Why The Future of Autism Care is Holistic with Savannah Jaska, MT-BC, BCAT | Part 1

0:00Welcome to Magnificent Minds, where we explore the science of child development with both heart and reason, bringing clarity, compassion and scientific evidence to questions that matter deeply to families. Hi everyone and welcome back. I'm so glad you're here. Today we're talking about something that is shaping the future of care for autistic people in a really meaningful way. And honestly, something that I feel is long overdue. We're talking about why the future of autism care is holistic. And with us on this episode is Savannah Jaska. She is Cortica’s senior manager of Transdisciplinary collaboration and a board certified music therapist.

0:40She's part of our clinical leadership team and has spent her entire career working alongside just about every discipline in this field, including ABA, occupational therapy, speech language pathology, medical care, and counseling. Savannah, thank you so much for being here. Thank you for having me. This is a topic that I could talk about all day. I think this is going to be just an awesome conversation. It's by far one of my most favorite topics and one that I think is just incredibly important. So we're going to get into it in a lot of depth in just a moment.

1:16But before we do. Tell me a little bit about your role. So this title of senior manager of transdisciplinary collaboration. It is not a job that exists in most organizations, not one that we could I think, in the autism space even have conceived of until very recently. So what is this role and how did you end up in the role? Yeah, I think it honestly, I think it found me before it even had a name because I, as a music therapist starting at Cortica, just started from the beginning, working alongside many, many different professionals from ABA clinicians, occupational therapists, speech therapists, medical professionals and counselors as well.

2:02And I learned so much from all of them. And I just found that I was never in the room by myself. And it eventually led me to, being in this role and being able to learn about collaboration and help others be collaborators. So when you think about the future of autism care, what feels most different from where we've been in the past? And I ask this because for a long time, care for autistic children and adults has been extremely fragmented. So families are often navigating multiple health professionals, different clinics, lots of different recommendations, a lot of perspectives.

2:41And they're trying to piece together a plan that actually makes sense for their child. But fortunately there has been really positive change. So let's talk about what the shift looks like, why it matters so much, and then what it actually means for children and for their families and for their experience, their learning and their ultimate outcomes. It's core holistic care means we're not just looking at behaviors. We're not just targeting skills. We're not just addressing one area of development. We're trying to understand the entire system that makes up a child's life.

3:18So that can mean understanding the environment they are in daily. Their physical health, their brain development, their sensory experiences, their movement, the way that they think, their communication and their relationships and emotional experiences. Because development doesn't just happen in isolation. There isn't just one skill that develops and then the next skill that develops. There's lots of skills that are getting better being built over time, and it happens within an interconnected system, which is the brain, the body, and the child's environment.

3:55And when we zoom out and look at that system, something really important becomes clear. Is that the or the output what we see on the outside is not the starting point, but it's actually that the ending point, the output. And so, our goal is to try to figure out what that path is to that output and what are all the pieces of development that are important to help kids learn skills and and develop behaviors that are really meaningful in their life. And really, the goal is to help a child and a family find joy in every day.

4:35I have to say, I think that that reframing of behavior as output rather than the starting point is just unbelievably important. And I do want to come back to that because I think it changes a lot and how we approach things. But first, let's dive a little bit more into how we can understand the whole child from this holistic point of view. So at Cortica, one of the most helpful ways to think about this comes from our child development framework. It defines our entire approach to whole child care. So could you walk me through that? Yes, definitely. So when we're thinking about whole child development, imagine a tree.

5:15And with a tree at the bottom of the tree is the roots going into the ground. And that is what we consider the child's daily life. So thinking of their home and their family relationships, their school environment, if they're in school and also their community. So we're thinking of the places where a child is exposed to experiences, and those experiences can actually guide their development. When we think about the roots of child development, emphasizing how important those environments are. Feels really important to me.

5:52The roots are stabilizing. The roots are where you absorb nutrients that help the growth of the tree. And so for our listeners, I just want everyone to kind of begin to, to picture this as they begin to, you know, formulate kind of this image of their child's development as a tree. So we've got the roots. We're going to talk more about that in just a moment, but let's move on. For now up to the trunk. The trunk of the tree is what in our framework represents the brain and the body. So when we think about brain and body health, we think about a few different categories.

