Recent Aspen cutback and re-structureSOURCE: Aspen Education Group
May 17, 2010 08:00 ET
Aspen Education Group Announces Program Conversion, Will Open Talisman School in August 2010 HENDERSONVILLE, NC--(Marketwire - May 17, 2010) - Aspen Education Group, the leading provider of therapeutic education programs for struggling youth, today announced the conversion of its New Leaf Academy in Hendersonville, North Carolina, to become The Talisman School. The new school will serve the growing number of youth with Asperger's and other autism spectrum disorders, and will open its doors on August 23 of this year.
"There is a growing need in this country for schools dedicated to young people dealing with Asperger's Disorder and high-functioning autism," said Linda Tatsapaugh, current Executive Director of Talisman Programs, and now the Executive Director of the new Talisman School.
"Adolescence may be the most difficult time for an individual with Asperger's or high-functioning autism," explains Tatsapaugh. "In adolescence, social demands become more complex, subtle social cues become more important, and kids with these disorders may have difficulty understanding their peers and the inherent social status structure of high school. Because they are socially naive, the child may not realize when someone is trying to take advantage of them and they can be especially vulnerable to manipulation and peer pressure."
She adds, "This school will be a comfortable place for them to feel safe and be who they are without peer ridicule."
I can't believe how these places actually think that a program environment, one that specifically relies on manipulation and peer pressure to effect behavior modification, and hence, perhaps unavoidably, also peer ridicule, will be of benefit to kids with Asperger's or high-functioning autism.
See also:
Also removing these kids from a familiar home environment. Thoroughly incompetent and wholly self serving.
Separation, Autism, and Residential TreatmentLeigh Solomon, MD, FRCPC1 and Louis Peltz, MD, MSc, FRCPC2,32008 Canadian Academy of Child and Adolescent Psychiatry
Introduction:We present the case of an 11-year-old boy with autistic disorder who developed a marked escalation in psychiatric symptoms after being removed from his family’s home and placed in a residential setting. Psychiatric sequelae of separating children from their parents have long been recognized (Bowlby, 1951). Children with developmental challenges are often unable to express their feelings with regards to separation due to communicative and cognitive limitations. In addition, it is well appreciated that autistic children are highly reactive to changes in their environment. We hypothesize that autistic children may experience separation in a powerfully traumatic fashion yet may be unable to describe, understand and interpret the feelings of loss and abandonment. There are some case reports in the literature that address the traumatic impact of sexual and physical abuse on children with autistic disorder (Cook et al, 1993). Our case adds to the literature by focusing on the impact of separation and the subsequent development of profound psychiatric symptoms in a child with pervasive developmental disorder sub-type autistic disorder. Some aspects of the case have been changed in order to protect confidentiality.
Case History:J.D. is an 11-year-old boy with a diagnosis of autistic disorder, based on DSM-IV criteria of language delay, poor social interaction and the presence of repetitive behaviours (American Psychiatric Association, 2000). Nonverbal cognitive functioning is in the normal range. He lived in a family with two parents and a younger brother. At 18 months of age behavioral challenges increased with extensive tantrums and aggressive behaviour. Upon entering school behavioral difficulties continued, resulting in frequent periods of explosive anger towards others. He was often suspended from his classroom. At age 7, J.D. was diagnosed with oppositional defiant disorder as well as autistic disorder. He was also found to have severe disturbance of attention, concentration and impulse control. Psychiatric evaluation revealed obsessional thinking with agitation and dysphoric mood particularly during periods of transition and change.
At age 10, J.D. was admitted, via the emergency room, to a community hospital for the first time. He remained on a psychiatric inpatient unit for approximately one month. He was found to display impulsive and noncompliant behaviour, and was aggressive, particularly toward his mother. He was treated with risperidone and methylphenidate as well as with behavioral interventions. There was mild to moderate improvement in his symptoms, but at the time of discharge, his parents decided to not have him return home. He was subsequently placed in a community group home with 7 other children, visiting his parents on weekends. After a short time in the group home, his presentation changed markedly. He appeared fatigued, withdrawn, depressed and less communicative. Methylphenidate was discontinued, resulting in some improvement in his mood and energy level, but soon afterwards he became distressed and agitated. He began counting repeatedly to 21. At times, he would approach staff saying, “Please help me”. He displayed symptoms of anxiety with repetitive thoughts and dysphoric mood, leading to the addition of fluoxetine to the risperidone.
