Exam 2 Flashcards
(153 cards)
least credible level of evidence
Expert committee report
most credible level of evidence
**Gold standard
systematic meta-analysis of more than one randomized control trial.
Other levels of evidence
-more credible to less credible
- well-designed, randomized control trials
- well-designed control trials without randomization
- well-designed, quasi-experimental studies
- well-designed, non-experimental studies
what is the five step approach to EBP
- ask question
- use best evidence to answer question
- determine if results pertinent to patient
- determine if evidence applicable and feasible to patient
- measure performance following intervention
medical intervention for ASD
- What types are used?
- anti-psychotic medication
- Serotonin-reuptake inhibitors
- stimulants
Medical interventions
- anti-psychotic meds, why?
- decreases challenging behaviors: irritability, aggression, self-injury.
examples: risperidone (risperdal), aripiprazole (abilify), haloperidol (haldol)
Medical intervention
- serotonin reuptake inhibitors, why?
- decrease repetitive and problem behaviors
Examples: fluoxetine (prozac), citalopram (celexa)
Medical Interventions
- stimulants, why?
- decrease hyperactivity
Examples: methylphenidate (ritalin), amphetamine, dextroamphetamine
Types of complementary/alternative medicine
- Biologically based therapies
- mind-body interventions
- manipulation/body-based methods
- energy therapies
- alternative medical systems
Biologically based therapies for ASD
- modified diet (gluten free diet, casein free diet, sugar free diet)
- vitamins/minerals (vitamin B6, Magnesium, Zinc, Vitamin C)
- food supplements (fish oil, Omega-3)
Mind-body interventions
- prayer/shaman (“getting the evil out”)
- biofeedback (EEG, EMG)
- meditation/relaxation
- Guided imagery (hypnosis)
Manipulation/body-based methods for ASD
- massage/bodywork
- craniosacral therapy (head massage)
- special exercises (yoga, tai chi)
- auditory integration
- vagus nerve stimulation (implant in Vagus nerve)
Energy Therapies for ASD
- Healer/healing touch
- REIKI
alternative medical systems for ASD
- acupuncture/acupressure
- anthroposophic medicine
Most common individual therapies for ASD
- Modified diet (38%) -> no conclusive evidence of effectiveness, should be recommended only for children with Celiac disease or food allergies.
- Vitamins/minerals (vitamin B6) (30%) -> no conclusive evidence of effectiveness. long term supplementation has led to sensory peripheral neuropathy.
- Food Supplements (23%) -> no conclusive evidence of effectiveness.
What is the most common complementary/alternative medicine for ASD?
- Modified Diet
evidence for medical intervention
- anti-psychotic medication
- Risperidone -> 2 strong RCTs indicating decreased challenging behaviors (most common side effect: sleepiness).
- Aripiprazole -> 2 RCTs (both sponsored by the maker of the drug) indicated decreased challenging behaviors (most common side effect: sleepiness).
– Risk of tremor, rigidity, dyskinesia
evidence for medical intervention
- serotonin reuptake inhibitors
-1 RCT -> insufficient evidence
evidence for medical intervention
- stimulants
- 1 RCT -> insufficient evidence
- - Risk of increased challenging behaviors and loss of appetite
Major weaknesses in evidence for medical intervention for ASD
- studies supported by drug companies
- small sample sizes
- poor methodology
- inconsistent methodology
- no meta-analysis
- no comparison with behavioral interventions
- no comparison with behavioral + medication interventions
Enhanced Milieu teaching
- Skill specific
- targets children with ASD who are minimally verbal (but no nonverbal)
- imitate at least 80% of words on an imitation task.
- spontaneously use at least 10 words
- MLU less than 3
EMT Goal?
Evaluates what?
- Goal: semantic goals are created based on evaluations
- Evaluates:
- receptive, expressive, language sample, parent-report measure.
EMT treatment methods
- administrator: clinician or parent
- environment: clinic/school/home
- materials: toys and materials for play
- frequency: 24 sessions (clinician implemented 15-20 min.; parent implemented 45 minutes.)
- session aim: increase language complexity
EMT procedures
- environmental arrangment
- responsive interaction
- language modeling
- Milieu teaching prompts