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Chris De Villeneuve
Worked at Central Washington Comprehensive Mental Health
Attended George Fox University
Lives in Yakima, WA
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Hi,

I haven't posted in a long time but wanted to share something from the work that I'm doing at Central Washington University. This quarter the university started offering a autism navigator program. It's a collaborative program started at Bellevue university that partners students with autism, peer mentors and faculty. It's one of a number of programs in the northwest that is challenging the ideas that students with autism can't succeed on college campuses.

The program includes a "university" class where students work with peer mentors and faculty to learn about campus resources, identify problem areas (public speaking or similar challenge) and ways to address it.

The program is run by Wendy Holden, the director of Disability Services. I'll write more later as the quarter goes on. 
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I love how the regular subway patrons mostly look like they really not too much here for all that n they just trying to get to work! 
One dude still look sleep which I guess if you can sleep on a NYC subway you can pretty much stay asleep through anything including a bunch of yell singing artists lol but I bet his ass get up in time for his stop though! 
I guess Lion King thought since their airplane flash mob went over so well they could do it again.  Only one problem, NY as a state is utterly unimpressed about everything. 
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ok message me thanks
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This is the Japanese garden at Central Washington University. It's my favorite place to go when I need to focus and clear my head.
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New Practice Guidelines for Autism 

Author: Deborah Brauser

Date: January 29, 2014 

An evidence-based, multi-part, multidisciplinary treatment plan for children and adolescents with autism spectrum disorder (ASD) is among the primary recommendations from a new practice parameter released by the American Academy of Child and Adolescent Psychiatry (AACAP). 

Based on almost 200 studies, these clinical guidelines will replace those released in 1999 on how to assess and manage children with ASD. Other key recommendations include that medications be used "judiciously" and that prescribing be guided by best evidence. 
In addition, the new practice parameter calls for physical examinations and genetic testing, and asks clinicians to look out for comorbid and co-occurring issues. 

"The goal of this parameter is really to raise the standard of care for children and adolescents with autism," coauthor Matthew Siegel, MD, director of the Developmental Disorders Program at Spring Harbor Hospital in Westbrook, Maine, and clinical investigator at the Maine Medical Center Research Institute, told Medscape Medical News. 
"The number 1 take-away is that these children must have a multidisciplinary treatment plan that considers areas of communication and socialization, behavioral challenges, and medical, comorbid, and occupational needs," added Dr. Siegel, who is also a member of the AACAP Committee on Quality Issues. 

He noted that "it was not that long ago" when a single clinician, whether a psychiatrist, neurologist, or primary care physician, would see a child with autism and then diagnose and treat them themselves. 

"But we've now seen that this is a disorder that touches multiple areas of functioning. So to give children the best chance for a good outcome, it's not acceptable to operate from a single viewpoint." 
The practice parameter is published in the February issue of the Journal of the American Academy of Child and Adolescent Psychiatry. 

"Woefully Out of Date" 

According to the authors, there have been "several thousand research and clinical articles" published since the release of the first practice parameter in 1999. In addition, the diagnostic criteria for ASD have changed. 

"Practice parameters are important because they really guide practice both in the United States and, in the case of child psychiatry, internationally. Because of that, they take an enormous amount of work and effort. And the one for autism was woefully out of date," said
Dr. Siegel. 

"The field has moved forward significantly. So there was a real need to revise and update this parameter and bring recommended practices in line with the best research and outcomes currently available." 
Dr. Siegel spent significant time during the past 5 years researching and developing the new parameter.

"These guidelines are not just about people's opinions about what's best in the treatment and assessment of children with autism. But rather, it represents a very rigorous systematic review of all research that was publicly available for the past 20 years," he explained. 
The investigators reviewed data for 9581 studies published between 1991 and March 2013 before selecting 186 for full-text examination. The body of research for this set of guidelines was performed under the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) because the DSM-5 was not released until May 2013. 

"It will be some years before the implication of these changes for autism prevalence [based on the DSM-5 criteria] and other facets of assessment and treatment can be fully assessed," write the authors. 
"We can only work off the evidence base we have. But we also recognize that this shift in diagnostic definition is occurring," added Dr. Siegel. 

Assessment Recommendations 

There are 3 recommendations for assessment of ASD in the new parameter. First, psychiatric and developmental assessments of young children should routinely include questions about core symptoms of ASD, including any unusual or repetitive behaviors. 
Second, a thorough evaluation should be performed if a screening shows significant ASD symptomatology, based on DSM-5 diagnostic criteria. In addition, consideration should be made of possible comorbid diagnoses. 

Third, clinicians should coordinate a multidisciplinary assessment of these children, including a physical examination, a hearing screen, communication and psychological tests, and genetic testing, "which may include G-banded karyotype, fragile X testing, or chromosomal microarray." 

