71 children ages 6-12 receiving applied behavior analysis were randomized to receive Google Glass and a control group. The children wore Google Glass accompanied by a smart phone app. The Google Glass assisted with facial engagement and emotion recognition by displaying an emoji consistent with facial expression detected with the device's camera. There is also an audio device option. The accompanying mobile app had social engagement activities which included games and "free play" to help with social interaction. The children used the intervention four times a week for 20 minutes, one session with a behavior therapist and three times with family members, for six weeks. The children in the intervention group showed improvements in social behavior compared to the control group, (Voss C, Schwartz J, Daniels J, et al. Effect of Wearable Digital Intervention for Improving Socialization in Children With Autism Spectrum Disorder: A Randomized Clinical Trial. JAMA Pediatr. Published online March 25, 2019. doi:10.1001/jamapediatrics.2019.0285).
Autism, Families, Resiliency and Symbiosis
Three days ago, a new controlled study was published online which showed improved resiliency in parents of children with autism who engaged in an eight session one hour to one and a half hours virtual mind-body group program which included "relaxation techniques, stress awareness discussion, and adaptive strategies for coping with stress." Resiliency is the ability to adapt (bounce back) to stressors. In this study, the treatment group showed improvements in resiliency and stress/reactivity compared to the control group, (Kuhlthau, KA, Luberto CM, Traeger L, et al. "A Virtual Resiliency Intervention for Parents of Children with Autism: A Randomized Pilot Trial," J Autism and Developmental Disorders, (March 21, 2019): 1-14.
As a parent and a sibling of individuals with autism, there is a lot I get stress out about. I have a child Talia who needs constant supervision, who among other behaviors bangs her head, bites and makes loud noises during the night. I have to think about how I am going to pay the next autism school tuition installment while dreading the possibility of an impartial hearing. I also have to run the house and get involved with my brothers' issues, especially Stuart who has no access to ABA, has problem behaviors, numerous side effects to medications and often is so sedated he basically lives in a chemical prison.
Stuart often refuses his day program and either lies in bed all day or sits on a chair. He does not go out on weekends. He is morbidly obese and has permanent tardive dyskinesia.
A month ago, I told him I would have a Purim party at my house and I told him I would have a favorite dessert for him, but he had to attend program every day, and he did! When he came over, he started bothering my mother with repetitive nonsense, "You have a thin head." I needed to cook for ten people and did care to deal with this. Talia wanted to play in the occupational therapy gym I installed years ago in the basement, so I asked Stuart to watch his niece. He actually did very well. Once she tried to leave the gym and walk towards the laundry room, Stuart told her right away to come back and she listened to him. We had autism symbiosis! This is another reason we should not focus simply on deficits and look at what people with special needs can do. As I have stated many times before we need to prioritize psychosocial interventions, including applied behavior analysis rather than drugs.
Adults with Autism, Self-injury, Hospitalizations and Aversives
According to a recent study, "Adults with ASD were twice as likely as adults without ASD to have a hospitalization related to self-injurious behavior and ideation. Among adults with such a hospitalization, those with ASD had longer stays and, even after the analysis accounted for length of stay, higher costs." The study involved "5,341 discharge records for adults with ASD and 16,023 records for adults without ASD," (Morgan C. Shields, Ilhom Akobirshoev, Robert S. Dembo, and Monika Mitra, "Self-Injurious Behavior Among Adults With ASD: Hospitalizations, Length of Stay, and Costs of Resources to Deliver Care," Psychiatric Services; published Online:7 Mar 2019, https://doi.org/10.1176/appi.ps.201800318).
Here are some highlights of a literature analysis, discussed in a previous post, how skin shock is much more effective for some individuals than second generation antipsychotics (SGAs) in reducing and even eliminating self-injury. Skin shock certainly for some individuals improves functioning, quality of life and decreases costs.
With SGAs, 23 of 136 problem behaviors were eliminated in 88 subjects With skin shock treatment, 83 of 117 problem behaviors were eliminated in 114 subjects The mean daily rate of baseline problem behaviors were 5,300.23 in skin shock studies compared to 282.31 with SGAs, nearly 19 times as high as in the studies on SGAs, Blenkush N (2017) A Risk-Benefit Analysis of Antipsychotic Medication and Contingent Skin Shock for the Treatment of Destructive Behaviors. Into J Psychol Behav Anal 3: 121.
Making an effective evidence based treatment which cuts costs by preventing hospitalizations and medication side effects inaccessible for political reasons is unethical.
Aversives Compared to Medication Study
A literature analysis compared second generation antipsychotic medications (SGAs) to skin shock.
With SGAs, 23 of 136 problem behaviors were eliminated in 88 subjects.
With skin shock treatment, 83 of 117 problem behaviors were eliminated in 114 subjects.
The mean daily rate of baseline problem behaviors were 5,300.23 in skin shock studies compared to 282.31 with SGAs, nearly 19 times as high as in the studies on SGAs.
Science and personal decisions need to determine treatment, not prejudice!
Blenkush N, Int J Psychol Behav Anal. 2017; 3(121).
My Lecture at Psych Congress 2018
“My Personal and Professional Journey Through Autism: Update on Autism Treatment Through the Lifespan,” with Carol Fiorile, BCBA-D
available for continuing education credit for physicians, psychologists, nurses and physician assistants