6:29Sleep is a very important one. Nutrition, gut health, immune function, stress level and neurological activity. And all of these matter because they play a very important role in a child's ability to learn and experience the world around them and interact with the world around them. Yes. And I'll have to say, this is often a part that people overlook the most physical health factors influence behavior and learning in ways that all too often are missed. And these systems are incredibly, deeply interconnected.

7:08Things like, as you mentioned, sleep, nutrition, stress level, all impact learning and well-being, and discomfort or interruptions. For example, in something like gut health can impact the nutrients person gets and then how well they feel and how will they can engage with the world around them. So that's just one example. There are many others. Think, for example, about your immune system that can kind of contribute to illness, whether it kind of chronic, low grade or acute illnesses. And then when we think about the complexity of the the brain and the brain environment and all of the neurological activity and how bodily health influences that, all of that cascades into influencing a child's ability to learn, to develop, to engage with their environment.

7:53So things that, for example, like seizures, which we know are so common in autism, can disrupt the brain's function and in some cases even cause a regression or loss of developmental skills. So if a person is experiencing any of these health conditions that we know are very common in autism, it will of course, affect their learning, their development and their behavior. Yeah. And I think, sleep is one that I said is very important. And I think people hear that a lot. But I think a lot of clinicians and families may even see that as a nicety, rather than seeing it as something clinical that needs to be addressed.

8:33Especially for for clinicians, it's not always something that or therapists are not necessarily asking caregivers about or inquiring about, and not making the connection of how a child's progress and therapies can be impacted by sleep. That's right. One other really important medical area that I'd love to touch on now for just a moment is the gut. So we know that autistic children are roughly 2 to 4 times more likely to have gastrointestinal problems. Constipation is one of the most common something all of us can relate to.

9:09Because you think about what chronic constipation does to a person, you are uncomfortable all day. It can affect sleep. It can make it hard for person to eat, especially to get the nutrients that they need. One additional consideration actually in autism as well, is if a person has difficulty localizing internal sensations, what we call interception It's one of our senses. If somebody has trouble localizing internal sensations or describing them, it's hard to then express what's wrong. Sometimes it manifests as a behavior. So, you know, imagine a child who might be sitting at a table and then suddenly has a moment of aggression, or maybe a child who won't sit for circle time at school.

9:54It could be something like abdominal pain. I think all of us have experienced that to some degree or other. And what I have seen in a behavior plans, is strategies to try to address these so-called behaviors for something that turns out to be a gastrointestinal issue that needs to be treated from the inside, that that is a medical concern. Yes. And once that medical picture is addressed, then often that behavior plan isn't even needed. That's right. And then things like ABA therapy and speech therapy and occupational therapy, even learning in school settings or in community activities finally can actually work.

10:37They can actually benefit and help the child to learn because the child can actually participate meaningfully. One other related topic to gut health is nutrition. It is, an area that really deserves a lot of attention as well. We know food selectivity is very common in autism. It has a lot of downstream consequences. Things like vitamin deficiencies in autism, especially things like vitamin D, vitamin A, B vitamins, calcium and iron. Just being sure that children are getting the types of macro and micro nutrients they need is also so important. Yeah. And I think about clinical therapies and how we can see energy changes and how those having not having the right nutrients is going to lead to children who struggle to maintain their regulation or maintain their engagement throughout the day.

11:29And even building strength right in their bodies. One more part that you had mentioned of the trunk that I just want to touch on before we move on to continuing to kind of fill in this holistic tree. One more piece I want to talk about is the electrical activity of the brain, or what we see sometimes manifest as seizures. And these are very common in autistic children. Somewhere around 10 to 20% of autistic individuals have seizures at some time in their life. And that type of abnormal electrical activity in the brain can really impact a child's ability to learn, to participate, to regulate their emotions, can influence their behavior.

12:13There can be a loss of developmental skills or what we call regression if that's not addressed. And so I think that's just one additional piece. And on top of all the others that we've talked about, the kind of make up the trunk of the tree and really are in need of medical attention. Yeah. So let's move on now to think about the branches of the tree. So we've talked about the roots. We've talked about the trunk and then the branches of the tree. What in in this holistic approach to child development do the branches represent. So the branches are where a lot of our clinical therapy teams really focus in on and have expertise on.