"These tests currently detect known abnormalities clearly associated with increased rates of ASD," write the authors. Additional evaluations should be conducted if the child has a history of regression, dysmorphology, or staring spells. 

Psychological assessment should include measures of cognitive ability, adaptive skills, intelligence, and unusual abilities, such as detailed drawings or calendar calculations. 

"Psychological tests clarify areas of strength and weakness useful in designing intervention programs and may need to include instruments valid for a nonverbal population." 

Other assessments should include communication measurements, occupational and physical therapy evaluations, and sleep variables. For all of the measures listed, the authors note that "it is optimal" that coordination occur among all members of the multiple disciplines. 
"While not every practitioner around the country, due to geographic location, will have access to experts in the areas we've recommended, they should always be thinking about how the child is being served in those different areas," said Dr. Siegel. 

Treatment Plans 

For treating children and adolescents with ASD, the new practice parameter also provides 4 primary recommendations for clinicians:

1. Help families obtain "appropriate, evidence-based, and structured" educational and behavioral interventions.

2. Offer pharmacotherapy when there is a specific target symptom or comorbid condition.

3. Maintain an active role in long-term treatment planning.

4. Inquire about the use of alternative/complementary treatment.
Under the first recommendation, the authors suggest that applied behavioral analysis (ABA) programs such as early intensive behavioral intervention have been shown to be effective, especially for treating specific problem behaviors. 

They also highlight benefits of communication interventions and a highly structured, individualized educational program.
As for pharmacotherapy, "the parameter really highlights the limited benefits and significant limitations of pharmacologic treatments for autism at this time," said Dr. Siegel. 

"It encourages people to consider medication but to look beyond it and move past the idea that a medication alone is going to be the answer," he said. 

"After reviewing all the evidence, the parameter clearly states that medication can be an important tool to address either co-occurring psychiatric or behavioral disorders or specific problems, such as aggression. But it's only 1 tool in the toolbox." 

Bottom Line 

There are now plans for new updates to be released in 5 years, based on studies using criteria from the DSM-5, reported Dr. Siegel. He also noted that the current parameter points out a lack of research in the areas of co-occurring psychiatric disorders. 
"In other words, there's still a huge need to better understand how one can best screen, diagnose, and treat in children the disorders you see in all people. At this time, we do not have any widely disseminated measures that have been validated for this population," he explained. 
"And frequently, these co-occurring conditions keep children from benefitting from their education program interventions."
But for now, the new guidelines are designed to provide updated, best-evidence recommendations.

"AACAP Practice Parameters are developed to assist clinicians in psychiatric decision making," write the authors, adding that they are not intended to define the sole standard of care. 

"The ultimate judgment regarding the care of a particular patient must be made by the clinician in light of all of the circumstances presented by the patient and his or her family, the diagnostic and treatment options available, and available resources," they conclude. 
The authors have reported no relevant financial relationships. 

J Am Acad Child Adolesc Psychiatry. 2014;53:237-257. Full text 
 
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I am thankful for anything you post for us. I am doing okay, still in recovery, they are saying it takes a full year to get back to normal, but I'm doing great. Thank you :D
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Forgiveness
There's no command-Z for this great man's suffering.
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Oxytocin 'Normalizes' Social Deficits in Kids With Autism

Author: Caroline Cassels

Date: December 10, 2013


A single dose of the hormone oxytocin administered via nasal spray enhances brain activity in key regions, temporarily improving social information processing in children with autism spectrum disorder (ASD), new research suggests.

The double-blind, placebo-controlled imaging study of 17 children and adolescents with ASD showed that those who received intranasal oxytocin had increased activity in brain regions associated with reward, social perception, and emotional awareness compared with their counterparts in the placebo group.

"We found that brain centers associated with reward and emotion recognition responded more during social tasks when children received oxytocin instead of the placebo. Oxytocin temporarily normalized brain regions responsible for the social deficits seen in children with autism," lead author Ilanit Gordon, PhD, Yale Child Study Center, Yale University, in New Haven, Connecticut, said in a release.

Dr. Gordon added that the study is the first to evaluate the effect of oxytocin on brain function in children with ASD.
The findings were published online December 2 in the Proceedings of the National Academy of Sciences.

