Autism with Cynthia Slomowitz, DPT

Transcript

Marsh Naidoo (00:16):

Welcome to the Raising Kellan podcast. My name is Marsh Naidoo and I blog at raisingkellan.org where we curate resources for parents raising children with developmental delay and disabilities.

Marsh Naidoo (00:32):

The information provided on this podcast is for educational purposes only, and if you have questions regarding your specific situation, it's best to seek the advice of a trained professional. April is Autism Awareness Month, and today I am joined by Ciyndi Slomowitz who is a dedicated pediatric physical therapist. And today we are going to delve into autism and what autism encompasses, as well as some possible treatment strategies for parents who are working under the supervision of either a physical therapist, occupational therapist, or speech therapist. So grab that cup of coffee, put your legs up, and get ready for some awesome conversation. Cynthia Slomowitz is a pediatric PT that has written a course setting the stage for success in the treatment of children with autism based on her experience as a PT and a mother of a child with autism. Good morning, Cyndi, and thank you for joining us today.

Cynthia Slomowitz (01:56):

Good morning. Thanks for having me.

Marsh Naidoo (01:58):

Cynthia, I just wanna open the floor to you and have you tell us a little bit about yourself as a pediatric PT and tell us about this course offering that you have.

Cynthia Slomowitz (02:12):

I started out writing this course when Covid hit. I was treating for 13 years in school based and birth to three settings. And I had all this knowledge from also being a stay at home mom with my son for previously 13 years. So I thought it was time to put everything down that I had experienced personally and professionally, starting from diagnosis birth to three to five school-aged and even onto college.

Marsh Naidoo (02:57):

Your experience as a pediatric therapist, can you talk a little bit more about that and how you came to pediatric physical therapy?

Cynthia Slomowitz (03:09):

Sure. I actually started my career more in orthopedics and then when my son was diagnosed with at the time it was mild PD D, but now it's mild autism. The DSM five now includes PDD and Asperger's in autism under the umbrella. So he received services birth to three and he just kept receiving services all the way up. Even now he's an adult and he still has services. It's a good safety net to keep them going as long as possible because you just never know. I was told by a consultant that even adults can lose their job more frequently, and OVR, Office of Vocational Rehab also helps train and there's also a program at Westchester University where they have, and also St. Joe's has it, and a bunch of other schools in the country have social skill groups within universities to help individuals integrate into society and college life. So that's been really helpful as well. And there's called the Peers Program, P e er s I believe out of UCLA. That's a very validated course for older individuals in the spectrum but getting back to younger children starting birth to three and three to five, those are the years where there's still a lot of neuroplasticity going on more so birth to 5, 6, 7 in that age range. So the more they get when they're younger I think it sets a really good foundation for long-term improvement.

Marsh Naidoo (05:46):

Cynthia, I'm gonna be honest, and all I have is just the medical definition surrounding autism. Okay. May I please ask you to give our listeners more sustenance to that? Sure. As you describe autism to us.

Cynthia Slomowitz (06:05):

Sure. So autism, the actual diagnosis includes speech, can include speech delay, it can include sensory. And one of the biggest problems in treating children with autism are called RRB's They're repetitive and restrictive behaviors and they can really interfere with function. Those behaviors, you see that it could be flapping their hands, it can be watching their fingers under the lights, It can be walking in and out of a room 10 times or 20 times, or it can be so many different coping mechanisms that these individuals come up with and they can be extremely disruptive.They interrupt the academic and social process because they just are so embedded in the behavior. So that's a really important factor. And then 50% of the people diagnosed with autism are intellectually disabled. But what I've read, and it can be just that people are using poor IQs testing measures because it's like how if a child can't speak properly, can they really express themselves in an IQ score? So we may be underestimating a lot of intelligent people on the spectrum.

(08:13):

As a matter of fact, I know one friend of mine's son is in college using an AAC device, an augmentative and alternative communication device. Even though he can't speak, he's completely able to take college courses. So he uses that to communicate with peers and professors. So I think that I've covered, So it's social, it's communicative, it's sensory, and hopefully eventually we'll add a motor piece to that because clearly people in the spectrum are having trouble functioning, school age, putting on coats hanging up their coats and hygiene, traveling, feeding, self, feeding play skills. So hopefully at some point later they'll add motor to the DSM five for autism.

Marsh Naidoo (09:26):

Cynthia would, my experience with cerebral palsy, you kind of know that something is not quite right <affirmative>, whereas my understanding of autism is that the lines are not as clearly defined. For those parents that might be listening out there, that there's a inkling of is this how things should be or shouldn't be, what would be your pointer to that parent or just some kind of, how can they go about investigating what's going on with their child?