12:50They are the brain networks that support development. So brain networks, including sensory processing, our motor skills, cognition, language, social development and emotional processing. So there's there's quite a few there for us to go into. Sensory processing is really one of the most foundational skills that we develop. This is how we take in the world around us. It's what we hear, what we see, feel, smell and taste. Those are common, the common five senses that we know. But there's also three additional.

13:26There's how we feel our bodies in space or proprioception, how we maintain our balance, vestibular sense, and then how we hear, how we understand our own body cues. Internal body cues, which you had mentioned was interception. And when one or more of these senses isn't coming in and being understood by our bodies and our brain, it can actually change how we interact with and how we perceive the environment and our motor skills.

14:03I'm going to go right into motor because it really builds on top of sensory. Sensory is all the information coming in, and motor is how we are putting out energy really in a way. So it's how we are moving our bodies. So our ability to reach and hold for something or write, or look at someone or even a complex task like driving a car, there's a lot of things we can do with our, our motor system and our bodies to interact with the environment. Yeah. And so you covered two of the big domains of brain development, sensory and motor. And, the next one that we think about and and again, for parents, it might seem like this is quite technical, but what I've seen over the years in my practice is that the more parents can understand and be thinking about these six domains of brain development sensory, motor, cognitive, language, social and emotional, everything falls within one of those and it all begins to make more sense.

15:06And then they, are empowered to, to help support their child's learning. So much better. So let's move on to the next one now, which is cognition or cognitive skills. And cognition is the way that we think. So it is a big category. But really networks across our entire brain help us to think, to attend to tasks and activities and information, to organize all of that, to plan to set goals. And many autistic children and and adults think in very specific and unique ways, often with a lot of strengths that come with it, but some some difficulties as well.

15:41So it's just important to understand what that unique profile might be. And when it comes to cognition, it's kind of it's one of the most complex aspects of development. It is not one thing. It is many things like attention, like working memory, which is the ability to kind of take an information, hold it in mind and then apply that information. So it's a type of memory, things like a planning, that is quite a complex cognitive task. A simpler one is inhibition. So the ability ability to simply control one's impulses and control one's reflexes, and the task of even shifting from one task to another, we sometimes call that switching or transitioning.

16:24These all rely on brain networks to work in synchrony. And we know that those brain networks also connect kind of parts of the brain that are very far apart, and that these brain networks mature along different timelines for different people. Yeah, you can see these different systems come together. So even recognizing someone's face is, you know, there's the cognitive aspect to that, but there's the sensory part to it, which we talked about. So being able to see there's the movement piece, being able to move the eyes or turn the body and look at someone.

16:59And so all of those elements go into that one behavior, that one action that that person is doing. And for us to be aware of, all of those things can be so vital to understanding the child and helping support them in their development. That's right. So we talked about sensory motor cognition. Now language is next. And I'd love to talk a little bit about that. Another one that builds on everything else that we've talked about. So it really emerges from, you know, cognitive skills and there's a sensory piece.

17:35There's also a motor or movement within language and communication. So communication is how we understand and use language to communicate. So understanding language and expressing language, are two elements of that. And they happen in two different parts of the brain actually. So it is possible for someone to understand what people are saying but not be able to communicate well or vice versa, communicate, but not be able to understand what others are saying.

18:11And many people assume that people who have difficulty with communication or maybe communicate in different ways, don't understand someone, don't understand people, or have maybe lower cognitive abilities. But as going back to what I said about those areas being in different parts of the brain, we know that someone may have difficulty with, the expressive communication part, but they very much can have great receptive language skills as well. So it's it's a tricky thing because without being able to communicate, how can you show your intelligence and your abilities?

18:52And it's our responsibility to support all forms of communication. So let's move on. Next to social development and social development is how we connect with other people. Our brains have networks that are tuned really fine tuned for this from birth were drawn to faces. We track where someone else is looking. We take turns in a back and forth way long before we have words to use with that. So as we grow, those same networks help us to do things like read a room, share attention with someone else, and build relationships over time.

19:27And social connection is a two way street. It's reciprocal. When we say someone has social difficulty, we usually mean they have difficulty connecting with people who communicate in more neurotypical ways. But autistic people often connect easily and comfortably with each other, so socialization and autism can look different, like sharing information about something you love can be an act of closeness, being side by side, doing separate things, skipping small talk for talking about what actually matters. Sometimes those are special interests. That's not being less social.

