Kentuckiana Children’s Center Helps Fight Autism

Orion Diagnostic & Chiropractic Center - Dr. Khaled Khorshid
Chicago Ridge Medical Center
9830 Ridgeland Ave. Suite 5 - Chicago Ridge, IL 60415
Tel: (708) 288-2239

Three articles define autism and present successful methods of dealing with it.

 

MAKING A DIFFERENCE IN THE LIVES OF SPECIAL KIDS & THEIR SPECIAL PATENTS

Kentuckiana Children’s Center in Louisville, Kentucky, was founded in 1957 by Lorraine M. Golden, D.C. A graduate of Palmer College, Dr. Golden envisioned a place where special needs children could receive chiropractic care and thereby lead a better quality of life. From the beginning, Dr. Golden and her team combined chiropractic care with other health services, and pioneered the use of holistic methods of caring for multi-challenged children. The longevity of Kentuckiana Children’s Center and its success with challenged children is a tribute to this courageous chiropractor’s determination to serve any child, regardless of theirability to pay.  

 

Disorders of the Autistic Spectrum

By Khaled A. Khorshid, M.B.B. Ch., M.S., D.C. with Sharon A. Vallone, D.C., D.I.C.C.P.

Since it inception in 1956, Kentuckiana Children’s Center (KCC) has existed to provide chiropractic care for children in exceptional circumstances. Lorraine M. Golden, D.C., Kentuckiana’s founder, called them “special needs children.” In the early days of operation, the Center’s staff served children suffering from the ravages of polio, the myriad disabilities associated with cerebral palsy and epilepsy as well as children with a variety of genetic limitations including children with Downs Syndrome. This population of children has shifted over the years and today we find that the greater percentage of children who are being cared for at Kentuckiana are classified with disorders of the autistic spectrum.

As early as 1943, Leo Kanner described the main features of “the autistic syndrome” as physically healthy children from birth to 30 months who were able to relate to other people in the usual way, who failed to use language to communicate, who demonstrated an obsessive need for their world to remain the same at all times, lacked spontaneity, had a fascination for objects that needed development of fine motor skills to handle (like a puzzle cube) and possessed good cognitive potential. (Table 1) Although Kanner thought that autism occurred in only highly intelligent families, we now know that autism knows no racial, ethnic or social boundaries and is four times more prevalent in boys than girls. Family income, lifestyle, and educational levels do not appear to have any impact on the occurrence of autism.

Children diagnosed with autism often have delayed and disordered development which affect their abilities in social interaction, communication and creative play. In addition, there may be a number of non-specific behavioral problems such as hyperactivity, disruptive behavior, temper tantrums, aggressive behavior, self-injurious behavior (e.g. biting themselves, banging their heads, throwing themselves down from high places, hitting or punching themselves), fears and phobias, sleep disturbances, bedwetting or encoparesis (Rutter 1985).


TABLE 1

The Autistic Syndrome Leo Kanner-1943

  • Physically healthy child
  • Birth to 30 months
  • Unable to relate to other people
  • Fail to use language for communication
  • Obsessive need for sameness
  • Lack spontaneity
  • Fascinating for objects requiring small motor skills to handle
  • Possesses good cognitive skills 

            

 

 

 

 

 

 

 

 

 

            Children diagnosed with autism are often intolerant of specific stimuli like loud sounds, bright lights or touch. An increase in the sensitivity of the organs of taste and smell as well as an increased sensitivity to texture may make eating a treacherous adventure, severely limiting the diet and seriously affecting the nutrition of the child.

Children with autism are often rated as being intellectually disabled (Wing & Gould 1979) but upon observation, demonstrate excellent visual motor skills as compared to language/social skills. These children lack the ability to relate socially (Rutter & Schopler 1987), make friends or emphasize and their behaviors are often considered inappropriate in any social context. The child with autism is a “loner”, rarely if ever seeking out anyone else’s company. Children with autism do not share their pleasure in objects (a toy) or the world (a child pointing at a neighbor walking their puppy) with others (Barron-Cohen et al 1992) and demonstrate this with a lack of visual contact or seeking out the reinforcement of other’s opinions. They do not substitute mime or sign language for the spoken language and do not appear to interpret the body language, facial expressions and tones in the voices of the people around them. If a child with autism is verbal, they frequently repeat words or phrases that they have heard (echolalia) and use their pronouns incorrectly (as in congratulating themselves by saying “you did it!” instead of “I did it!”).         

