Supreme Court Ruling

I published the following on my web site. I am publishing it here for wider distribution.

The following is taken from the Shaffer Report, November 16, 2005, Vol 9 No 182. For more information go to www.sarnet.org.

The Supreme Court Rules Against Special Education Parents

Parents who demand better special education services for their child have the burden of proof in challenges according to this weeks Supreme Court decision. Sandra Day O’Connor, writing for the 6-2 court indicates that if parents challenge a program, they have burden of proof, if schools bring a complaint, the burden rests with them.

The decision required the high court to interpret the Individuals With Disabilities Act (IDEA) which does not specify burden of proof. The law currently covers more than 6 million students.

The case is Shaffer v Weast, 04-698.
Denise Jones

Autism and Christmas

I posted this on my website www.ABA4Autism this morning. I am posting it here for wider distribution to families.
Autism and the Christmas Holidays
I have had many parents of children with autism or other neuropsychological disorders tell me that the Christmas holidays are an especially difficult time for them. Of course, any holiday can be difficult for any child with the changes in routine. But Christmas is usually the most difficult holiday for parents of children with autism or other neuropsychological disorders.
There are no sure-fire techniques to use with your child that will insure a "Martha Stewart Christmas." Families who have children with autism or other neuropsychological disorders have used the following 10 tips to make their Christmas better. And this year I'm adding a new suggestion to the list.
Several years ago Leigh Grannon and I did a study using pictures to increase social interactions in a child with autism. Children with autism are visual learners, and I have suggested to parents that they take pictures of what is going to happen at Christmas--the tree, the gifts, the relatives--and starting several weeks before Christmas show these pictures repeatedly to the child with autism. Tell a little story to the child while he/she is looking at the picture about how to behave, what's going to happen, and what the child can do if it is too much. Include your child in the pictures if possible. A picture of the child going to his room to escape the noise and confusion when he/she gets overloaded seems to help, too.
1. Try to keep your child in his or her usual routine as much as possible.
2. Sensory over stimulation—the lights, the sounds, the smells, the relatives touching your child--are the main culprits during the holidays. Eliminating or minimizing these culprits are your best bet.
3. Some families who have children with autism or other neuropsychological disorders wait until Christmas Eve to put up their tree and decorate.
4. Some families let their children with autism or other neuropsychological disorders do all of the decorating. Children with autism or other neuropsychological disorders may line up or stack decorations rather than decorate in the traditional way, but so what.
5. Rather than try to do the Christmas shopping with children with autism or other neuropsychological disorders in a crowded, noisy mall, many families shop by catalog or online and let the child point to or circle the toys he/she wants. Websites, such as www.stars4kidz, offer a variety of toys for children with autism or other neuropsychological disorders. Just type "autism toys" in your search engine.
6. Tactile toys are often a better choice for children with autism or other neuropsychological disorders. Toys that make sounds or involve too much stimulation or are too complex may not cause an aversive reaction in the child. As mentioned above there are web sites that sell toys designed for children with autism or other neuropsychological disorders. Try ordering some of these toys and then let your child select the ones to play with as they are unwrapped.
7. Talk to relatives before they come over about the best way to behave with children with autism or other neuropsychological disorders. Have them read my article, “What Horses Tell Us About Autism,” which is available for free on the second page of my website.
8. Generally, kids with autism or other neuropsychological disorders do better in the morning than in the late afternoon or evening when they are tired. It may be better to schedule Christmas events at these times.
9. The parents of children with autism or other neuropsychological disorders need to relax themselves. Often the child with autism picks up on the parents’ stress and that is enough to ruin Christmas.
10. And last but not least, realize that you are probably not going to have a perfect food, perfect decorations, and perfect gifts. Christmas with children with autism or other neuropsychological disorders may not be traditional, but it can still have real meaning. (Sometimes I wonder if children with autism or other neuropsychological disorders know that Christmas has become too commercial.)
I wish you and your child the happiest of holidays.
Gary Brown, Ph.D
Psychologist/HSP
(Thanks to the mothers of children with autism or other neuropsychological disorders who help with this post.)

Clinic Notes: New Discussion Board and Questions and Answer Feature

My on line ABA course will feature a discussion board in the near future. Students taking my on line course may posts questions, observations they have made while applying ABA procedure, or ask for help with specific behavioral problems. Other students may respond to posts or I may respond when necessary.In additions, I will require my on campus ABA students to post weekly to the discussion board. Caregivers who visit www.ABA4autism may ask questions about ABA and autism or ABA and other neuropsychological disorders. Of course, questions and comments are always welcome on my blog.

Clinic Notes: Pictorial Prompts and Autism

Several years ago my student, Leigh Grannon and I, presented a paper titled "The Effect of Pictorial Prompts on Verbal Interactions in a Child Diagnosed with Autism." This study used a personalized set of pictures with verbal prompts to establish verbal social interactions in a child with autism. Results indicated that the number of verbal social interactions made by the child with peers in a daycare setting increased and generalized to children and adults and in other settings.
I am now working on a paper that will use pictorial prompts to teach children with autism and other neuropsychological disorders how to behave at Christmas time. Many parent who bring their children to my clinic complain that the Christmas holidays are an especially difficult time for them. I plan to have the paper on my web site in time for the holidays.

