma
Neurological disorders• Epilepsy/seizures
• Restless leg syndrome• abnormal movements
Skin and integumentary
disorders• Eczem a/itching
Dental issues
Sensitivity to textures/light/sound
Nutrition• Hunger
• Iron deficiency
Obstructive sleep apnea
28
Immune Dysregulation and ASD
• Those with Autism have an elevated prevalence of specific immune-related comorbidities: • Allergies to food and rhinitis, and • autoimmune diseases, in particular psoriasis,occur more often than expected in children with autism.
• The presence of an ASD diagnosis does not appear to influence the diagnosis of the immune condition.
More research is needed into the biologic mechanisms underpinning the association between immune-mediated conditions and autism spectrum disorders. Findings from such research could aid discovery of etiologic factors and help focus treatment approaches for individuals with autism spectrum disorders and immune comorbidities.
29
Genetic Disorders and ASD
• Collectively called syndromic autism. • Fragile X syndrome (21–50% of individuals affected have autism)• Rett syndrome (most have autistic features but with profiles different from idiopathic autism)
• Tuberous sclerosis complex (24–60%)• Down’s syndrome (5–39%)• Phenylketonuria (5–20%)• CHARGE syndrome (coloboma of the eye; heart defects; atresia of the choana; retardation of
growth and development, or both; genital and urinary abnormalities, or both; and ear abnormalities and deafness; 15–50%)
• Angelman syndrome (50–81%)
• Timothy syndrome (60–70%)• Joubert syndrome (~40%)
30
1/30/20
6
Developmental Co-Occurring Conditions
Developmental
Intellectual Disability
45%
Language Disorder
Variable
Attention Deficit Hyperactivity
Disorder
28-44%
Tic Disorders
14-38%
Motor Abnormalities
<79%
31
Cognitive Functioning And Intellectual Disabilities and ASD
• Prevalence estimate of intellectual disabilities is affected by the diagnostic boundary and the definition of intelligence (eg, whether verbal ability is used as a criterion)
• In individuals, discrepant performance between subtests is common
• Among preschool children in whom ASD is a concern, many but not all will have an intellectual disability
• Statistics vary tremendously, with 11–65% of school-age children with ASD reported as having intellectual disabilities (IQ <70)
• Populations of children in different clinics and research samples can be quite dissimilar, and variation among adults can be even more pronounced
• Important for clinicians and families to know about cognitive and language abilities for children as they grow older and to discuss these issues
32
ADHD & ASD
•ADHD is highly co-morbid in children and adolescents with ASD, and should be screened for in all youth with ASD
• The higher the severity of ASD, the higher the chance of comorbidities
•ADHD co-occurrence in ASD is associated with worse functioning and additional psychiatric symptoms
•The differential diagnosis of ADHD in ASD is more complex
33
Preschoolers With ADHD & ASD
• Preschoolers with severe ADHD present significant challenges
• Evidence for treatment is sparse
• An evidence base for several medications is growing (methylphenidate, adderall, guanfacine)
• Response rates are reduced
• Side effect burdens are greater
• Larger studies on effects on core ASD deficits and cognition are needed
• Careful monitoring of treatment effects using multiple informants is recommended
34
Tic Disorders and ASD
~6.5% of individuals with Autism have Tourette’s syndrome
35
Motor Abnormalities and ASD
Motor delay
Hypotonia
Deficits in coordination
Movement preparation
and planning
Praxis
Gait
Balance
36
1/30/20
7
Psychiatric Co-Occurring Conditions
Psychiatric
Anxiety
42-56%
Depression
12=70%
Obsessive-Compulsive
Disorder
7-24%
Substance Use Disorders
<15%
Psychotic Disorder
12-17%
Oppositional Defiant
Disorder
16-28%
Eating Disorder
4-5%
37
Concomitant Psychiatric Disorders in Children With ASD
658 ASD (age 3–17 years; mean = 7.2 years) children referred for hyperactivity or irritability between 1999 and 2014 using Child and Adolescent Symptom Inventory or Early Childhood Inventory
ADHD 81%
ODD 46%
Anxiety Disorders 42%
Mood Disorders 8%
Conduct Disorder 12%
Compr Psychiatry. 2019 Jan;88:57-64. doi: 10.1016/j.comppsych.2018.10.012. Epub 2018 Nov 6. An exploration of concomitant psychiatric disorders in children with autism spectrum disorder.