20:03So when autistic people spend, we know when they spend years masking or suppressing their natural style to blend in. It comes at a real cost to their health and well-being. So I think there's a lot better understanding today that what's considered socialization should be much broader than neurotypical socialization. So let's move on to the sixth of the six domains of brain development, which is emotion processing. So emotional processing is how we notice, understand and respond to feelings, our own and other people's.

20:39So oftentimes it starts in the body. So we have feelings like our heart, our heart rate speeding up our chest might tighten, our stomach drops. And our brains are working to interpret those signals and put a name to them or understand them better and understand why maybe they're happening. And that internal sense, especially the sensations of inside the body we talked about was interception. But, emotions aren't necessarily separate from that sensory processing piece. So sometimes if you have difficulties with that, identifying or processing, understanding emotions related to those feelings, internal sensations can be, difficult.

21:25And so many autistic people describe knowing that something may feel wrong, but not being able to tell whether that's anger or hunger or anxiety or exhaustion. And, you know, individuals who may express that may be experiencing something called alexithymia. And this, condition, alexithymia is probably new to a lot of parents and professionals, but knowing that autistic individuals may be experiencing alexithymia. So difficulty and identifying and labeling emotions, it means things that we might reflexively use, like pain scales or mood check ins.

22:08Something like rate your anxiety level from 1 to 10, or use your words to tell me how you feel. You know, all of this might be unfair because it assumes the person can read their own internal state and map it to a label. So if that mappings in reliable, the person isn't being evasive. They're not not they're not sort of lacking insight or not complying. It's that the instrument isn't designed for them. So being more individualized and customizing and understanding what would work for them and how to support their understanding of emotions is really where we need to focus.

22:43And all of this reframes what a meltdown is. So tell me more about that. Meltdown. With everything we've been talking about so far, we can start to understand that this actually is a nervous system that has taken in more information than it can process and, and, maybe even compartmentalize or kind of understand and organize to be able to work through that. And what helps in those moments isn't necessarily a consequence, but support and what's important to you and I'll, I speak about this many times is that regulation is something that children learn with us before they can do it alone and regulation is that ability to be in in the state of overwhelm and, and get to a state of, of, you know, normalcy or feeling really well in our body.

23:43And that can change how clinicians really see behavior and take steps to support it. That's right. And so we've covered now the six major domains of brain development sensory, motor, cognitive, language, social and emotional. Now if we think about an approach to therapies which professional covers which of these? It's a tricky question, and I think that each discipline has their own expertise. Each of the areas holds enough, enough depth that people do spend their entire careers studying them and becoming experts.

24:19And that's that is why we have specialists like occupational therapists, who understand sensory processing and motor development, and speech language pathologist for communication and psychologists and counselors for emotional health, and and then physicians watching the whole the, you know, the medical side of things in the body and the brain health. And that depth does matter and it is important. And so, when the catch with all of this is that the domains don't actually separate the way our professions do. So we may have expertise in our professions, but the brain and development doesn't work in isolation, as we can see again from the examples we had.

25:04So like a child who bumps into furniture or maybe struggles to name her feelings and meltdowns at the end of, has meltdowns, at the end of the day at school, may not have three problems, actually, and those could be seen as three separate problems from different experts. And if the people that are supporting her never talk to each other and they work in isolation and they're going to only see them as three separate problems. And so we need professionals to have knowledge and depth in each of these areas. But we we especially need communication between them and understanding and connecting that information.

25:45So we have a holistic view of the child. Well, Savannah, it's been such an awesome conversation. We're going to we're going to conclude for today, but we'll pick up again in the next episode. What we were able to cover today is really the many of the key parts of a holistic child development framework to drive whole child autism care. We talked about the roots of this overall development tree and the importance of the home community experiences, school experiences in stabilizing the foundation of the tree.

26:20We talked about the trunk of the tree as the health of brain and body, and then the branches, which are the six domains of brain development sensory, motor, cognitive, language, social and emotional. And I want every parent and every professional to be so fluent in those and to be thinking about behavior as the output from those brain networks. So I hope you've enjoyed and learned from the conversations so far today, and we will pick up again on this topic in our next episode. So thank you, Savannah, for being here. And thank you to all of you for listening in today.