Over half-a-million people in the United States today have autism or some form of pervasive developmental disorder. Its prevalence rate makes autism one of the most common developmental disabilities. Yet, most of the public and many professionals in the medical, educational and vocational fields are still unaware of how autism affects the people and they can effectively work with people diagnosed with this condition.

 

Is there more than one type of autism?

            Several related disorders are grouped under the broad heading of “Pervasive Developmental Disorder” or PDD- a general category of disorders characterized by severe and pervasive impairment in several areas of development (American Psychiatric Association 1994). A standard reference is the Diagnostic and Statistical Manual (DSM), a diagnostic handbook now in its fourth edition. The DSM-IV lists criteria to be met for a specific diagnosis under the category of Pervasive Developmental Disorder. Diagnosis is made when a specified number of characteristics listed in the DSM-IV are present. Diagnostic evaluations are based on the presence of specific behaviors indicated by observation and through parent consultation, and should be made by an experienced, highly trained team which may include a neurologist, psychologist, developmental pediatrician, speech/language therapist, learning consultant, or other professionals knowledgeable about autism. Thus, when professionals or parents are referring to different types of autism, often they are distinguishing autism from one of the other pervasive developmental disorders.  

Individuals, who fall under the Pervasive Developmental Disorder category in the DSM-IV exhibit commonalties in communication and social deficits, but differ in terms of severity. Listed below are some major points that help distinguish the difference between the specific diagnoses used:

AUTISTIC DISORDER- Impairments in social interaction, communication, and imaginative play prior to age 3 years. Stereotyped behaviors, interests and activities.

ASPERGER’S DISORDER- Characterized by impairments in social interactions and the presence of restricted interests and activities, with no clinically significant general delay in language, and testing in the range of average to above average intelligence.            

PERVASIVE DEVELOPMENTAL DISORDER- NOT OTHERWISE SPECIFIED (commonly referred to as atypical autism)- A diagnosis of PDD-NOS may be made when a child does not meet the criteria for a specific diagnosis, but there is a severe and pervasive impairment in specified behaviors.

RETT’S DISORDER- A progressive disorder which, to date, has occurred only in girls. Period of normal development and then loss of previously acquired skills, loss of purposeful use of the hands replaced with repetitive hand movements beginning at the age of 1-4 years.

CHILDHOOD DISINTEGRATIVE DISORDER- Characterized by normal development for at least the first 2 years, significant loss of previously acquired skills. (American Psychiatric Association 1994)

Autism is a spectrum disorder. In other words, the symptoms and characteristics of autism can present themselves in a wide variety of combinations, from mild to severe. Although autism is defined by a certain set of behaviors, children and adults can exhibit any combination of the behaviors in any degree of severity. Two children, both with the same diagnosis, can act very differently from one another and have varying skills.

There is no standard “type” of “typical” person with autism. Parents may hear different terms used to describe children within this spectrum, such as: autistic-like, autistic tendencies, autism spectrum, high-functioning or low-functioning autism, more-abled or less-abled. More important to understand is, whatever the diagnosis is that children can learn and function productively and show gains from appropriate education and treatment. The Autism Society of America provides information to serve the needs of all individuals within the spectrum.

 

Developmental Challenges

Diagnostic categories have changed over the years as research progresses and as new editions of the DSM have been issued. For that reason, we will use the term “autism” to refer to the above disorders. Children within the pervasive developmental disorder spectrum often appear relatively normal in their development until the age of 24-30 months, when parents may notice delays in language, play or social interaction. Any of the following delays, by themselves, would not result in a diagnosis of a pervasive developmental disorder. Autism is a combination of several developmental challenges.