New Autism Survey

ABA4Autism.com and the Psychology Department at the University of Tennessee at Martin are conducting a second survey on the causes of Autism Spectrum Disorders (ASD). This survey is for mothers of children with ASD as well as mothers of normally developing children who are ten years of age or younger. Mothers who participate in the survey will receive a free ABA program to teach their child to follow directions as well as free ABA mini programs for common problems like sharing. To take the survey please go to http://www.aba4autism.com

The preliminary results of the first survey may be found at http://aba4autism.blogspot.com/.

ABA4Autism's New Web Page

Check out ABA4Autism's newly designed web site at http://www.ABA4Autism.com. For three years we have been trying to reach families with low costs ABA eBooks, Case Histories, and an online ABA course. Our old web site was not professionally designed and no doubt many visitors had problems navigating the site. Now our web site is professionally designed and easy to use. We will be adding new features soon such as a question and answer feature with Dr. Brown and a chatroom option. Both of these new features will be free. Check us out and take our new survey on the causes of autism if you have not done so already.

Clinic Notes: Autism in the News

I published the study below on my website this morning. I am also publishing here for wider distribution.

Treating Autism with Applied Behavioral Analysis
(For full story go to http://tinyurl.com/9lvh4)
A recent California study finds that intensive Applied Behavior Analysis (ABA) was more effective in treating preschool children with autism than other methods provided in many community-based education and treatment programs.
ABA uses the concepts of repetition and reinforcement of specific desirable behaviors to increase their frequency. At the same time, harmful or undesirable behaviors are not reinforced. This study reinforces the idea that early intervention for children diagnosed with Autism is a major step in producing successful and independent children in the schools and at home.
The research team includes a pair of California State University, Stanislaus psychology professors, Dr. Jane Howard and Dr. Harold Stanislaw and their colleagues Colleen Sparkman, Director of The Kendall School in Modesto; Dr. Howard Cohen, Clinical Director of Valley Mountain Regional Center in Stockton; and Dr. Gina Green of San Diego

Clinic Notes: Etiological Factors in Children Diagnosed with Autism or Pervasive Developmental Disorder-Preliminary Results

*Poster session II Human Behavior and Evolution Society Conference. June 1-4, 2005. Austin, Texas
Angie S. MacKewn, Sherry D. Jones, Gary E. Brown & Esther J. Plank
The purpose of the current study was to develop a predictive model of more frequently occurring pre and postnatal etiological factors in children diagnosed with autism. A survey of biological mothers of children diagnosed with autism or PDD and of children without developmental delays were matched on gender (n=134 males and 56 females) and age (M=6.54 years, SD=2.78 in autistic); (M=6.23 years, SD= 2.90 in controls). The developmental survey asked several questions including, pregnancy food cravings and aversions, childhood ear infection, presence of tubes, vomiting and nausea patterns, and speech development. A logistic regression equation found that not vomiting in the first trimester, the mother having an infection while pregnant, and the child having over 7 ear infections, were significant predictors of whether a child was diagnosed with autism or not. Of mothers of autistic children, 40% vomited in the first trimester compared to 53% of the control mothers. The “embryo protection hypothesis” suggests that morning sickness has an evolutionary basis and protects the embryo from teratogens by causing pregnant women to purge (Profet, 1992).

Clinic Notes: Performance deficits

ABA Program for Eliminating Performance Deficits

After you have your child making eye contact, following directions, and have eliminated behaviors that interfere with learning, such as tantrums, aggressive behavior, and self-injurious behavior, you are ready to start teaching skills so that your child can overcome developmental delays. (ABA Program Number 9 for toilet training is a good place to start if your child is not toilet trained.)
ABA Program Number 10, Teaching Stimulus Discriminations (Colors, Shapes, Letters, etc.), covers Discrete Trial Training (DTT), one of the most useful ABA techniques for teaching skills to children with autism or other neuropsychological disorders. But with many children DTT doesn’t work as well as it should. Usually, this is because caregivers, as well as clinicians, have not determined if the child they are working with has skill deficits or performance deficits before they start DTT.
A child with skill deficits cannot perform a task because the task has not been learned for one reason or another. For example, the child may have sensory, motor, or cognitive problems that interfere with learning. However, with performance deficits, the child has learned the task and can perform the task. But the child has learned that giving the wrong answer, or simply not performing the task when asked to do so, results in more reinforcement (usually in the form of attention) than performing the task.
Generally, if a child can perform a task at one time and not another time, or perform the task with one caregiver and not another caregiver, then we know we are dealing with a performance deficit. (There are exceptions to this. Some children with neurological problems fatigue easily and cannot perform a task consistently.) Often caregivers tell me that their child can name different colors or shapes, but then seems to “forget.” Most of the time the child did not forget. The child has learned not to perform.
Once you have determined that your child has performance deficits, stop all drills. The following drill should be the only drill you run until performance deficits are eliminated:
1. Choose material that you know your child knows. For example, flash cards the child can name or shapes or colors the child can identify.
2. We only want to practice giving correct answers so only run 3-4 trials at a time. Wait 20-30 seconds between trials so we can be sure that we are eliminating fatigue as a variable.
3. On trial one present the stimulus that you are using. For example, ask the child to tell you what is on a flash card that you know the child can name. Only ask one time. If the child gives the correct answer, then give tangible reinforcement plus praise. Tell the child, “Good, you gave the right answer.” If the child gives the wrong answer say, “No, you gave the wrong answer” and do the body part drill 25 times (See ABA Program number 7). Then ask the child again. If the child gives the correct answer, follow the directions above for correct answers above. If the child gives the wrong answer, repeat the body parts drill 25 times until the child gives the correct answer. If the child gives the correct answer while you are doing the body part drill, stop and follow the instructions above for correct answers. If the child does not give the correct answer when you ask again, repeat the directions above for incorrect answers.
4. Once the child gives the correct answer, wait 20 to 30 seconds and go to the next trial.
5. After 3-4 trials, give the child a short play break.
6. Once the child is answering correctly 100% of the time, slowly increase the number of trials, one trial a day, until you get to ten trials. Once the child is performing consistently on ten trials, then this should be the number of trials you use before a short break in most cases.

