Therapeuticum.org

Intensive Outpatient Program
for Autism Spectrum Disorders

An integrated treatment approach that addresses autism,
Asperger's Syndrome, and other developmental challenges

Fair Oaks Therapeuticum offers an integrative treatment approach for children with developmental problems—especially problems with relational and social deficits as their central concern. We believe the best treatment is based in relational and social skill therapy under the direct guidance of a developmental specialist. Therapy can be even more effective when patients attend multiple treatment sessions each week and when the entire family is involved in the therapeutic process. Effective intervention can make a huge difference for an affected child's adaptive functioning and enjoyment of life and in the normalization of family life.

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Program Contents

Who is this treatment for?
Assessment
Treatment
Supportive therapies
Contact

Who is this treatment for?

Our intensive outpatient treatment program for autism spectrum disorders and Asperger's Syndrome is for children (starting with infancy), teenagers and adults with a diagnosis of high-functioning autism and/or Asperger's Syndrome. Patients with other pervasive developmental disorders may be accepted into the program, provided they can benefit from practicing relational competence and that other mental health issues will not interfere with treatment.

Frequently, children and teenagers are referred to our clinic because their parents and teachers notice that even though children may show average or above average intelligence, they do not understand the laws of social conduct and communication. These children frequently suffer from heightened anxiety, compulsive and repetitive behaviors, and a much-compromised ability to tolerate stress and change. As a result, these children are often isolated from peers, experience chronic depression, and have difficulty with functioning in school. As adults, they often suffer a significantly compromised occupational, relational, and social quality of life.

In response to the higher education, occupational, and employment needs and challenges of young adults (ages 16 through adulthood), we offer the BEST Program, a course of study and training that teaches important job-search and career-development skills (see our BEST brochure). The program helps young adults focus on:

• Moving from dependence to independence, and ultimately to interdependence within a work environment.
• Improving productivity in their public lives as well as their personal lives.
• Enhancing their quality of life by through improved social interaction and career development.

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Assessment

• Initial consultation and interview
  The first steps in our assessment are a detailed family and patient questionnaire followed by a family interview. We educate the family about our program, its components and its limitations. We discuss the anticipated length of each child's treatment and the financial commitment it will entail. Finally, we assess the appropriateness of the child and family for the program.
• Psychological assessment
  Diagnosis of autism spectrum or developmental disorders using psychological tests recommended for Best Practices for Developmental Disorders. Our assessments are widely accepted by school districts, ALTA California Regional Center, and other third party payors.
• Genetic screening
  We submit a DNA sample (taken by swabbing the inside of the mouth) to a medical lab to detect the presence of potentially important genetic variations called single nucleotide polymorphisms (or SNPs). Certain SNPs have been identified in individuals who have difficulty in processing heavy metals, particularly mercury. Research suggests these genetic markers run in families with autism, color blindness, arthritis, colitis, chronic fatigue, lupus, celiac disease, Parkinson's and Alzheimer's Disease.
• Additional tests
  Additional testing may be necessary to support or disprove diagnostic impressions and will require additional time and resources not included in the basic assessment. Additional testing is generally needed when multiple conditions are present.
• Evaluation of current medical treatment and medication/medicinal consultation
  Our clinical director evaluates a child's current medication and informs parents about additional treatment options (such as natural medicines, nutritional changes or Cranial Electro Stimulation). Our goal is to support current medication regimens or reduce the overall chemical load to the body and brain.
• Review of assessment and treatment plan
  After our assessment is complete, we conduct a feedback session with parents. Parents receive a comprehensive assessment and treatment plan. With parents, we discuss potential barriers to the treatment plan and identify support services that may help in implementing the plan.
• Evaluative report and treatment recommendations
  An evaluative report of all psychological testing, diagnosis, and treatment recommendations is available upon request. Since the feedback session with the parents is very comprehensive, the additional report is optional.

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Treatment: Our approach

Our treatment program presents an alternative to intensive behavioral interventions of 30 to 40 hours a week. Many experts in autism now recognize that the most successful intervention programs address the needs of the body, the needs of the mind, and the needs for satisfying social and relational interaction. Fair Oaks Therapeuticum offers a 360-degree program designed to address the needs of this complex condition, using a holistic methodology for real-life families. Most of our interventions can be accomplished in four to six therapeutic sessions a week.