The following are among those that may be affected by autism:

COMMUNICATION- Language develops slowly or not at all; uses words without attaching the usual meaning to them; communicates with gestures instead of words; short attention span.

SOCIAL INTERACTION- Spends time alone rather than with others; shows little interest in making friends; less responsive to social cues such as eye contact or smiles.   

SENSORY IMPAIRMENT- May have sensitivities in the areas of sight, hearing, touch, smell, and taste to a greater or lesser degree;

PLAY- Lack of spontaneous or imaginative play; does not imitate others’ actions; does not imitate pretend games.

BEHAVIORS- May be overactive or very passive; throws tantrums for no apparent reason perseverates (shows an obsessive interest in a single item, idea, activity or person); seems to lack common sense; may show aggression to others or self; often has difficulty with changes in routine. Some individuals with autism may also have other disorders which affect the functioning of the brain such as: epilepsy, mental retardation, Downs Syndrome, or genetic disorders such as: Fragile X Syndrome, Landau-Kleffner Syndrome, William’s Syndrome or Tourette’s Syndrome. Many of those diagnosed with autism will test in the range of mental retardation. Approximately 25-30 percent may develop a seizure pattern at some period during life.

Every person with autism is an individual, and like all individuals, has a unique personality and combination of characteristics. There are great differences among people with autism. Some individuals mildly affected may exhibit only slight delays in language and greater challenges with social interactions. The person may have difficulty initiating and/or maintaining a conversation, or keeping a conversation going. Communication is often described as talking at others (for example, monologue on a favorite subject that continues despite attempts of others to interject comments).

People with autism process and respond to information in unique ways. Educators and other service providers must consider the unique pattern of learning strengths and difficulties in the individual with autism when assessing learning and behavior to ensure effective intervention. Individuals with autism can learn when information about their unique styles of receiving and expressing information is addressed and implemented in their programs.

The abilities of an individual with autism may fluctuate from day to day due to difficulties in concentration, processing, or anxiety. The child may show evidence of learning one day, but not the next. Changes in external stimuli and anxiety can affect learning. They may have average or above average verbal, memory or spatial skills but find it difficult to be imaginative or join in activities with others. Individuals with more severe challenges may require intensive support to manage the basic tasks and needs of living day to day.

Contrary to popular understanding, many children and adults with autism may make eye contact, show affection, smile and laugh, and demonstrate a variety of other emotions, although in varying degrees. Like other children, they respond to their environment in both positive and negative ways. Autism may affect their range of responses and make it more difficult to control how their bodies and minds react. Sometimes visual, motor, and/or processing problems make it difficult to maintain eye contact with others.

Some individuals with autism use peripheral vision rather than looking directly at others. Sometimes the touch or closeness of others may be painful to a person with autism, resulting in withdrawal even from family members. Anxiety, fear and confusion may result from being unable to “make sense” of the world in a routine way. With appropriate treatment, some behaviors associated with autism may change or diminish over time.

The communication and social deficits continue in some form throughout life, but difficulties in other areas may fade or change with age, education, or level of stress. Often, the person begins to use skills in natural situations and to participate in a broader range of interests and activities. Many individuals with autism enjoy their lives and contribute to their community in a meaningful way. People with autism can learn to compensate for and cope with their disability, often quite well.

While no one can predict the future, it is known that some adults with autism live and work independently in the community (drive a car, earn a college degree, get married); some may be fairly independent in the community and only need some support for daily pressures; while others depend on much support from family and professionals. Adults with autism can benefit from vocational training to provide them with the skills needed for obtaining jobs, in addition to social and recreational programs.

Adults with autism may live in a variety of residential settings, ranging from an independent home or apartment to group homes, supervised apartment settings, living with other family members or more structured residential care. An increasing number of support groups for adults with autism are emerging around the country. Many self-advocates are forming networks to share information, support each other, and speak for themselves in the public arena. More frequently, people with autism are attending and/or speaking at conferences and workshops on autism. Individuals with autism are providing valuable insight into the challenges of this disability by publishing articles and books and appearing in television specials about themselves and their disabilities.

 

What causes autism?

