Even with a Nanny in the home, Julius and Sasha are exhausted! Because the Jones love their son so very much, they want the best for him and fight everyday to get just that. Three years have since passed and Devontae has just had his 8th birthday. Devontae’s IEP had been developed. Julius and Sasha had been to several meetings with special education teachers, representatives of the public schools who are knowledgeable about the program and other individuals invited by the school. Both Julius and Sasha played an important part in creating Devontae’s program and had set specific goals for him. Both Julius and Sasha attend meetings once a year to review Devontae’s progress and to make any alterations to reflect his changing needs. Devontae’s IEP included continuing his education at public school. Devontae is now enrolled in 2nd grade at the local public school, and the start of the year has already been filled with a challenge. It seems like going to school everyday is a struggle for Devontae. He just isn’t like other kids, and his peers are still getting use to handing him in the classroom with them. He throws tantrums for no reason at all and has difficultly following instructions. Devontae has trouble learning to interpret what others are thinking and feeling, and gets frustrated when he can’t do this. Devontae likes to throw a fit when he finds that nobody understands what he wants. The skill of social interaction, especially the skill of using his imagination seems to be a problem for Devontae. When given free time, Devontae will wander off by himself and spend the entire time, not playing with cars but lining them up over and over again.
Julius and Sasha have put together a top of the line multidisciplinary team for their son. Devontae is still receiving structured, therapeutic activities for 25 hours every week by a therapist. This therapy continues to focus on core areas such as language and communication, social skills, imitation, motor skills, and play skills. Devontae sees a Speech Pathologist every week and is working hard to become more and more audible every day. Devontae also works with an occupational therapist. Devontae still continues to make regular visits to his pediatrician. When time, he receives his immunizations. Julius and Sasha have also been receiving training in behavior therapy. This training helps to provide them with the key tools to encourage desired and un desired behaviors of their son. This training also gives Devontae’s parents the chance to meet and discuss with other parents of children with ASD.
When Devontae went to his 8 year old checkup, both his pediatrician and therapist brought up the thought of being prescribing him Prozac. Although this medicine was originally designed to treat depression, it helps to reduce repetitive or compulsive behaviors in children with ASD. His dosage would start very small, at 1-2 mg and go up 1 mg every 1-2 weeks.
Even though Julius and Sasha are both doctors and have a good salary, they are starting to encounter financial problems. All this therapy is extremely expensive and even though Devontae is now in school all day, they still have a live in Nanny. They now love this Nanny and highly admire her for being a tremendous help in helping to raise their son. The Jones’ feel as if she is part of their family now. Letting her go would be so sad and the Jones’ don’t know if they can come to parts to do this.
1) Do most insurance plans cover behavioral therapy and speech therapy?
2) What kind of skills would the Jones’ learn in behavioral therapy for their son’s autism management?
3) Is there evidence that behavioral therapy is useful in managing ASD? Is there evidence that occupational therapy is useful in addressing the problem of ASD in children?
4) Has Prozac been tested for use in children? Does it have any side effects?
DECISION POINTS:
Should the Jones’ let the nanny service go to save money?
Should the Jones’ agree to put Devontae on Prozac?
“Some families may spend more than $50,000 per year on autism-related therapies, such as applied behavior analysis.” Some states have been known to provide coverage for the treatment of autism. To this day, a total of 34 states have specific laws in regards to autism and insurance coverage. This is very lucky for the Jones’. However, they would need to speak to their specific insurance company to see what can be done. Medicaid will cover the therapies as long as the Jones’ qualify for it depending on the laws in the state they live in.
ReplyDeleteThe first and most important thing Sasha and Julius will learn from behavioral therapy is how to communicate and understand Devontae. The family will learn how to comprehend Devontae’s actions and therefore act accordingly to help him in any way plausible. In addition, over time the therapy will hopefully have a positive effect on Devontae and limit his tantrums and outbursts. The behavioral therapist will also show and explain everything that works and does not work well with Devontae with his parents in hopes that continuing the progress in therapy in the home will in turn have a more and more positive hold on Devontae. Sasha and Julius will have a better understanding of Devontae’s behaviors and be in control of them if they become dangerous as they learn the necessary skills to calm him down.