The best outcomes seem to be linked to early, intensive intervention: The younger the child, the greater the opportunity for effective therapy.

Treatment details

Over the course of the program, patients and their families receive:

• Biomedical interventions
  Recent research by Defeat Autism Now! (DAN!) and researchers such as S. Jill James, Ph.D. of the University of Arkansas, Dr. Andrew Wakefield of Thoughtful House, Northeastern University's Richard Deth Ph.D., Dr. Jeff Bradstreet of Florida's International Child Development Resource Center, Dr. James Neubrander, and others have resulted in new understandings about the role of metabolic functioning in autism spectrum disorders. Specifically, new research suggests a strong link between autism and a child's inability to process heavy metals, particularly mercury. Our treatment includes:
  • Genomic screening to assess whether a child may be predisposed to a compromised ability to detoxify.
  • Education for parents on the importance of diet and nutritional supplements that aid the body's natural ability to detoxify. Frequently good results are achieved with a gluten- and casein-free diet and with supplements such as calcium, magnesium, probiotics, and omega-3 fatty acids. If these interventions are not powerful enough, Dr. Terrance Chang, a DAN! physician who works in conjunction with our clinic, will initiate chelation therapy and, if indicated, methyl-B12 injections.
• REAL: Relational-Educational-Affective-Learning Social Skills
  Relational Social Skills Therapy is the cornerstone of our program. Our REAL Social Skills program uses Steven Gutstein's RDI approach, Dr. Stanley Greenspan's floortime method, Judith Bluestone's HANDLE program, and Michelle Winnner's approach to social thinking as well as our own techniques for relationship building, joint play, games, role playing and other exercises. Each child receives between one and three sessions per week of REAL therapy.

  Initially we work in individual session so the child can become used to the new environment, learn basic referencing with the primary therapist, learn boundaries, self-regulation and above all have fun. When the child is ready to transition to a facilitated peer group, another, developmentally compatible child will be included in the sessions. Later on, the group may include two to three more peers. Each child's work with her or his principal therapist is maintained at all times.

  Our games and activities are geared toward improving a child’s ability to function in their family, school environment, and with their peers. Our interventions cover the following areas; progress in each is evaluated twice a year in our functional assessment: communication, community activity, functional academics, home living, health and safety, leisure, self-direction, self-care, social functioning, and, for older teens and adults, work.

• Therapeutic yoga
  Children and adults affected by autism spectrum disorders have only a limited sense of their bodies. At times they are clumsy, sedentary, uninterested in physical activity, and generally lack motivation. In addition, these children tend to be anxious, focused on detail and objects, and have difficulty understanding the concept of inner experience. Therapeutic yoga addresses these challenges by helping affected children follow direction, establish a body self, connect with themselves as a physical and mental/spiritual entity, and learn to self-regulate by using breathing techniques.
• Family therapy
  Autism affects the entire family. As part of our intensive outpatient treatment program for autism spectrum disorders and Asperger's Syndrome, we offer regular family therapy sessions as well as monthly classes that allow parents to network with others and share strategies that have worked for their child. Our program also features:
  • Parent coaching and "social stories." Problem situations may be eased into new pathways by initially scripting them or using visual images to outline the sequence of a desired behavior, such as a child's morning routine. Whether a story is scripted or visual cues are used depends on the primary sensory modality a child uses.
  • Building meaningful structure. This is important for any family but especially so for families with special-needs children. Seeking treatment and securing necessary school services for these children may take so much time that family structures suffer. But family rhythms are crucial: They provide the basis for refueling both child's and parent's inner resources and to manage the relational demands of school. We teach parents strategies that help with transitions, how to minimize stress in the family and how to create meaningful and sustainable family rhythms.
  • Alternative family activities. We have found that autistic children in particular are drawn to television and videogames. When used in excess, these activities may prevent these children from engaging the environment and people around them in any meaningful way. We teach activities that are fun, low in stress, and include intrinsic rewards such as laughter, praise, and other positive feedback.
  • Modeling positive discipline. We help parents find, create and encourage success in their children's lives. Among other philosophies, we emphasize The Nurtured Heart approach by Howard Glasser, which minimizes resistance and fosters caring discipline.
• Therapeutic listening
  Therapeutic Listening is based on Auditory Intervention Training. It is a non-intrusive method that can be used in a home setting. The technique recognizes the crucial role the human auditory system plays in interpreting information from the world around us and regulating our physical and nervous system response to external stimuli. Therapeutic Listening uses sound to stimulate the brain stem through multiple channels; the brain stem, in turn, influences a variety of brain structures and basic bodily functions, from basic motor coordination to the cardiovascular system. It encourages deep changes on a neurological and physical level, changes that need to be reinforced and supported by ongoing psychotherapeutic treatments.
• Cranial electrotherapy stimulation (CES)
  

