Pendidikan Ilmu Kesehatan Anak Berkelanjutan [PIKAB]

16

Memahami dan Mempersiapkan

Masa Depan dari Low, Middle dan
High Functioning Autism

Purboyo Solek, dr., Sp.A(K)

El Royale Hotel Bandung 3-4 Agustus 2019

 “Critical Period Diagnosis- Risk
of ASD and Dyslexia

PDD NOS
G
Intelectual Disabilities (IQ average
(IQ < 70) or > ) I
Misdiagnosis, F
inapproriate Asperger
treratment
Syndrome T
important (AS)
(IQ > 120) E
AUTISTIC Develop-
DISORDER mental D
(AD) Language CDD
(>75%, below IQ) Disorders à RETT
(>130)
Hearing Expressive FRA-X
Impairment Language APDD
Disorder (Various IQ)
(IQ below)
ADHD
(IQ average or >)
A Theoritical Representation of Various Spectrum Disorders and
Related Developmental Language Disorders (Siegel, 2003)
 Very Complex
Autism Spectrum Neuro
Disorder (ASD) Developmental
Disorder

Low Functioning
Autism (LFA) dan
DSM 4 vs DSM 5
High Functioning
Autism (HFA)
Very Complex Neuro Developmental
Disorder
• DSM 5 à ASD, spectrum luas
• Long life treatment

DSM 5
• Gangguan komunikasi - interaksi
• Perilaku maladaptive
SCIENTIFIC FACTS...
• Prevalence 1: 10.000 ; now 1: 150

• Male : female = 4 : 1

• Approximately 75-85% autism child

showed IQ level that is far below
average (intellectual disability)
 Segawa Neulogical
Pathophysiology of Autism Clinic for Children

Developmental failure Failure in functional

5HT in lateralization of the
neuron(↓) S-W rhythm cortex
Determination of
Communication ↓
hand dominancy
Accommodation ↓
Echolalia
NA neuron Insistence on sameness Pronominal reverse
↓ Extreme rote memory
Prosody ↓
Postural tone ↓ Functional
Interlimb specialization of
coordination Cortex ↓
NLGN 4
Crawling ↓ Walking ↓ Orofacial apraxia
BDNF Limb kinetic apraxia
Grasping reflexes(-)
Parachute reaction(-)
Friendliness
Aggressiveness
Self mutilation
DA neuron
Hyperkinesia, Stereotyping
(↑)*
Frontal lobe dysfunction
7
Frontal lobe epilepsy
* Caused by receptor supersensitivity
 Diagnosis dini à 16 bulan

Over lapping diagnosis

Sebagian besar (75-85%)à low functioning

Terapi terpilih: Behavior therapy dan

farmakologi
DEVELOPMENTAL AREA THAT
IMPAIRED
Social Language/
Behaviour
Interaction Communication

Cognitive Locomotor Emotion

Sensory
profile
Autism Type Based on Social Interaction Skill
(Wing & Gold, 1996,2016)

ACTIVE BUT
ALOOF PASIVE ODD
• Very minimal • Able to • Unable to
eye contact interact interact due
• Unable to shortly to
initiate or • Unable to ‘hyperactivity’
maintain sustain behaviour
interaction interaction while doing
some odd
behaviour

Stiff
Autism Type Based on Cognitive Level

LOW • Severe Intellectual Disability

FUNCTIONING • Severe complexity of symptoms

<70

MIDDLE • Moderate Intellectual Disability

FUNCTIONING • Moderate complexity of symptoms

• Mild intellectual disability or Borderline

HIGH • Very few has normal IQ >70
FUNCTIONING • Minimal complexity of symptoms
 ‘ESTIMATING’
COGNITIVE LEVEL

COMPLEXITY OF SYMPTOMS

The more complex of If the symptoms showed

symptoms showed, the not too complex, cognitive
level might be slightly
lower cognitive level below normal
(low functioning) (high functioning)
EXECUTIVE FUNCTIONS IMPAIRED IN ADHD,
SPECIFIC LEARNING DIFFICULTIES, AUTISM Pre
(Brown, 2017) Frontal
Cortex
EXECUTIVE FUNCTIONS
(WORK TOGETHER IN VARIOUS
COMBINATIONS)

Focusing Regulating Utilizing

Organizing Managing Monitoring
sustaining alertness. working
prioritizing frustation and self-
and Sustaining memory
and and regulating
shifting effort and modulating and
activating action
attention processing emotionts accessing
to work
to tasks speed recall

1 2 3 4 5 6
Activation Focus Effort Emotion Memory Action
DIFFERENTIATION OF VARIOUS DEVELOPMENTAL AND BEHAVIOURAL
PEDIATRIC CASES (Solek P, 2017)
MANAGEMENT

Occupational
Speech Therapy
Sensory Therapy
Integration
Therapy
Behaviour
Therapy &
Pharmacotherapy
 AN OVERVIEW OF TREATMENT APPROACHES
(Alexis. L. Reyes, 2001)

TERAPI ABA/DT TEACCH INCLUSION PECS

Treatment and
Awal dr modifikasi terapi Education of Pictures
Spt didefinisikan
LATAR tingkah laku Autistic and related Exchange
BELAKANG
Di PL 94-142 REI
Dikenal juga sebagai Communication- Communication
Dan IDEA
Metode Discrete Trial Handicapped System
Children
Menolong anak
Fokus pada:
Diharapkan anak secara spontan
Perhatian, imitasi,
dapat mandiri Mendidik anak menirukan interaksi
Bahasa, ketrampilan pre
TUJUAN akademik dan
melakukan disable secara komunikatif, dan
pekerjaan di tiap kronologis mengembangkan
ketrampilan menolong
level fungsinya kemampuan ber-
diri sendiri
komunikasinya
Peningkatan fungsi & Beberapa dpt
Peningkatan IQ,
Perkembangan; survive,bahkan Peningkatan
Kemampuan berbahasa,
HASIL Kemampuan adaptif,
Peningkatan kemam- dpt lebih Kemampuan
puan adaptif, dan bersosialisasi berbahasa
Dan kemampuan sosial
Kemampuan sosial di kelas
Menggunakan
Meningkatkan kepatuhan Tidak banyak
YANG pemikiran abstrak; Dapat menekan
Training; Ketergantungan penekanan pada
PERLU menggunakan kemampuan ber-
DIPIKIRKAN pd prompt; aspek
instruksi yg sulit bg bahasa ekspresif
komunikasi & sosial
anak autis
LONG-TERM OUTCOME

Methode
Cognitive Family
Age of
Level suport
treatment
• KREATIFITAS,
• BAKAT,
• IQ
• PERILAKU ANAK
• EF

à Bagaimana kita memahami

korelasinya (pada kasus ASD)?
 Talenta

Manusia tidak memiliki talenta

yang sama,
tapi kita memiliki kesempatan
yang sama
untuk mengembangkan talenta
kita

John F Kennedy
 Talenta

Di dalam diri setiap manusia

terdapat kemampuan serta
talenta luar biasa untuk meraih
sukses, namun ada sebagian
orang yang tidak menyadari
apalagi memanfaatkannya

Deassy M Destiani
 ASD (Autism
Spectrum
Disorder)
DECREASE PERILAKU
= ACROSS LIFE SPAN=
MALADAPTIVE

5 tahun
Improvement:
receptive –
8 Autistic
expressive
tahun Savantt
language

< 2 thn:
Diagnosis, Low function
Intervensi à or
TALENT
behavior therapy high function
+ farmakologi
Terima
Kasih