Lecavalier L1, McCracken CE2, Aman MG3,
38
Overlapping Psychiatric Comorbidities With ADHD in ASD
39
Anxiety and ASD
• Common across all age groups
• Most common are:• Social anxiety disorder (13–29% of individuals with
autism)• Generalized anxiety disorder (13–22%)
• High-functioning individuals are more susceptible (or symptoms are more detectable)
40
Anxiety Adversely Impacts Functioning
Exacerbates ASD symptoms
Interferes with treatments for ASD
Irritability, outbursts, self-injury, GI symptoms
Increases parental stress and anxiety
Risk for long term psychopathology
Influences transition planning to adulthood
41
Common Presenting Symptoms“Having
meltdowns all day”
“Just seems on edge all day”
“Won’t go to community
college. Only takes online
classes”
“Not interested in making friends”
“Really scared of getting his haircut”
“Doesn’t like loud noises. We can’t go anywhere”
“Yelling at people at
work”
“Looks sad all the time”
42
1/30/20
8
Table 1. Prevalence of DSM-IV Disorders
Disorder Prevalence/100 95% Cl
Any disorder 70.8 58.2-83.4
Any main disordera 62.8 49.8-75.9
Any emotional disorderb 44.4 30.2-58.7
Any anxiety or phobic disordersc 41.9 26.8-57.0
Generalized anxiety disorder 13.4 0-27.4
Separation anxiety disorder 0.5 0-1.6
Panic disorder 10.1 0-24.8
Agoraphobia 7.9 3.0-12.9
Social anxiety disorder 29.2 13.2-45.1
Simple phobia 8.5 2.8-14.1
Obsessive-compulsive disorder 8.2 3.2-13.1
Any depressive disorder 1.4 0-3.0
Major depressive disorder 0.9 0-2.3
Dysthymic disorder 0.5 0-1.4
Simonoff et al., 2008 J Am AcadChild and AdolescPsychiatry
43
Types of Anxiety • Traditional disorders (based on the DSM)• Generalized anxiety disorder • Separation anxiety disorder • Social phobia Specific phobia • Obsessive-compulsive disorder • Posttraumatic stress disorder
• Ambiguous presentations
• Unspecified anxiety disorder (Connected to core features of ASD)
44
Ambiguous Anxiety and ASDExcessive fear about
novelty, rules,
change
Social
fearfulness
Worries related to intense
preoccupations Varied specific phobias
Fears of m
en
with beards,
exposed pipes,
graffiti, fans,
soap
Without the
fear of negative
evaluation
Anxiety that is linked to core ASD symptomsNot described in the DSM
45
ANXIETY ASD
Social avoidanceDisinterest
Fear of social situations Reduced social motivation
Repetitive behaviors Anxious/compulsive need to complete
Pleasurable/soothing
Perseveration True concern about a worry
Repetitive speech
Behavioral reactions to change
Anticipation about upcoming changes
Need for sameness
Sensory over-reactivity Excessive anxiety, anticipation, agitation when exposed to sensory trigger
Discomfort/behavioral reaction when exposed to sensory stimuli
Constricted affect Worrying/depression Reduced affect modulation in AS
Behavioral outburst Clearly in response to anxious trigger
Attention seeking, escaping demands, etc.
46
Modified Cognitive Behavioral Therapy
Primary Diagnosis ASD, FSIQ >70
Secondary Diagnoses
Social anxiety, generalized anxiety, and
separation anxiety disorder
Treatment: 12-16 weeks
Modifications: General
concepts of stress and
feeling upset
Identifying anxious
situations
Graduated exposures with reinforcem ent
Self-regulation strategies
Lim ited cognitive
restructuring
47
Behavioral Therapy In Individuals With ASD
• Graduated exposures and reinforcement • Relaxation strategies• Communication strategies• Modeling
48
1/30/20
9
Multidisciplinary Treatment Planning and ASD
Therapy
Assess level of supports -home and school
Improve communication, adaptive functioning, social skills
Address strengths
Build on strengths –build competencies
Medications are one part of the treatment plan
49
Pharmacotherapy
Meds for anxiety
Sertraline
Fluoxetine
Citalopram
Escitalopram
Meds for anxiety-specific symptoms
Insomnia: Melatonin, Clonidine
Physiological arousal: Clonidine, Guanfacine
Behavioral Dysregulation: Clonidine, Guanfacine, Atypical anti-psychotics
50
Depression
• Common in adults, less common in children
• High-functioning adults who are less socially impaired are more susceptible (or symptoms are more detectable)
51
Obsessive-compulsive disorder
repetitive behaviors that do not involve intrusive, anxiety-causing thoughts
or obsessions (part of autism)
repetitive behaviors that involve intrusive, anxiety-
causing thoughts or obsessions(and are part of
obsessive-compulsive disorder)
Shares the repetitive behavior domain with autismImportant to distinguish between:
52
Oppositional Defiant Disorder (ODD)
Oppositional behaviors could be a manifestation of anxiety, resistance to change, stubborn belief in the correctness of own point of view, difficulty seeing another’s point of view, poor awareness of the effect of own behavior on others, or no interest in social compliance.
53
Before the age of 8 years
May progress to Compliance Disorder (CD)
High percentage of children with ADHD have ODD
•More boys than girls before puberty then equal!•Start to see in late preschool and early elementary•Younger children need more frequent symptoms – differentiate from normal
The etiology of ODD is not clearly defined. Most experts think it is caused by the cumulative effect of multiple risk factors that stem from biologic, psychological, and social issues. Social support is a protective factor.