  Cranial electrotherapy stimulation (CES) is a method for treatment of depression, anxiety and insomnia—conditions from which most children with autism spectrum disorders suffer. The method employs a weak electrical current through CES electrodes placed behind the ear. Although researchers are still investigating exactly how CES works, studies have shown that it can produce chemical changes in the brain (through the release of chemicals like seratonin, dopamine and endorphins) and that these changes in turn have beneficial effects throughout the central nervous system.

  The Alpha-Stim devices we use, and recommend for home use, have been approved by the FDA. We provide CES training before parents use the device at home. (For more information on cranial electrotherapy stimulation, please see: Introduction to the Science Behind Cranial Electrotherapy Stimulation (on the Alpha-Stim site) and How Alpha-Stim Cranial Electrotherapy Stimulation (CES) Works.)











• Sensory interventions
  Many of our programs focus on sensory interventions or affect the sensory system. For example, Therapeutic Listening improves auditory processing and assists in perceptual organization. Therapeutic yoga supports body sense, listening, and touch. We also use a variety of methods to deal with the autistic child's oversensitivity to touch. Desensitization techniques include brushing with natural fiber brushes or massage rollers; deep pressure massage (uses the circular motion of a gel ball for relaxation); and joint compression. At times we encourage weighted vests to increase a child's sense of their body during the day and weighted blankets, body pillows and the like for containment and body sense at night. Again, we train parents in these interventions so that they may be used daily at home.
• Consultations with schools, including IEP/Section 504 guidance for parents and teachers.
• Parent coaching, modeling use of social stories, and structuring activities.
• A home program that includes sensory-integration techniques.
• Individual child psychotherapy to create relational competence, to address co-existing disorders like depression and anxieties, and to deepen strategic learning initiated in group sessions.

Periodic reassessment

Generally, reassessment is helpful between 12 and 18 months after intervention has been initiated and on an annual basis thereafter. To assist clinicians in refining treatment goals and strategies, reassessment is also indicated when a child experiences sudden changes in functioning. Assessments can also be of great benefit to determine appropriate accommodations and school objectives (for IEP planning, for instance).
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Supportive therapies

Children suffering from pervasive development disorders face many potential barriers in treatment; often, their developmental and relational issues go hand in hand with a variety of other problems: speech and movement delays, severe emotional problems and behavioral difficulties. At the same time, their treatment may be hindered by crises within their families such as a parent's chronic emotional stress, marital difficulties or divorce; and serious illness or death in the family. Fair Oaks Therapeuticum offers a full spectrum psychological services including speech therapy, family and individual psychotherapy as part of the autism spectrum treatment. If our clinic can't help, we'll make appropriate referrals for remedial therapies and strategies.

Becoming aware of the available help for autism spectrum disorders can seem overwhelming. Many parents who have used these therapies have seen their efforts pay off. At your request we can discuss with you our outcome studies and connect you with parents who have used our program. The journey out of autism remains extremely challenging, but there is no reward greater than watching your child wake up to himself or herself and to the world.
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Contact

If you have any questions about any aspect of our autism spectrum disorders and Asperger's Syndrome program, or if you want to inquire about a formal consultation, please contact Dr. Ursula Stehle at (916) 962-0222, ext 1#, or email her at drstehle@therapeuticum.org
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Last modified on 01.13.10

© All contents Copyright 2004-2010, Fair Oaks Therapeuticum