Íhlutun fyrir börn og

ungmenni með einhverfu

Hvað skiptir máli? María Sigurjónsdóttir

Þroskaþjálfi

Hvað er íhlutun fyrir börn með

einhverfu?

Allt það sem tengist þjálfun,

meðferð og þjónustu sem er

ætlað til þess að auka

lífsgæði barnanna og

fjölskyldna þeirra.

Catherine Lord, prófessor í sálfræði við Háskólann í Chicago sagði:

"As soon as children are recognized as having any autistic spectrum disorder,

they should receive intensive intervention. These efforts should be

systematically planned, tailored to the needs and strengths of individual children

and their families, and regularly evaluated.“

Af: http://books.nap.edu/catalog.php?record_id=10017

Íhlutun (intervention)

Heildstæð íhlutun:

Atferlisíhlutun

- byggð á Hagnýtri

atferlisgreiningu

Skipulögð kennsla – byggð á hugmyndafræði

TEACCH

Íhlutun á

afmörkuðum sviðum:

Boðskiptakerfið PECS

Tákn með Tali

Félagshæfnisögur

CAT kassinn

Talþjálfun

Iðjuþjálfun

Sjúkraþjálfun

Snemmtæk íhlutun (early intervention)

Byrjar um leið og grunur vaknar

Meiri árangur með auknum tímafjölda

Getur haft áhrif á hegðun og þroska

(Dawson, 2008; Helt o.fl., 2008; Scott og Baldwin, 2005)

Sannreyndar aðferðir (Evidence based methods)

aðferðir sem sýnt hafa fram á

árangur með rannsóknum og hafa

verið birtar í vísindaritum

Nánar á:

http://autismpdc.fpg.unc.edu/content/evidence-based-practices

Viðurkennt verklag (Best practice guidelines)

Þættir sem niðurstöður

rannsókna hafa sýnt að skipta

máli í vinnu með börnum með

einhverfu.

Íhlutunarleiðir • Ambient Prism Lenses and Autism • Animal Therapies and Autism • Anticonvulsants and Autism • Antidepressants and Autism • Antifungal Drugs, Supplements and

Autism • Antipsychotics and Autism • Applied Behaviour Analysis (ABA) and

Autism • Aripiprazole and Autism • Art, Art Therapy and Autism • Assistance Dogs and Autism • Atomoxetine and Autism • Auditory Integration Training and

Autism • Carbamazepine and Autism • Carnosine and Autism • Cell Therapy and Autism • Chelation and Autism • Chiropractic and Autism • Cholinesterase Inhibitors and Autism • Citalopram and Autism • Clomipramine and Autism • Clonidine and Autism • Clozapine and Autism • Cognitive Behavioural Therapy (CBT)

and Autism • Coloured Filters and Autism • Computer Applications and Autism • Daily Life Therapy and Autism • Dance Movement Therapy • Dextro - / Levo- Amphetamine and

Autism • Dietary Supplements and Autism • Digestive Enzymes and Autism • Dimethylglycine and Autism • DIR Method (Floortime) and Autism • Discrete Trial Training and Autism • Advocacy / Self Advocacy and Autism • Dolphin Therapy and Autism • Donepezil and Autism • Dore Programme and Autism • Drama Therapy and Autism • Early Intensive Behavioural

Intervention (UCLA Model) and Autism • Escitalopram and Autism • Facilitated Communication and Autism • Feingold Diet and Autism • Fenfluramine and Autism • Fluoxetine and Autism

