ADULTS WITH AUTISM: AGING, & MENTAL HEALTH

Josh Feder, MD Autism Society San Diego March 13, 2012

START RECORDING.
canned intro: Say the title again

ADULTS WITH AUTISM: AGING, & MENTAL HEALTH

Josh Feder, MD Autism Society San Diego March 13, 2012

Director of Research, Graduate School, Interdisciplinary Council on Developmental and Learning Disorders

Assistant Clinical Professor, Voluntary Dept of Psychiatry, University of California at San Diego School of Medicine

Outline

Remember Rosetta,PA
What do we want? Ethics Practicalities Organizing the approach Stuck at home Eventual Placement

What do we want for our (adult) children?

white board discussion

What do want for our (adult) children?

A meaningful life

Safety and protection

Life, liberty, and the pursuit of happiness Avoiding pain Avoiding abandonment what else?

Ethics: how do we figure out what's the right thing to do?

Beneficence - do good Non-maleficence. - do no harm Autonomy - (competent to decide?) Justice - preserving rights, access to services

& care

Ethics: how do we figure out what's the right thing to do?

What are the facts?
What are the options? What should be done? Who should decide?

Practicalities
More on the white board:
What are the everyday things you worry about most?

Practicalities Home family, function, safety Education/Work - levels of

participation and accommodations Activities/ Recreation critical importance of play / symbolic or presymbolic activity, friendships Drugs medications; health care; diet, activity, sleep, medical (seizures); Mental Health- anxiety, depression, etc. and their management. Sexuality intimacy, what to allow or encourage?

A general way to do support progress using a Developmental, Individualized, Relationship based approach (DIR).
People do things when they care about them. Leverage what the person is doing Become part of the persons world Leverage your relationship to help the person do more Take into account the persons individual profile

Developmental Approach
Developmental Calm enough to interact Truly connected in the moment Back and forth flow of communication Importance of repair of interactions Waiting for the other person to repair (respond)

Individual Differences
Sensory modulation and processing

Motor tone and motor planning

Receptive communication (esp. non-verbal) Expressive communication Visual-spatial abilities Executive function: idea, plan, sequence, execute, adapt

Relationship based
Because we do things when we care about people

Need to have us become more interesting and valued

than the things Use the relationship to support the persons function Use the relationship to expand the persons function

Stuck at home
Most frequent concern

Hard to fight the habits

Tighter and tighter circle of anxiety Gradually stretch the circle toward more

adaptive behavior

Eventual Placement
Back to the white board:

What are your thoughts?

Eventual Placement
Why - we age, they get big, sometimes

aggressive When rarely soon enough when it is needed What - other relatives? group home? supported living? How Section 8? SSI?

Resources
www.circlestretch.com

transition and inclusion resources

Books Temple Grandin, et al Websites government and others Local research Bonnie Kramer, et al Employment services

Supported living services

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