Cynthia Slomowitz (10:05):

Yeah, that's a good, great question. I know a lot of parents are so nervous when their child is not functioning at the level that they think they should be functioning. And there's so many other diagnoses that can occur from birth to three, from birth to two, I definitely warn my parents not to, I call it the wormhole, don't go down the wormhole because there's just so many other factors that could be happening. I've had twins who one just had more of a failure to thrive. I have low-tone kids that have idiopathic low tone, which means basically they have low tone for no reason and they look a lot like they're autistic, but they're not. So birth to two, I basically just tell them to just, let's just wait and see. Once they hit two, you can start seeing that things are either getting worse or they're staying the same. You'll start to see the perseverations where they'll look at a mobile in the room and they'll start to stem on it which is part of those RRB, the self stimulatory behavior.

(11:41):

They might not have great eye contact They may just be not even hearing you or responding to their name. Those start to tease out a little bit after two, I noticed at 18 months my son was starting to have some self stimulatory behavior and he hadn't had any low tone or anything else prior to that. And then the speech is usually significantly delayed. There's a condition called hyperlexia where some children who are autistic will start actually reading before they're actually having a conversation. So my son could decode a book, but he couldn't say his name or say, Mommy, I want milk or something. So there's other, I guess comorbidities or co-diagnoses that sometimes occur with autism. Another one that we're trying to figure out dyspraxia is like motoring coordination or uncoordination. And one question I have is autism, is the autistic version different than just the standard coordination disorders found in other sets of children that don't have autism?

(13:31):

So that's something that I'll probably look into in the next five years or so. But if the child's IQ is in the typical range or low to middle, typical range, there's hope to improve. Even if they start out fairly low the children that just can't respond whether it's due to low IQ or just their RRB's are just so outta control their sensory, so outta control, parents need to spend a lot of time on. There's a study that I found, I actually added it to my course this year where it said the three things that you should do for RRBs precedent, which is making your environment sensory friendly so that you're not creating these behaviors or redirecting these behaviors. There's a strategy we use called first, the next First you do what I want you to do and then you get to do what you wanna do.

(15:00):

So if you wanna stem in the corner for 15 minutes, first you have to unpack your lunch, put it in the cubby and hang up your coat. So we're trying to extinguish the RRBs but in order to do that, you have to give them something that's functionally useful and then still let them do the RRBs but slowly decrease the time that you're letting them flap in the corner, whatever it is that they like to do. So that's redirecting. And then the third is just blocking them, which is just like, No thank you. If they're going for that corner, cuz they wanna rock in the corner for a few minutes some people just walk them and say, No thank you. Look at your picture for we're going, we're hanging up our coat, we're sitting at our desk, we're doing work, we're going to gym, then we're going to lunch, sorry. And just having them sit down. They might have a tantrum.

(16:16):

The two more popular ways to extinguish our RBS are antecedent, which is, like I said, just getting the environment more friendly and then redirecting them, which is giving them, first you do what I want you to do, then you can have your little break and do what you want. So at least they know they're getting it. It's almost like a perseveration. They really want that break to stem in the corner. So if they know that they're getting, they have to do their work first, they can hold it together for a little bit until they get a break.

Marsh Naidoo (17:04):

What does therapy of physical, occupational and speech therapy, what does that look like for a child with autism?

Cynthia Slomowitz (17:16):

Well, I've been doing this a while and I'm actually in the middle of getting my PhD and doing autism research. So I've given this a lot of thought recently. And although play is important, you need to play in gym class, you need to kick the ball, you need to throw it to your friend and say, Hey Jim, catch the ball. Have to, In the perfect world, that would be a wonderful goal for a child in the spectrum. But after giving it a little bit more thought I've also started thinking that, I know OTs do this anyway, but I think PTs should also do functional work within the classroom and push in to gym or push into recess a little bit more than it's like it's so hard because schedules aren't always flexible. But if we can be as flexible as possible what I used to do, which would really help me, I would actually give the aide's prompting chart for PT and I would have them count how many times that they had to prompt the child to get up the slide and down the slide or climb the obstacle course or get on the swing so that the aides were using their time at recess prompting and keeping track of the children.

(19:15):

I think that's so important to encourage the aides to take as much data for us as they can because we can't be with the child all day and we really need to, it's called generalize. With autism, you have to generalize to every environment because even though children are learning things with autism, it's very hard for them to generalize from gym to art to music, to computer lab to classroom to lunch. They have a really hard time generalizing, so generalizing skills. So we have to pretty much teach them everything that they need to know. The more involved kids, there's really high-functioning kids that may not need anything except for occasional behavior prompts. And then there's kids in the middle that need more prompting and scripting. Scripting is like you're like, say Johnny comes to your PT room and he really wants to ride the bike, and Johnny can talk.

(20:42):

So you say, Johnny, if you wanna get on that bike, you need to say, I would like to turn on the bike. And because unfortunately we can't go home with them. And so they might just grab what they want at home. And mom doesn't put demands on them, but we have to put demands on them. So I'll have Johnny say he can't get on his bike until he says a full sentence <affirmative>. So I've done this with children, it's called scripting. You have them script appropriate behavior. And so he'll script, I wanna ride the bike and then he'll ride the bike. And so first you have to say, I wanna ride the bike, then you can ride the bike. It's like that first. The next put demands on the children so that they get what they want

Marsh Naidoo (21:42):

As far as, I mean parents will obviously do whatever they need to do for their child in order to aid development, but when it comes to things like introducing variation and introducing socialization for your child with autism <affirmative>, how much is too much? Or how do you find that balance mean? Right.