• Fluvoxamine and Autism

• Functional Communication Training

and Autism

• Galantamine and Autism

• Gentle Teaching and Autism

• Glutathione and Autism

• Gluten-Free, Casein-Free Diet and

Autism

• Haloperidol and Autism

• Hippotherapy and Autism

• Holding Therapy and Autism

• Hyperbaric Therapy and Autism

• Imipramine and Autism

• Immune Globulins and Autism

• Incidental Teaching and Autism

• Intensive Interaction

• Joint Action Routines and Autism

• Ketogenic Diet and Autism

• Lamotrigine and Autism

• LEAP and Autism

• Levetiracetam and Autism

• Lightwave Stimulation and Autism

• Massage and Autism

• Melatonin and Autism

• Memantine and Autism

• Methylphenidate and Autism

• Milieu Training and Autism

• Mirtazapine and Autism

• Multi-Sensory Environments and Autism

• Multi-Vitamin/Mineral Supplements

• Music Therapy and Autism

• Neurofeedback Training and Autism

• Nortriptyline and Autism

• Occupational Therapy and Autism

• Olanzapine and Autism

• Omega 3 Fatty Acid Supplements and

Autism

• Online Communities and Autism

• Opioid Antagonists and Autism

• Oxytocin and Autism

• Paroxetine and Autism

• Patterning Therapies and Autism

• Physiotherapy and Autism

• Picture Exchange Communication

System (PECS) and Autism

• Pivotal Response Training and Autism

• Play Therapy and Autism

• Propranolol

• Psychoanalysis and Autism

• Quetiapine and Autism

• Relationship Development

Intervention and Autism

• Responsive Teaching and Autism

• Restricted Environmental Stimulation

Therapy and Autism

• Risperidone and Autism

• Rivastigmine and Autism

• Robots and Autism

• SCERTS Model and Autism

• Secretin and Autism

• Sensory Integrative Therapy and

Autism

• Sertraline and Autism

• Short Breaks and Autism

• Sign Language and Autism

• Social Groups and Autism

• Social Skills Groups and Autism

• Social Stories™ and Autism

• Sodium Valproate and Autism

• Son-Rise Program and Autism

• Special Diets and Autism

• Specific Carbohydrate Diet and

Autism

• Speech and Language Therapy and

Autism

• Stimulant Medication and Autism

• Sulphation and Autism

• Supported Employment and Autism

• TEACCH and Autism

• Testosterone Regulation and Autism

• Theory of Mind Training and Autism

• Tianeptine and Autism

• Topiramate and Autism

• Transcranial Magnetic Stimulation

and Autism

• Venlafaxine and Autism

• Video Modelling and Autism

• Visual Schedules and Autism

• Vitamin A and Autism

• Vitamin B12 and Autism

• Vitamin B6, Magnesium and Autism

• Vitamin B9 (Folic Acid) and Autism

• Vitamin C (Ascorbic Acid) and

Autism

• Vitamin D and Autism

• Voice Output Communication Aids

and Autism

• Weighted Items and Autism

• Yeast-Free Diets and Autism

• Yoga and Autism

• Ziprasidone and Autism

Af www.researchautism.net

Research Autism

140 leiðir

Þar af 15 jákvæð áhrif

Þar af 2 verulega

jákvæð áhrif

Af http://researchautism.net

National Standards Report 2009

775 rannsóknir skoðaðar

38 íhlutunarleiðir

11 áhrifaríkar

22 líklega áhrifaríkar en

vantar rannsóknir

5 ekki vísbendingar um

jákvæð áhrif

Engin sem féll undir að

vera ekki áhrifarík eða

hættuleg

Af http://www.nationalautismcenter.org/

Hvað skiptir máli í íhlutun?

Byggi á sannreyndum aðferðum

Að byrja íhlutun strax

Öflug þjálfun í minnst 25 klukkustundir á viku

Stöðugar mælingar

Skipulag

(Maglione , 2012)

Hvað skiptir máli í íhlutun? -frh.

Einstaklingsáætlun

Kennari fái aðstöðu til að sinna barni og markmiðum

Virk þátttaka fjölskyldu

Þjálfun til fjölskyldu

Samskipti við jafnaldra

Hvað skiptir máli í íhlutun? -frh.