Children with ASD as in Devontae’s case have significant challenges with sensory processing, play, social interaction, communication, and regulating their emotions and behaviors. With these complications children with ASD cannot make sense of the world as well as children without ASD by not activity participating everyday activities. Behavior and occupational therapy all for the child to develop skills to interact better with others, be involved in community events, and transition to eventually gain and maintain employment after doing as best they can in their school tasks. “What we do see is a body of work that suggests that yes, in fact, young children with autism spectrum disorders who do receive early intensive intervention do show or tend to show benefit,” says Zachary Warren, PhD, director of the treatment and research institute for autism spectrum disorders at Vanderbilt’s Kennedy Center in Nashville, “But there are some who show much more benefit than others. And there are some interventions where the effects are very modest, and some subgroups are showing tremendous gains.” (Goodman, 2011) Behavioral therapy is very useful in children because often parents and educators do not how to go about managing these problems because they can become very severe. The behavioral therapist will work on the child becoming less dangerous to themselves and others as they a wide variety of behaviors including spinning, flapping, head-banging, kicking, screaming, biting, and sitting underneath tables. Evidence supports that occupational therapy allows the child with ASD to foster in areas such as daily living activities, fine motor skills, playing, coping, posture, perceptional skills, gross motor skills, and visual skills. Without behavorial and occupational therapy interventions the child will fall severely behind in common skills that they need to live an independent life. “The mantra in the field has been that with early identification and early intervention, you can improve the long-term developmental trajectory of the illness,” says Eric Hollander, MD, director of the Compulsive, Impulsive and Autism Spectrum Disorders Program at Montefiore Medical Center in New York City. (Goodman, 2011)
ReplyDeleteProzac has been tested for use in children but it has many harmful and serious side effects as there is not adequate research to show the results. In the trials where Prozac what given to children compared to the group given the placebo, the children taking Prozac showed a higher risk of committing suicide Most research concludes that there is not enough evidence recommend use if the medication is not desperately needed. In addition, there is little research done where the children are prescribed a mix of drugs of stimulants and antidepressants. There isn’t even enough research done with that kind of drug combination in adults. The Food and Drug Administration has recently approved its use in children between the ages of 7 and 17 if they have great depression or obsessive-compulsive disorder. The most serious side effect that Prozac can cause is the child wanting to harm him or herself. This can lead to depression and death, so parents have to have a close watch on their children if they start using this medication. Children also can experience side effects of not being able to sleep, headache, loss of appetite, blurred vision, inability to think clearly, vomiting, dry mouth, and nervousness. Also the child has to be extra careful if they were taking migraine medication at the same time along with any allergies that might flare up when taking this medication. If the child is allergic to Fluoxetine, the drug should not be taken at all.
ReplyDeleteDECISION POINTS:
Should the Jones’ let the nanny service go to save money?
The Jones’ should cut the down the nanny’s hours so that they don’t have to let her go entirely and so that they can save money. They should change her hours from after school to about 8:30. This way they pay her about 25 hours a week instead of full time all week. The nanny will still benefit Sasha and Julius so they don’t become overwhelmed with care for Devontae all at once while both are working full time so that they continue to support Devontae’s care. It will be hard to see the nanny less but they cannot get themselves into financial troubles for down the road which would cause even more problems.
Should the Jones’ agree to put Devontae on Prozac
The Jones’ should not agree to put Devontae on Prozac but instead look into other options first. There is good evidence for the drugs such as two antipsychotic drugs, Risperdal and Abilify, which decreased “challenging” behaviors. They have to be careful with these drugs too as there are side effects such as involuntary activities, drowsiness, and weight gain. If these drugs do not work then Prozac might be the next best option in small doses.
References:
ReplyDeleteAOTA’s Societal Statement on Autism Spectrum Disorders. (n.d.). e American Occupational Therapy Association. Retrieved June 9, 2012, from www.aota.org/Practitioners/Official/SocietalStmts/Autism.aspx
Benefits of Occupational Therapy for Autism. (n.d.). WebMD - Better information. Better health.. Retrieved June 10, 2012, from http://www.webmd.com/brain/autism/benefits-of-occupational-therapy-for-autism
Elleseff, Tatyana. (May 27, 2009) Speech Language Services and Insurance Coverage: What Parents Need to Know. Smart Speech Therapy LLC. Retrieved on June 9, 2012 from http://www.smartspeechtherapy.com/speech-language-services-and-insurance-coverage-what-parents-need-to-know/
Fluoxetine . (n.d.). KidsHealth - the Web's most visited site about children's health. Retrieved June 10, 2012, from http://kidshealth.org/parent/medications/fluoxetine
Goodman, B. (2011). What Works to Treat Autism?. WebMD - Better information. Better health.. Retrieved June 10, 2012, from http://www.webmd.com/brain/autism/news/20110404/what-works-to-treat-autism?page=2
Insurance Coverage for Autism. (January 2012). National Conference of State Legislatures. Retrieved on June 9, 2012 from http://www.ncsl.org/issues-research/health/autism-and-insurance-coverage-state-laws.aspx
Rudy, Lisa Jo. (April 17, 2009). Behavior Therapy as a Treatment for Autism. Autism Spectrum Disorders. Retrieved on June 9, 2012 from http://autism.about.com/od/autismtherapy101/a/behaviorspec.htm
Should children take antidepressants? - Harvard Health Publications. (n.d.). Health Information and Medical Information - Harvard Health Publications. Retrieved June 10, 2012, from http://www.health.harvard.edu/newsweek
Treatment for Autism - Behavior Therapy as a Treatment for Autism. (n.d.). Autism - Signs, Symptoms, Treatments, Resources, Support for Autism. Retrieved June 9, 2012, from http://autism.about.com/od/autismtherap