ODD - 2-15% of Children
54
1/30/20
10
ODD: Four Symptoms for at Least Four Months
55
Behavioral Co-Occurring Conditions with ASD
Behavioral issues
Aggressive behaviors
<68%
Self-injurious behaviors
<50%
PICA
~36%
56
Aggressive Behaviors and ASD
Often directed towards caregivers rather than non-caregivers
Could be a result of empathy difficulties, anxiety, sensory overload, disruption of routines, and difficulties with communication
57
Self-injurious Behaviors and ASD
Associated with impulsivity and hyperactivity, negative affect, and lower levels of ability and speech
Could signal frustration in individuals with reduced communication, as well as anxiety, sensory overload, or disruption of routines
Could also become a repetitive habit
Could cause tissue damage and need for restraint
58
Many Possible Targets For Treatment
Medical comorbidity (start here)
Core symptoms (behavioral treatment)
Communication (behavioral and speech treatment)
Psychosocial stress (structure and family treatment)
Psychiatric comorbidity –Pay attention to family history
59
Evaluating and Treating Agitation/Aggression in ASD
Treat co-occurring psychiatric disorders first (make ADHD, anxiety, mood diagnosis)
Improve maladaptive reinforcement –Differential reinforcement of other behavior (ABA)
Improve communication
Address psychosocial stressors
Medical/sleep work-up
60
1/30/20
11
Teaching Communication to Replace a Problem Behavior
Identify an appropriate
communication strategy to replace the
problem behavior
Set up context that triggers
problem behavior
Quickly prompt for the
communication behavior
Reinforce new appropriate
behavior with the desired
consequence
61
Selecting Appropriate Communication Form • Does the individual have any functional spoken
language?
• Can the individual imitate verbal models?
• Is the individual currently using any augmentative communication system?
• What type of system will be easy to introduce? • Options:
• Gestures • Verbal language • Picture cards • Communication devices
62
Important Considerations
Consequence must be MORE effective than consequences of problem behavior
Receptive language skills play a role in behavior-use simple communication and visual supports to support comprehension
Teaching communication will not by itself eliminate problem behaviors
Use positive behavioral supports
Alter antecedents
Teach delayed reinforcem ent
Generalize com m unication behavior
63
Functional Behavior Analysis
Direct Direct observation, interviews/checklists
Collect Collect data to confirm the function
Hypothesize Hypothesize the function
Consequences Identify the typical consequences
AntecedentIdentify the antecedents (events, times, and situations that predict problem behaviors)
Describe Describe behavior
64
Why Do Problem Behaviors Persist?
Problem behaviors persist because they
produce a desired consequence:
The delivery of a preferred item/activity
(i.e., positive reinforcement)
The removal of a non-preferred or aversive
item/activity (i.e., negative reinforcement)
Sensory stimulation
Pleasurable consequence
Attenuation of painful event
65
Behavioral Interventions
• Behavioral treatments involve: • Continuing to reinforce existing appropriate
behavior • Discontinuing the consequence found to
maintain the problem behavior. • Teaching new and appropriate ways to access
the consequence that maintained the inappropriate behavior.
66
1/30/20
12
Common Co-Occurring Conditions with ASD
General Medical Developmental
Psychiatric
Behavioral issues
67
Questions?
68
Thank you for your participation!
69
Email from EITP(eitraining@ illinois.edu)
AFTER the webinar concludes - Includes evaluation survey
Complete surveyCertificate of completion
emailed within 24 hours of survey received
ILLINOIS EI andILLINOIS STATE LICENSURE* credit
*OT, PT, SLP, SW, Nutrition/Dietitian
If you joined as a group, each individual will need to complete the unique survey for credit
70
Winter Webinars
Hosted by the Early Intervention Training Program at the University of Illinois
Winter Webinars for 2020 registration available online at http://go.illinois.edu/EITPonline
EITP Webinar Resources available online at http://go.illinois.edu/EITPwebinars
All start times are for Central Standard Time (CST)
Click on the title of the webinar to get more information (i.e. description, presenter biography and credit information)
Wednesday, February 19, 2020 9:00 am
Navigating Insurance-The Basics of Billing
Presenters:
Arkeitha Monroe May and Destiny Herpstreith
Wednesday, February 26, 2020 10:00 am
Inclusion in Birth-3: What Does It Mean?
Presenters:
Ann Kremer and Emily Ropars
Friday, January 31, 2020 9:00 am
Autism Review: Co-occurring Physical, Medical, & Mental Conditions in Young Children with ASD
Presenter:
Dr. Cesar Ochoa
Wednesday, February 5, 2020 10:00 am
Painting a 'Not-So-Perfect' Picture: Applying Strengths-based Approaches in Early Intervention
Presenters:
Anne Larson, PhD, and Alisha Wackerle-Hollman, PhD
Wednesday, March 4, 2020 9:00 am
Coaching Families to Address Challenging Behaviors
Presenter:
Johanna Higgins, PhD
Wednesday, March 11, 2020 10:00 am
Home Visiting in Illinois: Partnering to Promote Healthy Child Development
Presenter:
Karen Williams
Completed!
Follow us on Facebook www.facebook.com/EITPIllinois
Follow us on Twitter@EITPIllinois
Visit our Websiteeitp.education.illinois.edu
Thank you for supporting the children and families of Illinois!
71