Skipulagðar leiðir að markmiðum

Góð þjálfun starfsmanna

Góður undirbúningur fyrir skipti milli skólastiga

Markmið íhlutunar ættu að:

beinast að hegðun og færni

vera sýnileg og mælanleg

hafa áhrif á þátttöku barnsins í námi,

samfélagi og fjölskyldulífi

vera endurmetin oft og aðlöguð í

samræmi við niðurstöður endurmats

National Research Council, 2001

Hvað segir fagfólk að skipti

máli?

Félagsfærniþjálfun

Kenna tjáskipti

Auka þekkingu á einhverfu

Bera virðingu fyrir einhverfunni og takmörkum einstaklingsins

Byggja íhlutun á styrkleikum

Hvað segir fagfólk? -frh

Kenna í gegnum leik

Góðar skráningar

Raunhæfar kröfur

Skapa gott starfsumhverfi fyrir stuðningsaðila

Gleði

Hvað segja foreldrar að skipti

mestu máli?

Kenna félagsfærni þjálfun

FAGfólk sinni börnunum

Vinna með ALLA færni

Taka tillit til skynjunar þeirra

Sjónrænt skipulag

Kenna þeim að læra af umhverfinu

Efla málfærni og tjáskipti

Atferlisþjálfun

Hvað segja foreldrar? – frh.

Leikþjálfun

Góðar skráningar

Gleði og hlýja

Gott stuðningsnet

Góða eftirfylgni – líka í grunnskólum

Hvað segja foreldrar? – frh.

Allir í umhverfi barnsins viti hvað er verið að vinna með

Auka þekkingu og skilning í samfélaginu

Auka aðstoð við unglinga

Tryggja markvissan og öflugan stuðning (fleiri en einn sinni barninu)

Samstarf fagaðila og foreldra

Hreinskilni í samstarfi

Hvað segja þeir sem eru með

einhverfu?

Horfa á styrkleika

Kenna “óskrifaðar reglur”

Kenna hvernig á að nálgast jafnaldra

Kenna að leika

Að lokum

Á facebook síðu AutisMate var spurt:

„Hvers myndirðu helst óska þér frá barninu þínu á mæðradaginn?“

„Eitthvað sem hann hefur

búið til alveg sjálfur án

þess að nokkur stýrði

honum“

Heimilidir Dawson G. Early behavioral intervention, brain plasticity, and the prevention of autism

spectrum disorder. Dev Psychopathol. 2008;20:775-803.

Guðný Stefánsdóttir. Einhverfurófsröskun, leiðbeiningar um viðurkennt verklag. 2008.

Johnson C, Myers S, the Council on Children with Disabilities. Management of children with

autism spectrum disorders. Pediatrics. 2007;120(5):1162-82.

Litróf einhverfunnar, óútgefin bók. Væntanlega í lok árs 2013. Greiningar- og ráðgjafarstöð

ríkisins.

Maglione MA, Gans D, Das L, Timbie J, Kasari C. Nonmedical interventions for children with

ASD: recommended guidelines and further research needs. Pediatrics, Suppl 2.

2012;130:169-78.

National Standards Report. The national standards project, adressing the need for evidence

based practice guidelines for autism spectrum disorders. Massachusetts, National Autism

Center, 2009.

National Research Council, Committee on Educational Interventions for Children with Autism.

Educating children with autism. Lord C, McGee JP, ritstjórar. Washington DC: National

Academics Press; 2001.

New York State Department of Health, Early Intervention Program. Clinical Practice guideline:

Report of the recommendations. Autism/pervasive developmental disorders. Assessment and intervention for young children (age 0-3 yeras). Albany NY: Höfundur; 1999.

Scott J, Baldwin WL. The challenge of early intensive intervention. Í: Zager D, ritstjóri. Autism

spectrum disorders. Identification, education and treatment. 3. útgáfa. Mahwah, NJ:

Lawrence Erlbaum Associates; 2005:173-228.

Heimasíður

http://autismpdc.fpg.unc.edu/content/evidence-based-practices

http://books.nap.edu/catalog.php?record_id=10017

http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=10017

http://www.nationalautismcenter.org/

http://researchautism.net