Five months after his first admission, J.D. was readmitted to the inpatient psychiatric unit in an attempt to stabilize his symptoms and ameliorate his distress. While in hospital, he was generally sad and withdrawn, but at times became explosive and agitated. He responded positively to behavioral interventions and after 3 weeks, was discharged back to the group home.
Two days after returning to the group home J.D. became physically aggressive and injured one of his counselors. Again, he was brought to the Emergency room and was readmitted to the hospital.
A case conference was convened with representatives from the group home, child welfare, family and the inpatient team. It was decided that J.D. should return to his family and that assistance would be provided to support the transition. This decision was strongly encouraged by the treating psychiatrist in the community as well as by the inpatient psychiatrist.
J.D.’s mood and behaviour improved after moving back home to live with his family, although his parents reported that he continued to be aggressive at times, for example pinching them if he didn’t get what he wanted. They reported that his mood was generally happy, and he did not engage in repetitive behaviours or express repetitive thoughts as he had done previously. His medications were gradually discontinued.
Discussion:This case demonstrates how mental health professionals were unable to identify that escalation of symptoms in a child with autistic disorder was influenced by the impact of separation from his primary attachment figures. J.D. had a long history of oppositional behaviour but his behaviour worsened markedly when he was anxious. Failure to identify that his deterioration was associated with anxiety secondary to separation from his primary attachment figures resulted in unnecessary use of medication, costly inpatient hospitalization and prolonged distress for J.D. and his family.
It is of fundamental importance that practitioners recognize that children with autistic disorder can be very attached to their primary caregivers (Rutgers et al, 2004). Consequently, they may be highly sensitive to separation from a primary attachment figure. Separation may be experienced as emotionally traumatic, with accompanying feelings of fear and helplessness, resulting in an increase in symptoms of anxiety and agitation (Bowlby, 1960).
It is also important to recognize that the expression of trauma in all children is influenced by developmental factors (Salmon and Bryant, 2002). Recently, Scheeringa and colleagues (2006) have suggested that the diagnosis of Post Traumatic Stress Disorder (PTSD) in children be based on criteria that are more sensitive to developmental level. Children with Pervasive Developmental Disorders (PDD), especially those with intellectual disabilities, are even more limited than other children in their ability to understand, interpret and respond appropriately to trauma (Howlin and Clements, 1995). A child with intellectual disability may interpret a move to a residential setting as severe punishment. The child may lack an appreciation of time and be incapable of processing the concept of “temporary”. Cognitive limitations have been shown to be a significant risk factor for the onset of PTSD after traumatic events, for children and adolescents with a diagnosis of PDD. (Turk et al, 2005)
Autistic children have a limited capacity to express affect verbally and may do so behaviorally (Howlin and Clements, 1995). When highly anxious, aggressive behaviors can increase, resulting in a “spiral effect” whereby additional medications are prescribed with little if any benefit. Side effects, such as akathesia and dysphoria, cannot easily be described by the patient but may be interpreted as agitation and mood disturbance, leading to further increases in the dosage of the patient’s medications in an attempt to control symptoms.
Autistic children are overrepresented in residential settings. They often present with major behavioral challenges. Symptoms of aggression, agitation and poor impulse control may lead to psychiatric evaluation, hospitalization and/or treatment with medications. This case clearly illustrates how symptoms in this vulnerable population may escalate after being placed in a residential setting. Reaction to trauma, including the trauma of separation, should be considered in assessing such children.
Articles from Journal of the Canadian Academy of Child and Adolescent Psychiatry are provided here courtesy of
Canadian Academy of Child and Adolescent Psychiatry