Mixed Results

In typically developing adults, intranasal oxytocin has been shown to enhance processing of social stimuli and heighten activity in neuroanatomic brain structures involved in processing socially meaningful stimuli.
In addition, behavioral studies in children and adults suggest that a single dose of intranasal oxytocin improves social interaction and comprehension of affective speech. It has also been shown to reduce repetitive behaviors, improve social cognition, and increase understanding of others' mental states.
However, the authors note that results from clinical trials examining the effect of daily administration of oxytocin on behavior in children and adults have been "mixed at best."
To examine the neural basis of oxytocin's effects, the researchers conducted a randomized, double-blind, crossover functional magnetic resonance imaging (fMRI) study.
They investigated the effects of a single intranasal administration of oxytocin on brain activity in 17 high-functioning children and adolescents aged 8 to 16.5 years with ASD. They note that previous reports have not included individuals younger than 12 years.
The Social Brain
The researchers hypothesized that "during a task involving social judgments, OT [oxytocin] vs Placebo would heighten brain activity in the neural circuitry that supports reward (dorsal and ventral striatum and nucleus accumbens [NAcc], as well as social attention and social cognition (eg, posterior superior temporal cortex, cingulate, precuneus), that is, the 'social brain.' "
Participants were randomly assigned to receive either oxytocin or placebo nasal spray on 2 consecutive visits. Forty-five minutes after administration, brain function was assessed using the Reading the Mind in the Eyes Test (RMET), a validated fMRI emotion judgment task.
The results showed "oxytocin increased activity in the striatum, the middle frontal gyrus, the medial prefrontal cortex, the right orbitofrontal cortex, and the left superior temporal sulcus."
The researchers also reported that oxytocin increased activity during social judgments and decreased activity during nonsocial judgments in the striatum, nucleus accumbens, left posterior superior temporal sulcus, and left premotor cortex.
The researchers also tested oxytocin concentrations in saliva at baseline and 30 minutes after administration and found they were positively associated with enhanced brain function.
Potential Clinical Utility
These discoveries, the researchers write, are "particularly important given the urgent need for treatments that target the core social dysfunction in ASD."
"The functional neural attunement we demonstrated might facilitate social learning, thus potentially bringing about long-term change in neural systems and subsequent behavioral improvements," the authors conclude.
The researchers predict that clinically, oxytocin may be most useful when administered just prior to proven behavioral treatments that "provide opportunities for feedback and learning in supportive social contexts."
The authors report no relevant financial relationships.
Proc Natl Acad Sci. Published online December 2, 2013. Abstract
 
Medscape Medical News © 2013  WebMD, LLC

Send comments and news tips to news@medscape.net.

Cite this article: Oxytocin 'Normalizes' Social Deficits in Kids With Autism. Medscape. Dec 10, 2013.
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There is a lot of research posting on Oxytocin. It's showing some interesting positive results. 
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The Japanese garden at Central Washington University. It's my favorite place to go when I need to clear my mind and focus. 
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This is your chance to win a free Google Glass! All you have to do is:

+1 and SHARE this post, then join the giveaway here: http://muo.fm/1hy6duU
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Great article on the integration of mental health and primary care.
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It does seem like doctors do not communicate with one another as much as they should. It seems like, with all the technology and digitizing of information, medicine could potentially work a lot faster. I know there are issues with integrating technology with medicine, however, and that may be a major concern.
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Introduction

Hi, welcome.  If you are new please send me a note and introduce yourself.  I look foward towards hearing from you and connecting on Google+.
 
I work in mental health as an administrator, counselor and crisis worker.  Part of my time is spent as a hostage negotiator and crisis worker for the police department. 
 
There are things that are important in life that I really enjoy.  Well written posts, critical commentaries, some poetry and books by Christopher Moore. 
 
Below is one of my favorite poems from Yehuda Amachai. 
 
In This Valley

In this valley which many waters
carved out in endless years
so that the light breeze may now
pass through it to cool my forehead,
I think about you. From the hills I hear
voices of men and machines wrecking and building.

And there are loves which cannot
be moved to another site.
They must die at their place and in their time
like an old clumsy piece of furniture
that’s destroyed together with
the house in which it stands.

But this valley is a hope
of starting afresh without having to die first,
of loving without forgetting the other love,
of being like the breeze that passes through it now
without being destined for it.
 
 
**PRIVACY NOTICE:
 
Warning--any person and/or institution and/or Agent and/or Agency of any governmental structure including but not limited to ALL Governments or private mediums or corporations or individuals also using or monitoring/using this website or any of its associated websites, you do NOT have my permission to utilize any of my profile information nor any of the content contained herein including, but not limited to my photos, and/ or the comments made about my photo's or any other "picture" art posted on my profile. You are hereby notified that you are strictly prohibited from disclosing, copying, distributing, disseminating, or taking any other action against me with regard to this profile and the contents herein. The foregoing prohibitions also apply to your employee(s), agent(s), student(s) or any personnel under your direction or control. The contents of this profile are private and legally privileged and confidential information, and the violation of my personal privacy is punishable by law and will be strictly enforced. 

Education
  • George Fox University
    Psychology, 1987 - 1990
  • Heritage University
    Counseling
  • University of Phoenix
    Healthcare Business
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Gender
Male
Work
Employment
  • Central Washington Comprehensive Mental Health
    Director
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Map of the places this user has livedMap of the places this user has livedMap of the places this user has lived
Currently
Yakima, WA
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