Although studied for years, all that we seem to know is what has been disproven. The early theories that autism is a form of mental illness have been debunked. We no longer think that autism is the result of bad parenting or psychological stressors during the development of the child.

Although a single specific cause of autism is not known, current research links autism to biological or neurological differences in the brain. Patterns of autism or related disabilities in families suggests there might be a genetic basis to the disorder but at this time, no gene or complex gene combination has been directly linked to autism.

 

What are the most effective approaches?

            Evidence shows that early intervention results in dramatically positive outcomes for young children with autism. This is why there is such an emphasis on early diagnosis. Diagnosis is difficult for a practitioner with limited training or exposure to autism. Sometimes, autism has been misdiagnosed by well-meaning professionals. Difficulties in the recognition and acknowledgment of autism often lead to a lack of services to meet the complex needs of individuals with autism. It is important to distinguish autism from other conditions, since an accurate diagnosis and early identification can provide the basis for building an appropriate and effective educational and treatment program. Sometimes professionals who are not knowledgeable about the needs and opportunities for early intervention in autism do not offer an autism diagnosis even if it is appropriate. This hesitation may be due to a misguided wish to spare the family. Unfortunately, this too can lead to failure to obtain appropriate services for the child.

While various pre-school models emphasize different program components, all share an emphasis on early, appropriate, and intensive educational interventions for young children. As chiropractors, we see the importance of chiropractic care to give the opportunity of the body to heal and restore the optimum function of the central nervous system. Other common factors may be: some degree of inclusion, mostly behaviorally-based interventions, programs which build on the interests of the child, extensive use of visuals to accompany instruction, highly structured schedule of activities, parent and staff training, transition planning and follow-up.

Because of the spectrum nature of autism and the many behavior combinations which can occur, no one approach is effective in alleviating symptoms of autism in all cases. Various types of therapies are available, including (but not limited to) applied behavior analysis, auditory integration training, dietary interventions, discrete trial teaching, medications, music therapy, occupational therapy, PECS, physical therapy, sensory integration, speech/language therapy, TEACCH, and vision therapy. (Table 2)

Studies show that individuals with autism respond well to a highly structured, specialized education program, tailored to their individual needs. A well-designed intervention approach may include some elements of communication therapy.


TABLE 2

An Interdisciplinary Approach

  • Applied behavior analysis
  • Occupational therapy
  • Auditory integration training
  • PECS
  • Dietary interventions
  • Sensory integration
  • Discrete trial teaching
  • Speech/language therapy
  • Medication
  • TEACCH
  • Music therapy
  • Vision therapy

              

 

 

 

 

 

 

 

 

Kentuckiana’s approach

     At Kentuckiana Children’s Center (KCC) we evaluate for mineral intoxication, nutritional deficiency or allergy, and/or gastro intestinal abnormalities (dyasbiosis, candida, infection, etc.) as well as a full chiropractic evaluation for the presence of vertebral subluxation. (Table 3) Full spine adjustments (Diversified, Thompson, Activator, and SOT) are the most common procedures we use at KCC. Currently, there is a research study in KCC solely utilizing upper cervical technique for children diagnosed with autism. The results of this clinical trial may help elucidate the efficacy of the chiropractic upper cervical adjustment in the protocol for treating and helping children with autism.


TABLE 3

Kentuckiana Children’s Center Approach

Evaluate and Correct

  • Vertebral subluxation
  • R/O mineral intoxication
  • Nutritional deficiencies
  • Allergies
  • GI abnormalities

 

 

 

 

 

 

 

References

 

Khalid Khorshid, M.B.B. Ch., M.S., D.C. is a clinic director at the Kentuckiana Children’s Center in Louisville, Kentucky. A graduate of Ain-Shams University Medical School, Dr. Khorshid worked as a general practitioner and a general surgeon for many years in Egypt. He became exposed to chiropractic during one of his many visits to the United States and his experience in a chiropractor’s office during a random visit impressed him so much he enrolled at Palmer College. Upon graduating from Palmer he became an instructor at the college while also running a private practice. He joined Kentuckiana Children’s Center in 2000.          

 

 

 

 

 

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