Cynthia Slomowitz (22:11):

Well, I definitely think that parents need to take their kids at least once a week to a social skills group in the beginning until the child is high enough functioning to actually say, I am burn out and I don't wanna go to anymore social skill groups because they are so important. And unfortunately, some kids are just not as high priority to parents. They might have other kids that are more athletic or musically inclined and their schedule gets first dibs but going to extra therapy after school is so important. You have to follow through and it pays off when they're younger. By the time they're six or seven they may be pretty much at their level of function, like we're taking a look at what levels and what age do they plateau. And we don't have an answer yet, but the only kids that might improve are the kids with fairly normal iq, with significant speech delays that improve over time. Other than that, especially those really low functioning kids I mean, they really need a lot of prompting in the beginning and they need to go to these social skill groups. And it may help, it may not work. We're still trying to figure out all the data but it certainly can hurt and can only help. But again, the IQ has a lot to do with it.

Marsh Naidoo (24:39):

As far as the sensory processing component, what are some of the therapeutic techniques that you would encourage parents on performing or looking at? Just a little bit of information on that. Okay.

Cynthia Slomowitz (24:57):

Well, to oversimplify, other than RRBs, which are the repetitive behavior, which I already discussed, how the three techniques generally to oversimplify this, there's either under-responsive or over-responsive children. So if they're over responsive, they're gonna be super hyper, they're gonna be crashing or things like that. You can set up deep pressure where they can crash into a beanbag chair go through tunnels, and actually under-responsive as well can go through different, they have these compression tunnels giving them lots of deep pressure real overactive children can also swing do heavy work. So things like that. And again, I'm not sensory is more of an OT domain and I'm not really other than some deep pressure, some heavy work. Jumping jacks, I think I saw a study that said jogging is a great way to burn off energy and increase energy. A lot of these techniques can be used either for under or overactive kids.

(26:46):

For the underactive kids, you wanna get their energy level up. And obesity is becoming a huge problem for the older adults because the lower functioning adults, a lot of them are just sitting They may be doing some type of work, but they have very little exercise built into their day. So jogging or treadmill would be great for them. For the younger kids they go to the playground and it's built into their day, so they get to burn off energy. But they also have what are called sensory diets where extra activities are added into their routine whether they're underactive or overactive they have different strategies built into their I E P and the I E P is a legal document. So you definitely wanna have everything written into the I E P for children

Marsh Naidoo (28:08):

Cynthia both as a PT and a mom. If you were making just a public just a general public statement as to what you wish folks knew about autism, how would you, in a simple layman's terms, break it down, what would you wanna educate folks on?

Cynthia Slomowitz (28:35):

I guess the biggest push that I have right now is that parents need to know that there is so many services that are offered through the Medicaid system that they really need to do their part to get their children services like after school. And they need to be consistent with their teachers. And it's hard, it's not easy and it's exhausting and it's hard to keep a job when you're doing this with your child. You may have to play tag team with your spouse or your, if your parents are around and helping you, but you gotta do the work in the beginning because it will be worth it in the end. And Medicaid has what are called wraparound services where they bring in extra behavior specialists to help you. They pay Medicaid pays for extra social skill groups and extra occupational therapy for sensory strategies. So you really, parents need to do their work, especially early on. It's all worth it in the end.

Marsh Naidoo (30:19):

Thank you so much for joining us today, Cynthia. I so value your time and is there anything that you would like to close off or say before we say goodbye to each other?

Cynthia Slomowitz (30:36):

I appreciate you having me on and I hope that we continue to improve the quality of life of children and adults with autism. And I know that we can definitely work together, all of us to just, it takes a village and I hope that everybody is kind and supportive. And again, I appreciate you having me on.

Marsh Naidoo (31:17):

Well, thank you so much and you have an amazing day.

Cynthia Slomowitz (31:21):

Thank you.

Marsh Naidoo (31:23):

Thank you so much for lending us your ears today. We would appreciate a rate review and a share of this podcast episode. Guys, if there are any specific topics that y'all would like to have research, please reach out to raisingkellan@gmail.com. And to stay connected, we have an active Facebook page at Raising Kellan, and we have an Instagram and YouTube channel as well at Raising_Kellan. There are some interesting topics on related to autism that we have done podcasts in the past. We have episode three, which was a interview with Christine Coronado and Christine started a restaurant called Jordan's Grab and Go here in Berg. And I would encourage you to listen to that episode as well as episode 54, which was a chat with Steven Ky of the We Rocked Spectrum Gym in Franklin, Tennessee. So some interesting episodes to reflect on. And as always, remember, get to the top of your mountain. This is Marsh Naidoo signing off.