Clinic Notes: An Autism Gene

Rita Cantor reports in the American Journal of Human Genetics that the segment 17q21 located on chromosome 17 contains several genes, one of which raises the risk of autism in boys. No doubt other genes involved in autism exist, but this discovery could lead to a screening test that could mean getting services to a child at an earlier age. The question then becomes which services should be provided? Of course, I would vote for ABA,and perhaps OT and speech. But what about drugs, such as the SSRI's to increase serotonin levels? We identify cases now as early as two and put children on Prozac, Zoloft, and Celexia, off label, because they are not approved by the FDA. Will we be ready to give infants these drugs?

Clinic Notes: Is there an autism Epidemic?

In previous posts I've discussed what to do when your child is first diagnosed and how to get services for your child. In this post I would like to answer the question--Is there an autism epidemic?
Many people think so and point to data supporting a dramatic increase in the number of cases of autism. I am often asked by pediatricians and other professionals, as well as lay groups if I am seeing more cases of autism in my clinic. My answer is "no."
When I first started practicing 35 years ago ADHD was the diagnosis of the day. Every other child had ADHD and large numbers of children were being treated with stimulants in an attempt to fight the "epidemic." Now autism is the epidemic of the day. But like ADHD there is no epidemic only hype. Next Monday on my web site a recent paper will be covered in my "Autism in the News" column outlining why you should not believe there is an autism epidemic. It all has to do with changes in the diagnostic category, greater public awarness, and intentionally looking for and finding more cases. Read "Autism in the News" next Monday at http://www.aba4autism.com. Dr. Brown

Clinic Notes: Do you need a lawyer?

As I mentioned in a previous post I am convinced that children with autism and other neuropsychological disorders can be effectively treated by a team approach. For care givers the challenge then becomes getting these services delivered to their child after age 3.
In many school systems around the country parents have gone to court to force the school system to pay for ABA and other services. In some cases the school system has agreed to pay for services following a directive to do so by the court and in other school systems the court's descision has been apealed. The higher courts have not yet ruled.
If you live in a school system that has not been sued I think it is best to try and work with the school system cooperatively. Do not sign the IEP though until you are satisfied. If you cannot get services for your child then consider hiring a lawyer who specializes in disability claims. Dr. Brown

Clinic Notes: Services for your Child

As I mentioned in my last post, Tennessee Early Intervention System (TEIS) will pay for all needed services up to age three. Other states have similiar systems. But at age three, the school system where the child resides becomes responsible for paying for all services according to federal law. The problem is that the federal law, although well intentioned, does not specify the quality or quanity of the services provided. Some school recognize the importance of early intervention and are very good about paying for services when asked. Others try to get by with providing little or no services. How parents can get these much needed services for their child is the subject of my next post.
Dr. Brown

Clinic Notes: Who pays for treatment?

In Tennessee, the state where I practice, the Tennessee Early Intervention System (TEIS) will pay for health care services for a child up to age 3. Pediatricians, psychologists, physical therapists, occupational therapists, speech-language pathologists, and other specialities are covered. And this is a good system if the child is diagnosed early enough. Parents of children under three, especially first time parents, do not know if their child has a developmental delay or is just a little slower than other children. For that reason, professionals are not consulted. Autism is one disorder that is not usually diagnosed until the child is nearly three. And then TEIS can no longer pay for needed services. I often have children, diagnosed with autism or some other neuropsychological disorder, present at my clinic and I only have a few weeks to work with them before they turn three. What happens then is the subject of my next post. Dr. Brown

Clinic Notes: What to do when your child is first diagnosed

What do you do when your child is first diagnosed? I am convinced that multiple clinical interventions at an early age can dramatically alter the course of autism or some other neuropsychological disorders and improve the quality of life for the family. Pediatric neurologists, Speech-Language Therapists, Occupational Therapists, Physical Therapists, and Psychologists versed in ABA should be part of the treatment team as needed. The next question then becomes who is going to pay for these services and that will be the topic of tomorrows post.