Clinic Notes: The Curious Incident of the Dog in the Nighttime Redux

Last year I read the novel, The Curious Incident of the Dog in the Nighttime by Mark Haddon. The protagonist in the novel is a boy with autism and is one of the best descriptions of the disorder that I have read. In a recent Schaffer Report reporter Jim Maniaci (http://www.gallupindependent.com/
2006/july/071206deaddog.html)
describes another "curious incident" in which a New Mexico woman returned home to find her autistic grandson's dog shot. She put the dog's body in a box by the road and her child frequently visited the temporary grave a number of times. The deputy investigating the case returned several days later and advised the grandmother she would have to bury the dog or call animal control because of the flies

Clinic Notes: Prenatal Exposure to Recreational Drugs

Prenatal exposure to recreational drugs causes a host of physical and neuropsychological problems in children. Some disorders, such as Fetal Alcohol Syndrome, are stereotypical while exposure to other drugs cause problem behaviors, which are more diverse. Investigative techniques used to study the precise neurological mechanisms involved in prenatal exposure to various drugs are too invasive to use with children as subjects so it is necessary to turn to animal models. The research is limited here, but we do know that prenatal exposure to alcohol produces abnormal spines on the dendrites of the neuron and reduces neural plasticity. In other words, it is more difficult for the neural circuits underlying various neurological functions to form when alcohol has been ingested.

Clinic Notes: Paying for ABA

Recently, I was in a meeting with the Commissioner Of Mental Health in Tennessee. After the meeting the psychologist who works for the Commissioner told me that TennCare, the states program for the uninsured, was now paying for ABA. Unfortunately, the reimbursement rate was only $27.00 per hour. Normally, ABA costs from $30,000 to $80,000 depending on the number of hours per week. Alberta Province in Canada pays up to $60,000 per year for ABA. At the Tenncare rate I would make $28,000 per year if I saw a child for 20 hours a week. When school systems and insurance companies agree to pay for ABA, which does not always happen, the pay rate is 2-3 time what Tenncare pays. I wonder who is doing ABA for $27 an hour? Probably not anyone qualified. It's unlikely that many kids on Tenncare are getting ABA. I guess if you want ABA for your child with autism and you cannot pay or get anyone else to pay do what many Canadians from other provinces are doing. Move to Aberta.
http://www.cbc.ca/canada/calgary/story/2006/07/10/
autism-therapy.html

Clinic Notes: Where is the Best Placement for a High Functioning Child with Autism?

One question I always get in my clinic from parents of high functioning children with autism is what program is best. Of course, the school system usually wants to put them in special ed classes or a separate autism program in the larger school systems. But then you run into a modeling problem. Children with or without developmental delays are going to imitate their peers. So if you have a class of children with autism who is the high functioning child going to imitate?
I have a mother of a high functioning child coming to my clinic now. She and her husband are traveling all over the country looking for the best autism program. I'd mainstream this child, while at the same time providing the ABA services the child needs. I've done this many time and it works well.

Clinic Notes: Wild Child

In graduate school I’d read The Wild Boy of Aveyron, an account of a ten to twelve year old who was captured in 1799 by French peasants in the forest where he had been living. The child acted like a wild animal running around on all fours, eating off the ground, smelling everything. There have been other published cases of abandoned kids, found living in the wild, like Amala and Kamala, the so-called “Wolf Children” found in India in the 1920s and “Wild Peter” discovered in Germany in 1724. Bruno Bettelheim argues that these wild or feral children were really abandoned autistic children. Since they couldn’t speak, it was assumed by the people who found them that these kids were raised in the wild by animals. There is some doubt about authenticity of these cases. None of them responded to "therapy" and their behavior was similar to more recent, confirmed cases of isolation and deprivation: infants and young children who have been kept in captivity, locked up in small rooms, closets, or attics, isolated from the outside world, and oten abused. I often wondered if these accounts of feral children led Bettelheim to propose his refrigerator theory of autism back in the forties. I had dinner with him in the seventies and asked him directly. But he was a grouchy depressed man and waved his hand at me and would not answer.
(See "Wild Child" at www.aba4autism.com)

Clinic Notes: Designing Non-Autistic Babies

Scientists in the UK already have approval to screen embryos for genetic disorders that would shorten life expectancy before implantation. Now ethicists are upset because these scientist want to only use female embryos for implantation in families with a high risk for autism. Since the incidence of autism is four to five times more likely in males than females this would cut the risk considerably. The ethicist argue that such screening procedures will create a society were only perfect children are tolerated. Well I don't know about that. But I do know there will still be plenty of children with autism around, both male and female. http://tinyurl.com/fwgcm